6 Expectations for Spine Surgeons After Health Insurance Exchanges

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1. Influx of patients. Without insurance as a barrier for seeking treatment, more patients will visit specialists. Back pain is a fairly common ailment in the United States and spine specialists should expect to see their patient volume increase. "Historically, there were instances where very realistically someone could have severe health issues and not qualify for health insurance," says Mr. Tolbert. "But starting January 1, that goes away. The other major inhibitor — high costs — goes away for people who are the most vulnerable because of subsidies that are part of healthcare reform."

2. Enrollment issues. Physician practices across the country are preparing for the increased volume, but they may also need to help current and potential patients enroll in the right government-subsidized programs to receive payment. "The biggest challenge is awareness of the steps that need to be taken to get coverage and enrolled," says Mr. Tolbert. "I believe a lot of spine surgeons do surgeries for people who don't have coverage, and as a result they don't get paid. They do it because they want to help people, but they should be paid for their work if possible."

3. Patient collections are higher. Patients who don't qualify for high subsidies will likely choose a high-deductible plan because their monthly contributions are lower. However, spine surgery is expensive and if they haven't already met their deductible, they'll likely pay for a large portion of the surgery. "Some providers are worried that patients don't have enough money to pay for surgeries and don't care about collection letters," says Mr. Tolbert. "Providers have to think about how they will handle patients who don't pay on time. Think about what exchange options your practice or group will network with."

4. Out-of-network concerns. Consider who will be in-network with the exchanges and work with patients who have coverage. "You don't want your patients to sign up for a plan when you are out-of-network," says Mr. Tolbert. "Many exchange options have linear or smaller networks than the broad networks people are familiar with. You need to pick a plan and help people sign up for that if they don't already have insurance."

5. Help ongoing patients. There may be patients your practice sees on an ongoing basis, especially if you include pain management and conservative care. Choose a specific day this fall to help these patients sign up for the right plans. "If you have any patients who are uninsured, bring them in and help them sign up for free because this doesn't have to be charity work anymore," says Mr. Tolbert. "If uninsured patients are a big problem in your practice, figure out whether they want to be in-network and make signing them up a priority. Spine surgeries are big-dollar procedures, so having a few that are not compensated is meaningful."

6. Help employees transition into the exchange. Most independent physician offices are small enough to drop their insurance coverage and allow employees to purchase coverage on the exchange without penalty. "When you have office staff members who are lower wage employees, they will be able to do better on the exchange than what the employer can offer," says Mr. Tolbert. "Help your employees transition into the exchange from the business-owner side of things."

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