9 changes surgeons say will spur adoption of spine bundled payments

As reimbursement continues to decline and the cost of running a practice becomes more challenging amid rising inflation and staffing difficulties, more independent practices are anticipated to dip their toes into the world of value-based care, seen by the federal government as a viable route to reduce national healthcare spending.

While bundled payment models have found success in joint replacement, spine surgery is seen as a different animal because of the challenges with case complexity and the distribution of risk.

Here are nine updates surgeons argue would increase the adoption of bundled payments in spine surgery: 

1. Spine bundles should be reflective of diagnosis-related groups, which can vary drastically, Alex Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, told Becker's.

"The average DRGs for cervical and lumbar surgical cases vary significantly, from $11,000 to over $100,000 for the same diagnosis, yet these differences in costs are not reflected in current CMS bundled payment reimbursement schemes," he said.

2. Carve-outs are necessary for high-risk patients, and bundles should have exclusions for complications out of the surgeon's control, Philip Schneider, MD, spine surgeon at The Centers for Advanced Orthopaedics in Bethesda, Md., told Becker's.

3. Payers must be more transparent about data to ensure a fair bundle, so surgeons can take on the risk.

4. Standardizing payment across multiple vendors would increase the adoption of spine surgery bundles, which are ideally suited for ASCs, Robert Bray Jr., MD, of DISC Sports & Spine Center in Newport Beach, Calif., told Becker's

"Prices can be fixed for implants per case type and standardization of cost per case can be developed across surgeons with a particular emphasis of excluding waste (i.e., we did not need to use three biologics on a single-level fusion case)," he said.

5. Spine surgeons must be able to manage all parts of the bundle — including who cares for the patient and their rehabilitation — to ensure the most cost-efficient and highest quality care. 

6. Spine surgeons must organize and provide leadership for the most basic procedures and push back against complex procedures being included in any type of bundle payment or value-based model, Andrew Hecht, MD, of Mount Sinai Health System in New York City, told Becker's.

7. ASCs should serve as anchors for bundles when clinically appropriate. 

8. Better acceptance of spine surgery bundles will depend on reimbursements as all patient outcomes are outlined and expected, Christian Zimmerman, MD, of St. Alphonsus Medical Group and SAHS Neuroscience Institute in Boise, Idaho, told Becker's.

"More cuts will create less willingness to treat patients and disparate patient populations will continue," he said.

9. An independent ombudsman or a union could be implemented to advocate for the proper apportionment of payment to physicians rather than middle management or administrators, according to Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles.



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