Four spine surgeons discuss trends in spine surgery compensation and where it may be going.
Question: Where is pay headed for spine surgeons?
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: I believe market pressures will drive the payout further down from health insurance entities as they follow the outdated SGR formula from Medicare. There will be, though, a significant group of spine surgeons who will remain outside of these networks, instead opting for direct payment models for PPO and commercial clients.
I think the patients will be willing to pay to keep their surgeons and/or go to the ones recommended to them. Referring physicians will be told to send in-network of course, but those surgeons who possess market share and the savoir faire of high quality patient care can still remain viable.
Paul J. Slosar, MD, President, SpineCare Medical Group, Daly City, Calif.: Most likely fee-for-service payments to spine surgeons will be pressured downward. Insurance companies and CMS are planning on converting more business to shared-risk models, such as bundled payments or episode of care management. Efficient surgeons may be able to offset reductions in fee-for-service payments with good risk management of bundled payments. Overhead expenses for doctors continue to rise, so will downward pressure on reimbursement, the take home pay for surgeons will decline without an increase in volume.
Jeffrey Wang, MD, Chief, Orthopedic Spine Service, Co-Director, USC Spine Center, Keck Medical Center of USC, Los Angeles: I think everyone is prepared for a situation where our reimbursements are going to decline overall for the services we provide. In addition, we will have an increased burden to track our outcomes and patient information, and we will have more paperwork and requirements for approvals for services to deliver appropriate care for our patients, which will result in an increase in our costs. The combination will decrease the overall pay for spine surgeons. The surgeons will need to work with the hospitals to decrease the overall costs of treatments to deliver more efficient and effective care and optimize outcomes for our patients.
A. Nick Shamie, MD, Chief of Orthopedic Spine Surgery, David Geffen School of Medicine at UCLA: I believe pay per patient for all physicians will be declining. We will be paid less per patient which means we have to see more patients to maintain the same pay. Patients will feel the impact as they will have less time to spend with their doctors and in some cases will visit with care extenders — NPs and PAs — instead of their physicians.
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