Rising healthcare costs, declining reimbursements and a surge in consolidation over the past decade is making it more difficult for private practices to stay competitive and maintain their independence.
The most recent Physicians Foundation Survey found the number of physicians self-identifying as independent decreased from 48 percent in 2012 to 31 percent in 2018.
Spine surgeons in private practice are becoming increasingly burdened with government regulations, rising administrative workloads, adoption of newer technologies and mounting pressure to lower costs as the industry looks to move away from the current fee-for-service model.
Five spine surgeons discuss struggles in their practices and how they are tackling them:
Note: Responses are lightly edited for style and content.
Scott Blumenthal, MD. Texas Back Institute (Plano): It's becoming more difficult for spine practices to achieve approvals from third-party payers to appropriately treat their patients. This creates difficult challenges for practices, because it increases the workload on team members securing authorizations, patients get frustrated as they work through the insurance approval process and providers find themselves trying to do the right thing for patients while also meeting the insurance company criteria. Overall it is more costly, creates barriers to the surgeons receiving payment and is not efficient for the treatment of the patient. Additionally, the cost of running a high-quality clinic continues to increase, while the revenue generated from performing professional services decreases.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Pressure to consolidate is palpable right now. Keeping your referring doctors close is key. Joining forces with other independent surgeons to control cost and share overhead is always a good idea. But it is most important to keep your skillset growing and refining. Carve out a niche, keep your reputation clean and don't compromise on doing what's right and what's indicated.
Brian Gill, MD. Nebraska Spine Hospital (Omaha): Private practices are becoming few and far between. These practices need to diversify themselves and look at partnering with various local health systems creating joint ventures so that these practices are not replaced but are a solution to local healthcare needs.
Thomas Loftus, MD. Austin (Texas) Neurosurgical Institute: I feel private practice physicians like myself will be burdened even more by increasing government regulation, drug prescription monitoring requirements, and increased costs associated with staffing to address these regulations. We try to tackle these head-on as they arise so that we don't have to spend even more time trying to 'catch up' as the regulations become more complicated and restrictive to patient care. Over the next three years we are expecting this to increase unless much-needed deregulation is enacted by our government.
Kristopher Kimmell, MD. Neurosurgeon (Rochester, N.Y.): It is clear that the trend of the last few years has been driving physicians to do more with less. Reimbursement rates are falling, indications for surgeries are tightening, and many surgeons are finding themselves beholden to larger and larger institutions and stakeholders. Surgeons must find ways to work smarter, not harder, by familiarizing themselves with rapidly evolving healthcare policy as well as digital technologies.
I subscribe to a wide variety of outlets reporting on changes in healthcare technology and policy and am actively involved in my specialties societies in order to 'keep my ear to ground' on policies coming down the pipeline that affect my patients. The only way for physicians to combat policies that are unfriendly to our patients is to be informed and speak up.