3 spine surgeons discuss bundled payments — The key trend in spine reimbursement

Anuja Vaidya -  

Three spine surgeons discuss the key trends in spine reimbursement today.

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: What are key considerations for small/solo practices that wish to remain independent?


Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Aug. 17, at 5 p.m. CST.


Question: What are the most important trends in spine reimbursement?


Jeffrey C. Wang, MD, Chief, Orthopedic Spine Service, Co-Director USC Spine Center, Keck Medical Center of USC, Los Angeles: The introduction of bundled payments will ultimately affect spine surgery and result in centers improving their efficiencies in order to survive. We have seen this with our total joint arthroplasty colleagues, and l believe it is a matter of time before they are prevalent for spine surgeries. In preparation, practices need to streamline their workflows and efficiencies to provide the most cost-effective and safe pathway for the patient to get from preoperative clearance all the way through the postoperative period. Studies show that cost-effective and streamlined pathways can be more efficient and result in fewer complications, which is necessary to work within the bundled payment model. Although the bundled payment model does not account for extreme cases, it does motivate centers to take a hard look at their practices to make things more efficient.


Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Two words — bundled payments. They are coming, and I think surgeons should align themselves with good quality surgery centers and share in that environment. I think working with hospitals can also be productive, provided the terms of disbursement are clear, and worked out well ahead of time.  There should be a functioning and defined grievance process in case a physician feels his portion may have been arbitrarily diminished.


Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: There are several different trends that are negative. There are increasing numbers of patients requiring surgeries that are being deemed experimental and hence, care is denied. This form of rationing is affecting overall case volumes, which do impact overall reimbursement. This important trend is likely to continue until it awakens a largely unaware public of the situation. These folks will either have to go without treatment or they will have to find a facility able to provide high value for the services. That leads to the next issue which is bundling of the surgical episode into one payment. CMS has already done that for joint replacements and spine is on the horizon. Look for rates to potentially drop again as this will create an end sum game for those heavily operating in the hospital setting. It provides for an opportunity however, for those in an ambulatory setting as they can provide value and may be able to capture larger market share.


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