Private insurance 'critical' for bundled models to thrive in spine


Bundled payments from private insurers were a viable option for lumbar spinal fusion patients, according to a study published in the January 2024 issue of Spine.

The study looked at lumbar spinal fusion patients from October 2018 to December 2018 who used CMS' Bundled Payments for Care Improvement Advance model, and compared that data with private bundle data from 2018 to 2020 to analyze the transition away from BPCI-A.

"Our healthcare system is undergoing a significant shift towards value-based models, and bundled payment programs are an integral tool in this transformation," Alexander Vaccaro, MD, PhD, and Jose Canseco, MD, PhD, who were authors in the study, said in a statement to Becker's. "The use of bundle payment strategies have sputtered recently under government oversight as its intended goal of reducing costs ultimately led to a race to the bottom in terms of reimbursement, making care for the sick and elderly more difficult due to associated costly comorbidities." 

The study found readmissions fell under private bundled payment models compared with CMS' Bundled Payments for Care Improvement initiative. The net surplus was lowest in 2018 but didn't differ between the years in private bundles. 

Researchers concluded that bundled payments can be successful in lumbar spinal fusions and that "constant price adjustment is necessary so bundled payments remain financially beneficial to both parties and systems overcome early losses."

"[Bundled] payments have recently started to gain traction in the private insurance realm," Dr. Vaccaro and Dr. Canseco said. "As suggested in our study, partnering with private insurers is crucial for the success of these models. By working together, healthcare providers and payers can achieve the ultimate goal of improving patient care while also achieving financial success in a healthcare environment with ever-rising costs. Risk stratification adjustment tools will have to be a key feature of these new bundles in order to allow surgical practices to remain financially viable while attempting to meet the higher demands and associated costs of caring for patients with significant comorbidities."

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