What 4 spine surgeons expect from payer negotiations in 2021

Alan Condon -   Print  |
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Four spine surgeons discuss how they expect negotiations with commercial payers to go this 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 your key considerations when recruiting staff at your practice?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CST Wednesday, Feb. 3.

Note: The following responses were lightly edited for style and clarity.

Question: What do you expect from negotiations with commercial payers this year?

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: I think commercial payers are really looking at what happens to the ACA and fee-for-service compensation. I feel there is not likely to be a lot of good news when it comes to surgeons who do a good job and have good outcomes to get duly compensated. As with years past, without holding their feet to the fire and holding them accountable — by stopping the illegal denial of payment for services rendered. Until societies and key players push back and demand doctors get paid, we will have little to negotiate.

Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Current local circumstances have large health systems weighted in accelerated competition to selective surgery centers/investment properties devoid of preoccupation of caring for chronic illness or pandemic. This past year had surgical code bundling of a number of spinal procedures, especially the more complex and higher-acuity patient populations, which is counterintuitive to current care models and application. This "cultural shift" predisposes already at-risk facilities with additional personnel constraints and financial burden. My predictive scenario will be minimal changes in most reimbursements because of the pandemic and its known negative effects on backlog of surgery scheduling, delivery of care to the sub-acute illness, which has affected all forms of healthcare.

Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): Negotiation with payers continues to move to bundling or global payment. We started with Blue Shield and United, and are rapidly adding more to our global billing strategy. While this does entail some risk sharing, it structures a known price without the hassles to us or the insurer of multiple codes. We have included the complete care, surgeon, assistant, the ASC and all aspects of the bill. An ongoing quality assurance monitoring program provides extra motivation during insurer negotiations. This approach has helped fuel ongoing growth, but you need to fully understand and control your case costing to take this approach.

Richard Chua, MD, Northwest NeuroSpecialists (Tucson, Ariz.): This will be challenging for sure, especially as everyone in healthcare begins to identify the true impact the COVID crisis has had for payers, employers, patients, industry partners, hospitals, medical practices, etc.

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