Written by Laura Dyrda
Healthcare employers and insurers are adopting or considering several tactics to limit payments for medical services, and since spine surgery can be a high-priced elective procedure, it could be a target going forward.
The price caps seek to limit payments for lab tests, imaging and surgery in “reference pricing” efforts, according to a Kaiser Health News report featured in Medpage Today. Reference pricing already exists for orthopedic procedures in some places — the California Public Employees’ Retirement System implemented reference pricing for elective hip and knee replacements three years ago. Here are three quick facts on the program:
• The insurer would pay $30,000 for surgeries performed within the preferred provider organization plan.
• When patients underwent surgery at a “preferred” hospital for $30,000 for less just paid regular cost-sharing.
• Patients had to pay the difference if an in-network hospital charged more than $30,000.