The spine partnership saving physicians, insurer money


A partnership with Blue Cross Blue Shield has proven beneficial for patient care and finances, Mick Perez-Cruet, MD, said during a panel at the 21st Annual Spine, Orthopedic & Pain Management-Driven ASC + The Future of Spine Conference in Chicago.

The collaboration, the Michigan Spine Surgery Improvement Collaborative, is a partnership with the insurer and provides an outcome platform for spine surgeons, he said.

"Blue Cross Blue Shield provides us with the money to pay for abstractors that look at variables in each patient's chart," he said. "We focus on degenerative spine conditions, and what we've done is we've created an outcome platform of over a hundred thousand patients, and we've been able to reduce things like surgical site infections, urinary retention and lengths of stay because we started to look at outcomes of various practices throughout the state of Michigan."

While the program is just in Michigan, Dr. Perez-Cruet said he's tried to bring it on the national level, citing the hundreds of millions of dollars it has saved for the insurer. There's also perks for physicians.

"What's the benefit for me as a physician? I've saved this big monster conglomerate a lot of money," Dr. Perez-Cruet said. "Well, we turn around and we get an uptick in our reimbursement for participation. I get an increase on my reimbursement for each CPT code [that] I code. So my reimbursements for Blue Cross and Blue Shield are the best of any payer. I have the gold card meaning that if you can show that you are doing the right thing for the right patients and so forth and they don't have to keep calling you. I don't do pre-authorizations. They just say [I'm] providing quality spine care [and] we are not going to waste time doing pre-authorizations, which we all know cost us a lot of money. So by far partnering with your payer is probably the most important thing we can do as physicians to improve our bottom line." 

The partnership and reaping the benefits is possible, and it's a team effort, he added.

"This takes a village, [and] it takes a lot of people … It takes your time, and we have meetings that we all meet at to show how we can improve," Dr. Perez-Cruet said. "But those are the foundations. You have to have an institution willing to work with the insurer and you have to have the insurer of your state willing to pay for the abstracters to collect the data from each physician's practice."

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