John Shiau, MD, a neurosurgeon and director of the Minimally Invasive Spine Institute at Staten Island, N.Y.-based Healthcare Associates in Medicine, discusses trends in outpatient spine surgery.
Question: Where do you see outpatient spine surgery headed?
Dr. John Shiau: I see outpatient spine surgery becoming more prevalent, with perhaps some short-term (72 hour) acute rehab centers affiliated with ASCs so that more complex surgeries can be done in the ambulatory setting.
Q: Are you planning to perform more procedures outpatient in the next year?
JS: I would definitely like to perform more outpatient procedures in the next year. Right now, it’s a difficult situation in terms of authorization because insurance companies and payers would rather have spine surgeries performed in an inpatient setting. I think they will eventually realize the economic realities of ambulatory spinal surgery and it will become less challenging to get authorization for it.
Q: What big trends have you noticed in your patient population over the past two or three years? What has changed since you started your practice?
JS: My patient population today, in general, is more educated about minimally invasive spine surgery and they are requesting ambulatory spine surgery much more often than in the past. Patients are hearing about minimally invasive spine surgery through marketing (in New York in particular), then utilizing the internet to do their own research and really educating themselves about spinal surgery.
Q: How do you envision your practice evolving in the future?
JS: I would like to perform more outpatient procedures in the next year. In terms of operative technique, more endoscopic spinal surgeries will eventually be performed. It's the future of ambulatory spinal surgery; the trend is to be less and less disruptive so endoscopic and minimally invasive spine surgery will play a larger role going forward.
Q: What are your long- and short-term professional goals?
JS: My short-term and long-term professional goals are to continue to keep my two New York City practices at the forefront of minimally invasive spine surgery as the field evolves. Another professional goal is teaching. I've taught minimally invasive spine surgery techniques to other surgeons around the world and found that to be extremely rewarding.
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