Editor's Column: Rites of Passage

By William Sullivan posted 03-06-2017 08:58 AM

This is an exciting time of year for many of us in academic practices because we are getting ever so close to the match. In fact, I have been spending a significant amount of time in medical student advising related to schedules for next year, picking electives and making plans for interviews in anticipation of Match 2018!
By the time you read this, the 2017 Match Day may have passed. Even for those who are not involved in medical student training, resident education and/or the resident selection process, you likely remember the process. There were interviews, and the anxiety and uncertainty related to how good a program really was. Would you fit in? Would they pick you? Later, filling out your rank list included more anxiety and uncertainty related to how good a program really was. Again—would you fit in? Would they pick you? By the time I got my envelope (that’s how they did it in the good old days), all I really wanted was to know was where (luckily, I already knew I matched somewhere and was not scrambling).

Our current medical students at the University of Colorado have spent months preparing for their Match Day. Like Match Day many years ago when I was finishing medical school, their big day this year is a glorious combination of Match Day, St. Patrick’s Day, and opening round of the NCAA basketball tournament games!
How does this affect us? Soon enough, these students will graduate and begin residency. This time will pass quickly, and some, we hope, will be encouraged to join us as spine care physicians. Some will choose surgical careers, others nonsurgical. We'll also welcome graduating trainees in physical therapy, PhDs, chiropractors, PAs, nurse practitioners and others who will join us working in the spine care field.

This edition begins with the President's column from NASS President, F. Todd Wetzel, MD. As you may guess from the title, "Really Very Useless," he has an interesting viewpoint on the acronym RVU. Having been the NASS advisor to the AMA/RUC (RVU Update Committee), I understand some of the issues related to this system. In addition, Dr. Wetzel outlines some of the (faulty?) arguments brought on by those who attempted a lawsuit in 2013. Overall, it will interesting to see where we end up as we move forward with health care changes and Relative Value Units.

Our Current Concepts section provides three articles that fit our desire for regular submissions in each of the following categories. In Spine in Sports, Ellen Casey, MD and Nicole Becker provide an overview on spine conditions in gymnastics with “How to Score a Perfect 10 in Caring for Gymnasts with Low Back Pain.” I am not an expert in this area, and not sure how much I watched in the last Olympics, but I thought the grading was no longer a “perfect 10” a la Nadia Comaneci? Anyway, you get their point on what you should look for to be successful. Radiology Rounds provides an overview on “Spine Trauma Imaging” by Bharti Khurani, MD, Chris Bono, MD, Mitch Harris, MD and Charles Cho, MD, MBA. As most of these authors are already busy as NASS Board Members, their SpineLine contribution is greatly appreciated. Literature Review Commentary also finds its usual place in SpineLine from Benjamin Geddes, MD and Jonathan Grauer, MD. These commentaries always help me find a starting place when reviewing articles.

Our Socioeconomics & Politics section also seems to note an annual rite of passage. Coding provides the annual update for “2017 CPT Code Changes for Spine Procedures” from our Coding Co-Chairs Dale Blasier, MD, and Scott Horn, DO. As usual, there are several surgical and nonsurgical changes this year which they outline. Regulatory Policy from Allison Waxler, MS, includes final rule information on “2017 Medicare Outpatient Prospective Payment System/ASC Payment Final Rule Released.” NASS Health Policy is active in providing comments to CMS regarding changes prior to release of the Final Rule. Coverage also presents “Working Together to Ride the Waves” from David O’Brien, MD and David Mino, MD, MBA. (No, this is not about surfing.) Skipping forward, Ethics looks at chronic pain patients caught in the middle of the trend toward more restrictive opioid prescribing. Mitchell Reiter, MD, discusses “Opioids: What To Do With the Patients Left Behind” and offers throught-provoking examples of patients in limbo as the medical community addresses the current opioid crisis.

Our cover article this edition highlights a bonus Regulatory Policy column from Charles Cho, MD, MBA, Karie Rosolowski, MHP, Allison Waxler, MS and Pamela Hayden. “MACRA Final Rule: New Value-Based Payment Options” is a great overview on changes that will impact us all. I have had to read this twice already, and expect a few more passes to really start comprehending all that these changes entail.

NASS News presents several quick bits of information related to a Traveling Fellow Report (congratulations to Pallav Bhatia, MBBS, MS), NASS online course on Psychologically Informed Practice, and an call to volunteer for NASS Committees. By the time of this publication, we will have had the 13th Annual Evidence and Technology Spine Summit in Park City, Utah. Be on the look-out for a recap in a future edition of SpineLine.

Of course, I close with a special thank you to all of the contributors, section editors, and especially NASS staff for their dedication in providing another edition of SpineLine. As always, we are receptive to any comments or suggestions that will help make a difference…

* This column originally appeared in the January/February 2017 issue of SpineLine. To read more articles in the issue, click here