Key thoughts on spine surgery reimbursement and the value equation: Q&A with Dr. Jeffrey Cantor

Practice Management

Jeffrey Cantor, MD, founder and medical director of Fort Lauderdale, Fla.-based Cantor Spine Institute, is passionate about minimally invasive spine surgery and advancing motion-preserving techniques to improve patient care.

Dr. Cantor has built his practice on pioneering new procedures and conducting outcomes analyses to prove the benefit of his solutions. Here, Dr. Cantor discusses the big challenges and opportunities in spine today, as well as where his practice is headed in the future.

Question: How has your role as a spine department leader evolved over the past two to three years? How have your responsibilities changed?

Dr. Jeffrey Cantor: Spinal surgery has been functioning under the same paradigm for many years. Clearly definable differences in value, for patients and insurance providers, is distinctly absent in most markets. For that reason, over the past three years, the healthcare system is moving toward cheap and less focused on quality. Since 2016, in-network operating costs have dramatically increased and RVU (relative value units) rates have plummeted. In the south Florida region, average reimbursement rates have dropped below Medicare. Reimbursement rates are below operating costs for less invasive operations forcing providers to do more extensive surgeries and overutilize in order to cover overhead costs. In the long run, this method of practice is not good for patients and will not be good for our healthcare system.

Therefore, to be successful and develop a spine center of excellence, my role over the past three years [has been] to create clearly definable value for our patients and insurance carriers. Value, as we define it, is higher quality spine care, integrally married to better management of cost. It must be a win for our patients and their insurance companies.

Q: What do you consider your No. 1 priority to ensure departmental success?

JC: Our practice is committed to the development of a process, and the adoption of new technology, particularly the use of ultrasonic surgery, to decrease the magnitude and consequence of spinal surgery. Using these new systems, we can reduce predictable complications. anatomical structures and have dramatically reduced the need for fusions and instrumentation. Patient satisfaction scores and outcome data has clearly shown that this type of surgery is better. The most profound difference is an enormous reduction in cost throughout all phases of the patient interaction. This new and better process of spinal surgery is a real paradigm change, and the adoption of this change is complicated.

Our No. 1 priority moving forward is to create patient awareness and develop a market for these alternatives to traditional spinal surgery. Concurrently, we are packaging these data for presentation to insurance carriers, self-insured companies, in order to negotiate fair in-network reimbursement.

Q: What is the biggest challenge you are facing as head of the department and how are you overcoming that?

JC: In a rapidly growing practice, I realize that operating out-of-network is not sustainable. Our lesser invasive approach to complicated spine problems is fantastic for patient outcomes, hospitals and insurance companies, but with current reimbursement rates, these procedures do not cover our overhead. Financially, it is not an optimal system for our doctors. We are combatting that problem with cost, measurable outcome and patient satisfaction data. We are confident that we can show that this new approach can be, and needs to be, a big win for all parties.

Q: What are the department's goals for 2019 and what is your vision moving forward?

JC: Our plan for 2019 is to continue to develop and adopt enabling and advanced technologies for safer and better spinal care. We will refine our processes and protocols to create better and cost-effective solutions for our patients, doctors and insurance companies. In 2019, Cantor Spine Institute will create value and safer procedures for our patients.

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