Spine, orthopedic surgeons' holiday wish lists

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Many people have holiday wish lists for their dream gifts, and surgeons also think about what they want in their professions.

Here are what seven spine and orthopedic surgeons have on their wish lists this holiday season:

Note: Responses were edited for clarity and length.

Question: What's on the top of your wish list as a surgeon?

Alan Hilibrand, MD. Rothman Orthopaedic Institute (Philadelphia): An image guidance system that does not slow down flow in the operating room would be on the top of my wish list. Ideally, a system that could take the input of a preoperative MRI and produce CT-quality 3D anatomical images that could be used for both decompression and instrumentation.

Troy Morrison, DO. Citizens Memorial Healthcare (Bolivar, Mo.): Physicians must be empowered to put patient care first. The biggest roadblock to caring for our patients is the superfluous prior authorization process. According to the AMA more than 90 percent of all preauthorizations are granted and 20 percent of denials occurred despite meeting Medicare coverage rules. The process takes weeks in my office and consumes our most valuable and limited resource, our staff. The very top of my holiday wish list is prior authorization reform.

Morgan Lorio, MD. Advanced Orthopedics (Altamonte Springs, Fla.) and Chair of ISASS Coding and Reimbursement Task Force and ISASS RUC Advisor:

1. Reversal of Medicare whole 4.5 percent cut imposed by CMS' final rule with a subsequent permanent fix by Congress.

2. Return of integrity in healthcare starting with CDC and FDA.

3. Return of physician teamwork in both academic, hospital and private practice settings.

4. Recognition of AMA RUC input and value by CMS restoring voice of medicine.

5. A new CPT category for disruptive emerging tech that is rewarded equitably at 50 percent physician survey median quartile for value proposition with wRVUs based more on
intensity and/or parity rather than time.

6. Unbiased peer review based on validity — not popularity or perception — allowing
uncensored freedom of speech. 

7. Senate approval of recent CMS proposed rule targeting reforms in the prior authorization
process and timely adjudication of decisions for beneficiaries when required. 

8. The addition of "discogenic back pain" for further considered distinction by ISASS within
the upcoming March 2023 ICD-10 Coordination and Maintenance Committee Meeting.

9. Last, but not least, I would return identity back to physicians and surgeons by educating
both the public and the increasing muddled list of "healthcare providers," including
government and insurers, that the word "doctor" historically means "teacher."

Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): So, my kids came home with a little daycare virus, and I had to go to three different stores only to come home empty without the children's Tylenol that I went looking for. I ended up coming up with a different concoction of other medications — and they did the trick! But I realized I missed the days when the shelves were fully stocked.

That same wish is at the top of my wishlist as a surgeon — that our shelves can become fully stocked again. This year was full of opportunities to innovate due to the sheer necessity that life's barren shelves presented us with. So, what does that mean?

  • Staff shortages will be filled with workers wanting to return to healthcare
  • OR capacity back to full tilt with energetic hustle and bustle
  • Dwindling budgets are replenished with opportunistic funding and opportunities to re-invest
  • Research funding is bountiful to allow for prospective collaborations to grow our body of knowledge
  • Energy is renewed and restocked (and burnout fizzles away)
  • A full stock of health for healthcare workers and patients alike, without fear of the next wave of illnesses

Tim Bonatus, DO. Retired orthopedic surgeon in Arizona: I have come to understand that our "health" insurance plan is increasingly broken.

While I never was a fan before, our country needs to move to a more straightforward baseline tax-supported, base health insurance for all citizens.

Our system of employer-funded, state-by-state varying Medicaid, and ridiculously expensive healthcare is no longer viable. Employers and employees fund the un- and underinsured. There is far too much bureaucratic expense in the system.

Our country cannot afford to spend 20 percent or more of its gross national product on mediocre, incomplete healthcare.

I am not proposing a single payer, but a base insurance for all. There would still be an option to "buy up" with private or employer group insurance. Everyone gets a Motel 6. If you want a Hilton, Marriott or Ritz you can pay for it. Yes, this means the base group may have to wait for elective surgery, and may be in a double occupancy room. But, everyone would be insured to include health maintenance and preventative care.

It's a pipe dream, but that's my wish for the New Year.

Tyler Smith, MD. Sierra Spine Institute (Roseville, Calif.): On my holiday wishlist is prior authorization reform, first and foremost. The burden of proof is always on the requesting provider, and MRI reports from radiologists drive too much of the algorithm. The clinical context of patient evaluations is totally undermined by the arbitrary review model, and it sets up logistical nightmares and increased costs for patients, surgeons and facilities. Next would be collective bargaining for insurance reimbursements for physicians. It should be encouraged that we collaborate to articulate and defend our value in the current healthcare economy. It is unthinkable that it is illegal for us to discuss our contract rates with other practices, and it empowers payers to create more byzantine and confounding policies that are stacked against doctors and our mission of providing high quality care to the patients we serve.

Kofi Agyeman, MD. Arrowhead Orthopaedics (Beaumont, Calif.): I want friction-free processes for providers and patients alike. The technology is there. The interest is there. The implementation is not.

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