a
Spine Procedures, Practices and News
Terry Woodbeck, CEO of Tulsa Spine & Specialty Hospital, discusses seven ways his hospital has improved patient satisfaction and decreased healthcare costs.
Published in
Spine
Spine surgeons have seen reimbursements drop over the past few years, and will likely continue to experience downward pressure in the future. Medicare recently announced a 2 percent reimbursement reduction as part of sequestration spending cuts as well. Here are eight strategies spine surgeons can use to tackle dropping reimbursements with contract negotiations, cost cutting and increasing patient volume.
1. Show insurance companies market comparisons during contract negotiations. Insurance companies are offering lower rates than in the past for spinal procedures, which means surgeons must come to payor negotiations armed with more than just clinical documentation; they must also bring redacted payor data to show reasonable market rates.
"Present redacted payor data from other payors to compare their rates with other payors for high volume procedures," says Danielle Koelbl, president of MedRev Solutions, a healthcare revenue cycle and receivable management company. "If you are having coverage problems with a major player, show outcomes data along with other payor rates to help bring them on board."
Figure out where you can use positive reimbursement trends to correct negative ones. Physicians have assumed the responsibility for proving their case, and payors respond best to data.
2. Explore initiatives to lower the cost of care. One of the biggest efforts of healthcare reform is lowering the cost of care. Stephen Hochschuler, MD, co-founder of Texas Back Institute, is working with his colleagues on several initiatives to lower the cost of care while remaining profitable as an independent spine practice. One of the potential opportunities will be investing in an ambulatory surgery center in the future, which will lower the cost of the minimally invasive procedures performed there and enhance the practice's ancillary revenue stream.
"Our hospital chain agreed to build 30 surgery centers over the next three years with a corporate partner," says Dr. Hochschuler. "For the average spine or orthopedic surgeon, this is a great opportunity to be part of the operation structure and make ancillary income where their own healthcare dollar is being tremendously compromised. That's a huge potential lucrative area for Texas Back, and we are looking at that very seriously."
3. Save money on each case by cutting costs for supplies and implants. There are some devices and systems that use a high volume of disposables, which significantly increases the cost per case. Pay attention to the supplies such as bipolars and dural grafting material that are disposable but extremely expensive.
"There are certain retractor systems with disposable pieces that drive up costs," says Brian R. Gantwerker, MD, of The Craniospinal Center of Los Angeles. "Push more toward using a reusable package that is just as effective. That should be one of the top priorities to cut costs."
When surgeons are actively working with hospitals to cut their costs, especially if their work includes materials changes and vendor negotiations, they can add a consulting agreement to their relationship. "Nobody in this country works for free," says Dr. Gantwerker. "We are entitled to charge for our time if we are doing that service to the hospital, and we can be compensated for it at a reasonable rate."
Another option is to purchase cheaper implants, especially for routine cases. The commodity implant can be used for a variety of cases, such as one-level lumbar fusion, basic rotator cuff repair or a basic suture anchor. For example, the commodity implant for a one-level lumbar fusion costs $2,500-$3,000, compared with $14,000-$15,000 for full invoice price for the premium version for a savings of $12,000 on one case. Even with typical hospital and provider discounts, the surgeon can still save $5,000-$7,000 per case.
"A spine surgeon who uses commodity implants for most of his surgeries could realize a half-million dollars in savings a year," says Richard A. Kube, MD, CEO of Prairie Spine & Pain Institute in Peoria, Ill. However, make sure the implant is able to provide the same quality of care.
4. Find a way to work more patients into your schedule. Spine surgeons aren't paid as well today as they were a few years ago for the same amount of work as each unit of work receives smaller payment. To maintain their income level, some surgeons will take on more cases than in the past. "We'll need to bring more cases into the practice and surgery center. I think having a good physician extender is going to be key in the future," says Bryan Oh, MD, a spine surgeon with BASIC Spine in Orange, Calif.
If spine surgeons aren't routinely running more than one operating room at one time, the PA can open and close the cases. This allows surgeons to work the same number of hours but see increased patient flow.
"Obviously spine surgeons still need to be mindful of not cutting corners in the OR and have the same attention to detail as in the past," says Dr. Oh. "But this strategy should allow for increased efficiency and revenue."
