Alok Sharan, MD, recently appointed Director of Spine and Orthopedics at NJ Spine and Wellness in East Brunswick, New Jersey.
Dr. Sharan, one of the first to adopt spine surgery that does not require general anesthesia, has treated 130 cases since he began performing the procedure in 2017.
He spoke to Becker Spine Review about the position of spinal fusion in value-based care and how the COVID-19 pandemic highlighted some aspects of the procedure.
Note: Answers are changed for taste and clarity.
Question: How do you see your brain fusion protocols appear in your new closet?
Dr. Alok Sharan: NJ Spine and Wellness is a multi-specialized, multidisciplinary and column-based practice. The creed of our practice is to “make patients faster. “Spinal fusion has so much awakened with our practice that we are convinced that they are to achieve greater effects through a combination of my surgical strategy with pre- and postoperative rehabilitation.
At the end of the day, spinal fusion awakens is a protocol; it’s not just one thing. We observe the patient from the moment he makes the decision to operate on the process, adding what we do in the operating room, with the ultimate goal of getting it back faster. From a preoperative point of view, NJ Spine and Wellness has a wonderful provider organization that includes physical therapists, occupational therapists and chiropractors who work hard to take patients with initial pain to the next level faster, no matter what. ‘she’s.
Q: How does awake spine surgery support the price age at which the industry continues to evolve?
AS: If you compare apples with apples from awake spinal fusion compared to classical fusion, this represents approximately 10% savings. It is not so vital in terms of load saving, however, for awake surgery, we must discharge the patient on the same day. The cost of a hospital stay varies widely; $2,000 to $4,000. If you charge those who charge savings, we’re starting to see genuine savings. If you perform this surgery on a CSA, it’s about 50% of the cost of doing so in a hospital. Although the overall direct charge savings are approximately 10 consistent with penny, when you run the procedure on a CSA, the cost savings would be huge. I think awake spine surgery will be the catalyst for those CSA procedures. That’s where genuine charge savings will go in.
Q: Why do you think this procedure has been followed more widely than in the United States?
AS: We learned about the threats of intubation pandemic, I think there are patients who were intubated by COVID or who were at risk of intubation who want spine surgery without being intubated, we actually see some patients who are now derived from us precisely why: they want surgery and want to avoid intubation or general anesthesia.
Outside the United States, where resources are limited, a patient’s intubation presents a threat and a massive cost. If you intubate a patient with COVID, the anesthesia device is removed for cleaning, which is a high cost. call an Egyptian surgeon about this. In Egypt and similar countries, they need to perform spine surgery without intubating patients because they do not have enough anesthesia devices to remove them from circulation.
A similar scenario occurs in the United States, I recently started running in a New Jersey hospital that followed our spinal awakening protocols, there was a patient who needed spine surgery and had recently had a COVID, the anaesthetist sought to avoid intubation and followed us awake Spine protocol for this specific patient.
Q: What are the demanding situations you have with payers for this procedure?
AS: I’ve had conversations with some of the leading pay-check doctors, like everything else, the first time you hear it there’s an initial hesitation, a payer in particular, I asked permission for a spinal fusion awake and there was this hesitation. I told them to see me again three months after surgery when the episode was over. We compare the cost of my surgery with what historically they allow. The savings on the charge were so wonderful that we started looking for how we might do it more often. Not only did the patient return home the same day, however, it did not require many painkillers and its rehabilitation was limited, so the overall burden of the episode was much lower. those effects at all times.
Q: Do you think awake spine surgery will be more vital in outpatient settings for the next five years?
AS: Over the next five years, I expect 80% of patients who undergo spinal surgery to be treated with the awake spine surgery protocol, if there is one. That the COVID-19 pandemic will only drive this adoption. Now we want to start thinking even more than before about how to reduce prices while achieving the right results. As a spine surgeon, how can you save money? Of course, you can lower your installation prices, but there is no question that reaching a less expensive service site like the CSA would be better.
Q: How is verbal exchange with patients going when they propose awake spine surgery?
AS: Naturally, patients do not need to be awake for surgery, I tell them that it is more as if they are in an area of gloom than in reality, but also the benefits of doing surgery without intubation, they may wake up after surgery and avoid sore throats, nausea, vomiting and constipation.
Many of the dangers of surgery can be summed up in general anesthesia and COVID has highlighted those dangers. We eliminate many of the procedural hazards without general anesthesia or intubation. Of course, there are dangers of surgery in general and dangers of the spine. surgery, but by eliminating some of these dangers, we perform a safer procedure, which patients appreciate.
Q: How did your awakening spinal fusion virtual examination organization advance the pandemic?
AS: We were making plans to take a course on awake spine surgery in Seattle before COVID arrived. Unfortunately, this course had to be canceled, so we rotated. As a result, we have created an online learning platform called doc. social. We learned of the pandemic that surgical education wants to pass digital. Doc. social allows surgeons to expand online courses for other surgeons to consult. We’re getting ready to launch the brain surgery course on this platform. There is also a segment on how to create an exam organization around your course.
We have about 10 spinal surgeons who are part of the Awakening Spinal Fusion Study Group, adding surgeons from India, Italy and soon England. We meet online and share our case protocols and discussions. As a result, surgeons took this test data, organization, surgeons from Colorado, Tennessee, and North Carolina, and combined it and adapted it to its patient population. We are now looking to find out the kind of effects we deserve to start collecting, so that we can show the price of this procedure.
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