Becker's Spine Review

16 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. e 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 quality provided. Depending on the competition in your particular geographic area, it simply becomes a game of racing to the bottom to accept the lowest payment just to get a contract. Yet, the days of fighting against insurance companies are over. If we want to see higher reimbursements, we need to find a way to work The leaders 4 orthopedic surgeons look up to By Carly Behm Role models and leaders have had a strong influence on orthopedic surgeons practicing today. Four physicians told Becker's about the leaders who have influenced them. Editor's note: Responses were lightly edited for clarity and length. Question: Which orthopedic leader do you look up to the most and why? Scott Sigman, MD. OrthoLazer Orthopedic Laser Centers (Rochester, N.Y.): I look up to William Levine, MD, professor and chair at New York City-based Columbia Orthopedics. Ever since our days as co-chief residents together in 1995 at the Tufts Orthopedic program in Boston, we all knew Dr. Levine was destined for orthopedic greatness. Bill's passion for orthopedic education is unparalleled. He is arguably the greatest orthopedic mentor of his generation. Diversity has always been a priority for Dr. Levine in the choice of his fellows and residents. Dr. Levine's lineage of Columbia Orthopedic fellows and residents is spread across all the top orthopedic programs in our country and around the world. He is one of the most influential orthopedic educators of our time. I am privileged to call him my friend and colleague. Bruce Gomberg, MD. Northern Light Health (Falmouth, Maine): I look up to Ira Kirchenbaum, MD, because he always asks the questions nobody else thinks to ask. Gregory Graziano, MD. Henry Ford Health (Detroit): I look up to Edward Simmons, MD, my mentor and role model. He was a creative thinker, brilliant in his thought process. Morgan Lorio, MD. Advanced Orthopedics (Altamonte Springs, Fla.): I frankly look up to Hansen Yuan, MD, the most as an orthopedic leader. Although now retired from clinical practice, Dr. Yuan remains very active within the spine orthopedic space while humbly remaining in the background. One must remember that when pedicle screws were under attack, no one stood up for the technology and the surgeon's and patient's needs except for Dr. Yuan. Dr. Yuan had the vision to help found the Spine Arthroplasty Society, now the International Society for the Advancement of Spine Surgery and its journal, the International Journal of Spine Surgery as the initial editor-in-chief. n

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