Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What excites you most about the spine industry at the moment?

Question: What are some strategies that you will implement to deal with declining reimbursements?

 Philip Schneider, MD, Montgomery Orthopaedics, The Centers for Advanced Orthopaedics (Kensington, Md.).: The standard answer to this question in the past has been to increase the use of physician extenders, do in-office physical therapy, do in-office imaging, do in-office DMEs as well as have ownership interests in an MRI, a specialty hospital and an ambulatory surgery center. Many of us have already done some or all of these, although we are always tweaking it. If you have not done this, you definitely should consider these.  

Our strategies have now evolved further. We have merged a large number of practices in Maryland, Virginia and Washington, D.C. to form The Centers for Advanced Orthopaedics. Insurance companies want to work with us because we can supply outcome data, treatment algorithms and quality assurance in order to help them control their costs. Ultimately, this will hopefully lower the cost for patients.

Additionally, as a much larger group, we have now drastically cut our medical malpractice costs and the costs of medical supplies. The local hospital system has also approached us to collaborate on some novel approaches to healthcare delivery.

Although increasing ancillary services in the office and investing in medical enterprises is helpful, the next wave of medical savings will be working with the insurance companies and hospitals, and also significantly controlling the overhead.

Jeffrey Wang, MD, Chief, Orthopedic Spine Service, Co-Director, USC Spine Center, Keck Medical Center of USC (Los Angeles): Our strategy is to deliver a better patient experience but do it more efficiently. More efficient and better care is less expensive, so we are focused on preoperative patient education, more coordination of our perioperative services and better postoperative pathways that will be more efficient, less costly and improve outcomes. We feel the best way to deal with declining reimbursements is to be more efficient and pro-active with our services to decrease the cost of delivering care.

Read more here: http://www.beckersspine.com/spine/item/19654-dealing-with-declining-reimbursements-strategies-from-spine-surgeons