Here five spine surgeons discuss whether the spine industry will soon see a bundled payments initiative from CMS.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
Next week's question: Is it still possible for smaller spine practices to thrive, or do these practices need to consider merging or turning to hospital employment?
Please send responses to Anuja Vaidya at firstname.lastname@example.org by Wednesday, Jan. 20, at 5 p.m. CST.
Question: Last year, CMS finalized a bundled payments initiative for hip and knee replacements. Do you see a similar initiative for spine coming down the pipeline in the future?
Scott Blumenthal, MD, Texas Back Institute, Plano: I think the intent for bundled payments in spine is there, but due to the heterogeneity of spine procedures it will be difficult, though not impossible, to figure out. There are so many ways to treat a spine condition and it would be difficult to figure out a way to bundle payments. I anticipate there will be some resistance.
Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: Yes. I think it will be viewed as another way to cut costs. It will also be viewed as a way to decrease the number of parties at the negotiation table. Smaller groups can get left out of the bundled payment talks when super-providers (huge hospital and practice conglomerates) carve up the business. I believe [CMS] sees it as a way to drive more providers into employment which, based on their actions, seems to be a goal. It will be important for providers to collect data and be able to support their roles as this movement matures.
William Taylor, MD, Director, Spine Surgery, Vice Chairman, Division of Neurological Surgery, University of California, San Diego: Yes, we are going to see this extend into all areas of healthcare. This can be beneficial for spine surgeons if we concentrate on episodes of care. Surgical intervention remains a cost-effective solution for all types of spine diagnoses. There is little evidence that conservative management for many episodes offer improved outcomes that are sustained.
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Unfortunately, yes. The trend for the healthcare system has been oversimplification of surgical care within the system and perpetually forcing square blocks into round holes. My hope is our professional organizations will make a serious effort and make the government play fair, or toss it out for spine altogether.
Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: Sure, in the next three to five years maybe. But anytime reimbursement goes down it is never a good thing.