'The latest evolution in minimally invasive approaches': What we heard in January

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Spine and orthopedic experts in January spoke with Becker's Spine Review about topics from compensation to total disc replacement.

1. As payers continue to signal a shift from fee-for-service to value-based care models, independent practices will need significant resources and infrastructure to facilitate this successfully. Independent practices may encounter substantial challenges in building these capabilities, given limited resources and experience. Practices can, however, consider aligning or partnering with organizations that have a comprehensive and proven infrastructure and platform for [musculoskeletal] value-based care success." — Wael Barsoum, MD, president and chief transformation officer at Phoenix-based Healthcare Outcomes Performance Company on his outlook for independent orthopedic practices.

2. "Unfortunately, the prior authorization has become somewhat of a cat and mouse game, with insurance companies enacting ever increasing barriers to approval for surgeons and surgeons having to find ways to overcome those barriers. It seems the hope is that with more and more barriers, surgeons will give up trying to get a case authorized. However, the goal of reducing overutilization is not being achieved this way. The only thing this is achieving is delaying care, in some cases delaying care for cases which are truly necessary. We need better agreement on standards and appropriateness criteria between insurance companies, surgeons and physicians, and health systems, for spine surgeries and interventional procedures. These need to be uniform and transparent. These need to be standardized. This is the only way we can bring American spine care into the 21st century." — Vijay Yanamadala, MD, of Hartford (Conn.) HealthCare on what's next for total dis replacement coverage.

3. "Part of what has been an issue with Medicare is that we have not had a cost of living adjustment to Medicare for at least two or three decades. So, it costs more to do business in, say, Los Angeles versus Punxsutawney, Pa. That regional variation, but also just in general, they have not given us an increase to offset the gradual cost of doing business. The short answer is no, and there is an obvious disparity between people who run the health systems and the insurance company and the people who are actually doing the care. Until that gets better, we won't see improvements to patient outcomes, patient satisfaction and the cost of doing care. The failure of Medicare to compensate fairly is part of where we are right now." — Brian Gantwerker, MD, The Craniospinal Center of Los Angeles, on compensation satisfaction.

4. "The use of prone lateral single position spine surgery is the latest evolution in minimally invasive approaches to the anterior spine. The technique has gained adoption over the past several years, largely for degenerative conditions. The advantages realized have included minimally invasive access for larger interbody preparation, implant placement and fusion surface area while [performing] single prone position surgery, allowing maximum lordotic alignment and simultaneous access to the anterior and posterior spine. These benefits of prone lateral access surgery will allow the procedure to have a greater presence and utility in the outpatient setting in the next few years. Additionally, as our instrumentation and techniques have advanced, we are now able to use prone lateral surgery in complex pathology including deformity, trauma and tumor settings, including prone lateral corpectomies. As the current generation of spine surgery fellows and trainees continues to have greater exposure to this technique and its workflow, we will see increased use of single position lateral spine surgery. In my practice, prone lateral surgery allows me to perform single-stage surgeries for patients requiring posterior decompression, revision or extension of instrumentation/fusion, and deformity correction through osteotomies. These single-stage procedures have allowed patients to start their postoperative recovery earlier and avoid multiple anesthetic administrations in a short period of time, especially in our geriatric patient population." — Sohaib Hashmi, MD, of UCI Health in Orange, Calif., on prone lateral spine surgery.

5. "I believe the trend that is upcoming and most important revolves around technology. Technology branches to the patient experience as well as the physician's ability to maintain an efficient and safe practice environment. With regard to patient experience, technology may be able to improve one's ability to communicate with their surgeon and telehealth should be embraced for certain patient concerns (postoperative wound checks, pain management, etc.) and communication with colleagues. As for practice management, the ability to maintain efficient volume thus leading to increased productivity is critical. Harnessing the various benefits that technology can provide is key to ensuring appropriate throughput all the while maintaining a high level of quality." — Adam Bitterman, DO, of Huntington (N.Y.) Hospital, on top trends he's following in 2023.

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