Becker's ASC Review

34 THOUGHT LEADERSHIP 'Depersonalization' of medicine likely to continue amid CMS physician pay cuts, physician says By Patsy Newitt C MS' plan to cut physician pay by 4.42 percent in its Medicare physician fee schedule proposal is leaving many physicians worried about healthcare becoming more impersonal. Shamsideen Musa, MD, pain management physician in Anchorage, Alaska, joined Becker's in July to discuss how declining physician pay will change the healthcare industry. Question: How will declining physician pay alter the healthcare industry? Dr. Shamsideen Musa: If physician payments continue to decline, we will continue to see the consolidation and corporatization of medical practices. As a result, patients will likely continue to experience the depersonalization and corporate feel of medical treatment offered by large groups. Physicians will increasingly seek employment at hospitals and private equity-backed corporations for stable income while the number of solo practitioners declines. Q: If CMS follows through with its proposed 4.42 percent physician pay cut, how will physicians and patients be affected? SM: If the 4.42 percent physician pay cut moves forward, it will further decrease patient access to specialty care. Initially, patients with Medicare as their primary insurance will have difficulty finding specialists with available appointments for new patients. This will then progress to all patients, as commercial insurers change their reimbursement policy to fall in line with CMS rates. Ultimately, this will continue to drive physicians away from solo practice toward large group practices that leverage economies of scale and care team models using physician assistants and nurse practitioners to handle the higher volume of patients necessary to be profitable. n 'Fatiguing, but ultimately necessary': A physician's playbook for successful payer negotiations By Alan Condon F rom the time it requires to the revenue implications it entails, negotiating with insurers is one of the most important, if most challenging, aspects of a physician's practice. For surgeons seeking to boost reimbursement rates or ensure bills and claims are paid out as expected, there are a few factors to keep top of mind, as outlined by three spine surgeons. 1. Understand your market and costs. Over the past few years, the costs associated with running an independent practice have been steadily rising while reimbursement has been declining. When sitting down with insurers, physicians must know their costs, projected costs as well as the market in which they operate. "When negotiating a contract the surgeon must understand their overhead costs. Avoid contracts that do not meet your costs," Praveen Mummaneni, MD, of San Francisco-based UCSF Health, told Becker's. "e cost of doing business in the San Francisco Bay area where I practice is high. Overhead costs for labor and space are driving costs. e contract must compensate for the cost to be worthwhile. "Furthermore, the surgeon must understand their local market. In your local market, is it important to be a surgeon who sees a large volume of patients or a surgeon who sees fewer patients but spends more time with them? If you choose contracts based on volume but low reimbursement, be prepared to spend less time with patients who then may not choose you as their surgeon." 2. Bring data to the table. Physician practices armed with data are best equipped to drive the best deal. at data should demonstrate that a physician's practice provides quality care to satisfied patients while containing costs, which helps the payer understand that their members are in the best hands and their margins are protected. Other important factors include defining how long the contract will be, possible reasons for termination, the implications of two payers merging and the time frame for payments. "Payers are solely interested in price marks and savings. We have been under growing pressure to improve the numerator of the value equation: patient safety, quality of care and patient satisfaction, while parring costs and limiting implant charges," Christian Zimmerman, MD, of Saint Alphonsus Medical Group and SAHS Neuroscience Institute in Boise, Idaho, told Becker's. "Arming oneself with cost per unit case and MedPAR outcome data is simultaneously advantageous. Competing for annual contracts is frustrating and fatiguing, but ultimately necessary." 3. Use a consultant or healthcare attorney. Health insurance contracts have become increasingly complex and it is challenging for physician practices to secure a good deal without using a consultant or healthcare attorney unless their business manager or administrators are well-versed in the contracts they are negotiating. "Utilize a healthcare attorney, go in with a group and be tactful. You will be better off negotiating with an upper hand if you control a large market share. Make sure you have confidence that your attorney can review the contract correctly," Brain Gantwerker, MD, of e Craniospinal Center of Los Angeles, told Becker's. "Inevitably, the payer will at some point not follow the letter of the agreement. It is then, when you have to litigate it, that you will need to know how firm your standing is. I believe if surgeons are not being treated fairly, use of litigation should be strongly and readily considered." n

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