Spine technologies are gaining traction, especially among early-career surgeons, but not all of them have strong payer coverage, Ali Mesiwala, MD, said.
Dr. Mesiwala, of Newport Beach, Calif.-based DISC Sports & Spine Center joined the "Becker's Spine and Orthopedic Podcast" to discuss payer challenges with new technologies and how he helps patients understand costs.
Note: This is an edited excerpt. Listen to the full conversation here.
Q: What strategies have worked for your organization in tackling [patient experience] challenges, and what is one recommendation you have for healthcare leaders to stay ahead?
Dr. Ali Mesiwala: There are two things that are competitive: technology and the desire to bring the latest and greatest stuff to the ASC setting. Many of those things nowadays have to do with robotics and AI, and those are expensive purchases and really not developed and designed for the ASC setting, but we have them in hospitals. So patients, and even newer physicians who've just finished their training really rely on that technology to provide cutting edge building based care, and that can be in direct conflict with the contracts and payers that you already have set up. Oftentimes new technology is not covered within these contracts. Whether they're implants or whether they're robots, these are things that you have to build into your negotiating and building your contracts so that you can actually keep up with and anticipate the changes that are coming. There's always so much money in the healthcare pot, and it's being divided in different ways every year.
Q: How can leaders ensure their staff are well equipped to help patients navigate the financial aspects of care, and how does this benefit patient provider relationships?
AM: Transparency is key. Historically, the finances of healthcare have been a black box for most patients. Now more and more patients are getting their explanation of benefits from the hospital from their insurer, and they can really go through in line item fashion what money was spent on what part of their care. When it comes to the ASC setting for certain insurers, certain policies, patients may have a substantial out of pocket fee, which they may not have in a traditional hospital setting. So it's understanding where their dollar is going and what they can essentially buy for their particular spend. For a lot of our patients who need surgery they will use up their deductible earlier in the year, and they will shift their surgery towards the end of the year so they don't need to come with out of pocket expenses. The other thing is that in some cases, it's actually less expensive to pay cash for certain things, and they have to use your insurance. One of those examples would be imaging. So particular imaging centers that you work with can offer an MRI for a few hundred dollars, or they went through their insurance [and it] might be $800, so the system doesn't always make sense. But if you're transparent with the patient in terms of the true cost of things and where their money is going, oftentimes it only encourages them to want to come to you, because it's a more trusting relationship.