Emerging partnerships and payer strategy shifts are creating new dynamics for outpatient spine practices, according to healthcare leaders interviewed by Becker's ASC Review.
Three insights on changes in the field:
John Lewis, CEO of Memphis, Tenn.-based Semmes Murphey Clinic: Payers are more willing to negotiate with us knowing that we can provide value-based care options. Our value-based model of care includes not only cost savings but higher-quality outcomes and quicker recovery times. One of the unique things about our practice is that we are one of the largest contributors to the quality outcomes database spine registry, which serves as a continuous national clinical registry for the most common neurosurgical and spine procedures. This has given us the ability to not only negotiate with third-party payers, but we are also able to identify practice gaps through established benchmarks, meet merit-based incentive payment system reporting requirements and be a part of structured quality improvement projects.
DeeDee Dalke, solutions consultant at ASC management software company Simplify ASC: More specialty-only centers moving to multispecialty status is another opportunity on the horizon, but only where it makes sense. … We're also seeing more partnerships emerge to offer care from all sides: A joint or spine program might include the physician, at-home care post-procedure, physical therapy and the ASC all partnering together to offer more coordinated care, which will help lower costs and boost the quality of care.
Joy Taylor, COO of Polaris Spine & Neurosurgery Center in Atlanta: [Our spine center has] two primary challenges: the payer environment and costs. We are experiencing what has been described by so many well-established centers as increasing scrutiny of out-of-network claims and payments. Further, as insurance plan design has shifted more of the burden to patient consumers, we find ourselves in the position of having to provide more financial counseling to patients, to ensure they are informed of and comfortable with the costs of their care, and then collecting on their expected balances.
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