Q: How do you see bundled payments, value-based care and other new payment models affecting spine?
Andrew Freese, MD. Neurosurgeon at Philadelphia-based The Rothman Institute and Suburban Community Hospital (East Norriton Township, Pa.): Of course these new payment mechanisms are affecting and will affect spine. Some of them are legitimate, some are based on cutting costs with no thought about patient welfare. Outcomes are difficult to predict with spine surgery, unlike joint replacement surgery, as spine related issues are multifactorial. Legitimate decisions to proceed with surgery, properly done, should not be punished based on a suboptimal outcome. This will prevent spine surgeons from taking on difficult, elderly, or disabled patients, and make it almost impossible to consider revision surgery.
Harel Deutsch, MD. Associate Professor in the Department of Neurosurgery at Rush University (Chicago) and Co-director of the Rush Spine Center: We have participated in pilot programs for bundled payments but none have been successful so far. I’m not sure if these programs will result in lower costs.
Ciro G. Randazzo, MD: Chief of Neurosurgery at Hudson Regional Hospital (Secaucus, N.J.) and a Physician at IGEA Brain, Spine & Orthopedics: After successful models of bundling for other surgical classes, this will also spread to spine surgery. This will lead to a reduction in the use of hardware with a return to non-fused decompression surgeries and outcome studies directly comparing implants across different manufacturers.
Lali Sekhon, MD, PhD. Chief of Neurosurgery at Renown Regional Medical Center (Reno, Nev.): It will come. Codes are already being bundled. General orthopedics has led the way.
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