5 key notes on new spine surgery reimbursement models

Spine

A new study published in Spine examines the new reimbursement models in spine care.

The researchers interviewed 24 stakeholders in 18 organizations where 12,000 inpatient spine surgeries are performed annually. The organizations were engaged in bundled payment initiatives for spine and included health systems, physician groups and organizations that help set up the bundle. A large employer was also surveyed.

 

The researchers found:

 

1. Fee-for-service is still the largest portion of the organization's revenue, but several of the organizations expect 30 percent to 45 percent of spine volume to be covered under bundled payments in the next three years.

 

2. The organizations said they underwent bundled payments because of increased new patient volume, surgical yield and financial benefits due to efficiency improvement.

 

3. The current initiatives are heterogeneous but have similar factors and challenges.

 

4. The institutions hesitant to adopt risk-based payments for chronic back care named several factors in their hesitancy, including:

 

• Difficulty modeling risk
• Patient heterogeneity
• Difficulty aligning incentives

 

5. The article authors recommend organizations begin considering reimbursement models focusing on non-interventional spine care.

 

"Payment models outside of the traditional fee-for-service paradigm are emerging in spine care. Providers that preemptively adopt bundled payments can increase patient volumes from payers seeking cost-effective care," concluded the study authors.

 

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