"I will tell you there was strong bipartisan agreement that we have a problem on our hands. And the problem involves Medicare Advantage and consolidation within healthcare systems and honestly even somewhat within physician groups as well, whether we're talking about being bought up by insurance companies or being bought up by large healthcare systems."

 Adam J. Bruggeman, MD, CEO and surgeon, Texas Spine Care Center (San Antonio)

"For the past 15 years, I feel like I've been talking about value-based care coming in some meaningful way, but for us, it never seems to arrive. So we are actually having more success negotiating with our commercial payers. I think part of that is because we've done a much better job of getting granular with our data." 

Vishal Mehta, MD, president and managing partner, Fox Valley Orthopedics (Geneva, Ill.)

"I think healthcare still is very much in the transactional environment, still very much a fee-for-service environment where we haven't really seen a big, aggressive push to value-based care. We're trying to reposition our company to be prepared for value-based medicine."

Michael C. Boblitz, CEO, Tallahassee (Fla.) Orthopedic Clinic

Consolidation and Integration: The healthcare industry is experiencing increasing consolidation, with spine surgeons and practices joining larger healthcare systems or forming strategic partnerships. Consolidation offers economies of scale, access to resources and opportunities for collaboration with other specialists. Integrated care models facilitate care coordination, streamline administrative processes and improve patient access to comprehensive spine care services across the continuum of care.

But consolidation trends are raising concern among some leaders. In a panel discussion, Adam J. Bruggeman, MD, CEO and surgeon, Texas Spine Care Center (San Antonio) shared a recent experience where he testified in front of the state budget committee on consolidation and its impact on the healthcare environment. 

"I will tell you there was strong bipartisan agreement that we have a problem on our hands," Dr. Bruggeman said. "And the problem involves Medicare Advantage and consolidation within healthcare systems and honestly even somewhat within physician groups as well, whether we're talking about being bought up by insurance companies or being bought up by large healthcare systems."

Dr. Burggeman said he believes there's a growing desire to "attack the Medicare Advantage problem" — but the bigger question is how. He underscored the challenge in determining how to ensure competition and pay are appropriate.

Carlos Carrasco, president, Orlando (Fla.) Health Jewett Orthopedic Institute, and senior vice president, Orlando (Fla.) Health, discussed the importance of integration within his organization and how it's expanded options and access for patients.

"We've developed a large group of non-operative doctors, as well as tight integration with our therapists to be able to provide non-surgical options that patients really want," Mr. Carrasco said. "But I think what I'm particularly grateful for is the integration of the team. It's really across our system. I think that really gives the patient a much more integrated feel and a wide array of options so they can make their own choices. It really is how you put together physician talent with the access, ease of access and getting the patient not just an appointment, but to the right clinician at the right time — that's what consumers are looking for."

Robotics and Navigation: Robotics and navigation systems are revolutionizing spine surgery by enhancing precision and accuracy. Surgeons can now plan procedures with detailed preoperative imaging and execute them with robotic assistance or intraoperative navigation systems. These technologies improve the surgeon's ability to precisely place implants, navigate complex anatomy and achieve optimal patient outcomes. As the technology continues to evolve, its adoption is expected to increase.

In a panel session on strategies for physician investors, Adam Shurtz, administrator of Provo, Utah-based Riverwoods Surgery Center, discussed how his practice has benefitted from robotics investments. 

"When robotics were first coming out, it was a tough pill to swallow as there aren't additional codes that you get for using a $1.5 million or $2.3 million robot, which is a little ridiculous for ASCs," he said. "But in hindsight, it was a good decision. It added more cases, more revenue, and it seems like most of our new orthopedic doctors are coming out with robotics training. Whereas our older physician group, they're better than a robot; they don't need one. But if you want to continue to grow, robotics for us has been a positive thing for our surgery centers and it helps us market for our communities. I think we're the only ASC in at least the Utah market that has a robotic program for total joints." 

With higher patient demand for this technology, Helen Aretakis, administrator of Rochester Hills, Mich.-based Orthopaedic Surgical Institute, reiterated the importance of education and making patients aware of robotics offerings.

"Robots in your ORs, whether the physician uses them or not, I think patients need to know they're available," Ms. Aretakis said in a panel session on profitability in orthopedics, spine and pain management. "Patients are calling doctor's offices and asking if they're doing procedures robotically, whether it really serves their purpose or not. It is something that patients are asking for currently."