5. Maintain the same OR team to improve efficiency. Spine surgeons must have a high level of expertise among their operating room staff to appropriately utilize OR time. Staff members should be familiar with the minimally invasive technique and experienced with the surgeon, which means working with the same team for every surgery if possible.
"Everyone should know everyone else and be comfortable in the operating room, and understand who the patient is and what is being done," says Dr. Gantwerker. "There should be specialized teams formed where people know spine very well and others are cross trained to speed up the process. There is a lot of teamwork in the OR and everyone has to be comfortable working together and having an open and efficient discussion when issues come up."
Just like surgeons, the operating room staff will have a learning curve when you first begin performing the minimally invasive procedures. However, with the right preparation work and repetition, the staff will become as efficient as the surgeon in the operating room.
6. Drive additional case volume with comprehensive marketing. An effective marketing plan will identify the key markets to pursue. Spine centers are finding success in the employer, third-party payor, niche and consumer markets. Spine centers should find industries that carry a risk of back injury and reach out to employers in these areas. "The employer market is a very large opportunity for spine centers," says Marcy T. Rogers, M.Ed., president and CEO of SpineMark. These efforts can help open lines of communication for referrals and the possibility of contracted business.
Adopting an attitude of complete transparency is one of the best ways to cater to your specific markets. "One of the initiatives we highly recommend is quarterly white papers on patient outcomes," said Ms. Rogers. Education is a vital aspect of your marketing strategy, which is particularly important for third-party payors. Spine surgeons can explain the training they have received, new advances in the field and what a payor should be looking for to determine when to cover procedures.
7. Enter into partnership with the hospital. Surgeon groups may also want to enter into partnerships with hospitals than call coverage or payment agreements by contracting professional service agreements or co-management arrangements. These arrangements will allow surgeons to become more involved with the hospital while remaining independent and strengthening their revenue stream.
"I think you'll see more surgeons doing professional service agreements," says Michael Webb, MD, a neurosurgeon with NeuroTexas Institute in Austin. "In these types of arrangements, hospitals start a clinic and a physician or physician group contracts to provide services for the clinic. The two most common reimbursement arrangements are based on RVU or a percentage of collections."
Surgeons may also have an opportunity to roll call coverage into a medical directorship position or form a management company that will provide expertise in running the orthopedic or spine service line at a hospital.
"These are some of the more complicated relationships available with hospitals, and I think they are a good option for people who are relatively new to the practice, or even those who are established who want to prop up their fee-for-service income but still have the freedom to control their own practice," says Dr. Webb. "For co-management arrangements, the management company is compensated for reaching goals like patient satisfaction or lowering hospital implant cost, which can prop up income without being directly employed."
8. Participate in new payment models. New payment models such as accountable care organizations and bundled payments are forcing providers to take more risk for patient care than in the past. Insurance companies are passing the risk by negotiating a single pay rate for global coverage, including conservative care, spine surgery and postoperative rehabilitation.
"Our practice has spine surgeons, physical medicine and rehabilitation, physiatry, pain management, pain psychology and chiropractic care," says Dr. Oh. "This is the beginning of a spine care ACO model. In the future we could go to big carriers and offer to handle all spine care for their customers. We haven't executed any contracts yet, but they are in the works."
Under these agreements, if there were complications insurance companies wouldn't pay more to cover them. "However, if the providers execute quality care, they can actually stand to increase their revenue," says Dr. Oh.
In the future, Texas Back Institute will also be looking at bundled payments and other ways to assume risk in accordance with national healthcare provider trends. Providers are also marketing their services to patients more now than in the past, and patients are taking control of their healthcare experience.
"We've got to make the patient in charge of their healthcare dollar," says Dr. Hochschuler. "We need to get health savings accounts on a bigger level so patients can shop for a surgeon or program based on quality, cost and outcomes."
More Articles on Spine Surgery:
10 Big Healthcare Policy Trends for Spine Surgeons to Know
5 Qualities of Effective Spine Surgeon Leaders in Profitable Practices
Big Trends in Spine Technology Research & Development: Q&A With Dr. Marc Cohen
1. Show insurance companies market comparisons during contract negotiations. Insurance companies are offering lower rates than in the past for spinal procedures, which means surgeons must come to payor negotiations armed with more than just clinical documentation; they must also bring redacted payor data to show reasonable market rates."Present redacted payor data from other payors to compare their rates with other payors for high volume procedures," says Danielle Koelbl, president of MedRev Solutions, a healthcare revenue cycle and receivable management company. "If you are having coverage problems with a major player, show outcomes data along with other payor rates to help bring them on board."
