Where spine practices are making, losing money

Practice Management

There are several factors behind what's profitable for a spine practice and what could be putting one in the red. 

Four spine surgeons told Becker's what's making spine practices money and what's holding back revenues.

Note: Responses were lightly edited for clarity.

Question: Where are spine practices making money? Where are they losing money?

Harel Deutsch, MD. Midwest Orthopaedics at Rush (Chicago): Clearly the main avenue of making money is the outpatient surgery center and facility fees. Practices are likely losing money on patient visits and medicare surgery professional fees.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Some spine practices are making money by doing more volume. Many practices hire midlevel practitioners to 'amplify' their reach and increase their work productivity. Whether or not this is a winning strategy is debatable, as continued reimbursement cuts administration after administration coupled with inflation, it seems doctors are running harder and faster for the same or less money. Money is being lost in practices on unnecessary employees and expenses. Practices have to look hard at how many full-time employees they employ and decide if you need two FTEs for each physician? Or would one FTE and one part-time employee cover them? Sometimes, physicians need to not be afraid to send their own faxes and answer their own emails. The more costly layers of expenses physicians ladle upon themselves and their business, the more bloat and cost it creates.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): Spine practices make money when they have adequate insurance contracts with fair reimbursement or if they charge their patients fair price for their services that covers the costs of running the practice and allows for profit. Spine practices lose money when their insurance contracts do not adequately reimburse them. This especially applies to Medicare as they continue to lower physician reimbursements every year.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Clearly the provider owned surgical clinics and hospitals are continuing their methodologies of money making, based on case mix and insurance base indices. While the non-patient discerning hospital systems have experienced another round of Medicare Physician Fee Schedule and Medicare Sequestration cuts (5% combined) for 2023. A recent internal polling of surgeon-physician patient payor mix revealed a greater than fifty percent Medicare and Medicaid shift among employed providers. The employed neurosurgical pool was even higher in these two underinsured populations.  

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