Health Insurance Exchanges: The Impact on Spine Practices


Here five spine surgeons discuss aspects of the spine surgery industry that concerns them the most.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: Ideally, what would you like to see Congress do with SGR?


Please send responses to Anuja Vaidya at by Wednesday, April 9, at 5 p.m. CST.


Question: How will health insurance exchanges impact spine practices?Pernendu Gupta


Purnendu Gupta, MD, Director, Chicago Spine Center, Weiss Memorial Hospital, Chicago: Right now, we are not seeing a change in patient volume as a result of the nation's new healthcare system. At the moment, it is difficult to predict how our practice will be impacted by a potential influx of patients who were not previously covered but who have or will have insurance through one of the health exchanges. Even three months into the official implementation of the new Affordable Care Act, it is speculation regarding reimbursement for care and the type of treatments and procedures that may be covered.

We are hopeful that people who could not get care due to insurance denial or pre-existing illness will now be able to do so. Although we are not yet seeing any kind of significant shift directly related to the new healthcare structure, we are prepared to treat them in our multidisciplinary setting — which includes physical medicine, rehabilitation, pain management and surgical treatment — when they need it.


Dr. Fred A SweetFred Sweet MD, Co-Founder, Orthopedic Spine Surgeon, Rockford (Ill.) Spine Center: In order to accommodate the increased burden of high-risk patients, insurance carriers are migrating away from full coverage to high-deductible plans. This will displace the burden of debt collection directly on the surgeons and hospitals. Many patients cannot afford the higher deductibles, often times in the $7,000 to $10,000 range.


Unless practices are proactive in assisting patients with financing options with third party institutions and collection of large surgical deposits, we can anticipate significant revenue losses and escalating accounts receivable. The net effect, I believe, is fewer patients are going to commit to elective surgery or they may assume a debt they cannot pay. The subsequent economic impact on practices and the middle class will be significant.


Mark M. Mikhael, MD, Orthopedic Spine Surgeon, Illinois Bone & Joint Institute, Glenview: The ideal surgical practice in properly managing the spine patient involves comprehensive discussion and decision-making between the surgeon and patient. The surgeon must provide accurate and honest advice regarding surgical options including the proposed intervention, technique, instrumentation and biologics when applicable. The involvement of the patient in the decision-making of these factors is vital when individualizing the surgery to each patient's unique circumstances and expectations.  Health insurance companies are becoming increasingly more involved in medical decision-making, which is Marc Mikhaelaffecting this ideal exchange and relationship between the spine surgeon and patient.


In recent years, many health insurance companies have put several restrictions and qualifications to be met in order to approve certain spine procedures and instrumentation used. While these policies [were] developed with the good intentions to attempt to standardize surgical care and minimize unfounded or excessively costly surgical practices, they have now tipped toward another extreme. Unfortunately, health insurance policies and restrictions are now infringing on the ability of the patient to decide upon the best surgical procedure to suit their needs. In effect, it is taking the surgical decision asking away from the surgeon and patient and putting it in the hands of health insurance administrators.


The ultimate surgical care and planning must remain an informed exchange between the surgeon and the patient. While certain health insurance policies are vital to direct the best cost-effective practices and avoid overspending, it is important to facilitate multiple reasonable options to address various patient needs. While the surgical care of most patients can fall within a reasonable set of guidelines, we must not forget the humanity of the individual patient.

More Articles on Spine:

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The Robotic Difference: How New Technology Could Impact Spine

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