7 spine, orthopedic insights to know from Q3

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Spine and orthopedic experts shared their insights on a variety of clinical, business and policy issues in their work during the third quarter of 2023.

"The collaboration between a small practice and a hospital must be approached thoughtfully. As a surgeon fresh out of training who has worked with practices of all scopes, I recommend smaller practices to first evaluate their compatibility with the hospital's culture and values. Smaller practices should prioritize patient care and long-term benefits over short-term gains. It's crucial to thoroughly understand the partnership's terms, considering factors like shared values, patient care enhancements and workflow changes. As an example, new technologies in surgery could potentially greatly enhance patient care, but the lack of direct control over procurement decisions can be a challenge for smaller practices that do not fully explore the terms of the partnership prior to entering an agreement. Smaller practices should also anticipate changes in workflow and administrative processes, and ensure that the partnership enhances their ability to provide high-quality patient care," — Rafid Kasir, MD, of San Diego Orthopaedic Associates Medical Group, on orthopedic practice partnerships with hospitals.

"Overall, orthobiologics are not overhyped. This type of treatment has been established as being safe and effective in the well-selected patient. The proper use of leukocyte-rich or leukocyte-poor PRP formulations, minimally manipulated adipose, or bone marrow concentrate has shown benefit in many common orthopedic injuries. On the other hand, 'regenerative medicine' is not a proper description of these treatments. Advertisements that suggest cartilage, tendon or spinal discs can 'regrow' are extremely misleading and medically false. Patients should consult with their doctors to ensure they pursue the treatment best for them rather than the treatment receiving the most hype," — Gurtej Singh, MD, a physical medicine and rehabilitation physician, on orthobiologics.

"I do not listen to music in the operating room. I like my operating room quiet, actually. I don't like distractions or anything that takes my focus away from the patient. I remind everyone in my operating room that everyone there is there for the patient. I do not want them talking about their weekend. I don't want them talking about their evenings or shopping lists or scrolling through Instagram. I want them all focused on the surgery. It's our duty to do that and we are all better together doing that. Music and socializing are great, but not in the OR," Todd Lanman, MD, of Beverly Hills, Calif.-based ADR Spinal Restoration Center, on why he doesn't have music in the operating room.

"I would remove prior authorization from insurance companies as a requirement for surgical treatment. Patients don't like it, physicians don't like it. It takes time physicians could be spending on patient care and ties us up in paperwork. Research shows it contributes to longer wait times, elevated risks, and negative health outcomes for patients. Physicians should be able to recommend and carry through with the most effective care for their patients without being bogged down by administrative checklists. The American Academy of Orthopaedic Surgeons is supporting the proposed CMS interoperability and prior authorization rule, and I stand with them in their efforts to reduce the burdens created by prior authorization and improve patient care," — Jennifer Wood, MD, of Reston-based OrthoVirginia, on what she would change in orthopedics.

"Spine surgery still clings to an outdated idea that extensive spinal fusion is often necessary, despite evidence supporting the effectiveness of non-fusion alternatives with fewer risks. Some medical practices continue to hold onto the traditional mindset of defaulting to fusion as the primary treatment option," — Mohammed Khan, MD, of Hackensack-based New Jersey Brain and Spine, on outdated ideas in spine surgery.

"At least in the field of spine care, the focus is on evidence-based research, especially real-world outcomes utilizing big data platforms so that we truly understand if our surgical treatments are providing clinically important differences across a complex, highly variable patient population. Secondly, the trend towards more comprehensive multidisciplinary specialty interaction. Tearing down the barriers of compartmentalized medicine approaches, it is extremely important that spine surgeons work together closely with physiatry, neurology, anesthesia and pain management to really take global care of the patient. Finally, the world has changed post-COVID, and being able to interact with patients by new platform mediums like virtual appointments and interactive patient portals allows greater connectivity to your patients, which can only result in better care management," — Frank Cammisa, MD, of New York City-based Hospital for Special Surgery, on healthcare trends he's following.

"At a professional level, the hope is that the physicians who have the expertise to care for those athletes would be able to provide that care without feeling the risk of their decisions being scrutinized when they do things that are absolutely evidence-based and appropriate for an athlete. We know that even with all the tremendous advances in sports medicine and the extensive research on diagnosis, nonoperative treatment, operative treatment, rehabilitation and injury prevention, there are still undetermined issues, still shades of gray. Nothing is absolutely black and white. There's a massive amount of research that guides us on our treatments, and even when we do things exactly the way they should be done, sometimes an athlete doesn't end up performing at their pre-injury level even when diagnosis, treatment and rehabilitation are done perfectly. The idea would be that you allow the most appropriately trained and experienced physicians to provide care for these athletes without feeling the risk of legal scrutiny when an athlete, who for other non-medical or non-orthopedic reasons, might not be able to return to pre-injury level of performance. The hope is to maintain and create an environment that allows the most skilled, experienced physicians with that added sports medicine expertise to be able to feel confident and comfortable enough to care for those elite-level athletes," — Michael Ciccotti, MD, of Philadelphia-based Rothman Orthopaedic Institute, on physician liability in sports medicine.

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