Three spine surgeons offer advice for negotiating contracts with payers.
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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Note: The following responses were edited for length and clarity.
Question: What is your best advice for spine surgeons negotiating with payers?
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Utilize a healthcare attorney, go in with a group and be tactful. You will be better off negotiating with an upper hand if you control a large market share. Make sure you have confidence that your attorney can review the contract correctly. Inevitably, the payer will at some point not follow the letter of the agreement. It is then, when you have to litigate it, that you will need to know how firm your standing is. I believe if surgeons are not being treated fairly, use of litigation should be strongly and readily considered.
James Chappuis, MD. Spine Center Atlanta: As complex as health insurance contracts have become, I would most likely advise them to utilize a consultant unless their business manager or practice administrators are very well-versed in the contracts they are negotiating.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Payers are solely interested in price marks and savings. We have been under growing pressure to improve the numerator of the value equation: patient safety, quality of care and patient satisfaction, while parring costs and limiting implant charges. Arming oneself with cost per unit case and MedPAR outcome data is simultaneously advantageous. Competing for annual contracts is frustrating and fatiguing, but ultimately necessary.
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