From Medicare pay cuts to inflation, spine and orthopedic leaders are constantly thinking about how to stay on top of the next financial challenge that comes their way.
Here are the strategies four leaders have discussed with Becker's.
Alex Bateman, CEO. United Musculoskeletal Partners: The headwinds that our partners have faced are not unique to their market and are the same challenges most MSK practices are facing. Inflation, increased administrative burden and lower reimbursements have exerted additional downward pressure on our performance.
Fortunately, UMP leaders at the MSO level and market level have approached these challenges with innovative solutions that continue to allow our partners to grow. As we approach the fourth quarter of this year, we have already seen positive growth indicators that are positioning our partners for a strong second half of the year.
Michael Boblitz, CEO. Tallahassee (Fla.) Orthopedic Clinic: 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.
Nicholas Grosso, MD, President. The Centers for Advanced Orthopaedics (Bethesda, Md.): They obviously continue with CMS cutting physician pay. Although I do think Congress is going to move on that, we'll have to wait and see what happens. The key is, if you're negotiating with a payer from a position of at least being equal, they can't stop us for being too big. We cover too much of a geographic area, and whether they like it or not, they have to work with us. I hate saying that to make it sound like we're trying to be a bully, and we're not. We're just trying to be fair because our costs go up every year or our salaries go up, our prices go up, and everything goes up. Cost of living goes up. If they want to keep our doors open and provide care for their patients, we've got to make ends meet.
Andrew Sama, MD, Co-chief of spine. Hospital for Special Surgery (New York City): This has been coming for a long time and it's sort of coming to a head in the sense that we're feeling pressures from both ends. The cost of care delivery has gone up. The reimbursements are going down. But I think being smart and deliberate about how we think about what we do, being mindful about how we lay out capital and costs. It's not just about driving volume, which is important, but it's really about providing fiscally responsible care.