Dr. Alexander Vaccaro: Why Rothman Orthopaedics is dropping out of bundles

Laura Dyrda -   Print  |

Alexander Vaccaro, MD, PhD, is president of Philadelphia-based Rothman Orthopaedics and Chairman of Orthopedic Surgery at Thomas Jefferson University Hospitals.

Dr. Vaccaro has devoted his career to minimally invasive spine surgery and building a leading practice focused on academic research and community engagement. Dr. Vaccaro participated in a fireside chat during the Becker's Spine, Orthopedic and Pain Management-Driven ASC + the Future of Spine Virtual Event on June 19, discussing his outlook for spine, technology and private practice in the future.

Click here to view the full interview on-demand as well as access several other fireside chats, panels and workshops during the event.

In this excerpt, Dr. Vaccaro talks about value-based care and the emergence of telehealth in spine today. Note: responses are edited slightly for clarity.

Question: What is your view on bundled payments and value-based care in spine? I know Rothman was an early adopter; how are you thinking about it now and what's on the horizon?

Dr. Alexander Vaccaro: We go through stages. We were in bundled payments for the last 10 years, and we did great. We had shared savings with the insurance company and with the hospital. What happens is the growth changes every year; the better you get the more difficult it is to save money, so we're now bottomed out. In the federal government and a lot of their value-based systems, we're actually dropping out a lot of them because we can't get any more efficient.

We can get a hip fracture to the operating room within 24 hours and we can get them out of the hospital to a rehab or a home within one to two days; we've done everything. We looked at everything that we could to sort of squeeze out any inefficiencies. The next step is population-based medicine where you do per patient, a per member per month, per member per year arrangements.

The low hanging fruit now is with the technology with telemedicine, as long as all the players are aligned and they say, listen, this telemedicine, you're delivering the same amount of care, the same value of care to the patient. We're going to now share the savings if they do that, that's a big one for value-based healthcare. … We have to be aligned with the insurance company for the right care at the right time for the right person. If they come back and they cut that value in half or 75 percent, then what's going to happen? Physicians aren't going to use telemedicine and we're going to lose our opportunity for value-based care. As long as we're aligned and no one over-leverages there, we can continue to decrease the spend for healthcare.

Q: How do you think the pandemic will change the spine field and healthcare overall?

AV: Well, I think we're going to become much more efficient in accessing the appropriate care at the right time. You want every person on your team to live up to the license, and what I mean by that is a medical assistant, a PA, a resident fellow, an attending, a professor, an expert. Right now we have clinics that we see, like say one day you see 35 to 45 patients and maybe four will need surgery. Well, the best world would be the surgeon sees the surgical patients, the non-operative people see the non-operative patients and those that just need screening for back pain, get evaluated by the PA. We can do interviews with patients using telehealth, so you call up front for an appointment and I could sit down and I could talk to you.

I believe strongly that 80 percent of the time I can make a diagnosis appropriately through telemedicine, without ever seeing the patient, watching a patient through their visual examination online. So it's going to change the world; no longer will we have those barriers to care. Because of 1135 waiver, I'm doing telemedicine with people in different states, because there's no state boundary anymore. [When the waiver expires] I won't be able to do that anymore, but it is phenomenal what we can do with telemedicine.

That's how spine surgery will change, will be much more efficient, be less likely to get burnt out, be more resilient because we're doing things we really love to do. I'm exercising to the level of my license. The PA is doing exactly what he or she wants to do. So that's going to be the change I see in spine surgery.

More articles on spine surgery:
The next big breakthrough in spine: 5 surgeons share insights
'I anticipate our field will be a lot in flux': Dr. Cynthia Emory on difficult decisions, big trends in store for spine
The most essential technology in spine and orthopedics post-pandemic — key concepts and big ideas

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