Spine surgery is one of the big opportunities for value-based care to affect quality of care and cost to the healthcare system.
Here, four spine surgeons discuss the biggest trends in bundled payments for spine and where they see risk-sharing efforts headed in the future.
Frank Phillips, MD. Midwest Orthopaedics at Rush (Chicago): Bundled payments will continue to evolve with the inevitable march away from a fee-for-service model. Bundles are readily managed for spinal procedures with reproducible and predictable outcomes, such as ACDF. More complex treatments, such as surgery for advanced spinal deformity, will remain a challenge in a value-based purchasing system. With increased emphasis on value and transparency, practices' and practitioners' outcomes will become increasingly available to the public, who will become much more sophisticated healthcare shoppers.
Dwight Tyndall, MD. Private Practice (Munster, Ind.): Important trends are the growth of outpatient spine surgery, bundled payments and application of robot technology. The key business challenges spine surgeons will face this year are decreasing reimbursements and access to patients as narrow networks continue to grow. The best opportunity is to show value within bundled care and to capitalize on outpatient spine surgery as a way to contain cost while showing superior patient outcomes and satisfaction.
Paul Slosar, MD. SpineCare Medical Group (Daly City, Calif.): Although it's been on the radar for several years, this may be the year that bundled payment models finally hit their stride. While CMS has adopted a more voluntary posture toward participation, that hasn’t discouraged interest in their Bundled Payments for Care Improvement program, now entering its third year. Commercial payers are following and, in 2018, some will begin with small, selective networks of spine specialists to grow their own risk-sharing programs.
Adam Bruggeman, MD. Texas Spine Care Center (San Antonio): I think it is clear that public and private insurers are increasingly interested in quality over quantity, but they pay based on quantity. With the transition to [the Merit-based Incentive Payment System] and the significant cost pressures, the treatment (operative and nonoperative) of spinal issues will be required to show value for the services provided. The easiest way surgeons will be able to show value is through partnering with CMS and private insurers through bundling in a way that financially incentivizes the physician significantly and also provides the insurance company with cost savings.