Lali Sekhon, MD, PhD, is a double-fellowship trained neurosurgeon who recently joined Reno (Nev.) Orthopedic Clinic.
Here, Dr. Sekhon provides his insight into the future of value-based care in spine and strategies for dealing with declining reimbursements.
Note: Responses are lightly edited for style and clarity.
Question: How do you expect value-based care to develop in spine?
Dr. Lali Sekhon: It sounds good in principle — tying reimbursement to efficiency and effectiveness. However, the execution is difficult. I have presented outcomes data to payers in contract negotiations and it is mostly ignored. The cynic in me says it will be used like meaningful use was; a stick rather than a carrot. Another way for payers to reduce reimbursement and increase denials.
Q: What impact do you see bundled payment programs having on the field in the next five years?
LS: Bundled payments means the surgeon, other physicians, the hospital and possibly other healthcare providers and facilities share one surgical fee for a surgical procedure. This will come to spine care. It will benefit spine surgeons who operate appropriately, economically and efficiently. It will weed out those who over-service and possibly those with poor outcomes and extended length of stays. This is already happening with total joints.
Q: What strategies can spine surgeons employ to deal with declining reimbursements?
LS: Physicians can:
1. Increase ancillary services such as physical therapy, MRI, urgent care, surgery centers and durable medical equipment.
2. Use mid-levels.
3. Partner with hospitals for co-management with reimbursement.
The last option is to accept the reductions, don't work like a dog, and consider a lateral move or early retirement.
Q: What goals do you have for your practice in 2020?
LS: Our group consists of 30 physicians and has recruited five this year. It has a large footprint of ancillaries. This expansion and growth needs to continue. On a personal level, I wish to finish my MBA, explore reimbursement outside medicine, recruit and build.