P. Douglas deHoll, MD, a spine surgeon with Palmetto Health-USC Orthopedic Center in Lexington, S.C., examines the reimbursement environment for spine and where the field is trending in the future.
Question: What are the biggest reimbursement challenges for you today? What is the payer landscape like for your practice?
Dr. P. Douglas deHoll: Commercial and governmental payers are enacting stricter pre-authorization requirements for spine surgery. They are calling for conservative care options to be exhausted and well documented before allowing the authorization. Also, they are strictly scrutinizing radiology reports to be sure my interpretation and the radiologist interpretation are similar.
Additionally, technological advancements are contributing to the inpatient to outpatient shift. More spine surgeries can be done in the outpatient setting with quicker recovery times.
Q: Where do you see the biggest opportunity for spine in bundled payments and other risk-based contracts? Have you considered them for your practice?
PDD: Surgically focused programs allow organizations to leverage their expertise and generate high revenue. However, because they are less able to control downstream costs, they may not do well with bundled payments. An integrated model offering a range of services from nonoperative and conservative treatments to surgical procedures is more suitable for bundles.
The opportunities lie in offering comprehensive care and medical management of spine patients. This is an attractive model to payers and patients. A spine program that focuses on appropriateness may result in fewer procedures.
It will be important for a comprehensive program to capture the ancillary revenue of physical therapy, imaging and pain management to offset the reduction in revenue from fewer surgical cases.
Negotiating outpatient versus inpatient reimbursement for similar procedures will also be key to a system's bottom line. Anticipation of these bundled payments and lower revenue will force hospitals to be proactive in cost containment or risk further financial demise.
Q: What changes have you made or are you considering for your practice as healthcare moves toward value-based reimbursement and care delivery?
PDD: My practice has become more conservative across the board. Patient selection has become the key. The cases that are done are well within traditional surgical indications such as instability or severe stenosis with few multilevel disease cases. Patient profiles of morbid obesity, smoking or uncontrolled diabetes have become much more important factors prior to offering surgery to patients as an option.
Learn more about the big trends in spine at the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC Conference in Chicago, June 13-15, 2019. Click here
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