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Payers in spine surgery: A changing dynamic

By Admin | March 05, 2022

Question: How has the payer landscape evolved in your market over the last five years? What do you expect in the future?

Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): The market is constantly changing in California. There has been a relative balance of managed care, private payer and government payer systems. Attempts have been made to go to a one-payer system, but failed again this year in the California State Senate. I do not anticipate that will change in the near future.

What we are seeing, however, is the progressive trend toward bundles and moving on from there to globalizing care. It is approaching the spine market quickly. We have begun a program with several payers to globalize our payment, including the surgical center, physicians involved, anesthesia, surgeon and assistant, as well as all costs of the event of care. This program has become very popular with the payers and is expected to expand quite quickly in the commercial market.

Ultimately, the managed care market will likely move to the same type of scenario, whether that is instituted through hospitals or clinical groups, in an effort to mitigate the risk by having a global event with a known price tag and quality outcome. The movement will happen first through...(More)

For more info please read, Payers in spine surgery: A changing dynamic, by Becker's Spine Review

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