NASS On Spine

March 05, 2019

Q&A With Andrew Pugely, MD

1. What is your hometown and where do you currently live?

I was born and raised in the Midwest, spending most of my younger life in Wisconsin. Here I became accustomed to great traditions like Green Bay Packers football. For orthopaedic surgery residency, I moved one state over to Iowa. After five years, my wife and I fell in love with the ease of living and beauty of Iowa City. It is a small college town, with a strong spirit, plenty of activities, and great schools—an ideal place to raise a family. After residency, I took a 1-year detour for a complex adult spine fellowship at Washington University in St Louis and Columbia University.

2. What type of physician are you? How long have you been practicing?

I am a Board Certified orthopaedic spine surgeon and work at the University of Iowa. The scope of my practice is broad and I treat all types of spine conditions: cervical, thoracic and lumbar. In addition to treating primary degenerative spine conditions, some areas of focus include complex thoracolumbar revision and deformity surgery.

3. How long have you been a NASS member and why did you join?

I have been a NASS member since residency (2013). NASS is one of the few societies that offer resident memberships and allow them to get involved. NASS offers members a variety of opportunities to become engaged with advancing spine care, such as education, research, advocacy and more.

4. As a member of NASS’ coding committee, what is the committee working on that the average NASS member might not be aware of?

Over the last decade, most spine specialists have seen a decline in reimbursements. Unfortunately this is a national trend for all of medicine. While the NASS coding committee helps introduce new codes and provide extensive member coding education, one of the less known functions include protecting our current payments. In the context of these ever decreasing physician payments, the NASS coding committee works very hard (internally and with other spine societies) to minimize these drops in reimbursements. Relative to some other specialties, payments for spine care have remained relatively strong.

5. What are the biggest coding and payment hurdles facing spine specialists as less physicians are in private practice than in years past?

Downward payment pressure will undoubtedly continue. We are seeing unprecedented attempts by payors to not reimburse physicians properly for work performed. For example, one of the major commercial carriers announced a policy where they would no longer routinely pay for additional level spine fusions (code 22614). Luckily through the work of NASS and others, this policy was reversed.

As more physicians become employed, the awareness and desire to advocate for maintenance of professional side fees will inevitably decline. Hospitals continue to make substantial margins off spine procedures, but care less about physician payments. With more and more physicians paid on RVUs (and less based on direct collections and may include hospital offsets), we cannot let this “decoupling” of RVU models from collection models break our unity in fighting to preserve fair reimbursements. Another major challenge facing spine specialists is payment reform. Already major payors, including CMS, have begun deploying alternative payment models such as ACOs and bundled payments. Given the costly nature of spine care, these novel payment models will become increasingly important. Spine specialists must begin to educate and position themselves to perform in these new environments.

6. How can spine specialists best influence value in health care?

The value movement is upon us—the future of spine care involves delivering higher quality care at lower costs. In February 2019, I completed a Masters of Healthcare Delivery Science Degree at Dartmouth College. Here I was exposed to novel concepts in value-based health care. Many of the instructors and participants have been deeply involved in national health care policy setting. Unfortunately, many of these leaders do not have a deep understanding of sub-specialty care such as spine.

To influence the value movement, spine specialists need to seek local and national engagement. We need to be at the table making the decisions and proposing new policy. Through strong participation in societies like NASS, we can collectively send messages to the legislature, payors and other policymakers about the importance of preserving access to spine care. I encourage every spine practitioner to find ways to influence policy, even on the local level.

7. Social media is becoming more prevalent every day in our world. Do you use social media at all professionally and if so, which platforms do you prefer?

The use of social media for physician marketing and reputation building has exploded. Our practice does use social media to post approved patient stories and deploy new marketing. To maintain a professional relationship with my patients, I try to minimize personal social media use. We are carefully looking to further expand our social media footprint in the upcoming year.

8. What is your opinion of the way the health care industry is currently covered in the media?

Media coverage of health care is generally negative. The absolute complexity of the health care system is often underappreciated. There will always be “winners” and “losers” in our system. I have studied other health systems such as Canada, Europe and others. While they have some tremendous advantages of greater coverage (and possible access), their system also have significant drawbacks for patients and providers.

Health care has been overly politicized and many facts misconstrued. As a nation, we have undeniable issues of quality and cost containment. I am hopeful that we will continue to make small strides to improve patient care and access to healthcare while bending the cost curve.

9. What do you do for relaxation in your down time (example: hobbies, sports, travel)?

Upon moving back to Iowa, we were fortunate to purchase a small farm on sizable acreage less than 20 minutes from the hospital. Much of my free time is spent with my family outside maintaining the land and working with our animals/crops. We alternate corn/soybeans as crops and have horses, alpacas, goats, chickens, cats and dogs. Working with heavy farm machinery (tractors/excavators) is a great after work de-stressor!
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