Issue link: https://beckershealthcare.uberflip.com/i/172341
Spine Practice Management & Industry Trends The Future of Spine Surgeon Employment: Q&A With Dr. Gunnar Andersson of Midwest Orthopaedics at Rush (continued from page 1) Q: Will independent spine practices become a thing of the past? Gunnar Andersson: Over time, as more and more physicians enter the healthcare market as it is now evolving, there will be fewer independent practices. There will certainly be less of us older doctors around to remind the younger ones of how it used to be, "back in the day." However, unless something significant happens beyond implementation of the Affordable Care Act, there will always be physicians and surgeons practicing independently, albeit aligned with hospitals, accountable care organizations and state health exchanges. Q: Do you foresee hospital employment of spine surgeons becoming a new norm? What about surgery centers? GA: It seems that in some states, like California, hospital employment of spine surgeons is advancing rapidly. In Illinois, however, surgical practices, while becoming more aligned with specific hospitals and ASCs, are being acquired at a slower rate than those in other states. Clearly this is a trend that may become the "new normal," but we saw this back in the 1990s with hospitals and HMOs buying up practices in order to control their costs in a capitated environment and then a quick reversal of that trend once everyone determined it wasn't a successful business model. Hospital employment offers a degree of security but at the cost of losing independence and control. Q: What are the biggest drivers of spine surgeon employment trends? 13 Strategies for Spine Surgeons to Improve Clinic Efficiency (continued from page 1) surgery, have a complex history or have a postoperative complication and thus require 20 to 30 minute discussions. On such days, I can fall an hour behind, the patients can become upset." Here are Dr. Khanna's tips for staying on schedule and running an efficient spine practice. 1. Monitor the schedule and clinic template. When you book patients from 8 a.m. to 5 p.m., keep a close eye on the type of patients scheduled. Depending on whether they are new, follow-up or post-operative patients, the sequence in which you see the patients will make a difference. "Constantly update and optimize the clinic template," says Dr. Khanna. "Look at it both GA: As government and private payers pilot new methods of bundling payments for entire episodes of care — including site-of-care reimbursement, as well as device acquisition and fees for physicians and other healthcare providers — it will be more likely that surgeons will become more closely aligned with hospitals and ambulatory surgical centers. Some will choose to be employed, while others may simply wish to contract with those entities while maintaining more autonomy. I suspect most surgeons would choose to maintain some level of independence until or unless it seriously impacts their ability to make a living. 19 Dr. Gunnar Andersson Q: What does the future model of spine surgeon employment look like? GA: I think a lot of that will be determined by current and future regulatory changes. Will CMS and commercial payers allow more spine surgeries to take place in ambulatory surgical centers? How will payers reimburse for ASC-based surgeries versus hospital inpatient surgeries? Will lower payment rates for procedures at ASCs offset the loss of control an employed surgeon might experience working solely in one hospital? How will regulatory changes impact a surgeon's ownership of, or referral of patients to ASCs? If spine surgeons are able to develop and grow a practice within their own ASCs, and are successfully able to gain access to patients through accountable care organizations and state health exchanges, then I don't think they will be rushing to become employed by hospitals any time soon. Q: For surgeons who remain independent of health systems, how must they alter their approach and practice to survive in a tighter economic market? GA: I think as ACOs continue to evolve and state health exchanges get up and running next year (in some states, anyway), many surgeons formally and informally with your office manager, your medical office administrator, medical assistants and your physician assistant or other midlevel providers. Always take input and advice from others who are involved in patient care or flow on improving your template. This will not only improve patient flow and satisfaction but will likely also improve the engagement and satisfaction of those who work with you." 2. Block interruptions during clinic sessions. It's tempting to check email or make quick phone calls in between patients during office hours, but these distractions can quickly put your schedule behind. "Try to avoid meetings in the middle of the day, conference calls and anything else that would slow the day down and break it up," says Dr. Khanna. "Along those same lines, avoid multitasking during clinic. This is likely the mistake I am most guilty of." will be taking a "wait and see" approach. Certainly remaining independent is going to take more work and require a continual acquisition of health information technology to remain relevant with and acceptable to payers. Again, if bundled payments for an entire episode of care become the norm in terms of reimbursement, then independent surgeons are not going to have a lot of leverage with hospitals and ASCs in order to gain their share of that shrinking pie. The other challenge independent surgeons face is a growing trend of payers requiring data collection as part of an approval of a given surgery; independent surgeons are going to have to build the proper infrastructure to accommodate those requirements, and that requires resources and efficiencies that may not be possible in smaller, independent settings. Independent physicians can work with hospitals without being employed through physician-hospital organizations, provider contracts and similar arrangements. I foresee alternative approaches being developed over the next several years. n Read the full article at beckersspine.com. Dr. A. Jay Khanna