Big Payer Trends in Spine and Orthopedics


At the 20th Annual Spine, Orthopedic + Pain Management-Driven ASC Conference, attendees had the opportunity to attend the keynote panel, "Big Payer Trends in Spine and Orthopedics." 

The panel of esteemed speakers included Gregory P. DeConciliis, PA-C, CASC, Administrator of the Boston OutPatient Surgical Suites; Lisa Rock, President of nimble solutions; Andrew H. Lovewell, MHA, MSHI, FACHE, Chief Executive Officer of Columbia Orthopaedic Group; and Molly Gamble, Vice President of Editorial at Becker's Healthcare, who moderated the panel.

Key Takeaways:

Contracts and Negotiations

Knowing your contracts thoroughly and leveraging internal resources to maximize output is crucial. Hiring a professional to understand and negotiate contracts is highly recommended. Additionally, embracing opportunities for education with payers and hiring passionate individuals are important.

Risks Associated with ASC Industry

Panelists highlighted the importance of understanding the risks associated with the ASC industry, including tactics taken by those trying to take advantage of the industry. To mitigate these risks, it is important to have a good game plan when dealing with insurance companies, negotiate with vendors, and look for cost efficiencies.

Challenges in Orthopedic and Spine Providers

Network steerage and rising costs of implants and technology are the two biggest challenges faced by orthopedic and spine providers. Panelists discussed the importance of implementing a comprehensive patient engagement solution to track outcomes and combat rising costs by standardizing procedures with certain vendors. Additionally, it is essential to be attentive to potential denials, as they may lead to revenue delay, and case rates should account for new technologies.

Value-Based Care and Long-Term Viability

Bundles are becoming increasingly popular as a form of value-based reimbursement. However, they are defined differently by each carrier, and some surgery centers are purchasing anesthesia to get surgeries on the books. Regarding the viability of their centers, panelists suggest cutting out commercial payers altogether to aid with long-term sustainability.

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