'Any good spine surgeon does their homework': What we heard in February

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Spine and orthopedic experts in February spoke with Becker's about topics from sacroiliac joint fusion to daily routines ahead of surgery days.

"The pressing issues for HSS clinicians are similar to the issues facing clinicians across the country: declining reimbursements, less control over third-party payers, increasing costs to provide services and this massive migration from inpatient to outpatient surgery. One exciting initiative that we have underway involves increasing our capacity to do more high-quality ambulatory orthopedic surgery cases in more places through the development of an ASC network. This approach will allow us to address some of the challenges associated with the migration from inpatient to outpatient surgery while making sure that outpatient surgeries are delivered in the safest possible way. New models like this one can help us to increase economic alignment across our various constituencies while allowing us to maintain our competitiveness advantage," — Bryan Kelly, MD, on the biggest concerns for physicians at New York City-based Hospital for Special Surgery.

"I think sports medicine is evolving so quickly, there are so many innovative surgeons, companies and technologies. We all share the information immediately with each other through educational videos, society meetings, and literature that the rapidity of information transfer allows for much faster levels of innovation and improvement in our abilities to treat athletes. It is probably one of the most rapidly changing fields in orthopedics and in medicine. Additionally, sports medicine surgeons get immediate feedback of whether the athlete is able to perform or not. In other branches of medicine, you have to wait, perhaps several years, to understand whether it had an effect. In this case, you are getting feedback pretty quickly on how quickly the athlete can return to play and how their performance is once they return. That feedback is really valuable from a learning perspective and helps us continue to get better at our craft," — Peter Millett, MD, on the evolution of sports medicine.

"Any good spine surgeon does their homework. The night before a case, I review the images for surgery and go over the plan I prepared to address the issue. I review my notes. In my mind's eye, I imagine each step of the procedure I'm going to do and any potential difficulties I might encounter during surgery. Most importantly, I get a good night's sleep!" — Jeremy Smith, MD, of Hoag Orthopedic Institute in Newport Beach, Calif., on how he prepares for a busy day.

"The SI joint fusion groundswell has leveled off quite a bit in the past four to five years. While we cannot replace this joint, I think more interesting companies will come to the fore with simpler techniques and likely integrated with image guidance out of the box. This would be dually good and not so good for patients. While it would help make us better at the operation, it opens the door for unqualified people to do them on likely thin or nonexistent indications. The democratization of spine surgery should not mean everyone should do it, quite simply because they lack the training, insight and ability to manage these patients in the long term," Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, on his outlook for sacroiliac joint fusion.

"Medicare has continued to cut our reimbursement year after year despite our cost of doing business as an independent practice having gone up significantly. At the same time, we are asked to do more and more uncompensated care. This has forced a record number of independent practices to close down or sell to private equity. When this happens, the cost of healthcare escalates and the patients suffer the most. We are also the only profession that provides a service without ever knowing if we'll get paid for it or not. This system is unsustainable," Ramy Elias, MD. Medical Director for the Center for Advanced Orthopedics & Sports Medicine at Cerritos (Calif.) Surgery Center, on the state of orthopedic compensation.

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