Despite challenges, bundled payments for spine, orthopedics are coming quickly

Practice Management

Government action can feel slow, but when it comes to making inroads on reimbursement patterns, the government as a payer moves pretty swiftly.

"I'm taken aback by CMS and how innovative and aggressively CMS is moving this forward," said Jeff Leland, executive vice president of NueHealth, referring to bundled payments for spine and orthopedics. "This value-based contracting, it's happening quickly."


Mr. Leland and Charles Dailey, vice president of business strategy and development at ASD Management, discussed bundled payments in spine and orthopedics at the Becker's ASC Review 14th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine on June 9 in Chicago.


Mr. Dailey said while bundled payments have largely been focused so far in the inpatient setting, they will become more prevalent in the outpatient setting and in surgery centers to help the initiatives gain economies of scale.


However, challenges to orthopedic and spine bundled payments certainly remain, and there are key questions to sort through before the industry can achieve those economies of scale.


For example, Mr. Leland said there is still some confusion regarding the definition of a bundle and episode of care.


"When does it begin? When you have back pain when the surgeon says, 'We're going to do surgery?'" he said. "Also, when does it end? We need to zero in on what's included in a bundle. Is a skilled nursing facility? Is home health? When does it stop? When does it start? If all of a sudden I can't get paid until we meet six of nine quality metrics, we better agree on how to meet those and track them."


Orthopedic bundled payments are a little more advanced than bundled payments for spine, Mr. Dailey said, but both are quickly advancing despite these challenges.


"This model is upon us, and it's for real," he said. "With that said, there is still a lot of unknown out thereā€¦.Regardless of where this goes, eventually [it's] going to grow and it's going to come our way."


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