Bundled Payment Models in Spine Surgery

Abstract

Study Design: The following is a narrative discussion of bundled payments in spine surgery. Objective: The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery. Methods: Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts. Results: Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine surgery, it is important to understand concepts such as value-based purchasing, episodes of care, prospective versus retrospective payment models, one versus two-sided risk, risk adjustment, and outlier protection. Strategies for implementation underscore the importance of risk stratification and modeling, adoption of evidence based clinical pathways, and data collection and dissemination. While bundled care models have been successfully implemented, challenges facing institutions adopting bundled care payment models include financial stressors during adoption of the model, distribution of risks, incentivization of treating only low risk patients, and nuanced variation in procedures leading to variation in costs. Conclusion: An alternative for fee for service payments, bundled care payments may lead to higher cost savings and surgeon accountability in a patient’s care.

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

“…In addition, hospital systems must evaluate risk allocation as repayment models are defined to avoid financially incentivizing doctors to select for only healthy patients with mild chronic conditions. Furthermore, moving to bundled payment may be complicated for practices that accommodate multiple payer types, as multiple eligibility requirements will have to be met and multiple provider-payer agreements will need to be forged (Heo et al, 2022;Hines et al, 2021;Hurh et al, 2017;Ryan et al, 2019;Stiegel et al, 2021).…”

Profit-Influencing Factors in Orthopedic Surgery: An Analysis of Costs and Reimbursements

“…Spine surgery in particular shows higher fluctuations in profit/loss than other interventions ( Figure 9 ), as well as a higher cost weight with greater variability ( Figure 10 ). Indeed, Hines et al’s narrative review categorize spine patients as very heterogeneous with regard to surgery and postoperative outcomes [ 10 ]. They concluded that bundle payment systems could produce benefits in this surgery subtype, but should be stratified for risks and treatment costs.…”

Price Transparency: The Good, the Bad, and the Ugly

“…One notable key to success is that price transparency can help leverage the direct knowledge of cost by incorporating equipment/implant procurement, information technology, labor, ancillary services, facility upkeep, and postacute care, to accurately record resource consumption, a process known as time-driven activity-based costing 20–22. Although this requires upfront investment and regular audit, practices will be in a position to maximize value of otherwise high-cost cases, offer greater price flexibility, and provide more accurate estimates for (bundled) price negotiations with insurers 23…”

“…[20][21][22] Although this requires upfront investment and regular audit, practices will be in a position to maximize value of otherwise high-cost cases, offer greater price flexibility, and provide more accurate estimates for (bundled) price negotiations with insurers. 23…”