Spine surgeon leaders traditionally held a few key roles, including teaching appointments, national organization committee chairs, hospital department heads or serving on a device company board. But today, with the focus in healthcare shifting toward evidence-based medicine, the most valuable leadership position is becoming the sustainable spine care champion.
Spinal disorders and diseases have long been among the most expensive ailments to treat — whether patients are undergoing costly surgeries or paying for non-surgical intervention incrementally for years that don't relieve their pain. Almost everyone suffers from either acute or chronic back pain at some point in their lives and as the older population grows — from living longer and remaining more active — the demand for spine care will increase.
But, if quality outcomes aren't proven and costs aren't lowered to some degree, patients won't have access to critical treatment. Many surgeons are already seeing insurance companies deny procedures that would have been routine five years ago and bundling procedure codes to lower their overall payments. New technology is nearly dead-on-arrival if insurance companies won't cover the cost, even after FDA approval.
So how can spine surgeons ensure their patients will have access to the best care possible? Become a sustainable spine champion.
"Conscious adoptions in the spine surgery specialty play a small but important role in the overall movement toward sustainable healthcare," says Chris Tomaras, MD, a spine surgeon with Peachtree Neurosurgery and on staff at Northside Hospital Healthcare System in Atlanta. "Many spine procedures can have long term implications, so it's critically important to take the long view regarding choice of procedure as well as the extent of the surgery to be performed."
Here are five ideas for spine surgeons leading the charge toward sustainable spine care:
1. Manage time and resources effectively. The most expensive aspects of spine surgery are costs associated with hospital stays and implants. If surgeons can perform a less invasive — or even outpatient procedure — to reduce or eliminate days in the hospital, they can significantly impact the overall cost of care. The less invasive procedures may reduce operating room time, when the surgeon becomes experienced with the technique, which lowers anesthesia time/costs and often eliminates blood transfusions.
The second half of resource management includes implant and materials costs. Many surgeons maintain longstanding relationships with certain device companies, having used those devices since training, and their device company representative becomes a friend. But, in today's cost-conscious healthcare environment, it's worth exploring other less expensive devices with the same quality.
"If proactive physicians can engage with their hospitals to scrutinize the OR packs on their preference lists, there might well be opportunities to pare down what's included as standard in the pack for particular surgeries, potentially eliminating needless waste and costs," says Dr. Tomaras. "Similarly, if hospitals involve physicians in decisions about resource purchasing, they may well find there are less expensive options the physicians find to be just as efficacious. We have the best and most accurate information about what our patients need, what's mission critical and what other ways we can approach these issues."
2. Network with other surgeons and health systems. Hospitals and surgeons have often considered others in the market — and even sometimes others across the country — as competitors and kept operational, financial and clinical successes secret. However, collaboration and coordination between providers is encouraged in this new age and connecting with others who meet the high quality, low cost goals could jump-start your hospital's initiatives.
"Responsible organizations, responsible surgeons and a sharing of best practices between surgeons and hospitals will create an ecosystem that inspires dedication to more sustainable spine surgery," says Dr. Tomaras. "Meaningful discussions between surgeons and insurance payers also need to occur to try to account for the entire arc of patient care and what different interventions look like over time."
3. Preach a "big picture" approach with payers for new technology. It's difficult for some stakeholders in the healthcare industry to look at big picture treatment. Payers often see the hefty bill for spine surgeries — and then when surgeries fail, they're also covering reoperations — and balk at coverage. Nonoperative treatment over six weeks or a few months looks like a less expensive option if the patient is pain-free by the end of treatment. However, if the patient goes through weeks or months of nonoperative care and still needs surgery, they've wasted time and money.
Additionally, payers often reject new technology with proven clinical benefits because the overall cost is still high. For example, some insurers refuse to reimburse for artificial disc replacement despite FDA clearances and an increasing body of literature showing short and long term benefits.
"This technology has demonstrated the ability to reduce the likelihood the patient will need future surgery due to disc degeneration at levels adjacent to the intervention, which should be good for the patient and for the healthcare system," says Dr. Tomaras. "But there is a reluctance to embrace this approach, whether because of institutional conservatism or a fear of 'trendy' medicine. At any rate, it's certainly an example of the road between here and integrating all the components of care successfully to try to encompass the 'true' cost of care."
4. Join community organizations and champion the cause. Healthcare providers aren't the only stakeholders in making spine surgery sustainable; patients also have a huge responsibility to lower the cost and need for spine surgery. Surgeons can use their experience, education and position to educate people about healthy lifestyles — physical and psychological — to really make progress toward better outcomes and lower costs.
"Surgeons can be leaders in the sustainable healthcare movement by getting involved in local communities, participating in hospital committees, joining local boards, participating in environmental forums locally and sharing best practices with peers," says Dr. Tomaras.
Surgeons around the country are partnering with local hospitals to hold seminars about appropriate back care and preventing pain. They are presenting to athletic clubs and local teams about caring for the athlete's spine and preventing early degeneration. There are also surgeons authoring books or YouTube videos with exercises and recovery plans for when spinal injuries do occur.
5. Adopt prudent new technology for quality and cost. Electronic health records and sophisticated data gathering software allow surgeons to build or contribute to registries and then mine data across the country to develop more meaningful studies.
High-level studies can also show which treatments and technologies fit best for a specific patient population. This will be critical for developing new technology, achieving reimbursement and moving patients to the most cost-effective surgical setting possible.
"As technologies improve and minimally invasive procedures become more effective and widely used, we would expect a trend toward more procedures being done on an ambulatory basis," says Dr. Tomaras. "This would vastly reduce the resources needed for the given procedure, as well as the costs to the healthcare system for rendering the same care. Exciting times are ahead, for sure."
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