Glenn Sabin on the status of third party payment for group services

Integrator editorial adviser and integrative center consultant Glenn Sabin of FON Therapeutics recently remarked via e-mail that he is exploring reimbursement for group-delivered services for a large, integrative orthopedic center with which he is consulting. I invited him to share some of what he is finding. Here are Sabin’s comments:

“This is what I am finding as I build the clinic and business model for a very large orthopedic surgery practice in Florida. Reimbursements vary across the country based on the deal made between the payer and provider. CMS varies some as well across the country. So my focus is on MSK-musculoskeletal-for this client.”

by John Weeks, Publisher/Editor of The Integrator Blog News & Reports

Glenn Sabin on the status of third party payment for group services

Integrator editorial adviser and integrative center consultant Glenn Sabin of FON Therapeutics recently remarked via e-mail that he is exploring reimbursement for group-delivered services for a large, integrative orthopedic center with which he is consulting. I invited him to share some of what he is finding. Here are Sabin’s comments:

“This is what I am finding as I build the clinic and business model for a very large orthopedic surgery practice in Florida. Reimbursements vary across the country based on the deal made between the payer and provider. CMS varies some as well across the country. So my focus is on MSK-musculoskeletal-for this client.”

Sabin continued: “There are numerous ways to approach group clinic visits. If you have enough patients and can achieve economies of scale, the reimbursements can work OK for primary care.  Not so much for more highly compensated specialists, i.e., orthopedic surgeons. Have found nothing re: group acupuncture, but even at self-pay it would seem to work well economically for both patient and practitioner.”

Sabin then provided these specific details: Group Clinical Visits Focused on lifestyle/pre-surgical; co-morbidities: diabetes, heart disease, obesity, and hypertension. Medicare: $0 (no guidelines or fee schedules); Private Insurance: $14 CPT 99078; no time published (BCBS (counseling and education by a physician to a group) physician or otherwise certified provider (RD, RN, PA) with training in group settings. Scribe needs to be in room during sessions; Medical Nutrition Therapy-Group (CPT 97804; RD led); Medicare: $15.62 per person, per 30 min session, Private Insurance: $14.74 (BCBS); and Exercise Counseling: Group (CPT 99411: 30 min; 99412: 60 min) Medicare: No fee schedule or guidelines available Private Insurance: $16.58 (11); $22.20 (12) (BCBS; no coverage guidelines available). Sabin also noted that he has been exploring the work of the “guru of group visits” Ed Nofzinger, PhD, the former Kaiser lead in developing group services in an HMO environment.

Related post: Sabin recently posted The Best Clinic and Business Model for Integrative Medicine on his FON Therapeutics site.

Comment: Great details, if evidence to date suggests that they are clearly under-appreciated for their potential value to meeting the Triple Aim. Notably, the single integrative health and medicine PCORI grant reported by Taylor Walsh, above, is for integrative medicine group visits. A good sign.