<body><div><img src="https://img.particlenews.com/image.php?type=thumbnail_580x000&amp;url=1WtAFT_1EjH7Xkf00" alt="https://img.particlenews.com/image.php?url=1WtAFT_1EjH7Xkf00" width="800" height="600" >From mounting administrative burdens to fragmented care and volume-driven reimbursement, spine surgeons see mounting pressure on long-standing care models. Eight spine surgeons discussed which parts of spine care may not survive the next decade and what could replace them.Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.Next question: CMS is shifting more financial risk onto spine surgeons. What are you doing now to prepare, and what do you think most surgeons are underestimating about it?Please send responses to Sophie Eydis at seydis@beckershealthcare.com by 5 p.m. Central time Sunday, Sept. 6.Editor’s note: Responses were lightly edited for clarity and length.Question: What part of today’s spine care model do you think will not survive the next decade, and what takes its place?Milad Alam, MD. Spine Surgeon at DISC Palm Beach (West Palm Beach, Fla.): The part of today’s spine care model that won’t survive the next decade is the enormous administrative burden placed on physicians. We spend an incredible amount of time justifying medically necessary procedures to insurance companies, obtaining prior authorizations and navigating layers of bureaucracy that often delay patient care. Beyond the physician’s time, practices now require entire teams dedicated to authorizations, appeals and post-procedure collections. Those are resources that could be directed toward improving patient care rather than managing administrative hurdles.If this trend continues, I believe more spine surgeons will choose to practice outside of insurance networks or move toward alternative care models that allow them to focus on treating patients instead of paperwork. I hope the future of spine care is one where technology, evidence-based guidelines and streamlined authorization processes reduce unnecessary administrative work, allowing physicians to spend more time where they’re needed most.Bryce Basques, MD. Spine Surgeon and Director of Minimally Invasive and Endoscopic Spine Surgery at Brown University (Providence, R.I.): The fragmented model of spine care will become very difficult to sustain. Patients are passed among primary care, therapy, pain management and surgery with no single team accountable for the diagnosis, the sequence of care or the result, and payment is now moving toward episodes rather than individual services. This will be replaced by integrated spine programs that provide coordinated nonsurgical and surgical care and robust outcomes data. Any program that cannot document its outcomes will find itself at a severe disadvantage regardless of surgical quality. Marco Burkhard, MD. Attending Spine Surgeon at Hospital for Special Surgery (New York City): I do not think “bigger surgery” because of radiographic malalignment will define the next decade of spine care. The field is moving toward biologically informed, tissue-preserving surgery with increasingly personalized decision-making. Better imaging, AI and objective patient-specific risk assessment will allow us to identify who truly benefits from surgery and, just as importantly, who can safely avoid it.Brian Gantwerker, MD. Neurosurgeon and President of The Craniospinal Center of Los Angeles: In today’s model, we will see more referrals for nonsurgical management than ever before. And with that, missed diagnoses and delayed diagnoses. Rather than make people better at ascertaining when to refer, whoever ends up in charge of healthcare, will try to do things on the uber cheap and not the uber good, and so that means not referring to surgeons. I see no good coming from that. Patients will need to push back, remain staunch self advocates and make sure their care is not where the cuts are made. Jason Liauw, MD. Spine Surgeon at DISC Newport Beach (Calif.) and DISC Carlsbad (Calif.): Spine practices that offer only fusion surgery will not remain competitive over the next decade. The era of fusion as the default solution for degenerative cervical and lumbar pathology is coming to an end. Cervical and lumbar artificial disc replacement has evolved from a niche procedure into a mainstream, evidence-based treatment that is increasingly recognized by both surgeons and patients. More importantly, patients are no longer simply accepting fusion, they are specifically asking about motion-preserving alternatives.The clinical evidence supporting artificial disc replacement in appropriately selected patients is now mature and compelling. Long-term studies have consistently demonstrated excellent outcomes, making it difficult to justify offering fusion as the only surgical option for many patients.The future of spine surgery belongs to surgeons who can thoughtfully offer the full spectrum of evidence-based procedures and match the operation to the patient’s pathology, rather than forcing every patient into a fusion paradigm.Issada Thongtrangan, MD. Endoscopic and Minimally Invasive Spine Surgeon at MicroSpine (Scottsdale, Ariz.): The traditional, siloed, procedure-driven spine practice, especially the small independent office dependent on professional fees, will become increasingly difficult to sustain if Medicare cuts continue. The future will favor integrated, value-based models with better patient selection, coordinated nonoperative care, efficient ASC surgery for appropriate cases and measurable functional outcomes rather than simply greater procedural volume. For independent surgeons, however, a hybrid concierge model may offer a meaningful alternative: continue insurance-based surgical care while offering an optional membership program built around timely access, longer consultations, direct surgeon communication, second opinions, care navigation and closer perioperative follow-up. The opportunity is to preserve independence and restore time for thoughtful patient care, but the model must remain transparent and clinically disciplined, surgery should always be based on appropriate indications, not membership status, and patients who do not participate must retain access to necessary care.Jacky Yeung, MD. Neurosurgeon at Yale Medicine (New Haven, Conn.): I don’t think the current model of rewarding volume over value is sustainable. As healthcare costs continue to rise, reimbursement models that primarily incentivize larger operations and higher RVU generation will increasingly come under scrutiny. The future of spine care will be driven more by outcomes than procedure volume, measuring functional recovery, quality of life, complication rates and patient satisfaction. That doesn’t mean big surgery will disappear; many patients still require complex reconstructive procedures. But I do think we’ll see a greater emphasis on selecting the least invasive intervention that reliably achieves the best long-term outcome, with reimbursement increasingly tied to value rather than volume.Christian Zimmerman, MD. Spinal Neurosurgeon at St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Remnants of past modeling, such as health maintenance organizations, remain in the form of integrated primary care and enduring, costly and assigned successive treatments prior to surgical interventions. Posting meaningful and successful metrics in a value-based model currently depends on reportable outcomes and cost control, not just volume.The efficiencies surrounding timely referral patterns and preoperative processes are as important to the patient’s experience as the surgery itself. Avoidance of gaps and waste in any surgical specialty and operating room system is the ultimate objective of healthcare delivery systems and message articulation.The prevailing focus is cost control and expense. Extended and consecutive reimbursements are looming, so the economics of healthcare delivery becomes more pressing.In short, spine care models that ignore value-based metrics, especially high-priced durable goods and computer-assisted furnishings, are predestined for additional scrutiny and limitation in the future.At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.</div></body>

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From mounting administrative burdens to fragmented care and volume-driven reimbursement, spine surgeons see mounting pressure on long-standing care models. Eight spine surgeons discussed which parts of spine care may not survive the next decade and what could replace them. Ask Spine Surgeons is a weekly series of questions posed to...

The spine surgery models headed for extinction

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From mounting administrative burdens to fragmented care and volume-driven reimbursement, spine surgeons see mounting pressure on long-standing care models.

The spine surgery models headed for extinction

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