Will spine payments be capped?

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.



Josh Sandberg

Josh Sandberg is the President of Ortho Sales Partners and Partner for The De Angelis Group. He also serves as Co-Founder and Editor of OrthoSpineNews.

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