Dr. Jesse Even: 3 key thoughts on ACOs, high deductibles and patient access to care + how he grows his practice without spending on marketing

Laura Dyrda -   Print  |

Jesse Even, MD, is an orthopedic spine surgeon with Irving, Texas-based TMI Sports Medicine and Orthopedic Surgery. He also serves as an orthopedic and spine surgery consultant for the Texas Rangers and Dallas Stars.

Here, Dr. Even discusses how insurance and reimbursement trends are affecting his practice and the biggest opportunity for growth in the future.

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

Dr. Jesse Even: New challenges come each year, especially in the realm of spine surgery. Practitioners are challenged with increasing costs of overhead, decreasing reimbursements and bundled payments. With what we have lost in reimbursement, we try and make up with volume, but not at the expense of sacrificing the quality of care to our patients.

The three trends that I see affecting my practice over the next several years will have to do with patients' increasing deductibles, cost containment and working with ACOs to manage healthcare cost for the systems they represent.

Patient access to care is becoming more difficult. As deductibles climb, the patient must be very calculated and decide if they can afford to have surgery. I personally have had several 'insured' patients with well-known commercial plans who were financially unable to proceed with their surgical intervention because their out-of-pocket deductibles were so large. This is a problem for patients and providers.

In trying to mitigate increasing out-of-pocket deductibles, a lot of the burden falls on the providers. We, as surgeons, need to start to take a more in-depth look at the costs that we create to the system. We are one of the few entities that can slow or reverse the high costs of healthcare in our society. We need to understand what the cost is for everything we do. Clinic injections, implants and disposables in the operating room, appropriate use of neuromonitoring and postoperative care, including rehabilitation or home health, all need to be carefully evaluated.

With cost containment comes savings to the system. ACOs were created to capitalize on these savings and some of them have been very successful in doing so. They track the providers that cost the system more and look at every aspect of care including the practitioners' practice patters (conversion of patients to surgery), use of advanced imaging [as well as] surgical costs including implants, neuromonitoring and biologics. Practitioners need to understand that we will, in the near future, be accountable for what we cost the system, and the system will stop referring patients to high-cost providers.

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

JE: I feel the best opportunity to grow in this environment is being a highly efficient and cost-conscious surgeon. The two ways I plan to expand my business come in the form of cost containment for ACOs.

The first way I am helping to contain cost is doing appropriate procedures in an ASC setting. There are many spine procedures that can be done in the ASC setting with appropriate patient selections and ASC spine program development and education. I perform minimally invasive procedures including cervical fusions, disc replacements, microdiscectomies and outpatient laminectomies in an ASC setting. Doing these cases in an ASC setting saves the ACOs a large amount of money on patient care.

However, not all cases or patients are a good fit for the ASC setting, so a hospital setting will always be needed for spine surgeons to do complicated procedures and for patients with multiple medical comorbidities. When in the hospital setting though, it is important to understand the expense of the implants, including biologics, when performing cases as these can cause large operating room cost variations. Also, after the care in the operating room and upon discharge, I think it is very important that surgeons understand the dramatic difference between a postoperative rehabilitation stay for their patients, versus arranging home health company services. In my practice, 95 percent of my inpatient spine surgeries go home with home health physical rehabilitation and not to a rehabilitation facility.

These cost-saving interventions have caught the attention of regional ACOs, and they have approached me to accept their patients into my practice. They clearly see the cost savings when comparing my practice to other practices in the region. This, in turn, grows my practice without me spending extra time or money on marketing, while also saving the system large amounts of cost.

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.

More articles on spine surgeons:
3 big difference-makers for spine surgeons in the future
Dr. J. Brian Gill: 3 observations on bundled payments, high deductibles & payer approvals in spine
Dr. Stephen Hochschuler: 3 trends in healthcare to watch + 2 opportunities for growth in spine

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