Becker's ASC Review

64 ORTHOPEDICS 9 key thoughts on bundled payments in spine surgery By Alan Condon N ine insights on bundled payments in spine, including CMS changes in 2021: 1. While bundled payments have found some success in total joint replacement, many spine surgeons are not sold on the idea due to the wide variation of surgeries, approaches and levels that may be operated on in any given diagnosis, as well as the cost differences based on in- and outpatient settings. However, many stakeholders — hospitals, consumers, payers and employers — have embraced bundles. 2. While the purpose of bundled payment programs is to cut costs, many physicians are concerned about the effects on quality and safety. An analysis of CMS' Bundled Payments for Care Improvement initiative found no change in length of stay for spinal fusion and an increase in both 90-day emergency room use and 90-day readmission rate, according to the American Academy of Orthopaedic Surgeons. Additionally, there was an increased rate of subsequent surgery at participating hospitals within the 90-day bundle period. 3. As healthcare in the U.S. continues its push from a fee-for-service model toward value-based care, physicians are expected more than ever to demonstrate the benefit of their interventions and accurately predict costs, according to University of California San Francisco neurosurgeon Christopher Ames, MD. "ere are currently no validated predictive models of improvement that could be used to generate reliable bundle payment options for complex spine surgery," Dr. Ames said. However, UCSF, in collaboration with the International Spine Study Group, is applying accurate predictive models deemed pivotal "to prevent incentives for providers to with- hold care in value-based care models." 4. A study published in e Spine Journal calculated 90-day costs for all lumbar fusions to be $31,716 ± $18,124, with individual 90-day payments being $54,607 ± $30,643 in DRG-459 — spinal fusion except cervical with major comorbidity or complication — and $30,338 ± $16,074 in DRG-460 — spinal fusion except cervical without major comorbidity or complica- tion. Researchers called on policymakers to account for individual patient, state and procedure variation seen within diagnosis- related groups to stop the formation of financial disincentives in caring for sicker patients and performing more complex fusions. 5. A well-rounded bundled payment model for spine could be cemented within the next eight to 10 years, according to David Janiec, a financial services executive with expertise in value-based care and alternative payment models. "Early activity in bundled programs dem- onstrates the development of increased use of evidenced-based medicine, a better understanding of costs, improvements in care coordination and higher quality pa- tient care, " Mr. Janiec said. "It is extremely important not only to participate in these value-based models for educational and fi- nancial benefit, currently, but also to look with a critical eye to ensure a sustainable final model evolves." 6. CMS made several changes to the BPCI Advanced program for 2021, the most sig- nificant of which is that participants are no longer able to select individual episode types, such as lower extremity, upper extremity or spinal fusion. 7. Last year, UnitedHealthcare expanded BPCI Bundled Payments to include Medicare Advantage beneficiaries. e UnitedHealth- care Care Bundles program offers bundled payments for noncervical spinal fusions. In 2019, Humana began offering Humana Medicare Advantage members access to bundled payments for spinal fusion. 8. Two condition-specific bundle payment programs recently emerged for spine sur- gery as well as joint replacement and bar- iatric surgery, according to the American Journal of Managed Care. The Pacific Busi- ness Group on Health/Health Design Plus Employers Centers of Excellence Network created a direct-to-employer program where condition-specific bundle payment programs are created for high-volume, high-quality centers. Largely through reductions in surgical rates, the program decreased costs by about $1.2 million for joint replacement and spine surgery. 9. A study on bundled payments for lum- bar spinal fusions found increased case complexity was responsible for rising costs relative to the negotiated baseline target price. Researchers analyzed two-year data of one institution participating in the BPCI program and determined that the value- based model "may discourage advancement in spine surgery due to the financial penalty associated with novel techniques and tech- nologies." n New sacroiliac joint device hits US market By Alan Condon O rthopedic device company Sacrix launched the third iteration of SacroFuse, a threaded compression device designed for immediate stabilization of the sacroiliac joint. The new design is a screw-cage hybrid intended to facilitate insertion and os- seointegration, according to a Jan. 23 news release. The device is self-drilling, self-tapping and compresses across the sacroiliac joint. Sacrix added more graft space, while maintaining the product's biomechani- cal and pull-out strength. An orthopedic spine surgeon developed the device with input from pain management and interventional physicians. The company said it has performed more than 20 labs in 2020 and five labs so far in 2021. Sacrix is a portfolio company of KICVentures Group, which acquired Nano- Fuse Biologics in December. n

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