The Growth Channel

Expanding spine services across the care continuum


Leah Reidy

Although spine procedures are considered to be a bread and butter service of hospital business units, there are a number of challenges that will affect the pace at which these procedures are poised to grow in the future. The traditional growth drivers of the past, such as demographics and advances in technology, may actually temper growth in coming years. The utilization of certain spine procedures, spinal fusion in particular, may begin to slow as baby boomers continue to age—the utilization of spine surgery peaks between ages 45 and 64. 

Advances in technology and treatment techniques may also reduce inpatient volumes by pushing procedures to outpatient settings (see the Marketing and Planning Leadership Council’s Service Line Forecast Compendium for inpatient and outpatient forecasts).

Commercial payers and government agencies are also increasing their scrutiny of spine surgery utilization, putting additional pressure on growth prospects. For example, CMS recently announced (and then postponed) plans to launch a demonstration in 11 states evaluating the appropriateness of high-end procedures, including common spine procedures, by conducting prepayment reviews to ensure medical necessity before providers are reimbursed. Such efforts, along with news coverage putting “unnecessary” utilization of spine procedures in the spotlight, are likely to push providers to offer more conservative therapies as penalties and denied payments increase.

Offering medical management of spine conditions in conjunction with spine surgery will serve as a growth mechanism and point of differentiation as institutions make the transition toward managing population health. Comprehensive spine care is a compelling strategy, especially to institutions pursuing a more aggressive path toward accountable care.

These organizations are instituting an appropriateness infrastructure to manage cost and utilization risk. Further, primary care physicians (PCPs) and consumers are increasingly pressuring spine programs to provide a full range of treatments, including more conservative pain management options. PCPs are less inclined to refer to programs that are procedure-based—both PCPs and consumers are seeking a more multidisciplinary approach to back pain, one that emphasizes patient navigation and personalized care.

In theory, a comprehensive spine program that focuses on appropriateness may result in fewer procedures. However, programs that focus on offering the full continuum of care may find a competitive advantage by positioning themselves to better compete for and capture more ancillary share related to back pain, such as imaging, physical therapy, and pain management. Additionally,  the highly organized triage and navigation components, characteristic of comprehensive spine programs, often result in increased surgical productivity, which increases the value of total spine care to the institution.

For additional detail on the transition from episodic to continuous care in spine programs, please refer to the section "Developing Comprehensive Spine Programs" in the Council’s most recent publication, Neurosciences: Service Line Strategic Outlook.