Jesse Even, MD, is a spine surgeon with TMI Sports Medicine and Orthopedic Surgery in Arlington, Texas.
Here, he shares his perspective on robotic technology, price transparency and why he is working with ACOs to prepare for the future.
Question: What do you think about robotic technology in the spine field?
Dr. Jesse Even: I think it is a very exciting technology that in the most difficult cases could prove to be a real asset to the surgeon and patient. However, I am not a fan of trying to fit a square peg though a round hole. This technology does not need to be applied to every spine case performed. There are significant costs to using the robotic technology up front and with disposables. There is also a much longer set up and turn over time which adds to overall hospital cost and decrease efficiencies. My other concern is with the younger surgeons becoming dependent on the technology for even basic cases thus overall increasing health care expenditures.
Q: Where do you see the biggest need for improvement in spine patient care?
JE: I think focusing on ambulatory cases that can be safely done in the ASC setting will be a huge improvement for patient satisfaction from an outcomes standpoint and from a financial standpoint for the patients.
Q: How do you see trends toward price transparency and value-based care affecting spine?
JE: The higher the deductibles go on our patients the more we are going to have to push for price transparency. Now that people are paying a larger and larger portion of their costs for their healthcare, and are consumers now instead of just receivers, we are going to have to be much more transparent in our pricing structures. The practices and hospitals that adapt to this will gain the confidence of the people they serve, and like other transparent organizations such as Amazon, Walmart, etc., they will gain a much larger market share.
Q: What is the smartest thing you've done in the past 12 months to prepare your practice for the future?
JE: I have been in close discussions with various ACOs evaluating cost containment opportunities identified as high cost items by the ACOs. They have identified neuromonitoring as one of those high cost centers. In response, I have been working to decrease the cost of neuromonitoring by using a device that does free running mechanomyography in my lumbar fusions. The cost of the free running MMG is a fraction of the cost of neuromonitoring to the health care system. The drawback currently is that it only is useful in lumbar procedures below the level of the spinal cord. However, once I showed the ACOs the cost saving of this device over standard neuromonitoring they were more than intrigued.