Becker's ASC Review

22 THOUGHT LEADERSHIP 'Avoid contracts that do not meet your costs': How spine surgeons should approach payer negotiations By Alan Condon N egotiating with payers 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. Editor's note: Responses were lightly edited for clarity and length. Question: How can spine practices ensure they get the best contracts possible when negotiating with payers? Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: If one has to contract with payers, come armed with outcome data such as ODI, NDI and postop med usage. Certain payers will be reasonable and want to retain good surgeons in their network. Make sure you have carve-outs for certain procedures such as disc replacement or endoscopic surgery that provide good value. Remuneration should be commensurate with the quality of work you do, and restoring your patient to health and functionality. Praveen Mummaneni, MD. University of California San Francisco: When negotiating a contract, surgeons must understand their overhead costs. Avoid contracts that do not meet your costs. 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. Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): It has become increasingly difficult for spine surgeons to obtain adequate and appropriate reimbursement for helping patients get their lives back. Insurers are oen looking to provide the cheapest care possible — irrespective of How orthopedics, spine surgery will evolve at ASCs in the next 2 years, per 1 administrator By Ariana Portalatin E xpansion of procedures, new technology and physicians taking back autonomy are three ways one ASC administrator sees orthopedic and spine surgery changing in the next two years. Greg Deconciliis is a physician assistant and administrator at Waltham, Mass.-based Boston Out-Patient Surgical Suites. He joined the "Becker's Healthcare Spine and Orthopedic Podcast" to discuss work at the center and the trends he is following in orthopedic and spine surgery. Question: What are some trends that you are following most closely today? Greg Deconciliis: When I think about trends, my mind jumps right to orthopedics and certainly the shift that we've seen in terms of types of cases. We've been performing total joint replacements and some spine procedures, more minor procedures now for quite some time, about five years, but we still don't have a really strong, robust program because we have a small three-OR facility ... but we're following this shift and we're making some movements for the future to position ourselves to be able to provide some more of these total joint replacement, spine procedures and some obviously larger acuity orthopedic cases. Q: How do you see orthopedics, spine and ASCs evolving in the next two years? GD: This trend of growth, I think, will continue. We're kind of last to do things, so for us primaries are kind of a big deal around here, but certainly I think scaling the types of arthroplasty — so maybe revision arthroplasty, some larger spine procedures, those types of things, maybe even scaling into patients who have higher BMIs or more comorbidities — scaling the types of patients we're doing as well as we get more comfortable. Those are certainly big things. The advances in anesthesia and technology ... We certainly see them kind of shaping our future and they've obviously shaped the ability for us to do orthopedics even early on back in 2004, but they'll continue to shape that as we go forward as well. There will be a big focus on technologies and not only things like robots, but technologies that we utilize to make us more efficient, more precise, provide better patient care, all those types of things. There's just so much growth in technology, you have to keep up with it. 3D printing [and artificial intelligence], there's a lot out there. What we're also seeing in our area, recently some consolidation in some joint ventures and partnerships with hospitals and private equity growth. I think we'll see maybe a little more independence with surgeons and realizing that there's a big jump in the employed model, and maybe there's some frustrations there. They certainly are in our area. Physicians coming together to take back patient care and how their lives run and what they can do with their patients I think is really key, so we'll follow that over the next couple years and kind of see how things shape out. It's obviously very exciting. n

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