How can spine practices boost revenue? 10 surgeon insights


Ten spine surgeons shared the opportunities they see to grow revenue at their practices amid economic headwinds.

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.

The next set of Ask Spine Surgeons questions will be sent Oct. 17. To be included on our email list, please contact Carly Behm at

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

Question: What innovative ways can spine practices use to increase their revenue in the current economic climate?

Chester Donnally, MD. Texas Spine Consultants (Dallas): We all appropriately complain about reimbursement, but I don't think we collectively do anything about it. Part of the reason we don't do anything about it is we simply don't have much guidance of where to unite. Local level? State? National? It would be great if I knew which PAC or leadership group is the best bang for our buck.

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): In the current economic climate, spine practices can explore a few ways to increase their revenue. 

Telemedicine: Offering telemedicine services allows spine practices to reach a broader patient base and provide consultations remotely. This can help reduce overhead costs and increase patient satisfaction, leading to potential revenue growth. 

Collaborations with other specialties: By partnering with other healthcare specialties, such as physical therapy or pain management, spine practices can create comprehensive treatment plans that attract more patients and generate additional revenue streams. 

Ancillary services: Considering the addition of ancillary services, such as diagnostic imaging or durable medical equipment, can provide additional revenue streams for spine practices. However, it's important to carefully assess the feasibility and regulatory requirements before implementing these services. It's crucial for spine practices to regularly evaluate their business strategies and adapt to the evolving healthcare landscape to ensure long-term success and financial stability. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Much like investing, diversifying your income stream helps a lot. There are many ways to do this: consulting, expertise and monetizing social media. We as physicians give a lot of our time away for free.  Once you stop doing that, things might get better. 

Richard Kube II, MD. Prairie Spine & Pain Institute (Peoria, Ill.): We have been pushing into the direct contracting arena. Increasing numbers of small businesses are reaching pain points that drive them to be innovative in the way they provide care benefits for employees. This is an opportunity to provide a solution for those businesses in a way that also helps the community in which we live. We can increase our own revenue and simultaneously provide a path to keep more money in local pockets, employer and employee alike. This improves employee retention and talent attraction to our community which increases a population of future healthcare consumers. It is a move that positively impacts near and long-term revenue while improving your surrounding living environment.

Todd Lanman, MD. ADR Spinal Restoration Center (Beverly Hills, Calif.): Innovative strategies for enhancing revenue within spine practices are most effective when spine surgeons collaborate. I strongly believe that the future of spine care hinges on the establishment of a national consortium of hand-picked, top-tier physicians proficient in performing artificial disc replacement procedures. This collaborative effort is pivotal in advancing the standards and accessibility of artificial disc replacement practices, ensuring patients have a streamlined portal to access these vital healthcare services.

Scott Raffa, MD. Cantor Spine Center at the Paley Orthopedic & Spine Institute (West Palm Beach, Fla.): Spine practices can increase revenue in the current economic climate by expanding their geographic reach and considering satellite clinics in underserved areas or tapping into new markets regionally or nationally.

Heavy use of telemedicine services can also optimize clinic throughput and be used in the expansion of services geographically. Ongoing expansion of services such as second opinion services, specialized programs, and/or wellness and preventative programs may also contribute to an expanded products and service lines for additional top-line revenue.

Philip Schneider, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): There are a few innovative ways that I believe spine practices can increase their revenue. One way is through supporting legislation to tie Medicare rates to the Medicare Economic Index. Practices can also enhance income by expanding traditional and innovative physical therapy offerings, such as concussion programs, occupational medicine programs and/or work hardening programs. Finally, at my practice, we are looking at expanding pain management in the office to include procedures previously done in the ambulatory surgery center, which can lead to higher reimbursement rates. 

Andre Shaffer, MD. Orthopaedic Specialists of Seattle: For years, surgeons of all kinds have subsisted solely on professional fees, with perverse incentives to perform more procedures as opposed to working holistically with patients to move appropriately through nonoperative modalities prior to surgical or procedural modalities. As insurance companies have moved to curtail professional fees reimbursements and practice revenues have certainly dried up, which has consolidated providers both regionally and in terms of practice structure. As a result, treatment choices are constrained by institutional and insurance prerogatives. So how can the modern spine surgeon increase revenues, and hopefully gain some additional independence?

Simply by doing something different. 

Surgeons tend to see their value as being good surgeons, whereas I'd posit that our true value lies less in what procedures we do, and more in why we do the procedures we do, and who we do those procedures for. Our role is as much guides or navigators as it is proceduralists. We help educate and guide people through the contours of injury, illness and their medical experiences and translate their goals into a clear pathway forward. I aim to leverage this expertise in order to monetize by offering patients value directly. Either via content creation in the form of magazine articles and books or videos that answer questions for patients that patients may have. While this pathway isn't for everyone, if you are accustomed to many of the social media platforms, you understand that these platforms are used not just for entertainment, but also for education.

And that is what a doctor ultimately is — a teacher. 

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): The biggest opportunity to reduce the immediate costs of surgical procedures is to move the surgery from a hospital to an ASC setting (when safe and appropriate). Being considerate with the choice of implants and bone grafting materials could also have a significant effect on the overall cost of the procedure (whenever safe and clinically appropriate). 

Performing a spine surgery in a minimally invasive fashion can also substantially reduce the cost of care by significantly reducing the length of hospital stay, the risk of complications such as infection, and the duration of time the patient will need to take prescription pain medications after the surgery. The patients also typically return to full function and work significantly faster after a minimally invasive procedure. This will reduce the non-clinical and societal costs associated with the loss of productivity.  

Another great opportunity is to provide timely and appropriate care. Sometimes delaying medically necessary surgery by trying additional physical therapy or injections only delays the "inevitable," increases the overall cost of care for this diagnosis, and prolongs the duration of time the patient is not back to full function or work.

Hao-Hua Wu, MD. UCI Health: The most innovative way spine practices can increase revenue is to transition more surgical care into an ambulatory setting. To do this successfully, it is important to avoid prolonged hospital stays and optimize each patient's presurgical health with a standardized checklist that helps with smoking cessation, blood glucose management, nutrition and medical clearance. 

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