Three spine surgeons discuss strategies for successful payer negotiations.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 24, 5 p.m. CST.
Question: What is your best advice for payer negotiations?
Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): We constantly monitor outcomes. We feel it helps to market ourselves to the community. That same reasoning works for the payers. In addition to benchmarking outcomes, you need to benchmark price with your competitors. Use this combination to your advantage. In the end, do not be afraid to say no. You need to know your internal margins for conducting business so that you know where to draw the line. You will have to say no to some carriers. If you lose money on every case, you won't solve it with more volume.
Issada Thongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): The most important is to be able to show the payers patient outcome data. The second most important is the 'cost effectiveness' and/or cost-savings data — showing them why you are different and backing it up with the data. For example, my practice is a multimodality spine practice, which it is essentially a 'one-stop shop,' so it is very convenient for the patients and payers from first visit to postoperative care.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Stay erudite and be tenacious. Payers continue to not play by their own rules. You must know the timeline, treatments and plan for your patient's care. Never stop being their advocate and steward. The payers certainly do not have that role and are doing everything they can to delay care in order to get the patient or doctor to give up and/or go elsewhere. Knowing this ahead of time, be prepared for peer-to-peer interviews. Be kind, but be to the point and not chatty. Tell the other person your outcomes, and what your beliefs are as to what your patient needs to get better. At the end of all this, the payers will need to explain their decisions to the patient, or better yet, to the insurance commission.