Becker's Spine Review

51 Practice Management cialty is unique and complementary of the other. Increasing the number of specialists in an established setting is market dependent and variable based on available specialists, competitive practice issues, merger consid- erations, etc. Q: How do you expect reimbursement changes over the next year or two to impact outpatient spine surgery centers? KH: Currently, there isn't a Medicare fee schedule for spine surgery in an ASC setting; therefore, each market is dependent on the ASC's ability to ne- gotiate a suitable case rate or fee schedule with commercial payers. Some payers, certainly not all, are beginning to recognize that spine surgery can be performed safely in an ASC setting at a lower cost than hospitals. We an- ticipate downward pressure on spine reimbursement rates, just as we've seen historically with other specialties. ASCs will continue to provide high quality in the lowest cost surgical setting. Q: What key trends in healthcare present the best opportunities for success with outpatient spine centers? KH: The ASC setting produces the lowest cost surgical option. According to a recent study by ASCA, ASCs currently save the Medicare system $2.6 billion a year and if just half of the eligible procedures were moved to the ASC setting from HOPDs it would save the system another $2.5 billion. The savings for the Medicare program generated by ASCs could exceed $57 billion over the next decade. Over the last 10 years, ASC reimbursement rates have declined in comparison to HOPD reimbursement rates and are now on average 58 percent of what an HOPD receives for a similar procedure. Providing high quality spine surgery for the lowest cost will matter as consumers take on a more active responsibility for their healthcare expenses. Transparency is needed to fully expose the cost differential between the ASC setting and hospitals. As that evolves and patients are aware of their options, many will select the ASC versus the hospital due to savings, high quality care, excellent patient satisfaction and decreased risk of infection. Growth oppor- tunities will include participation with self-insured employers, acutely aware of their cost of employee healthcare, seeking high quality, lower cost surgical alternatives. Groups managing populations will also be viable growth op- portunities as they seek lower surgical cost alternatives. As more and more groups emerge that manage populations such as ACOs, IPAs, large physician networks, etc., it will continue to be extremely important for ASCs to be rec- ognized as a high quality lower cost provider of spine surgery. n "Growth is driven as surgeons become more com- fortable moving spine cases safely into the outpa- tient setting. Discussions about clinical success in the ASC setting are now evidence within the profes- sion and serve as a catalyst for more spine surgeons to explore the option." — Kenny Hancock, the President and Chief Development Officer of Meridian Surgical Partners A recent examination of 103 orthopedic spine patients examined how patients view spine surgeon reimbursement. The results were pub- lished in The Spine Journal. Thirty-three percent of the patients said their insurance coverage impacted their access to care but 71.8 percent did not believe that insurance coverage influenced the decisions their spine surgeons made. Around 38 percent of the patients thought surgeon compensation should be addressed in healthcare reform and 27 percent of the patients thought it should not. When asked what they thought spine surgeon reimbursement was for their procedures, 62 percent of the patients undergoing minor procedures thought reimbursement was $5,000 to $10,000 when in actuality Medicare and Blue Cross Blue Shield compensated all of the minor procedures at less than $2,500. The highest reimbursement was for two-level laminectomy with fu- sion, which received $1,363 from Medicare and $2,038 from BCBS. Around 84 percent of patients undergoing major fusion procedures thought the reimbursement was greater than $5,000 for spine surgeons and 28 percent of those patients thought the reimbursement was more than $15,000. However, reimbursement to the spine surgeons for these procedures was less than $5,000 for Medicare patients and less than $7,000 for BCBS patients undergoing laminectomies with fusion. The greatest reimbursement was two-level lumbar laminectomy, which received $4,880 from Medicare and $6,611 from BCBS. The survey also measured where patients thought orthopedic spine surgeon salary fell; 41 percent thought the salary was $250,000 to $500,000 and 22 per- cent thought it was $500,000 to $750,000 when in actuality 68 percent of or- thopedic spine surgeons receive less than $750,000 according to the MGMA Physician Compensation and Production Survey, noted in the report. Around 24 percent of patients thought spine surgeons were under compensated. Most believed that reimbursement should be based on technical difficulty then sur- gical time, patient satisfaction and risk should be considered. "The findings from this study highlight the discontinuity between how phy- sicians are reimbursed and how the patient population perceives their health- care dollars are being spent. If healthcare is seen as a free-market commodity, then it is one of only a few industries in which buyers have no real idea of how much they are paying for the services they receive," the authors wrote in the discussion. n Orthopedic Spine Surgeon Reimbursement: Patient Perception vs. Reality By Laura Miller "If healthcare is seen as a free-market commodity, then it is one of only a few industries in which buyers have no real idea of how much they are paying for the services they receive." — Dr. K. Linnea Welton, University of Michigan, et al.

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