Dr. Knight will be speaking at the Becker’s 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference. To learn more and register, click here. Contact Maura Jodoin at mjodoin@beckershealthcare.com or Kristelle Khazzaka at Kkhazzaka@beckershealthcare.com for further information about sponsorship and exhibitor opportunities.
Questions: What should spine surgeons consider before pursuing a bundled payment?
Dr. Ellis Knight: Key considerations prior to pursuing bundled payments include the following items:
- Inclusion and exclusion criteria – which procedures will be included in the bundle and which won’t.
- Patient selection criteria – which patients will be excluded from the bundle based on clinical criteria, e.g. co-morbid conditions.
- Location of surgery – will this include inpatient and outpatient surgical services?
- Mapping of the care processes and procedures involved and ensuring that these include evidence-based, best practice components and exclude non-value-added care steps, i.e. those that add costs but don’t improve quality or patient experience.
- Cost accounting of the care processes and procedures, ideally using a time-driven, activity-based, cost accounting (time-driven activity-based costing) methodology.
- Selection of quality and patient experience outcome measures and how these will be captured, aggregated and reported to payers, regulators and most importantly to front-line providers for use in continuous, data-driven, process improvement activities.
- Network formation – who will be in the narrow network surrounding the bundled services – surgeons, anesthesiologists, hospitals, post-acute care providers etc.?
- Marketing of spine surgery bundles – who will be the target market for these services – payers (government and commercial), employers (self-insured), ACOs or clinically integrated networks (via wrap around agreements).
Q: How is the field of spine surgery changing to keep pace with healthcare’s transition to value-based care?
EK: Like other specialties, the overarching imperative in spine surgery today is to reliably deliver high quality (as measured by true outcome measures) in as cost efficient a manner as possible (by eliminating non-value-add costs as outlined above). To do this spine surgeons will need to master the following capabilities:
- Care mapping
- Application of evidence-based, best practices to care processes and procedures
- Cost accounting – using techniques such as time-driven activity-based costing
- Continuous data-driven, process improvement, wherein value can be steadily increased through an iterative process over time
- Marketing of bundled services
