Becker's ASC Review

11 ASC MANAGEMENT Bundled Payments in Spine: Key Thoughts from Dr. Stephen Hochschuler By Laura Dyrda S tephen Hochschuler, MD, co-founder of Texas Back Institute in Plano, dis- cusses bundled payments for global episodes of care and how the spine field is adapting to value-based payments. Question: Where do you see bundled payments for orthopedics headed in the future? Dr. Stephen Hochschuler: It doesn't mat- ter what changes occur to Obamacare, I think global fees and episodes of care are going to continue. Everybody now is looking at value and value has to be determined in regards to cost as well as performance and results. Unfor- tunately, most insurance companies only care about costs where we as physicians care about results and patient satisfaction. e bundled payments usually cover 30 days preop, surgery, anesthesia, hospitalization and 90 days aer surgery. All of those elements are part of your bundle. In Texas, we aren't pushed to do bundles because the system is still cost- plus and everyone is squeezed. e margins for the implant companies will go down and they'll have to change their distribution mod- el. In bundled payments, it all comes together and in spine many procedures will be trans- ferred to the outpatient facility. My feelings are that we're headed toward more bundled payments and outpatient spine sur- gery. e migration has been slow so far, but I think it will become more rapid in the future. Q: How can surgeons successfully navigate bundled payment participation? SH: Follow the money. There are around 70 percent of the neurospine surgeons and 50 percent of the orthopedic spine surgeons who have sold to hospitals. In essence, hos- pitals are expanding and opening ASCs, but they don't know how to manage the surgery centers so they're partnering with physi- cians and companies like SCA and USPI. Ei- ther the hospital will provide the service at the same cost as the surgery center or they won't survive. Everyone is trying to figure out what will happen, from the insurance companies to the hospitals and physicians. Everyone is nervous. My advice to physicians is to get started with bundled payments, even if most of your practice is private pay. Get your feet wet. Hospitals move more quickly than physicians, but we will all have to do it eventually. Q: What are the biggest opportunities for physicians with global episodes of care? SH: I am so convinced that bundled payments are the future that I helped start a new company called Spine Systems. What is going to happen is that data is going to run the medical field. If you look at big data in the rest of the world, data runs the world. Unfortunately, the medical world is way behind the data world in other arenas. For example, you can pull up your financial state- ments in 30 seconds on the internet. In the future, quality measurements will rely more on data. Right now we are measuring pa- tient satisfaction by whether people like their physician, which is absurd. Healthcare provid- ers need to collect their data and use it to their advantage. e last thing you want is insur- ance companies having data that you don't. Our goal at Spine Systems is to really run your medical care based on outcomes data, consid- ering pre-injury, conditioning of the patients, ergonomic analysis and other criteria. We will track the patient from the time of injury through rehab to develop terms for global payments and episodes of care. n 8 Things to Know About Anesthesiologist Compensation in 2017 By Laura Dyrda H ere are eight things to know about anesthesiologist com- pensation this year, based on the Medscape Anesthesiologist Com- pensation Report 2017. 1. Anesthesiologists made $364,000 on average last year, the ninth highest paid specialty. Orthopedists topped the list as the highest paid specialists, reporting $489,000 in average annual compensation. 2. Anesthesiologists trained in the U.S. reported slightly higher average compensation — at $368,000 — than foreign-trained anesthesiologists, who reported receiving $348,000 on aver- age last year. 3. The North Central region of the United States was the most highly compensating region for anesthesi- ologists, where the average compen- sation was reported at $405,000; the Northeast was the lowest compen- sating region, where anesthesiolo- gists reported making $334,000 per year. 4. Self-employed anesthesiologists received $408,000 average com- pensation last year, compared with employed anesthesiologists who re- ceived $338,000. 5. Male anesthesiologists earned more than female anesthesiologists: $382,000 compared to $308,000. 6. More than half — 57 percent — of an- esthesiologists feel they are fairly com- pensated. However, most also felt they should earn more in annual income; 44 percent thought they should earn 11 percent to 25 percent more and an- other 32 percent felt they should earn 26 percent to 50 percent more than their current income. 7. Thirty-nine percent of anesthesi- ologists are participating in ACOs; 5 percent are in cash-only practices. Thirty-three percent are participating in health insurance exchanges. 8. Fifty-three percent of anesthesiolo- gists expect to participate in the Medi- care Access and CHIP Reauthorization Act. n

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