8 bundled payment considerations for spine surgeons + 5 strategies to prepare for the future

Practice Management

Ellis Knight, MD, senior vice president and CMO of Coker Group in Alpharetta, Ga., says there are eight key factors for spine surgeons to consider before jumping into bundled payments. Dr. Knight discusses these factors and five ways surgeons can deliver higher quality, cost-effective care in healthcare's value-based reimbursement model.

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:


  1. Inclusion and exclusion criteria – which procedures will be included in the bundle and which won't.
  2. Patient selection criteria – which patients will be excluded from the bundle based on clinical criteria, e.g. co-morbid conditions.
  3. Location of surgery – will this include inpatient and outpatient surgical services?
  4. 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.
  5. Cost accounting of the care processes and procedures, ideally using a time-driven, activity-based, cost accounting (time-driven activity-based costing) methodology.
  6. 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.
  7. Network formation – who will be in the narrow network surrounding the bundled services – surgeons, anesthesiologists, hospitals, post-acute care providers etc.?
  8. 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:


  1. Care mapping
  2. Application of evidence-based, best practices to care processes and procedures
  3. Cost accounting – using techniques such as time-driven activity-based costing
  4. Continuous data-driven, process improvement, wherein value can be steadily increased through an iterative process over time
  5. Marketing of bundled services

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