Becker's Spine Review

19 SPINE SURGEONS 8. Bundled payments have shown the ability to reduce the costs associ- ated with a single episode of spine care, but not the overall procedure volume, according to Sullivan et al. Surgeons can influence the cost of procedures by their choice of procedure, implant and surgical setting. Patient selection also comes to the forefront in bundled payments. "If bundled payments become the primary means of reimbursement, healthcare systems will be forced to calculate financial risk based on patients' demographics and comorbidities," concluded Sullivan et al. "Some spine programs already have explicit guidelines which exclude smokers, patients with body mass index over 40 and patients with prior lumbar fusion. ese financial risk calculations have inherent ethical implications." 9. An International Society for the Advancement of Spine Surgery sur- vey published in the International Journal of Spine Surgery examined how bundled payments affected spine surgery resource utilization. e 43 survey respondents answered questions about how bundled payments might change their decision making in eight clinical scenar- ios. e study authors found: • Cases performed without implants were unchanged for half of the scenarios and increased by an average of 8 percent for the other half. • Autologous iliac crest bone gra use increased in all scenarios 18 percent on average. • Neuromonitoring use would decrease by an average of 21 per- cent in all scenarios. "Financial disincentives to resource utilization may result in some changes to surgeons' practices, but these appear limited to items with less clear benefits to patients. Choices of implants, which account for the majority of intraoperative costs, did not change meaningfully. A bundling strategy targeting perioperative costs solely related to surgical practice may not yield substantial savings while rationing potentially beneficial treatments to patient care," the study authors concluded. ree quotes from spine surgeons about bundled payments in the future: 10. J. Brian Gill, MD. Nebraska Spine Hospital (Oma- ha): Bundled-payments continue to gain traction as Medicare has launched a program for hospitals in an attempt to control costs. ere is more pressure to be more vertically integrated in an attempt to con- trol costs from start to finish for procedural episodes such as spine surgery. Ongoing reports show independent practices are continuing to dwindle as healthcare systems drive to control costs and gain mar- ket share. As a partner in an independent practice, we have to contin- ue to work with our healthcare systems to provide value with mutual strategic goals and alliances. 11. Brian Su, MD. Marin General Hospital (Greenbrae, Ca- lif.): Participation in BPCI-A is critical because it forces surgeons to be responsible for cost of care. Emphasis on reducing days in rehabili- tation, hospital readmissions and emergency room visits continues to drive savings. e shared savings of cost reduction will be significant over the next several years and is a win-win both for spine surgeons and patients. I believe that the transition of Medicare bundled payment to com- mercial insurance is inevitable. Surgeons who are initial adopters of the bundled payment system will have a significant advantage. Includ- ed in BPCI is the ability for surgeons to participate in internal cost savings, allowing surgeons to share in savings related to reduction in implant costs in their hospitals. e natural progression is for the sur- geon to not only control 90-day postsurgical care but also to control the hospital-based DRG. In that situation, the hospital or surgery cen- ter becomes a cost center since anything le in the bundle would go to the surgeon. 12. Jim Sanfilippo, MD. Reconstructive Orthopedics (Marl- ton, N.J.): As a group, we have entered both bundle payment ar- rangements that have no downside risk, as well as those with risk sharing. e biggest opportunities for bundled payments and other risk-based alternative payment programs revolve around patient navi- gation, moving cases to the appropriate site and level of care including hospital outpatient and ASCs, and in partnering with our healthcare systems to streamline our delivery and eliminate unnecessary pre- and postoperative testing and treatments. With patient navigation we can intervene at the necessary times to help prevent urgent care and ER visits, help drive down readmissions, promote overall compliance following surgery and limit the number of patients needing to go to expensive inpatient rehab facilities. By moving patients to the appropriate level of care, as well as eliminating unnecessary testing and treatments, we can drive down the cost asso- ciated with the procedure. However, my biggest concern is this "race to the bottom" with target pricing being adjusted down with each new contract. Eventually, there will be no more water to squeeze from this stone. n DIFFERENTIATED COMPLEMENTARY TECHNOLOGIES Providing complete procedural solutions by leveraging our core competencies in orthobiologics, interbody devices, and modular spinal instrumentation systems. seaspine.com SeaSpine, the SeaSpine logo, and Shoreline are registered trademarks of SeaSpine Orthopedics Corporation or its subsidiaries. OsteoStrand is a trademark of SeaSpine Orthopedics Corporation or its subsidiaries. ©2019 D0002533A 2019-03 01 SHORELINE ACS Modular Standalone Interbody featuring NanoMetalene ® Technology OSTEOSTRAND ™ PLUS Demineralized Bone Fibers powered by Accell ® Technology

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