2 spine surgeons on 2018's most anticipated payer trends

Anuja Vaidya -   Print  |

Two spine surgeons weigh in on payer trends they expect to see in the coming year.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.


Next week's question: What are the key trends in spinal deformity care today?


Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, March 14, at 5 p.m. CST.


Question: What payer trends do you anticipate in 2018?


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Payers will consolidate and mergers will continue. Their adherence to their in-house guidelines, based on poor papers or outdated information in the "scholastosphere" will give them grounds to deny appropriate treatment to patients. Also expect more payers to change contracts in terms of when they pay you and how long they have to respond to appeals. In effect, they are doling out their own rope. More doctors will become employed, and the insurers will most assuredly be forced to pay higher rates as these employment entities, be it hospital networks, HMOs or medical foundations, will have increased market clout.


But there is another, more concerning trend. In a large southern state, I am aware of an insurer that employs large numbers of physicians, but not in an HMO setting. There are no doctors on their governing boards and the physicians are treated rather unfairly. Employment terms are ever-changing, and promises are rarely kept to physicians.


Expect to see other large insurers try to do the same thing, much as a response to the aforementioned consolidation. One of the reasons groups like Kaiser have been so successful at taking care of people and attracting good doctors for so long is that doctors and administrators work hand-in-hand and their employed physicians have clear-cut rights and expectations. I would caution any physician becoming employed by these newer entities to remember their mission as physicians, and to know their rights as employees.


Michael Oberlander, MD. Orthopedic Surgeon, President and CMO of Trainer Rx: As an mHealth innovator, we constantly monitor trends, and one thing that we see more of is the focus on the entire patient journey, including to the home.


But one thing we expect to continue is caps on therapy coverage from Medicare. This puts pressure on the patient, their family, the provider and the healthcare system as a whole. Therapy is an important part of complete recovery. Without rehabilitation care, older Americans won't be able to maintain their independence, making them more likely to move into a nursing home or face frequent and costly hospitalizations, adding to rising costs of care.


Unfortunately, we also expect the adoption of value-based and bundled payment models to continue moving at a snail's pace in 2018. Many providers and clinicians worry these payment models are too complicated and time-consuming to implement in their busy practices. But telerehab makes their jobs easier. Data related to the patient journey outside the hospital is easy to gather and analyze, creating a better patient experience. Telerehab also creates efficiencies and reduces the number of follow-up visits, which providers and clinicians may see as revenue gains under these payment models.


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