As healthcare switches from a fee-for-service model to global payments, surgeons are seeing less compensation per episode of care. As a result, more surgeons are signing employment contracts with hospitals, and health systems are acquiring physician practices.
But that doesn't necessarily mean the surgeon will be able to practice as usual; even hospital-employed surgeons and physician champions are faced with quality and cost roadblocks to providing care for patients.
Here are five observations on the changes spine surgeons see in strategic planning, cost analysis and care delivery in the future.
1. Physician preferred implants aren't always given the green light. "There is a diminishing role of the surgeon champion saying they want a certain product or technique that costs more," says Dr. Singh. "Now a pedicle screw is a pedicle screw; a plate is a plate. The hospital isn't going to pay more for the device just because it's new."
2. Hospital partnerships with physicians are gaining momentum. "Physicians are either strategically partnering with the hospital in a profit-sharing model," says Dr. Singh. "If the hospital saves a certain amount of money on goods and services to the patient, that money can go back to hospital improvements and to the physician. The cost savings can be distributed to all physicians." When surgeons are aligned with the hospital, they evaluate whether they need a cage or to use expensive biologics on each case to realize savings without impacting quality of care.
3. Physicians are becoming more aggressive in bringing patients to the outpatient surgery center. "Even the single-level fusion procedures are going to the outpatient ASC," says Dr. Singh. "Physicians like the ASC because they can control the overall costs. Then they can go back to the major payers and compare the cost of surgery at their facility as compared to inpatient spine surgery performed at the hospital. Insurers like that and the surgeon can control the whole episode of care from the ambulatory environment."
4. Insurance companies may be more willing to approve spine surgeries for outpatient ASCs in the future. "Payers have been reluctant in the past because they don't make decisions unless CMS has guidelines for the procedure," says Dr. Singh. "They pay a percentage of Medicare and adopt CMS policies. Now, CMS is moving toward approving outpatient spine surgery CPT codes. Insurers will factor in the cost savings for their patients and surgeons will be able to perform outpatient spine surgeries without having to negotiate every contract."
5. Pain management and anesthesia techniques for outpatient spine surgery are the disruptive technology needed to take patients into the ASC. "We are developing the outpatient anesthesia protocol that can allow an excellent recovery," says Dr. Singh. "That's even more important than the procedure. We do multimodal anesthesia with anti-inflammatories, narcotics and short-acting local anesthetics."