6 trends gripping the spine industry


Spinal procedures shifting from inpatient to outpatient settings, evolving payer-provider relationships and a minimally invasive surgery boom are some of the key trends dominating the spine industry this year.

Here are six key trends at the top of spine surgeons' minds:

1. Decreasing reimbursement.

CMS has been steadily trimming physician fees for many years, with commercial payers following suit. In its 2022 Physician Fee Schedule proposal, issued July 13, CMS outlined more cuts to physician pay. CMS proposed reducing the physician pay conversion factor 3.75 percent in 2022, from $34.89 to $33.58, which would result in changes in the relative value units and expenditures related to other proposed policy updates.

"Spine surgery outcomes have gotten significantly better in recent years, especially with the introduction of such innovations as minimally invasive spine surgery, disc replacement, and navigated and robotic surgery. Despite that, CMS reimbursement per procedure has been going down every year," according to Vladimir Sinkov, MD, of Las Vegas-based Sinkov Spine Center. " Spine care would greatly benefit if CMS can start paying spine surgeons appropriately (commensurate with increasing practice costs, inflation and increasing regulatory burdens) for the work done."

2. Evolving relationships with payers.

New partnerships are expected to take shape between providers and payers as they increasingly push to shorten hospital stays and move cases to ASCs. Orthopedic practices that can get ahead of this shift and work with payers to find cost-effective solutions to care will stand to benefit the most.

"Payers will look to the ASC and physician network to bring to them quality, cost-efficient solutions and develop relationships such as Centers of Excellence with fair contracted rates that let all involved — patient, provider and payer — win," according to Robert Bray Jr., MD, of DISC Sports & Spine Center in Newport Beach, Calif.

"As these relationships develop, you will find great satisfaction working as a partner with payers to do what we do best: Deliver well thought-out, quality care," Dr. Bray said. "This is work that requires complete commitment to data-driven results and time spent to develop payer relationships. Find a champion that will lead this within your group and rally behind that effort."

3. Advancement of minimally invasive surgery.

Surgeons are increasingly treating spinal conditions using minimally invasive procedures, which have smaller incisions and are associated with less postoperative pain and fewer complications risks. Device companies are focusing more of their businesses on developing instrumentation, implants and other surgical technologies to facilitate minimally invasive procedures, which has contributed to more of these procedures being performed at surgery centers for a fraction of the cost of the same procedure at a hospital.  

"The drive toward outpatient surgery will accelerate," according to Jeremy Smith, MD, of Hoag Orthopedic Institute in Irvine, Calif. "Techniques involving single-position surgery (lateral or prone) will continue to improve and allow 360-degree fusions with minimal blood loss and perioperative morbidity. Endoscopic spine surgery continues to grow, and as surgeons continue to refine their skills, indications will become broader. Industry competition has allowed for multiple navigation and robotic technologies that continue to maximize accuracy and minimize invasiveness."

4. Outpatient migration.

Spine procedures have been steadily migrating to outpatient surgery centers for many years, but the COVID-19 pandemic significantly accelerated this trend. Over the past 15 months, more surgeons have been pushed to do cases in ASCs, opening more eyes to the safety and efficiency of the outpatient setting. In addition, many patients are still reluctant to have surgeries done at hospitals, which are still dealing with COVID-19 patients.

"The surgery centers are a good out for both the surgeon and the patient," Frank Phillips, MD, director of spine surgery at Rush University Medical Center in Chicago, told Becker's. "We've had no pushback from patients coming to the ASC, but have had people nervous going to the hospital. I think this has got to accelerate spine ASC surgery."

5. Rising consolidation.

Consolidation is expected to rise among orthopedic practices in the next three years. Spine care will continue to shift to the outpatient setting, where payers see cost savings and providers have greater opportunities for ASC ownership.

"Trends are shifting toward employment models and consolidation of practices, as we see hospital systems, private equity and insurance companies continue to employ a greater percentage of the workforce," according to Adam Bruggeman, MD, CMO of MpowerHealth in Addison, Texas. "Also pushing this trend is the growing attitude of physicians who prefer to avoid the ever-growing practice management requirements and increasing burden of preauthorization associated with payers."

6. Private equity partnerships.

More spine and orthopedic practices are considering strategic partnerships to survive and/or grow after the COVID-19 pandemic. Some prominent orthopedic groups recently partnered with private equity-backed platforms, including Birmingham, Ala.-based Andrews Sports Medicine & Orthopaedic Center and The Steadman Clinic in Vail, Colo. Click here to read about nine private equity transactions that took place in the orthopedic industry since January.

"[Private equity] will become more important as we move toward a need for greater efficiency and a more businesslike approach to sustain our practices in the ever-changing and more challenging healthcare environment of tomorrow," Kornelis Poelstra, MD, PhD, of The Robotic Spine Institute of Silicon Valley in Los Gatos, Calif., told Becker's.

"The upside will be the introduction of much greater business acumen and efficiencies that could allow us to stay away from hospital employment and possibly boost the bottom line for all," Dr. Poelstra said. "The downside would be that decisions could be forced upon us by nonclinicians solely for monetary gain, which is in stark contrast with the way we have usually practiced and approached the people we care for."

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