5 Tips for Spine Surgeons to Prepare for New Payment Models

1. Track cost and quality data. Several new payment models are now being introduced for medical care shifting from fee-for-service to pay-for performance. These payment models — such as accountable care organizations or bundled payments — are designed to split the risk among insurance companies and providers for the cost and quality of care. Ultimately, it remains to be seen whether any of these new models will become the standard reimbursement method or if yet another model will emerge.

"This is the period of greatest uncertainty in my professional career and this will continue over the next five years," says Chad Beste of Professional Business Consultants. "I try not to put all my eggs in one basket; the world isn't going to go all to ACOs, but we are headed to a system where a sizable percentage of the population will be willing to pay more for higher quality healthcare while others will be in a state run program. Surgeons will have to participate in one or the other."

2. Assess your marketplace and consider new partnerships. Spine surgeons and specialists around the country are concerned about how they will fit into new payment models, such as bundled payments or accountable care organizations. This will be a special challenge for private practice spine surgeons who provide care at multiple hospitals across several health systems.

"The spinal community continues to develop patient outcome measurement tools to objectively track our treatment strategies," says Anthony Rinella, MD, a spine surgeon with Illinois Spine & Scoliosis Center in Homer Glen and co-founder of SpineHope. "We are always looking to improve evidence-based analysis and recommendations in spinal surgery."

Andrew's Sports Medicine and Orthopaedic Center has partnered with a local hospital and in the process of exploring ACO options.

"Over the next few years, we'll be developing quality outcomes measures as part of an ACO," says Andrew Cordover, MD, a spine surgeon with Andrews Sports Medicine and Orthopaedic Center in Birmingham, Ala. "In the spine realm, I think it will be more challenging than other specialties to produce the outcomes measures because it's certainly not as clear cut as measuring survival rates for cancer or heart disease. There are some new instruments out there now and we are always looking to develop and improve upon the tools that we have to develop evidence based medicine in spine surgery."

3. Work with hospitals to improve quality and cost of care. It would be advantageous for both hospitals and spine surgeon groups to have hypothetical situations to basically predict future possibilities and watch each possibly on how the structure will work and what the agreement will be. That would help with future arrangements, including accountable care organizations. Medicare may require hospitals to directly align themselves with the government payors or they may require some division between the medical groups and hospitals.

"We have government payors, but also private payors, and what happens to private payors if the negotiation only considers ACOs with government payors?" says A. Nick Shamie, MD, associate professor of spine surgery at UCLA and president of the American College of Spine Surgery. "There has to be a clause discussing other payors that will remain as is. There could be opportunities for different arrangements for different payors."

4. Build a relationship with key area payors. Insurance companies are now looking to make the healthcare market more competitive in terms of pricing, and in some communities large physician groups are able to partner with them to keep costs low. "In states where there are favorable payors and workers compensation, partnering with payors instead of hospitals will help surgeons avoid employment," says William Stevens, MD, founder of the Center for Spinal Disorders and OSNA member in Phoenix. "Take advantage of the fact that payors are leery of hospitals being in the position to call all the shots."

For example, in Utah costs are high because hospitals have employed nearly all surgeons in the state. Since hospitals employ all the surgeons, they can demand a higher rate from payors than otherwise possible.

"When insurers look at their costs in places like Utah, they aren't happy with hospitals and large systems controlling everything in the market," says Dr. Stevens. "You can partner with insurance companies on contracts for reimbursement and providing care if they are concerned about hospitals having too much control. You can also work with them on an accountable care organization or bundled payments where the payment goes through the physician first."

Large orthopedic groups around the country are now exploring this option with payors, and it could become more common among spine surgeons as well. "With a large group of surgeons, such as OSNA, you are in a position to take advantage of these partnerships," says Dr. Stevens. "We are in the early phases of exploring these kinds of partnerships, but insurers are excited because they think we can do a good job of keeping the price down."

5. Cover the spectrum of care within your practice. Even if your group is a subspecialty spine group, bring in non-operative specialists to expand your care coverage. Patients and referring physicians are looking for one-stop shops for all of their needs and practices that can't accommodate them will be quickly passed over.

"It's really important to cover the whole gamut of care when it comes to spine," says Todd Albert, MD, spine surgeon and president of Rothman Institute in Philadelphia. "This means pain management, physiatry, physical therapy and non-operative sports medicine if that's an important part of your practice. In orthopedics, our group wants to cover the patients from start to finish."

Practices should also consider bringing imaging and other ancillary services into the practice when possible, or locating near those providers so patients don't have to go across town for care. This will be especially important as more patients take more risk for their healthcare with HSA plans and cash-pay initiatives.

More Articles on Spine Surgery:
Building a Multidisciplinary Spine Practice: Q&A With Dr. Ty Thaiyananthan of BASIC Spine
Becoming an Agent of Change: 4 Steps From Dr. Todd Albert
6 Trends in Scoliosis Treatment & Correction From Dr. Peter Gabos