Biologics and Regenerative Medicine: Biologic agents and regenerative therapies are gaining prominence in spine surgery for their potential to enhance spinal fusion, promote tissue healing and reduce complications. Innovations such as stem cell therapy, growth factors and bone graft substitutes are being incorporated into surgical protocols to accelerate bone formation and improve fusion rates. Research in this field is ongoing, with the aim of developing more effective and targeted biologic treatments for spinal disorders.

"I really think it's an evolving area in medicine, and I think some of the snake oil aspect of it is kind of going away as we build more and more data," Samer S. Hasan, MD, PhD, department chair, orthopedic surgery, The Jewish Hospital (Cincinnati) and co-director, Cincinnati SportsMedicine, said in a panel discussion on orthopedic technologies with big potential. "We do see there is a place for perhaps enlarged joints in orthopedics, and it may actually start evolving into technologies that could replace, improve or minimize degenerative facet and degenerative disc disease. So I think that we're getting there, but there's still some evolution."

Reimbursement Policies and Payment Changes: Insurers are increasingly implementing prior authorization requirements, utilization management strategies and stricter denial policies to control costs. Spine surgeons must navigate these processes to obtain approval for procedures and stay compliant with payer guidelines. Reimbursement rates for Medicare and commercial payers haven't kept up with inflation, further thinning ASC margins.

In a panel discussion on orthopedic practices' strategic partnerships, Mick Perez-Cruet, MD, professor and vice chair of neurosurgery, Oakland University William Beaumont School of Medicine in Michigan, said payer relationships are a key opportunity to improve the bottom line — which he's seen firsthand in a unique partnership with Blue Cross Blue Shield of Michigan via the Michigan Spine Surgery Improvement Collaborative. As part of the initiative, Blue Cross Blue Shield of Michigan provides the collaborative with funds to pay for extractors that assess variables in patient charts, focusing on degenerative spine conditions. The result is what Dr. Perez-Cruet calls an "outcome platform" of more than 100,000 patients, which enables providers to reduce surgical site infections and lengths of stay because they're able to see outcomes of various practices throughout Michigan.

"Now, currently this is a program just in the state of Michigan," Dr. Perez-Cruet said. "I've tried to bring it nationally — I think CMS should adopt it because it's huge. We've literally saved Blue Cross Blue Shield hundreds of millions of dollars. Now, what's the benefit for me as a physician, who's saved this big conglomerate a lot of money? Well, we turn around and we get an uptick in our reimbursement for participation. I get an uptick of 4%, 5%, but it's an increase on reimbursement for each CPT code submitted. So my reimbursement for Blue Cross Blue Shield of Michigan is the best of any payer I have, and they 'gold card' you, meaning if you can show that you're doing the right thing for the right patients and so forth, they don't have to keep calling you — and guess what? I don't do pre-authorizations." 

Value-Based Care and Alternative Payment Models: With a shift toward value-based care, spine surgeons are increasingly incentivized to deliver high-quality, cost-effective services. Alternative payment models, such as bundled payments and accountable care organizations, are becoming more prevalent, encouraging providers to focus on improving patient outcomes and reducing unnecessary healthcare spending. Surgeons who can demonstrate value through efficient care delivery, patient satisfaction and favorable outcomes will be better positioned to thrive in this evolving reimbursement landscape.

"I think healthcare still is very much in the transactional environment, still very much a fee-for-service environment where we haven't really seen a big, aggressive push to value-based care," Michael C. Boblitz, CEO, Tallahassee (Fla.) Orthopedic Clinic, said in a session on the competitive landscape for orthopedic supergroups. "We're trying to reposition our company to be prepared for value-based medicine."

Vishal Mehta, MD, president and managing partner, Fox Valley Orthopedics (Geneva, Ill.), shared a similar sentiment in another discussion on payer trends in spine and orthopedics.

"For the past 15 years, I feel like I've been talking about value-based care coming in some meaningful way, but for us, it never seems to arrive," Dr. Mehta said. "So we are actually having more success negotiating with our commercial payers. I think part of that is because we've done a much better job of getting granular with our data. We can track our costs — not just implant costs, but we can track our labor costs too and assign it to that case and actually show them that our costs are rising incredibly quickly."