The most dangerous trend in spine surgery

The most dangerous trend in spine surgeryby Laura Dyrda | August 16, 2019

Spine surgeons reveal the trends in healthcare that could have a negative impact on spine surgeons and care delivery in the future.

  • Timothy Witham, MD. Johns Hopkins Bayview (Baltimore)

The usual issues, mainly insurance companies dictating the way we care for patients and limiting the opportunities for patients to receive certain treatments.  

  • Jason Huang, MD. Baylor Scott & White Medical Center (Temple, Texas):

There are so many things going on in healthcare — the opioid crisis, increasing economic pressures on doctors, hospital closures, countless new emerging technologies, acquisition and merger of major medical device companies, health policy reforms, etc. It is easy to get loss in this environment or lose our focus entirely.

As physicians, the most dangerous trend is to lose focus on our single most important goal: making our patients healthier and better and serving our patients.

The lack of focus on patients, but too much emphasis on technology or profits, in my opinion, is the most dangerous trend in medicine.

  • Thomas Loftus, MD. Austin (Texas) Neurosurgical Institute:

By far the most dangerous trend is insurance treatment denials.

There seems to be a trend to limiting patient spine care using arbitrary rules and regulations by the insurance company. While there may be an immediate cost saving for the insurance companies, the costs to the patient in additional doctor visits, lost wages, and the ultimately higher likelihood of pain medicine addiction are significant.

The greatest danger is that these arbitrary guidelines created by insurance companies override the medical judgement of the treating surgeons.

That will never lead to better care for the most important person in the equation: the patient.

When insurance companies are patients’ adversaries, it’s clear that the patient will always lose.

  • Ashutosh Pradhan, MD. Ascension St. Vincent’s Riverside (Jacksonville, Fla.):

I am concerned that there is a race to the bottom to control cost without necessarily evaluating patient benefit.

This is the sad truth and I’m glad to see that doctors also recognize it.

We should all be good stewards of our healthcare system. In a race to improve our cost structure, I think we are eliminating opportunities for new technology and burdening physicians with documentation requirements that seem unnecessary.

In addition, it seems like I am spending more time on the phone with insurance companies for patients I have documented appropriate conservative treatment.

  • Kevin Foley, MD. Semmes Murphey Clinic (Memphis, Tenn.):

I believe the most dangerous trend in healthcare has been the tendency of too many physicians not to get involved in the management of the field.

Management positions in healthcare go to financiers who excel at managing money, not healthcare.

Things might improve if doctors were also in management, but this is unlikely because healthcare is run by profit-generating corporations, not medical professionals.

Delivering quality patient care can be time-consuming and exhausting, but we ignore the management of healthcare delivery at our peril and ultimately, to the detriment of our patients.

  • Dale Horne, MD. Neurosurgeon (Cincinnati):

Complacency and cutting corners by surgeons, physicians and staff, often due to the increased regulations and time demands, is dangerous.

Practice and hospital administrations must respect that quality care requires time with patients.

Furthermore, unless a surgical emergency exists, patients should be given the option of conservative measures and stable conditions should be followed. Just because we have the technology to perform a surgery does not mean we should.

  • Kristopher Kimmell, MD. Neurosurgeon (Rochester, N.Y.):

I think that we need to move away from a view of trying to extract maximum reimbursement from every patient and procedure and move toward demonstrating our value to healthcare systems and payers from a more holistic perspective.

Yet, “extracting maximum reimbursement” is what is required in pure capitalism.

Corporations now own most hospitals, doctor practices, and almost all healthcare services and they are legally required to maximize profit.

There’s no motive to “do good”, “be helpful”, or “show empathy” when profit is literally the only measure of success – and quick quarterly profits at that.

We do add value and contribute to our healthcare systems in multiple ways.

When doctors have to prove that they add value to healthcare, the system has become completely backward, ruled by financial factors and with patient services a cost only tolerable if it generates more profit.

But we have to be aware of these benefits and leverage them to our advantage while also delivering the best possible care to our patients

Other thoughts?

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