Becker's ASC Review

63 ORTHOPEDICS 9 changes surgeons say will spur adoption of spine bundled payments By Alan Condon A s reimbursement continues to decline and the cost of running a practice becomes more challenging amid rising inflation and staffing difficulties, more independent practices are anticipated to dip their toes into the world of value-based care, seen by the federal government as a viable route to reduce national healthcare spending. While bundled payment models have found success in joint replacement, spine surgery is seen as a different animal because of the challenges with case complexity and the distribution of risk. Here are nine updates surgeons argue would increase the adoption of bundled payments in spine surgery: 1. Spine bundles should be reflective of diagnosis-related groups, which can vary drastically, Alex Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, told Becker's. "e average DRGs for cervical and lumbar surgical cases vary significantly, from $11,000 to over $100,000 for the same diagnosis, yet these differences in costs are not reflected in current CMS bundled payment reimbursement schemes," he said. 2. Carve-outs are necessary for high-risk patients, and bundles should have exclusions for complications out of the surgeon's control, Philip Schneider, MD, spine surgeon at e Centers for Advanced Orthopaedics in Bethesda, Md., told Becker's. 3. Payers must be more transparent about data to ensure a fair bundle, so surgeons can take on the risk. 4. Standardizing payment across multiple vendors would increase the adoption of spine surgery bundles, which are ideally suited for ASCs, Robert Bray Jr., MD, of DISC Sports & Spine Center in Newport Beach, Calif., told Becker's. "Prices can be fixed for implants per case type and standardization of cost per case can be developed across surgeons with a particular emphasis of excluding waste (i.e., we did not need to use three biologics on a single-level fusion case)," he said. 5. Spine surgeons must be able to manage all parts of the bundle — including who cares for the patient and their rehabilitation — to ensure the most cost-efficient and highest quality care. 6. Spine surgeons must organize and provide leadership for the most basic procedures and push back against complex procedures being included in any type of bundle payment or value-based model, Andrew Hecht, MD, of Mount Sinai Health System in New York City, told Becker's. 7. ASCs should serve as anchors for bundles when clinically appropriate. 8. Better acceptance of spine surgery bundles will depend on reimbursements as all patient outcomes are outlined and expected, Christian Zimmerman, MD, of St. Alphonsus Medical Group and SAHS Neuroscience Institute in Boise, Idaho, told Becker's. "More cuts will create less willingness to treat patients and disparate patient populations will continue," he said. 9. An independent ombudsman or a union could be implemented to advocate for the proper apportionment of payment to physicians rather than middle management or administrators, according to Brian Gantwerker, MD, of e Craniospinal Center of Los Angeles. n Indiana ASC performs region's 1st outpatient robotic joint replacement By Marcus Robertson C olumbus (Ind.) Specialty Surgery Center performed the region's first outpatient robotic joint replace- ment surgery, according to a news release shared with Becker's. Eric Tannenbaum, MD, performed the knee replacement Aug. 1, using Zimmer Biomet's Rosa Knee System, the news release said. Dr. Tannenbaum also performed the area's first knee replacement using Stryker's Mako system earlier in 2022. Columbus Specialty Surgery Center was founded in 2012. In addition to orthopedics, the ASC offers services in plastic surgery, otolaryngology, podiatry and spine surgery. n Exactech recalls 40K more hip implants By Marcus Robertson Devicemaker Exactech is recalling 40,000 hip implants, the Sarasota Legal Examiner reported Aug. 14. The implants are being recalled over the failure of polyethylene liners, which could have been degraded due to oxygen exposure from nonconforming packaging, the report said. More than 250,000 recalled Exactech joint devices have been implanted in the U.S., including knee and ankle implants that were recalled in 2021 and February 2022. The latest recall of hip implants includes the Acumatch GXL; the Novation GXL and MCS GXL; Exactech All Polyethylene Cemented Cup; Acumatch Conventional UHMWPE; MCS Conventional UHMWPE; and the Novation Conventional UHMWPE. n

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