Peer Review: 2021 Game Changers for Spine Specialists

2020 has been a momentous year, to put it lightly. What will 2021 have in store for spine specialists? Our editorial board breaks out their crystal balls and makes predictions.

Welcome to another edition of Peer Review. Have you ever wished you could pick the brains of some of the best and brightest spine specialists in the world? Us too. That’s why we created Peer Review. Every month we ask a question that pertains to your practice, and our Editorial Board members share their thoughts.

Spine specialist predictions 2021Our board members prognosticate

The year 2020 has been momentous (understatement of the year). Now that it’s almost over, we wanted to know:           

              What will have the biggest impact on spine specialists in 2021?

Our Editorial Board members broke out their crystal balls and made some predictions. Here’s what they think.

“I see the continued migration of spine surgery to the ambulatory setting along with growing usage of regional anesthesia for spinal procedures as the two leading trends for the next 6 to 12 months,” says Joshua Ammerman, MD, a neurosurgeon who practices in Washington, DC. “With the COVID-19 pandemic patient and providers are increasingly concerned about in hospital exposure. This is naturally less of an issue at a free standing ASC.”  

Dr. Ammerman does see some specific challenges around these issues, however. “That said, moving a greater percentage of care to the ambulatory setting requires additional techniques to increase the reliable and safe discharge of patient without the capability of hospital admission. Regional techniques such as spinal anesthesia, TLIP blocks and paravertebral/ESP blocks permits a reduction in intraoperative narcotic usage and significant prolonged postoperative pain relief which helps to diminish narcotic usage and speed postoperative ambulation.”

Lali Sekhon, MD, PhD, who practices in Nevada, believes it’s not so much techniques as it is payment issues and other factors. “I think the biggest thing will be the continual erosion in payments/fee for service. That model no longer works,” he says. “Payment for quality is lip service. Ancillaries are the key. Large groups can negotiate contracts the best.”

Partnerships to create practices that treat the spine from multiple perspectives will be a game-changer, no matter if you’re a neurosurgeon, orthopedic surgeon or other specialty, says Dr. Sekhon. “From a person side the emergence of combined neuro/ortho spine services is a unique all-services feature,” he says. “I am a neurosurgeon in an orthopedic group with a new well-trained ortho spine partner. The best of both worlds.”

Changes at the Centers for Medicare Services, combined with COVID-19 issues, will continue to have outsized effects on spine specialists in 2021, contends Theresa Marko, DPT, who has a spine-focused physical therapy practice in New York City.

“CMS has implemented a 9% cut to physical therapy for Medicare part b recipients, effective Jan 2021. The American Physical Therapy Association and its membership are fiercely fighting this cut as it will have devastating effects all around,” Dr. Marko points out.  

“Firstly, this will reduce access to care for patients. This cut means less visits for PT, just at a time when people have been contracting covid19 and been sick and while people have been less active as they spend more time at home quarantining and sheltering in place,” she continues. “A sedentary population leads to many other secondary co-morbidities that also interplay with covid19 as well as fall risk for the elderly population. Secondly, this 9% cut to payment will be the breaking point for many clinics who closed during March and April of the pandemic and who's business income is struggling already.”

Telemedicine, too, will play a positive role in patient care next year, says Dr. Marko. “Physical therapists just got the privilege to perform telehealth visits from CMS for Medicare patients. However, this is only a temporary waiver.  Whenever the pandemic is deemed "over", that right goes away with it,” she says.

“The APTA is advocating for the permanent ability to perform telehealth visits as this is something that patients are now use to and expect,” adds Dr. Marko. “More than that, this increases access to care for those who live in rural areas where the closest PT clinic is many miles away, those who might be experiencing severe weather that prohibits them from leaving the house safely, and those who might be in pain and need immediate care instead of having to go to the emergency room and potentially receive only an opioid prescription.”

Your turn: What do you think will have the biggest impact on your practice or your specialty in 2021? Tweet us @SpineUniverse. And, if you have a burning question you want to ask our Editorial Board, it might be featured in a future edition of Peer Review!


Updated on: 11/09/20
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