Here are five ways spine surgeons can take control of their practice to cut costs and improve patient access to care.
1. Pay attention to appropriate patient selection. Proper patient and indication selection is crucial to the success of a surgery and can keep patients from needing revision surgeries or other costly follow-up visits.
"Eighty percent of healthcare dollars spent on spine are spent on failures in spine, including failures that result in long-term drug use or pain management," says Robert S. Bray, Jr., MD, is the founder and CEO of DISC Sports & Spine Center in Marina del Rey, Calif.
Surgeons must maintain the ability to use their best judgment and knowledge to select patients who are proper candidates for surgery. Insurance companies try to get involved in patient selection, but "you can't have them do that," he says. It's the wrong place for oversight.
2. Develop and maintain postoperative protocol. Surgical complications also drive up costs, and working to eliminate complications plays an important role in controlling costs. The cost of a post-operative pulmonary embolism or a wrong level surgery is massive, Dr. Bray says.
An important step to minimizing complications is setting protocols for all surgeons to follow. Post-operative protocols, including proper catheter drainage and use of the bladder to avoid infection, result in huge cost savings for patients and providers.
"Protocol management of patients to avoid complications dramatically reduces the cost of delivering care," he says. "This involves education of the nursing staff and proper selection of surgeons."
3. Make sure proper equipment is available before the case begins. Equipment efficiency is one of the most important elements for making sure a case runs smoothly. Have the proper equipment available and make sure there is a replacement if necessary. Your nurse should be in charge of coordinating these materials before the case begins.
"If, for example, a certain cervical retractor isn't available, the nurse should communicate that to the physician and have alternative options ready," says Brian R. Gantwerker, MD, of The Craniospinal Center of Los Angeles. "All it really takes is a couple of hours when setting up the spine service to go over preferences. Make sure all spine surgeons are present so there is unification of practice; it will make the service line more efficient because there will be less hunting for different equipment."
4. Track data to challenge coverage denials. Spine surgeons are beginning to see coverage denials for treatment that would have been reimbursed in the past as insurance companies develop new guidelines and requirements for surgical care. Some surgeons are finding unique partners in hospital administrators to promote coverage for appropriate care.
"There is a trend by physicians to increase their relationships with hospitals who are in good position to promote insurance participation," says Jeffrey A. Goldstein, MD, clinical professor of orthopedic surgery and director of spine service at Hospital for Joint Disease at NYU Langone Medical Center and member of the board of directors for the International Society for the Advancement of Spine Surgery. "As increased numbers of providers choose to participate in private insurance programs, access increases. Additionally, surgeons have become better at providing data to carriers that establishes the benefits of spine surgery and demonstrates positive outcomes."
Professional spine societies are also advocating insurance companies to cover appropriately indicated spine surgeries and sharing outcomes among spine surgeons.
5. Develop a relationship with insurance companies. Spine surgeons have adapted to insurance company regulations to provide patients with needed treatment. Douglas Geiger, MD, orthopedic spine surgeon at St. Joseph Mercy Ann Arbor, explains that he works to use the vernacular insurance companies are comfortable with and look for in claims that will receive reimbursement.
"Surgeons must use the words and phrases that Medicare and other payers are looking for in order to minimize denied claims and to more easily justify their anticipated surgery. For instance, specifying instability or spondylolisthesis in a given case where these conditions exist, will help the insurance payor to understand that a fusion procedure was necessary," says Dr. Geiger.
Communication with insurance companies can serve as the foundation of a solid working relationship. Marilyn Gates, MD, neurosurgeon with Spectrum Health Medical Group in Grand Rapids, Mich., has met with insurance company representatives.
"If you meet with an insurance company you can demonstrate how quality outcomes are being reached. Point out your premium physicians. Build the criteria for what a center of excellence is and meet those criteria," says Dr. Gates. The more knowledge insurance companies gain of how spine surgery works, the better the working relationship spine surgeons will have with them.
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