Dr. J. Brian Gill: 3 observations on bundled-payments, high deductibles & payer approvals in spine


J. Brian Gill, MD, is a fellowship-trained spine surgeon at Nebraska Spine Hospital in Omaha. He has a special interest into deformity conditions, minimally invasive procedures and disc replacement.

Here, Dr. Gill discusses three observations about the healthcare industry and predicts the biggest opportunity for growth next year.

Question: What are the 3 biggest business / healthcare trends you expect to affect your practice in 2019?

Dr. Brian Gill: A. Over the past year, patients have had a greater responsibility for out-of-pocket expenses for medical care, with higher deductible plans becoming more of the norm to offset rising premiums. This is only going to continue for the foreseeable future as employers try to offset their costs by pushing their employees into these type of plans. Additionally, insurers are promoting these plans to employers and consumers as it shifts the risk to the patient to make the decision.

B. Bundled-payments continue to gain traction as Medicare has launched a program for hospitals in an attempt to control costs. There is more pressure to be more vertically integrated in an attempt to control costs from start to finish for procedural episodes such as spine surgery. Ongoing reports show independent practices are continuing to dwindle as healthcare systems drive to control costs and gain market share. As a partner in an independent practice, we have to continue to work with our healthcare systems to provide value with mutual strategic goals and alliances.

C. This year, more than any other year that I can remember, insurers have taken longer to approve procedures and imaging. There has been a greater burden of proof placed on providers to show documentation of medical records, which can be difficult to obtain at times. Additionally, the number of modalities necessary to be done has placed an undue burden on patients wasting time and money. I only see this trend continuing as insurers place roadblocks up for patients and providers.

Q: Where do you see the best opportunities to grow?

BG: Any progressive practice is always searching for continued growth in services, volume, revenue, etc. A status quo practice is one which gets passed by. From a service standpoint, we are looking at adding new services that can continue to allow us to be a comprehensive spine practice. For example, we are developing telemedicine outreach clinics and weight loss clinics to address our outreach patients and obese patients, respectively, to name a few. In order to increase volume, we are developing strategies to be more efficient in how we use our physician extenders.

Additional outreach clinics within the community and in rural markets are under consideration as well. We continue to develop relationships with other providers in our community and how to best treat their respective patients. These initiatives help to drive revenue towards the practice. It is also important to keep expenses in check when developing new service lines or clinics as this can hurt the profitability of the practice.

I am an eternal optimist, so I am hopeful that 2019 will be better than 2018. We will continue to do what is right for the patients that we serve.

To participate in future Becker's Q&As, contact Laura Dyrda at ldyrda@beckershealthcare.com

For a deeper dive into the future of spine, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-5, 2019. Click here to learn more and register.

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