John Finkenberg, MD, serves as director of San Diego-based Alvarado Spine Center and on the board of directors at the North American Spine Society.
Dr. Finkenberg will serve on the panels "Payer Behavior: The Good, Bad and Intriguing Trends for Spine and ASCs" and "Capitol Hill Update: What to Expect From CMS, Midterm Elections and More" at Becker's 19th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place in Chicago from June 16-18.
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Question: What issues are you spending most of your time on today?
Dr. John Finkenberg: NASS and I are spending most of our energy on issues regarding treatment authorization. More than 30 percent of our physicians report serious adverse events due to prior authorization requirements. We are noting prior authorization for treatments that are nonsurgical, such as prescribing tramadol. It is no longer appropriate to treat a patient before they show neurologic deficits that have been present for an extended period of time. Obviously, this puts the patient at risk of obtaining an outcome that is less than ideal, even with a perfect surgical procedure.
We are also following the continued threat of decreasing Medicare reimbursement. Despite multiple patches to [the Medicare Access and CHIP Reauthorization Act], physicians have still received a 20 percent decline in reimbursement when adjusted for inflation. This does not mean much to anyone until they hear that the cost of running a medical practice has increased by 39 percent. Overhead is now approximately 60 percent of a physician's gross income. This continues to rise due to the need for ancillary staff to call in for prior authorization and wait on hold for an hour until they can request the authorization.
Surprise billing is also a concern, and NASS is adamant about holding the patient harmless and keeping them out of the problem created by narrow networking and forcing physicians to accept contracts that are not adequate to sustain their practices. Many physicians take ER calls to help their hospitals, but these volunteers should not be required to accept payment for their services at unacceptably low levels. Arbitration and utilization of the median costs of all insurers in a region are reasonable, but it cannot be the median of the lower-reimbursing insurer only.