Getting a Clinical Viewpoint

Last year, at the North American Spine Society’s (NASS) 33rd Annual Meeting, held in Los Angeles, Jeffrey C. Wang, M.D., professor of orthopaedic surgery and neurological surgery (clinical scholar) at the Keck Medical Center at the University of Southern California, was named the organization’s next president. As a recognized expert in the surgical treatment of all neck and back disorders, Dr. Wang is also intimately familiar with a large variety of the technologies being used for patient care. As such, the annual meeting offered the perfect opportunity to take some time to speak with the Society’s new president and get his insights on the relationship between surgeons and today’s technology providers. Dr. Wang offered his viewpoint on a number of topics, from FDA to the impact of emerging technologies to the effects value-based healthcare and bundled payments will have.

Sean Fenske: What has been your interaction with orthopedic device manufacturers, such as the companies that exhibit at the NASS annual meeting, beyond simply using their products/instruments?
Dr. Jeffrey Wang: I have interacted with industry and device manufacturers in various capacities. Currently, as president of NASS, we are always looking to work with them in appropriate and meaningful ways, which would ultimately benefit patient care, while maintaining safety and trying to base recommendations on evidence. I have always found these interactions to be positive, as I do believe in the end, the ultimate goal is to enhance patient care. The companies want to do this by selling their products and making a profit. Surgeons need these products in order to perform vital surgeries, but also need to make decisions based on evidence and appropriateness.

Fenske: Based on your professional experience, are orthopedic device companies listening to surgeons and addressing their needs?
Dr. Wang: Absolutely! The device manufacturers are looking for ways to make their products better and more easily used by the surgeons. The entire goal of getting feedback is to make their products more attractive. They accomplish this by making them less expensive, better, and easier to use, while, at the same time, allowing surgeons to achieve their surgical goals in the safest and most efficient way. There are numerous common goals between surgeons and the device manufacturers.

Fenske: How could device manufacturers do a better job interacting/communicating with surgeons?
Dr. Wang: I think they do a very good job currently, and this will only get better. Some of the challenges that are currently faced are common challenges while others are not. The more the companies can understand the challenges the surgeons face and try to resolve these, the better the level of interaction with the surgeons will be. For example, the costs of the implants are high, but of course, everyone is trying to save money. Working together to bring down costs while still providing a high degree of quality care is a worthwhile goal that will only be accomplished with better communication.

Fenske: Shifting to technologies, please provide your impressions on the impact the following product segments are having currently and/or will have on orthopedics in the next five to 10 years. Let’s start with biologics.
Dr. Wang: This is the future. If we can develop an understanding of how to address these spinal pathologies on a biological basis, we can work on prevention, or regenerative medicine, and try to reverse the pathologies. I believe the most impactful discoveries in the future will be in this arena.

Fenske: Next, what are your thoughts on robotic surgery/surgical systems?
Dr. Wang: This is more attractive, but we need to show evidence that this is worthwhile. It sounds futuristic and attracts our attention, but we need to integrate this and demonstrate it improves patient outcomes and surgical procedures. I personally feel this technology will advance us into the future but only time will tell. I am very excited about the developments in this area.

Fenske: Finally, a technology making an impact across many industries, additive manufacturing/3D printing. What are your thoughts on this?
Dr. Wang: This is very interesting, but we’re still trying to prove the value of the technology. It sounds attractive, but from a practicality perspective, the costs need to be justified. I am hopeful this will make an impact, but I believe it is still looking for the right area where it can be applied to truly demonstrate the value.

Fenske: In your opinion, does the FDA do a good job in balancing its responsibility to safeguard patient safety versus getting new innovations to the market in a timely manner?
Dr. Wang: The FDA does a very good job at balancing a very tough situation—patient safety versus innovation. The interpretation of their rules and guidelines is where things can get perverse. How patients, the public, and lawyers interpret these rules can have a negative impact on innovation, and can negatively impact patient care. Doctors are required to do the best for their patients. Unfortunately, sometimes they are doing what seems to be the best for their patients according to the interpretations of the rules by patients, lawyers, and the general public. This is a very contentious area, but is being made so by factors outside the FDA. This is not the fault of the FDA.

Fenske: What impact do you see bundled payments having on the orthopedic industry?
Dr. Wang: This has and will continue to have a huge impact on the orthopaedic industry. This requires that hospital systems work together with the surgeons to develop efficiencies in care throughout the continuum of care. This is good for everyone. At the USC Spine Center, we’ve seen consistent and safer care, and care that is more efficient and cost effective. The negative impact is felt by the complicated patient who is not routine. Bundled payments negatively affect the “special” or non-routine cases, where the reimbursement for the services required do not make sense and are not appropriate. Balancing this concept is the right thing to do.

Fenske: Is there any way orthopedic device manufactures can aid you in this movement to this type of reimbursement system?
Dr. Wang: The best thing they can do is to make their products to be used in an efficient way (since the surgeons need to deliver efficient care), while also trying to contain their costs. Novel ways of decreasing costs based on volume discounts, or other models, may also have a large and positive impact.

Fenske: Similarly, what impact will value-based healthcare have on the orthopedic industry?
Dr. Wang: This will drive surgeons, hospitals, and ancillary support to work together and consider the patient as a whole. In the end, I do believe this is better for everyone, including the patient.