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Gurvinder Deol, MD, is an orthopedic spine surgeon at Wake Orthopaedics based in Raleigh, N.C. His practice focuses on minimally invasive spine surgery, and in 2016, he was president of the North Carolina Spine Society.

Here, Dr. Deol discusses the reimbursement challenges for spine surgeons today and the big trends he's seeing in value-based care.

Question: What are the biggest reimbursement challenges for you today? What is the payer landscape like for your practice?

Dr. Gurvinder Deol: The healthcare atmosphere particularly in spine continues to evolve. One of the evolutions that continues to plague our day-to-day operations and ultimately infringe on the appropriate continuum of care is the increasing difficulty to maintain an efficient authorization process. Payers continue to increase the complexity of obtaining procedural authorizations thus delaying the process and creating obstacles and miscommunication that leads to a lengthy denial and appeal process. We are in-network with most government and commercial payers and their associated plans.

Q: Where do you see the biggest opportunity for bundled payments and other risk-based contracts? Have you considered them for your practice?

GD: Continued collaboration with systems to provide joint venture opportunities that create valuable buy-in for both physicians and systems will drive efficiency and open up avenues for additional risk-based contracts supported by joint savings. Currently, I'm not offering a bundled payment program for spine, but we have started these discussions for total joints and various other surgical specialties. The key will be establishing the appropriate balance between efficient patient care, buy-in from all parties and ensuring fees are not driven to an unreasonable low, as well as a method to assess how much risk we are willing to take.

Q: What changes have you made or are you considering for your practice as healthcare moves toward value-based reimbursement and care delivery?

GD: We have worked with the major system in the area to establish ASC opportunities that provide the playing field for both the system and physicians to drive cost-savings and the highest level of value care possible within a particular market. As payers and competition continue to change approaches, we are working to gather quality, cost and outcomes data that can serve as a key tool in what we anticipate being an increased frequency of discussion with payers regarding cost and how that plays into the true definition of value.