Two spine surgeons discuss trends in spine surgery compensation and where it may be going.
Question: Where is pay headed for spine surgeons?
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: I believe market pressures will drive the payout further down from health insurance entities as they follow the outdated SGR formula from Medicare. There will be, though, a significant group of spine surgeons who will remain outside of these networks, instead opting for direct payment models for PPO and commercial clients.
I think the patients will be willing to pay to keep their surgeons and/or go to the ones recommended to them. Referring physicians will be told to send in-network of course, but those surgeons who possess market share and the savoir faire of high quality patient care can still remain viable.
Paul J. Slosar, MD, President, SpineCare Medical Group, Daly City, Calif.: Most likely fee-for-service payments to spine surgeons will be pressured downward. Insurance companies and CMS are planning on converting more business to shared-risk models, such as bundled payments or episode of care management. Efficient surgeons may be able to offset reductions in fee-for-service payments with good risk management of bundled payments. Overhead expenses for doctors continue to rise, so will downward pressure on reimbursement, the take home pay for surgeons will decline without an increase in volume.
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