Gregory Lekovic, MD, is the medical director of the spine surgery program at California Hospital and Medical Center as well as a surgeon with House Clinic in Los Angeles.
Dr. Lekovic sees both the clinical and business sides of practicing spinal medicine changing in the next few years. Here, he discusses the most interesting trends in technology and headwinds to consider for the future.
Question: What emerging technology are you most interested in today and why?
Dr. Gregory Lekovic: The most interesting emerging technology to me is the introduction of advanced optical imaging techniques to operative microscopy. Ever since the introduction of the microscope to neurosurgery in the late 1950s, the optics of microscopy have been taken for granted and the means of operative visualization — whether with a traditional microscope or endoscope — have been passive. At the House Clinic in LA, we are excited by the recent explosion in new fluorescent dyes and imaging processing capabilities. Technology is now emerging that will allow us to use our microscopes (and soon endoscopes) to not only see the tissue but to query it for function, and perhaps one day soon to also interact with it in ways that were not previously possible.
Q: How do you think your practice will change in the next three years? What are you doing today to prepare?
GL: It is more important now than ever before to pick your friends wisely by seeking alignment with a health system or other institutional partner that understand your culture of excellence and can help you grow. Nevertheless, the more things change, the more they stay the same: the key to a 'destination' practice such as the House Clinic in LA remains excellence in clinical outcomes, high volume, assiduous commitment to detail, and communication with patients through their whole treatment journey.
Q: What is the most dangerous trend in healthcare, spine or orthopedics today and why?
GL: Headwinds abound, mainly in regulation and reimbursement. By far and away the most dangerous trend in healthcare is proposed legislation to combat 'surprise billing': the leading legislation will place the burden of payment for "out-of-network" (which in this context should read: "under-insured") patients on surgeons and other hospital-based specialists, who will in turn have to seek subsidy from hospitals in order to survive. This will also strengthen the negotiating hand of insurers with regard to all doctors, bolstering narrow network plans and lowering physician reimbursement across the board.
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