CMS’ shift toward greater financial risk is forcing spine surgeons to look beyond the operating room at the systems that could increasingly determine how they are paid. Three spine surgeons discussed why outcomes tracking, patient-reported data and practice infrastructure could become increasingly important as reimbursement moves toward value.
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. Becker’s invites all spine surgeon and specialist responses.
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Editor’s note: Responses were lightly edited for clarity and length.
Question: CMS is shifting more financial risk onto spine surgeons. What are you doing now to prepare, and what do you think most surgeons are underestimating about it?
Bryce Basques, MD. Spine Surgeon and Director of Minimally Invasive and Endoscopic Spine Surgery at Brown University (Providence, R.I.): It is important to start by actually understanding how the model pays and penalizes you: which episodes are included, which and how quality measures get scored. Then measure those things now, rather than finding out where you stand when the reconciliation shows up.
One of the more challenging pieces of the puzzle is collecting patient-reported outcome measures. It is easy to underestimate how hard that is to do well, because it goes beyond simply subscribing to a software platform. Getting robust capture is insanely difficult, and I would advise all practices to start working on implementing a good PROMs capture system now, instead of scrambling before the deadline and potentially getting penalized for poor capture and/or poor outcomes.
Brian Gantwerker, MD. Neurosurgeon and President of The Craniospinal Center of Los Angeles: It is not surprising given the track records of CMS and the folks in charge that they are cutting reimbursement and shifting risk. My advice is to think carefully if you want to be part of the system and maybe look at your options. You are likely underestimating your ability to exist outside of it.
Christian Zimmerman, MD. Spinal Neurosurgeon at St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As a long-term employee of a large national health system, surgical outcomes and administrative metrics define one’s contract and annual dividend. Those risks are much higher for complex-based spine surgery, which includes repeat and salvage operations, caring for the comorbid and the underserved. Patient indices carry weighty decisions and protracted strategies when hospital admission, length of stay criteria and the vexatious patient experience are closely examined. Patient acuity scores can be tailored to one’s ability or desire, also limiting risk and exposure when choices for predetermined outcomes are evident.
Possessing a system of well-staffed, deferential and attentive advanced providers and nurses, who oversee and engage all aspects of the patient’s continuum, is advantageous and expected by colleagues and patients and families alike. Habituation in a surgical center where metric and data surveillance is scant or even dismissed, will be short lived.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
