Frank Phillips, M.D.: New Head of Spine at Rush
Renowned spine surgeon Frank Phillips, M.D. has been named Director of the Division of Spine Surgery for the Department of Orthopedic Surgery at Rush University Medical Center. Dr. Phillips, one of the first surgeons in Chicago to develop and use minimally invasive spine procedures, specializes in using these techniques in the cervical and lumbar spine. He is a founder, board member, and past president of the Society of Minimally Invasive Spine Surgery.
Dr. Phillips earned his medical degree from the University of Witwatersrand, Johannesburg, South Africa, then completed his orthopedic residency at The University of Chicago Medical Center. In addition, he completed a spine fellowship at Case Western Reserve University School of Medicine.
Looking to the future, says Dr. Phillips, he is focused on growth. He told OTW, “The Rush Spine Program has a strong tradition of excellence in education and research that we will continue to nurture. My goal is to position our Section to function well in the modern day health care environment. I plan to expand our Division by recruiting outstanding surgeons as well as expand our geographic footprint around Chicago, adding to our recent expansion in Northwestern Indiana.
“We will also continue to be aggressive with regard to bundled payments. We have recently established such an agreement with United Airlines for spine care and will seek out similar opportunities. In our outpatient surgical centers as well we have bundling arrangements that include pricing transparency for the entire bundle. We ensure that everything is broken down in a transparent manner.
“I have just hired a new spine surgeon for our location in the western suburbs of Chicago, an area where thus far Midwest Orthopaedics at Rush has been underrepresented in spine. Finally, I plan to expand our spine deformity practice and research activities.”
Asked what mark he would like Rush spine to make under his leadership, Dr. Phillips said, “From a clinical and research perspective the spine group at Rush does a spectacular job. My goal is to position us so that we are able to excel in today’s evolving healthcare environment. By showing the value our practice provides, we will be well positioned as we move to bundled payments and value-based health care. In addition we are advancing minimally invasive spine to outpatient settings where we can control costs and quality for the episode of care.”
TKR Complication Rate Higher for Minorities
Minority populations, as compared to the white population, have lower rates of total knee replacement (TKR) and are less likely to have the surgery in a high-volume hospital. This is according to a new study from George Washington University, which also found that minorities were more at risk for in-hospital mortality. In addition, the complication rate following TKR was significantly higher for blacks, Native Americans and mixed-race individuals.
For this research, the authors examined the rate of TKR, the use of high total knee arthroplasty volume hospitals, in-hospital mortality and in-hospital complications. The study, funded by the Agency for Healthcare Research and Quality (AHRQ), analyzed data from eight years (2001–2008) and eight racially diverse states (Arizona, Colorado, Iowa, North Carolina, New Jersey, Rhode Island, Wisconsin, and Florida), identifying a total of 547, 380 patients who underwent TKR. The three largest ethnic groups were whites (87.2%), blacks (5.88%) and Hispanics (4.20%) and the smallest were Asians (0.46%), Native Americans (0.51%) and mixed race (1.71%).
Yan Ma, Ph.D., corresponding author of this study and associate professor in the Milken Institute School of Public Health at George Washington University, told OTW, Our results found that compared to whites, minorities had lower rates of TKR utilization but higher rates of adverse health outcomes associated with the procedure. Even after adjusting for certain patient demographics, socioeconomic status, and health care system characteristics, significant racial disparities in TKR utilization and outcomes exist. Minorities were also more likely to use low-volume hospitals. The choice of lower-volume hospitals and increased complications may adversely affect the experience and social network of minorities which further promulgates an unwillingness to undergo TKR. This creates an opportunity for health care providers to consider differences in utilization and outcomes that may result directly from their referral patterns. Physicians and health care providers also need to educate patients about the type of hospital in which they are receiving treatment and alternatives for care available to them that may include high-volume specialty institutions which may have better track records with outcomes for their patients.”
Where Is Innovation in Cartilage Repair?
A recently published article in The Journal of Bone and Joint Surgery indicates that innovation in cartilage repair has ground to a halt, to a great extent because of the degree of difficulty in completing randomized clinical trials (RCTs). The investigation, led by Dr. Stephen Lyman at Hospital for Special Surgery Healthcare Research Institute, points to several challenges with these studies, especially with surgical RCTs.
Andreas H. Gomoll, M.D., an orthopedic surgeon with Brigham and Women’s Hospital and Harvard Medical School, was a co-author on the study. Dr. Gomoll told OTW, “RCTs have been the gospel, but broke innovation in cartilage surgery. The need for a very streamlined group of patients with narrow indications doesn’t reflect clinical reality and makes study enrollment very difficult.
“A recent study demonstrated that only 5% of cartilage patients would fit the inclusion criteria for a typical RCT. Not surprisingly, several RCTs for next-generation cartilage repair implants were aborted because of inadequate enrollment. Part of the problem is that one must convince patients to chance microfracture if they get randomized to the control group, which many of them are trying to avoid. Also, these trials cost too much money and the mostly smaller companies can’t afford them. Therefore, the need for alternate statistical trial designs.
“Many orthopedic surgeons, myself included, are frustrated with the lack of innovation. Since Carticel was introduced in 1997 there hasn’t been a single cartilage implant approved by the FDA. A randomized clinical trial is not the only appropriate design. To advance prospective observational studies as an alternative, we need to continue to have discussions with the FDA. We also need an international registry for knee cartilage repair. This effort, if supported by academia, industry, and government leaders, would open up other pathways to innovation.”