Figure out where you can use positive reimbursement trends to correct negative ones. Physicians have assumed the responsibility for proving their case, and payors respond best to data.
2. Explore initiatives to lower the cost of care. One of the biggest efforts of healthcare reform is lowering the cost of care. Stephen Hochschuler, MD, co-founder of Texas Back Institute, is working with his colleagues on several initiatives to lower the cost of care while remaining profitable as an independent spine practice. One of the potential opportunities will be investing in an ambulatory surgery center in the future, which will lower the cost of the minimally invasive procedures performed there and enhance the practice's ancillary revenue stream.
"Our hospital chain agreed to build 30 surgery centers over the next three years with a corporate partner," says Dr. Hochschuler. "For the average spine or orthopedic surgeon, this is a great opportunity to be part of the operation structure and make ancillary income where their own healthcare dollar is being tremendously compromised. That's a huge potential lucrative area for Texas Back, and we are looking at that very seriously."
3. Save money on each case by cutting costs for supplies and implants. There are some devices and systems that use a high volume of disposables, which significantly increases the cost per case. Pay attention to the supplies such as bipolars and dural grafting material that are disposable but extremely expensive."There are certain retractor systems with disposable pieces that drive up costs," says Brian R. Gantwerker, MD, of The Craniospinal Center of Los Angeles. "Push more toward using a reusable package that is just as effective. That should be one of the top priorities to cut costs."
When surgeons are actively working with hospitals to cut their costs, especially if their work includes materials changes and vendor negotiations, they can add a consulting agreement to their relationship. "Nobody in this country works for free," says Dr. Gantwerker. "We are entitled to charge for our time if we are doing that service to the hospital, and we can be compensated for it at a reasonable rate."
Another option is to purchase cheaper implants, especially for routine cases. The commodity implant can be used for a variety of cases, such as one-level lumbar fusion, basic rotator cuff repair or a basic suture anchor. For example, the commodity implant for a one-level lumbar fusion costs $2,500-$3,000, compared with $14,000-$15,000 for full invoice price for the premium version for a savings of $12,000 on one case. Even with typical hospital and provider discounts, the surgeon can still save $5,000-$7,000 per case.
"A spine surgeon who uses commodity implants for most of his surgeries could realize a half-million dollars in savings a year," says Richard A. Kube, MD, CEO of Prairie Spine & Pain Institute in Peoria, Ill. However, make sure the implant is able to provide the same quality of care.
4. Find a way to work more patients into your schedule. Spine surgeons aren't paid as well today as they were a few years ago for the same amount of work as each unit of work receives smaller payment. To maintain their income level, some surgeons will take on more cases than in the past. "We'll need to bring more cases into the practice and surgery center. I think having a good physician extender is going to be key in the future," says Bryan Oh, MD, a spine surgeon with BASIC Spine in Orange, Calif.If spine surgeons aren't routinely running more than one operating room at one time, the PA can open and close the cases. This allows surgeons to work the same number of hours but see increased patient flow.
"Obviously spine surgeons still need to be mindful of not cutting corners in the OR and have the same attention to detail as in the past," says Dr. Oh. "But this strategy should allow for increased efficiency and revenue."
5. Maintain the same OR team to improve efficiency. Spine surgeons must have a high level of expertise among their operating room staff to appropriately utilize OR time. Staff members should be familiar with the minimally invasive technique and experienced with the surgeon, which means working with the same team for every surgery if possible.
"Everyone should know everyone else and be comfortable in the operating room, and understand who the patient is and what is being done," says Dr. Gantwerker. "There should be specialized teams formed where people know spine very well and others are cross trained to speed up the process. There is a lot of teamwork in the OR and everyone has to be comfortable working together and having an open and efficient discussion when issues come up."
