Orthopedic and spine practices are up against several payer challenges in 2024, from CMS pay cuts to the decision to keep or sever ties with Medicare patients.
Michael Boblitz, CEO of Tallahassee (Fla.) Orthopedic Clinic, told Becker's about the payer headwinds his practice is facing this year, and how payers will continue to dictate the future of the spine and orthopedic care market.
Question: What are the biggest payer headwinds your practice is facing in 2024?
Mr. Michael Boblitz: The ongoing Medicare payment cuts to physicians is challenging, especially in a market like North Florida where the population is aging and shifting to Medicare plans. In reviewing the Part B supplemental medical insurance fund balance over the last decade, the 2024 balance is near a record high at $183.2 billion, yet Medicare continues to make further cuts. My hope is Medicare reevaluates the delivery systems and recognizes physicians have the ability to reduce cost — and offer the same annual inflation increases always offered to Medicare Part A hospital insurance each year.
Aside from Medicare issues, the private insurers are closely aligned partners of TOC. We are working hard to accelerate our orthopedic platform to ensure the vast majority of our 270,000 patients never need to access care beyond our clinic, with easier access and lower cost. Our platform is well prepared for value and population health, as we can contract for longitudinal care that includes all services prior to, during and after the surgical episode. Our soon-to-open Spine and Joint Replacement Surgery Center is our most recent example, with private rooms that include private bathrooms to care for the extended-stay patients previously only being able to be served in the hospital inpatient setting. Representing a company myself as CEO, it is important to TOC that we play an active role in reducing the healthcare costs in the business community.
Q: Is your practice still accepting Medicare patients?
MB: Our mission is improving patients' lives through the delivery of the best orthopedic care with the aim of prevention, preservation and wellness. In order to execute upon our mission, we must provide care to all patients, even with the disappointing and ongoing Medicare cuts. Many of our private insurance partners also offer Medicare Advantage plans, and thus it is important we support our partners to ensure all beneficiaries receive the very best care. With this said, I am watching recent trends with several providers around the U.S. starting to drop one or more of the Medicare Advantage plans. My hope is we never have to consider such a difficult decision. In the meantime, we continue to outrun the Medicare reimbursement challenges with aggressive double-digit revenue growth every year via our vision 2030 strategic plan.
Q: Do you believe that the majority of orthopedic and spine procedures will eventually move to the ASC setting?
MB: The market forces are and will continue to dictate that the vast majority of orthopedic and spine cases must be performed within the ASC setting as a means to reduce cost of care. I feel if we ignore these market forces the purchasers, who represent the important employers, will be forced to find other provider partners. The challenge with all this is the need to still work hard to help support our hospital partners, as the purchasers keep pushing hard to get as many patients into lower cost settings as possible.