New partnership models with aligned goals, an increased push toward orthopedic Centers of Excellence and heightened calls for a single-payer system are among the major trends these four spine surgeons see over the next five years.
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Note: The following responses were lightly edited for style and clarity.
Question: What payer changes do you anticipate in your market in the next 3-5 years?
Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): The evolving payer changes we're seeing pertain to the development of partnership models with aligned goals. The days of out-of-network legal battles and fights with the insurer for utilization are in their final stages of dying off. The payers will look to the ASC and physician network to bring to them quality, cost-efficient solutions and develop relationships such as Centers of Excellence with fair contracted rates that let all involved — patient, provider and payer — win.
As these relationships develop, you will find great satisfaction working as a partner with payers to do what we do best: Deliver well thought-out, quality care. This is work that requires complete commitment to data-driven results and time spent to develop payer relationships. Find a champion that will lead this within your group and rally behind that effort.
For those that sought to abuse the system, I look forward to further legal regulation and prosecution, as we have recently seen, that shuts down those pathways. It harms the entire system and needs to be removed.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: There will likely be a two to three-fold increase in state-managed care. As we head further and further from the starting point of the ACA, and simultaneously a disdain for actually fixing the fixable on the part of Congress, we move closer and closer to single payer. Regardless of your political affiliation, there is very little that would be satisfactory in a single-payer system in this country. In our state, there have already been clear warning shots. Feasibility moves toward single payer.
Despite the untenable price tag, not to mention the unmanageable beast such a system would become in a state as populous as ours, powers that be continue to discuss and push for it. My belief is that by creating an environment where the insurance companies do what they are supposed to —pay for the care that patients contracted with the insurer to remunerate for — you will have coverage, stability and affordability.
By giving the laws that govern these insurers teeth, along with some very basic and enforceable consequences when they don't use case law, precedent and common sense, you will have a less mortally wounded system. That, is a start.
Andrew Hecht, MD. Mount Sinai Health System (New York City): There will be increased push to shorten hospital stays and move cases to the ASC. Surgeons must be careful about doing appropriate cases in the ambulatory setting.
Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): I anticipate that the authorization will get more difficult especially when the surgery involves expensive implants. The reimbursement will be cut in both professional and facility aspects. There will be a push toward bundled payments.