What surgeons are saying about value-based care

Practice Management

Value-based care has been a hot topic among spine and orthopedic surgeons. While some see promise in the way patient care can be delivered, many say there's still room for improvement.

Here are five quotes from Becker's articles on value-based care this year:

1. "Value-based care holds each and every physician accountable for their diagnosis, plan of care and ultimate outcome for their patients on a case-by-case basis. The cost is more effective than ever for both the patient and the healthcare system as a whole. To improve effectiveness of the value-based care model, it is important for each practice to undergo in-depth data collection and analysis. This level of analysis of data is essential to improving value-based care in orthopedics." — Ammar Saymeh, DPM, of NJ Spine and Wellness in East Brunswick, N.J.

2. "Value-based care must better align with specific CPT coding, as there is great variation in surgical procedures, especially in deformity surgery, where number of levels or complexity is not factored into bundle reimbursement. Costs also vary dramatically across locations, yet the impact of geography on reimbursement is not fully factored into CMS bundle cost. Lastly, technology advancements, which may result in improved patient outcomes, is actually penalized financially, as it is considered an additive cost, which is actually counterproductive to value-based healthcare." — Alex Vaccaro, MD, PhD, of Philadelphia-based Rothman Orthopaedics 

3. "From my perspective as a spine surgeon, I have not found any of them to provide any actual value to my patients. Instead, I approach each patient individually, determine the exact diagnosis and create a treatment plan that is most medically appropriate and takes into account their living situation and financial resources. I spend a significant amount of time with each patient to explain the nature of their problem and how and why the proposed treatment plan can help them. This ensures proper compliance, best clinical outcomes and highest patient satisfaction. I cannot imagine anything more valuable than that in patient care." — Vladimir Sinkov, MD, of Las Vegas-based Sinkov Spine Center

4. "For value-based care to succeed at a large scale, there must be collaboration among the various stakeholders that are involved in care today. Engagement of both commercial and government payers is essential to build programs for reimbursement that will adequately measure and reward quality care. Engagement of providers is critical as this transition will be massively more successful if the needs and challenges that providers face are met on the front end. Engagement with high-quality provider groups that have invested in value-based care is also important, as many of the lessons these forward-thinking organizations have learned will help guide this transition." — Brian Larkin, MD, of Denver-based Orthopedic Centers of Colorado

5. "At one point, I thought [bundled payments] was the future. We were all in to measure and get our metrics prepared for this. In spine, it has been a lot of fits and starts; it hasn't really panned out. Total joints are pretty uniform; every total hip replacement looks about the same. Spine is just a different animal. A bundle for a lumbar fusion up to five levels encompasses so many different pathologies, and the economics of those are so different. We have tried within our group to be part of Medicare bundles and accept different types of care, and that has been difficult to do in spine. It hasn't really taken off like it has in joints and other areas of orthopedics. I still think the principle of value based care will stay, there is no doubt, but it's a tough thing in spine to execute. Obviously, payers want to move away from fee-for-service, and we at the same time have to prove the value of what we do. But formal value-based programs have been very elusive in spine. I think we should collect data, and it's important that all practices do it. If you don't you'll be in trouble. But is it going to be the way of the future that people have talked about? I'm less certain of that than I might have been three or four years ago." — Frank Phillips, MD, of Chicago-based  Midwest Orthopaedics at Rush 

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