D. Scott Kreiner, MD, who was named the next president of the North American Spine Society, said he plans to focus on collaboration.
As director of interventional spine and sports medicine at Phoenix-based Barrow Brain & Spine, he has a unique perspective as a non-surgeon. He spoke with Becker's about continuing the collaborative mindset and what he hopes to achieve with NASS.
Note: This conversation was lightly edited for clarity.
Question: What are your goals heading into this position?
Dr. D. Scott Kreiner: My focus is going to be primarily on collaboration as a non surgeon. It's been interesting over the last few years watching a lot of infighting over some procedures that the spine surgeons say pain physicians shouldn't be doing. We had a meeting down at Barrow Brain & Spine not too long ago in a room full of neurosurgical spine leaders around the country, and outside of the invited endoscopic specialists, none of the neurosurgeons were interested in performing endoscopic spine surgery but there was a couple of invited non-surgeons that do that, and in the spine community, many do it quite well. It was interesting that the neurosurgeons choose to do microscopic technique instead of an endoscopic technique because they feel more comfortable.
I'd like to see a way where there's a space for everybody to exist and work together. In my daily practice, I co-clinic with neurosurgeons, and on a daily basis, we walk patients back and forth. I think I've got a great relationship with the people who I work with, and they respect what I do. I certainly respect what they do. So I would like to see if we could figure out a way that we can work together. When there's a lot of conflict going on, it tends to hit reimbursement for everybody, not just for the non surgeons. It tends to hurt the surgeons, and I know that's the last thing they want as well.
Q: Can you elaborate more on that?
DK: All it takes is somebody to argue that a single code is overvalued or undervalued, and we're seeing that right now. Then, what ends up happening is CMS will come in and ask for all of the codes to be revalued in a specific class. We've seen that happen quite a few times in the last few years, where all of the codes have gotten revalued based off of a hint that something a single code in the class may be overvalued. That's not always going to be on the good end of reimbursement. I'd like to see all spinal reimbursement, at least stay stable, if not increase. I know we're all working, certainly way harder than it feels like we're getting paid.
Q: When I talked to Zoher Ghogawala, MD, last year about his presidency, he mentioned the same thing about wanting to really prioritize collaboration at NASS. What has gone well in terms of these collaboration efforts and where do you want things to grow?
DK: Dr. Ghogawala being a neurosurgeon, took over leadership at a time where I think there was some conflict between the neurosurgeons and NASS. Building the bridges there between the neurosurgical groups and the orthopedically orthopedic surgical groups was really needed. I think it seems to be going quite well. I don't see conflict to the degree it was a few years ago, and Dr. Ghogawala has really done a great job with that. He is also super supportive of non surgical spine care. I have a little bit of a different perspective, so I think that continuing that collaborative effort into the non surgical space will be huge.
Q: What are some other interests or concerns among NASS members, and what's worrying them?
DK: I don't think it's unique to NASS members, but one thing that's worrisome for everybody right now is reimbursement. We're seeing the federal government cut reimbursement for all healthcare again. I think it's been 10 years before we've seen the cost of living increase for what we do, and inflation's gone through the roof, and so we're all having to pay more for our staff, more for our supplies. That ends up coming directly out of your pocket, if you're in a private practice, but it affects the whole healthcare industry. That's the biggest thing that's probably affecting everybody, and I'm not sure that I have a solution to that. But we're all concerned about it, and trying to navigate the minefield of health policy and advocacy is hugely needed.
Q: Can you elaborate more to the advocacy efforts you're hoping to get rolling in your term at NASS?
DK: We're going to be actively pursuing relationships between other societies to try to figure out some best ways to make our advocacy dollars work. Another goal is we're going to figure out the best way we can collectively work with other groups to be influential and help with policy.
Q: As a non surgeon in spine, how do you see the role of pain management physicians evolving with the evolution of spine care?
DK: We're at a time where innovation is driving a lot of the procedures that people do. What we're seeing is a trend towards procedures that are less invasive that pain management physicians feel comfortable doing. There's a whole area of new techniques out there that are done by pain physicians, and I think some of them are appropriately done, and some aren't. That's an area where caution needs to be taken with regard to implementation of innovation and how that's done correctly,and whether or not it should be done. Not every new innovative device that comes out is necessarily appropriate either. I think it's a balance, but I think I think we're going to continue to see the blurring of the lines from a less invasive method of handling patients with spine pain.