Disruptive Insights released a new report on the expected trends in payer management and reimbursement for spine surgery in the second quarter of this year.
The spine surgery market in the United States is $12 billion, but there are roadblocks for future innovation and payer reimbursement going forward. Here are eight things to know from the report.
1. There is a lack of price-sustaining innovation from large implant vendors.
2. Payer pushback on the efficiency of some spinal procedures is limiting growth.
3. The spine surgery market returned low, single-digit growth recently.
4. Many people feel pressure on access/volume from payers has eased for spine surgery, but this is only true for policies. It's also important to note practices have not become more onerous in recent months.
5. Per conversations with payers and hospital administrators, D1 found there payers haven't loosened policies or their focus on utilization.
6. Industry participants have been sanguine about the outlook for spine surgery as compared to recent years, but there is a "cloud lurking in the distance that could potentially bring darker days."
7. The increasing cost transparency, high deductible plays, hospital-employed physicians, ACA, accountable care organizations and new reimbursement pilots are giving rise to the potential for incentive disruption.
8. The disruptions in the market could have an impact on the physician preference market. Surgeons and supply chain participants will likely have to adjust how they deliver value.