2 orthopedic leaders' approaches to payers in 2024

Practice Management

Between Medicare cuts and changes in insurer policies, orthopedic leaders have to think strategically when it comes to payer negotiations.

For Stephen Holtzclaw, MD, the new CEO at U.S. Orthopaedic Partners, evidence will be key, he said. Bundled payments have done well at USOP practices in Mississippi, and he wants to grow them across the group's network. 

"The fact that Mississippi has done so well, we can use that as a proof statement," Dr. Holtzclaw told Becker's. "But also the high-quality physicians and the fact that we can do things in ASCs for a lower cost and higher quality should be an automatic interest for an insurance company. Why pay a higher cost and potentially higher complications at a hospital when you can move things to an ASC and save money and have higher quality? That's really the pitch there. I think they see and understand that we just need to get in front of them and show our worth."

Nicholas Grosso, MD, president of the Centers for Advanced Orthopaedics in Bethesda, Md., said he hopes relationships between physicians and payers can become less "one-sided."

"When we formed CAO, it put us in a much stronger position to negotiate," he said. "We were able to negotiate better reimbursement rates on our fee-for-service. We tried to build relationships with the payers, and we had better relationships with some because we were really built to get to this value. We saw the writing on the wall. We knew value-based care was going to come eventually and just took a lot longer than we thought it would. … I really hope going forward it's more cooperative. I mean, there's always going to be that tension there. They're the payer and we're the provider. But as we move toward capitated care, that kind of shifts the dynamic. I'm hoping it's not just an adversarial relationship where we go to the table and try to see who can take advantage of each other, because I think if we work together, we could get to that value-based care."

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