'It's an unending stall tactic': What we heard in March

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Spine and orthopedic experts in March spoke with Becker's about topics from prior authorization to new trends in artificial intelligence. 

"I see two trends that worry me. The first is the continued progress toward hospital bureaucrats making decisions to our exclusion — minimal vendor contracts being the most obvious. Hospital management limits new technology and cost by having middle bureaucrats say no. The second is the worsening trend for insurance, Medicare included, to ration healthcare. Obviously it's not worded that way as it would cause immediate pushback — but how else would you characterize the worsening trend of surgical delay by avoiding approval or denial? It's an unending stall tactic by requesting an ever growing listing of the patients care and history be elucidated. They have all that information, but by putting the burden on providers they avoid outright responsibility for delays. That is rationing under another name." — William Tally, MD, on the most dangerous trends for Athens (Ga.) Orthopedic Clinic. 

"A long overdue payer change is prior authorization reform. The prior authorization process is an onerous and opaque process, mandated by payers, which consumes significant healthcare resources. This wasteful process is exacerbated by the fact that prior authorization approval does not guarantee payment. The entire pre-approved surgical procedure is routinely denied payment if any additional procedure is performed. This is an unconscionable situation. At a minimum, obtaining prior authorization should equate to insurance coverage and payment of the pre-approved codes. Any additional procedures can subsequently be adjudicated based on medical necessity. Hopefully, 2023 will bring substantial prior authorization changes." — Domagoj Coric, MD, on the need for prior authorization reform at SpineFirst at Carolina Neurosurgery and Spine Associates in Charlotte, N.C.

"We are just scratching the surface of the potential possibilities of mixed reality currently. This technology may be very useful for orthopedic trauma as well. I would expect its use to grow as more features are incorporated into the technology, such as the ability to reliably use it for instrument navigation. Instrument navigation, without mixed reality, has been used in shoulder surgery and is an emerging technology that holds immense promise. Along with instrument navigation comes robotic surgery, which is currently in use for hip, knee and spine surgery, to name a few. This technology is gradually making its way into the shoulder replacement space and has the potential to improve accuracy and reliability." — Dave Shukla, MD, on the growth of mixed reality in orthopedics at New York City-based Mount Sinai. 

"There is constant innovation and evolution in orthopedic surgery. We are fortunate to have new technologies that improve our ability to perform procedures with greater accuracy, efficiency, and in a minimally invasive manner. The synergy of this continued innovation with data-driven algorithms and artificial intelligence improves our decision-making at every phase of patient care, from diagnosis and surgery to recovery. This innovation will be the future. While the principles of restoring anatomy and function will remain timeless, I suspect in 10 years we will look back to our practices with some amazement at the absence of digital enabling tools of the future to guide evidence-based decision-making and clinical practice." — Asheesh Bedi, MD, on how orthopedic surgeons at NorthShore Orthopaedic & Spine Institute in Glenview, Lincolnshire and Skokie, Ill., will view today's orthopedic procedures in 10 years. 

"The migration of total joint arthroplasty and spine surgery to an outpatient/short-stay setting is well underway, but in my opinion is still in the early innings. On the other end of this spectrum, some surgical cases are migrating to an in-office site of service, particularly in pain procedures, as well as hand and foot cases. ASCs must adapt to this transition in important ways which will require increasing investment in facility infrastructure and staff training. The same is true of in office procedure capabilities. This is a top-of-mind issue as our practice looks to the future of healthcare and the future of our surgical practice. This migration has legs as it is a strong value proposition for our patients and for third-party payers." — Paul Perry, MD, on how Tri-State Orthopedic Surgeons in Evansville, Ind., is seeing a shift to orthopedic ASCs. 



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