Managed Care

 

Occupy the OR

Occupy the OR

Steven Peskin, MD

Leaving the gym on an unseasonably warm night, I struck up a conversation in the parking lot with a vascular surgeon acquaintance. He recounted a technically demanding procedure that he had done the day before with a reported 10 percent risk of stroke and a 3 percent mortality risk.

The two-stage procedure was optimally done in one trip to the OR with two surgeons involved in the several-hour two-stage surgeries. My acquaintance commented that his reimbursement and that of his colleague came to about $70 an hour — and that does not include the 90 days of post-op care associated with the reimbursement for the surgery.

In the reimbursement of medical services, complexity abounds: new technologies or the application of existing technology in new ways; the supplanting of one modality for another; efforts to tie reimbursement to performance, outcomes, and/or quality.

This surgeon mentioned that he could have done the two-staged procedure as two separate surgeries and been reimbursed considerably more. I am heartened to know that he did what he perceived to be best for the patient versus his kids’ college fund. He also commented on witnessing interventional internists and surgeons who elected to separate procedures, for example, diagnostic cardiac catheterization followed by PCI, versus completing both in one trip to the cath lab.

Despite the enthusiasm that many of us share for the medical home and other forms of value-based reimbursement, there is still plenty of work to be done to rationalize the blocking and tackling in the still-dominant fee-for-service payment model.

Steven R. Peskin, MD, MBA, FACP is executive vice president and chief medical officer of MediMedia USA, which publishes Managed Care. He is Associate Clinical Professor of Medicine at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014