Health care in the United States is undergoing an unprecedented transformation. We are witnessing more physician employment, more challenges to scope of practice, more vertical and horizontal integration, and a transition from a fee-for-service system toward an outcome-based system. As interventional pain specialists, our survival is contingent upon our ability to profoundly change the way we envision health care delivery, for we are not undergoing an incremental shift in current practice; we are experiencing a paradigm shift.
And yet, as Jean Monnet wrote, "People only accept change when they are faced with necessity, and only recognize necessity when a crisis is upon them.” For many, the crisis is here. Group and practice dynamics are shifting towards alignment with health care systems, referral patterns are evolving rapidly, coverage is more restrictive, reimbursement is decreasing, burdensome regulatory mandates are looming, and the need to justify outcomes has never been greater. Fortunately, within every crisis there exists opportunity for those calm enough to perceive it, wise enough to understand it, and bold enough to act on it.
Over the past year, ISIS has undertaken strategic planning with a single goal in mind: to capitalize on the transitional state of health care. We have analyzed the core strengths of ISIS, as well as the challenges and opportunities that lie ahead; we have made fundamental changes to our structure; and have revised our mission, vision, and goals.
We began by asking, "What makes ISIS special? What are we passionate about?” It is fitting that, at this 20th anniversary Annual Scientific Meeting of our society, we begin by reflecting on this cornerstone that was laid by our founding fathers, Charles Aprill, Rick Derby, and Nik Bogduk, years ago – integrity. The cornerstone of integrity has set us apart over the years and has become the touchstone that still guides us today. ISIS’ reputation for integrity has been hard won and required uncompromising dedication – as integrity always does. Yet, our integrity has drawn policymakers, insurers, and others to ISIS again and again for collaboration and counsel. Our integrity has allowed us to work effectively on your behalf, as ISIS has an established record of doing the right thing for patients and providers, not always the easy thing.
We then went on to evaluate what ISIS does best, for passion alone is insufficient without a means to effect change. The answer was evident: ISIS has always excelled at scientifically evaluating data and setting standards for the performance of spine interventions. We get to the real answer. Period.
The intersection of these two spheres, what we are passionate about and what we are best at, is the distillation of our strength as a society: ISIS is the honest broker for interventional spine care. Put simply, ISIS has the reputation for unflinchingly evaluating the scientific evidence, and the integrity to stand by the outcome. Our strength spans across all four domains: Education, Health Policy, Research, and Quality Improvement, and takes many forms. The ISIS Guidelines, ISIS cadaver workshops, Annual Scientific Meetings, the ISIS e-News, collaboration with other like-minded societies, and ISIS advocacy with payers and policymakers are just a few examples.
Stated slightly differently, our integrity and our standards yield influence and project an image of what is right with our field. Influence and image naturally flow from our integrity, and, all together, they form the prism through which ISIS filters all Education, Research, Quality Improvement, and Health Policy decisions. We reaffirmed these principles in our new motto, ISIS: Integrity and Standards to Influence Spine care, and in our revised mission and vision statements:
To develop and promote the highest standards for the practice of interventional procedures in the diagnosis and treatment of spine pain.
Spine care that is correctly indicated, competently performed and beneficial to our patients and society.
In and of themselves, mission and vision statements, and mottos are merely words and catchy phrases. However, when used to focus attention in one direction and to unify around one purpose, they become transformational. For ISIS, this has been the case.
Throughout this meeting, you will see examples of our transformation. The Annual Scientific Meeting (ASM) committee now has a broad composition that includes input from our founding fathers, the executive committee, all four of the major committees, and ISIS members. It also reflects a bottom up power structure that is being promoted across ISIS. The Evidence-Based Medicine precourse is preparing members to work on important committees and task forces that will help secure the future of ISIS and Interventional Pain Medicine. These members will participate in rapid evaluations of the literature to defend against payer policy changes. They will also identify gaps in the evidence, allowing our Research committee to better match funding with need. The much anticipated release of Professor Bogduk’s Second Edition of the ISIS Guidelines this year reinforces our ties to evidence and standards; it reaffirms our roots in evidence-informed practice. Last, but certainly not least, the Appropriate Use Criteria (AUC) symposium highlights ISIS’ pioneering leadership in a multi-society effort to develop AUC on sacroiliac joint injections, demonstrating ISIS’ dedication to multi-society collaboration, and leveraging our reputation for integrity with payers as we seek novel ways to preserve access to valuable treatments for our patients.
Indeed, everywhere you will see evidence that, while preserving the foundational values that made ISIS great, we are breaking down the silos between committees, flattening the leadership structure, deepening our leadership ranks, and fostering collaboration between societies, payers, and policymakers. We are a nimbler, more focused ISIS with a ground up leadership structure and empowered committees. We stand ready to meet the future and to defend the specialty.
In the end, however, ISIS is your society. My hope is that this meeting will inspire you to get involved with a committee or other ISIS activity, and that you will be a part of leading ISIS into the future. With your help, the future is bright.
Ray M. Baker, MD