Here's what 3 spine surgeons are doing to keep practice costs lean


Between inflation and rising costs and reimbursement woes facing physicians, many spine surgeons are strategizing to manage finances at their practices.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next week's question: What's one thing the spine industry needs now more than ever?

Please send responses to Carly Behm at by 5 p.m. CDT Wednesday, May 31.

Editor's note: Responses were lightly edited for clarity and length.

Question: What cost-cutting measures are you taking at your practice?

Mladen Djurasooic, MD. Norton Leatherman Spine (Louisville, Ky.): We are implementing several cost measures. In the OR, we are constantly reevaluating implant costs, in particular biologics (e.g., bone graft extenders), which can be surprisingly expensive. In the office, we are constantly trying to convert paper processes into electronics. For example, currently we are looking at processes to allow direct input of patient-reported outcome measures into an EMR rather than having paper forms, which require manual input.

Alok Sharan, MD. Spine and Performance Institute (Edison, N.J.): Over the past few years I have been transitioning my practice towards primarily outpatient procedures and performing them at ambulatory surgery centers. At this point the majority of patients in my practice who need a lumbar fusion, laminectomy, or a cervical fusion are able to go home the same day. Using our awake spine surgery protocols, we are able to discharge patients home the same day and have them take opioids for only a few days.

Many payers are pushing cost-cutting measures by changing the site of service of cases towards ambulatory settings. Doing a case in an ASC instead of a hospital requires more than a change in the site of service. It requires educating the patient properly, optimizing their health, and making sure they will be safe at home. In anticipation of payers using the ASC as a cost-cutting measure, I have been constantly refining our protocols to make the surgical process a great experience for the patient so that they recover safer, better and faster.

Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: We have recognized that there are many sources of waste when it comes to spine surgery. In the operating room, we have started an initiative at Hartford HealthCare to ensure every surgeon knows their cost for a particular case as well as the system average. This helps all of us understand where our costs come from and how we can reduce them while maintaining the same quality of care. Ultimately, this is all about improving the value of the care delivered, ever reducing costs while improving the quality and outcomes for our patients. Personally, this has enabled me to see what implants are costing compared to my peers and also what disposables are being opened in my case (sometimes just because they were on an old preference card) that I can ultimately eliminate. This sort of lean work is embedded within our ethos at Hartford HealthCare and remains essential to improving our efficiency.

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