Just like surgeons, the operating room staff will have a learning curve when you first begin performing the minimally invasive procedures. However, with the right preparation work and repetition, the staff will become as efficient as the surgeon in the operating room.6. Drive additional case volume with comprehensive marketing. An effective marketing plan will identify the key markets to pursue. Spine centers are finding success in the employer, third-party payor, niche and consumer markets. Spine centers should find industries that carry a risk of back injury and reach out to employers in these areas. "The employer market is a very large opportunity for spine centers," says Marcy T. Rogers, M.Ed., president and CEO of SpineMark. These efforts can help open lines of communication for referrals and the possibility of contracted business.
Adopting an attitude of complete transparency is one of the best ways to cater to your specific markets. "One of the initiatives we highly recommend is quarterly white papers on patient outcomes," said Ms. Rogers. Education is a vital aspect of your marketing strategy, which is particularly important for third-party payors. Spine surgeons can explain the training they have received, new advances in the field and what a payor should be looking for to determine when to cover procedures.
7. Enter into partnership with the hospital. Surgeon groups may also want to enter into partnerships with hospitals than call coverage or payment agreements by contracting professional service agreements or co-management arrangements. These arrangements will allow surgeons to become more involved with the hospital while remaining independent and strengthening their revenue stream.
"I think you'll see more surgeons doing professional service agreements," says Michael Webb, MD, a neurosurgeon with NeuroTexas Institute in Austin. "In these types of arrangements, hospitals start a clinic and a physician or physician group contracts to provide services for the clinic. The two most common reimbursement arrangements are based on RVU or a percentage of collections."Surgeons may also have an opportunity to roll call coverage into a medical directorship position or form a management company that will provide expertise in running the orthopedic or spine service line at a hospital.
"These are some of the more complicated relationships available with hospitals, and I think they are a good option for people who are relatively new to the practice, or even those who are established who want to prop up their fee-for-service income but still have the freedom to control their own practice," says Dr. Webb. "For co-management arrangements, the management company is compensated for reaching goals like patient satisfaction or lowering hospital implant cost, which can prop up income without being directly employed."
8. Participate in new payment models. New payment models such as accountable care organizations and bundled payments are forcing providers to take more risk for patient care than in the past. Insurance companies are passing the risk by negotiating a single pay rate for global coverage, including conservative care, spine surgery and postoperative rehabilitation.
"Our practice has spine surgeons, physical medicine and rehabilitation, physiatry, pain management, pain psychology and chiropractic care," says Dr. Oh. "This is the beginning of a spine care ACO model. In the future we could go to big carriers and offer to handle all spine care for their customers. We haven't executed any contracts yet, but they are in the works."
Under these agreements, if there were complications insurance companies wouldn't pay more to cover them. "However, if the providers execute quality care, they can actually stand to increase their revenue," says Dr. Oh.
In the future, Texas Back Institute will also be looking at bundled payments and other ways to assume risk in accordance with national healthcare provider trends. Providers are also marketing their services to patients more now than in the past, and patients are taking control of their healthcare experience.
"We've got to make the patient in charge of their healthcare dollar," says Dr. Hochschuler. "We need to get health savings accounts on a bigger level so patients can shop for a surgeon or program based on quality, cost and outcomes."
More Articles on Spine Surgery:
10 Big Healthcare Policy Trends for Spine Surgeons to Know
5 Qualities of Effective Spine Surgeon Leaders in Profitable Practices
Big Trends in Spine Technology Research & Development: Q&A With Dr. Marc Cohen
Published in
Spine
A study recently published in Spine examined the reoperation rate for patients undergoing spine surgery for disc herniation.
Published in
Spine
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Incorporating Weight-Bearing MRI Into Spine Practices: Q&A With Dr. Douglas Smith of Musculoskeletal Imaging Consultants
Douglas Smith, MD, founder of Musculoskeletal Imaging Consultants, discusses what it takes to incorporate weight-bearing MRI into spine practices.
Published in
Spine
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10 Big Healthcare Policy Trends for Spine Surgeons to Know
Here are 10 big healthcare policy trends for spine surgeons to know.
Published in
Spine
Marc Cohen, MD, a spine surgeon based in New Jersey, discusses the biggest trends in spine research and technology, and where the field is headed in the future. Dr. Cohen has a special interest in minimally invasive micro spine surgery and endoscopic laser spine surgery.Q: What does the future hold for spine-related research?
