What Payer Relationships Will Look Like in 2 to 5 Years

At the 20th Annual Spine, Orthopedic + Pain Management-Driven ASC Conference, attendees had the opportunity to join in on a keynote panel discussion about what payer relationships will look like in the next 2-5 years.

The panel was made up of four industry veterans and was moderated by Laura Dyrda, Vice President and Editor-in-Chief of Becker's Healthcare. 

The panelists included 

  • Jacob Rodman, Chief Executive Officer, Raleigh Neurosurgical Clinic
  • Michael Redler, MD, Orthopedic Surgeon, Connecticut Orthopaedics
  • Robert Tatsumi, MD, President, Oregon Spine Care 
  • Adam Bruggeman, Chief Executive Officer, Surgeon, Texas Spine Care Center

Together, they discussed the challenges and opportunities that lay ahead in the upcoming years for payer relationships.

Key Takeaways:

1: Payer relationships are changing and physicians need to be persistent in advocating for their patients.

The panelists discussed how payer mix is changing and how payers are challenging physicians when it comes to patient care. In order to win, physicians need to be persistent and advocate for their patients.

2: Value-based care is the future and physicians need to manage a team in order to manage risk. CMS is still figuring out how musculoskeletal care fits into this paradigm.

The panelists agree that value-based care is the future and physicians need to manage a team in order to manage risk. CMS is still figuring out how musculoskeletal care fits into this paradigm, so physicians need to be prepared for potential cuts to the physician payment schedule and be aware of bills that could affect their reimbursement.

3: Physicians need to focus on demonstrating great metrics and vertically integrating care to get the most from payer negotiations.

Dr. Redler believes that in order for ASCs and surgeons to get the most from payer negotiations, they need to demonstrate their outcomes by having great metrics and vertically integrating care. They should also focus on providing lower cost, high quality care, and they need to differentiate themselves through low infection rates, low readmission rates, and a low use of implants.

4: Collecting data and joining registries is important for influencing contracts and reducing prior authorization.

The panelists suggest that collecting data and joining registries can help physicians influence contracts and make the most out of the fee for service model. Utilizing the registries can also help reduce prior authorization.

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