How spine surgeons approach outpatient payer negotiations

Outpatient spine surgery is growing in popularity, but payer response has varied.

Spine surgeons in three markets discuss how they manage.

Note: Responses were lightly edited.

Question: How do you approach payer negotiations — particularly with commercial plans that may be resistant to the shift from inpatient to outpatient for spine?

Richard Kube II, MD. Prairie Spine & Pain Institute (Peoria, Ill.): Our approach has been to work with commercial plans that are self-funded and self-insured. We have the ability to provide a bundled payment model whereby all costs are known up front. There is a distinct path to payment, so our overhead is minimized. Those savings are passed to the employer who owns the plan. We save tens of thousands of dollars on average per spine surgery as compared to our regional hospitals. We no longer bother speaking to the traditional commercial insurance plans. Most people don’t realize that the insurance carriers have a financial incentive to keep costs higher. They are not motivated to make a good faith effort to negotiate contracts with medical facilities and providers that dramatically cut costs.

Vladimir Sinkov, MD. Sinkov Spine. (Las Vegas): In my area, I have not had any difficulties with payers’ approval on taking my spine cases to an outpatient setting. They seem to welcome it and understand the cost savings combined with improved efficiency and safety of care that can be achieved in an outpatient setting for properly selected spine surgery cases.  

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Being employed for a large health system affords the advantages and leverage of a large multispecialty group to negotiate with perennial consistency and continued success. Complex spinal patients who (may) require additional medical interventions or protracted length of stays find accommodation through the larger, better equipped healthcare systems. Case by case submission with requests for inpatient admission status based on surgical complexity and accompanying comorbidities is indvidually done and usually approved without much push back. The cultural shift is outpatient surgery, the new countercurrent approach is inpatient or extended admission.

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