Dr. Marc Cohen: When you talk about the future for research in the spine world, the reality is that the interest of medical care used to be on the clinical research and outcomes, but now — with the changing healthcare environment, costs and restraints — the focus for all research is turning toward evidence-based medicine. Evidence-based medicine measures the patients' symptoms, functional status and patient satisfaction. The problem is that the technology of today has to be justified with healthcare costs and weighted with the evidence-based outcomes.
Q: Traditionally, academics have been most involved in research. Is that still true?
MC: You don't have to be in academia to conduct research today. I'm in private practice and I collect patient outcomes data with new devices and provide that information to registries that act as a database of documented information contributing to evidence-based medicine. These studies show hospitals and payors that new technology or techniques have merit and patients do better after treatment; therefore, the technology should be reimbursed.
The problem is today, guidelines and protocols are being controlled by insurance carriers and they set their own standards; they gather their own information, which is different than protocols physicians develop. Physicians and surgeons have the training and knowledge about their patients, and they are the ones with the expertise about which treatments are best. The problem is cost control by payors and government; they use their own data which makes gaining coverage an uphill battle for surgeons.
Q: How has this new focus impacted spine research and technology development?
MC: Technology and research is affected because every new development needs more justification; many decisions are based on cost analysis. Technology will be hard to bring into this country and hospital because the cost is so great. Government and insurance carriers are squeezing physicians and hospitals, which are scrutinizing new devices and weighing outcomes against cost.
The only way for surgeons to deal with this situation is by being an active player; they need to provide their own data for patient outcomes into their specialty societies. It will be important for spine surgeons to become involved in their medical and spine societies. They need to participate in initiatives to take back control and set guidelines for appropriate medical care for spine patients.
Q: What new technologies will be most successful in the future?
MC: I believe the future is in minimally invasive techniques. I think the technology is out there now for less invasive surgery, and spine surgeons can perform better procedures using modern technique. Minimally invasive surgeries mean less tissue damage, smaller incisions and quicker recovery times. In the future surgeries should be done more efficiently to cut costs.
I also see more specialty hospitals and spine centers, and more surgeries performed by physicians with a special focus on the spine. The protocols, outcomes and efficiency will all be better as a result of more research and development in spine surgery. This will cut costs and make surgeons and payors happy.
Q: Where do you see the most opportunity for development in spine technology? Are there any developments you are particularly excited about?
MC: The future technology will include endoscopic surgery, allowing routine spine surgical procedures through a smaller incision. The other technology that will develop is the use of artificial disc replacement, which has merit. I think data and evidence-based medicine is coming now in the cervical spine, and outcomes have been effective. However, some insurance companies still consider artificial disc replacement an experimental procedure.
It would be good to see whether artificial discs can be used at multiple levels in the future. Most surgeons only use it on one level. In the future, it will be interesting to see whether multiple levels can be used; then we can use artificial discs instead of hybrid surgery or open fusions.
Looking away from surgery, technology has to do with patients who have back pain. Technology will evolve so physicians can change the physiological and pathological state in the patient using stem cells and gene therapy. Spine surgeons have to pioneer research with pain physicians so they can reach patients undergoing treatment for painful discs in the early stages; these patients may be able to undergo a biological injection before the spine procedure. It has to be a combined effort to help the patients and avoid open surgical intervention.
More Articles on Spine Surgeons:
5 Qualities of Effective Spine Surgeon Leaders in Profitable Practices
Outpatient Cervical and Lumbar Spinal Fusion Research: Q&A With Dr. Jeffrey Carlson
8 Tips to Develop Spine Surgeon Marketing Strategies With High ROI
Published in
Spine
Physicians discussed the practical challenges of adopting minimally invasive spine surgery procedures during the session titled "The Current State of Minimally Invasive Spine Surgery" at the American Academy of Orthopaedic Surgeons Annual Meeting 2013 in Chicago.
Published in
Spine
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K2M Launches VENADO Biologic Bone Graft System
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Karen Reiter, administrator at DISC Sports & Spine Center in Marina del Rey, Calif., discusses five initiatives her surgery center has taken on to improve the patient and physician experience at the ASC.
Published in
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Westside Surgical Hospital in Houston, a multispecialty physican-owend hospital, has acquired the Mazor Robotics Renaissance system, one of seven systems being used in Texas, according to a Mazor Robotics news release.
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Spine