Teresa Copeland serves as director of payer contracting and surgical services at Knoxville-based OrthoTennessee.
Ms. Copeland will serve on the panels "Prior Authorizations, Denials and More: Big Payer Trends in Spine and Orthopedics" and "How to Build a Sustainable ASC Budget When the Future is Uncertain" at Becker's 19th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place in Chicago from June 16-18.
To learn more and register, click here.
Question: What issues are you spending most of your time on today?
Teresa Copeland: Most daily issues are related to prior authorization requirements. The criteria requirements per payer and their third-party administrators are changing daily. These third parties have become continually more inflexible in working with providers. This is extremely disruptive to patients when they have already made their preparations for their surgery, like taking time off work and making arrangements for their kids and pets.
Q: What are your top challenges and how will they change over the next 12 months?
TC: My top challenges go as follows:
- Prior authorizations — As discussed above.
- Limited ASC availability for procedures — We need fewer hospital outpatient procedures and more ASC procedures, which are proven to improve cost and convenience for the patient.
- Limitations/cost of staffing — There is a growing competition in the community outside of healthcare. Nowadays, people can elect to work at a grocery store at the same rate without the stresses of healthcare.
- Supply chain issues — The main challenges involve the availability and cost of medications and supplies.
- Disparity of reimbursement between hospital outpatient and ASCs as well as the cap on patient out-of-pocket expenses in the hospital setting, which does not exist in the ASC. This makes the lower-cost site of service, the ASC, cost the patient more for higher-cost procedures. This is a particular concern as higher-acuity procedures move to the ASC — the facility is paid significantly less but the patient pays more.
Q: How are you thinking about investments and growth in the next two years?
TC: The growth I imagine is additional ASC/office surgery space. The ability to create this space takes both time and funds, and since we're in a [certificate-of-need] state, it takes three or more years to develop this space. We are continually looking at the most appropriate service site for procedures involving moving total joints and spine to the ASC and interventional spine and hand procedures to the office.
Q: What are you most excited about right now?
TC: I am most excited about the cost and quality of care available to the patient in the ASC setting. Staff and surgeons take pride in offering this option to their patients, knowing they can have the best possible care and patient experience.