Dr. Jonathan Gottlieb: 'Preventing revenue bleed' and 'maintaining efficiency' in private practice

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Jonathan Gottlieb, MD, is a spine surgeon at the Minimally Invasive Spine Center of South Florida in Miami and a former assistant professor in the department of orthopedics at the University of Miami School of Medicine.

Here, Dr. Gottlieb discusses reimbursement challenges in private practice and navigating payer approvals.

Note: Responses are lightly edited for style and content.

Question: How have declining reimbursements for complex spine procedures affected your practice?

Dr. Jonathan Gottlieb: It puts us in a difficult position in maintaining our ethical and moral responsibilities of providing medically indicated care, while at the same time managing the financial realities of a private practice. It is a conflict with only one right answer: to do the right thing for the patient. However, this comes at a cost to the practice. We are forced to make decisions regarding personnel, benefits, capital investments and our personal income is adversely affected.

Q: What was your most recent struggle with payers? How did you navigate it?

JB: We are routinely filling out additional forms that take substantial time, even for testing procedures that are clearly indicated and described in the office notes. This consequently limits staff from dealing with more relevant clinical issues and backlogs of administrative chores ensue. 

We focused on optimizing documentation to limit authorization denials with marginal success at best. Unfortunately, it appears this is as much a manpower issue as anything else, which carries direct cost to the practice.

Q: What strategies can physicians in private practice employ to deal with rising costs and declining reimbursements?

JB: It is essential to focus on maintaining efficiencies and preventing revenue bleed. Closely watching augmented reality, assessing actual reimbursement versus expected and monitoring administrative costs translate directly to the bottom line. It is easy to ignore details with a fat wallet, but that wallet can lose weight quickly. I believe it also contributes to the interest many surgeons have in participating in legal cases as the reimbursement typically exceeds what we receive under conventional insurance contracts.

Q: What changes in reimbursement do you expect to see in the next five years?

JB: Unfortunately, I believe the situation is only going to become more complicated and disadvantageous for private practice physicians. There is consolidation and virtual monopolies in certain regions among payers and hospitals. Additionally, further governmental intervention — both at the state and federal level — have both direct and indirect implications. 

It is incumbent among all physicians and their practice managers to routinely reevaluate their business model and long-term sustainability. As Darwin said, "it is not the strongest of the species that survives, nor the most intelligent; it is the one most adaptable to changes."

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