The Cost of Spine Care: 5 Factors Surgeons Can Impact


Paul Huddleston 2Around 80 percent of Americans will suffer from back pain at some point in their lives and it's estimated that back pain costs more than $90 billion per year in lost productivity and work days, according to an ABC News report.


"Spine care addresses one of the most common, often painful and certainly expensive treatments existing," says Paul Huddleston, MD, of Mayo Clinic in Rochester, Minn. "With tremendous variability in how that care is delivered and the very high frequency of occurrence, spine care and its surgical components are a 'must do' to remain fiscally responsible."


True change requires leadership and takes a great deal of time to really show benefit. Dr. Huddleston and his colleagues at Mayo Clinic participate in the High Value Healthcare Collaborative and additional studies that describe factors surgeons can impact to make spine care more sustainable in the future:


1. Increase patient and family engagement. The High Value Healthcare Collaborative is about impacting three areas for patients with spine conditions, including engagement. Their goal is to engage more than 50 percent of the eligible patients referred to patient engagement interventions and promote shared decision making. "The project is in its late implementation phase and our early results look positive and we are hopeful that we will exceed our goals," says Dr. Huddleston. "Ultimately we would like to refine the interventions and meaningfully diffuse the success through the enterprise and HVHC."


2. Improve health status measures. The Collaborative aims to improve health status measures such as function and pain for more than 50 percent of patients considering spine surgery at one year. Dr. Huddleston sees care shifting from procedure-based care to condition management as the payment models and professional focus changes.


"Trends will be toward the development of more creative delivery models involving allied health personnel, payment models favoring bundling of reimbursement based on the global management of a condition such as spinal stenosis, not just the procedure of surgical decompression," he says. "Additionally, we will see increasing bonuses (for compliance) and eventually penalties (for deviation) from care guidelines."


3. Reduce costs of spine care. The Collaborative hopes to reduce the rate of spine surgeries and episode utilization which could result in a 5 percent total cost reduction. Patient selection is a key component to providing the best care possible for the patient, but patients sometimes visit spine surgeons when another specialist is better equipped to care for their needs.


"As spine surgeons, we can be familiar with the entire spectrum of interventions and education for spine care and can have credibility with both primary care providers and proceduralists, from creating educational interventions to standardization of the most technical procedures," says Dr. Huddleston.


4. Fusion materials. Implants and other materials are a huge contributor to overall cost of surgical care. Bone graft substitutes to promote fusion can be expensive and harvesting bone from the iliac crest is associated with increased morbidity. However, Dr. Huddleston and his colleagues recently published a study on using femoral head from patients undergoing total hip arthroplasty for spinal fusion as a source of allograft bone.


"We are directly responsible for decisions involving the most expensive procedures in the spine care value stream and can be important influencers about the appropriate use of these tools," he says.


The average cost of femoral head allograft is $435 for processing the tissue, resulting in $8.70 per cubic centimeter of allograft product. The researchers found this solution cost-effective when compared to commonly available bone graft substitutes, which has an average cost of $60 to $178 per cubic centimeter.


5. Better spine service organization. The current organization of many hospital departments and clinics contributes to unsustainable healthcare. Many providers are organized by departments, clinics and hospitals instead of by service line, which causes issues. "Lack of communication and integration causes duplication of services and distracts from providing the best value (quality, safety and satisfaction at the lowest possible cost over time) to the patient," says Dr. Huddleston. "Financial incentives will need to be aligned by outcome not just procedure to have a meaningful effect towards increasing value."


More Articles on Spine Surgery:
30 Hospitals With New, Expanded Spine Services
Association of Bone and Joint Surgeons Names Dr. Todd Albert Board Member
Zyga Enrolls 1st Patient in SImmetry SI Joint Fusion Study: 5 Observations


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