Three spine surgeons discuss the reimbursement challenges facing their practices.
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, August 22, at 5 p.m. CST.
Question: What are most pressing reimbursement challenges facing spine practices today?
Rob D. Dickerman, DO, PhD. Director of Neurosurgery at Presbyterian Hospital of Plano (Texas) and Director of Spine Surgery at Medical Center Frisco (Texas): Insurance companies changing what meets their medical necessary criteria for procedures, without notifying the physician's practice. Often, we are unaware of the changes and do not know to ask for pre-certification for certain CPT codes or to document exactly what the insurance companies are looking for. And every pre-certification comes with the stipulation that this is "not a guarantee of payment," despite giving an authorization number.
Daniel K. Park, MD. Spine Surgeon at Michigan Orthopaedic Surgeons (Southfield): With bundled care becoming the norm in joint replacement surgery, spine surgery is likely next. In the past, surgeons only had to pay attention to surgical choices, that is, what implant and biological product is used, but surgeons will now be faced with where to [perform] the surgery and all the aftercare issues such as rehab, home nursing and therapy.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I feel the most pressing challenge is the constant pressure being placed on all physicians, not just spine doctors by CMS. As of next year, there is a rule that might take effect eliminating the 99202-99205 and 99212-99215 and giving a combined payment. So, whether you spend 10 minutes or an hour with a patient, doctors will get the same amount. While not final, and may fail, CMS will obviously get something like this passed.
Historically, they have always found a way to get some version of a cut passed. Again, this is the same modus operandi of the government cutting doctor's reimbursements thinking it will save money. Negative incentives have never made behavior more desirable. In this case, it will negatively impact quality of care and make the physician-patient relationship ever more fetid, and not to mention, drive more independent practitioners out of a job.