Issue link: https://beckershealthcare.uberflip.com/i/571000
8 SPINE LEADERSHIP Spine Surgery in a Value-Based World: Dr. Jed Vanichkachorn on Spine Bundled Payments By Laura Dyrda S pine surgeons are begin- ning to see a real shi from fee-for-service to value-based care as insurance companies pass risk onto provid- ers. Payers are pushing integrated care models and population health initiatives for the future. "We are seeing more push-back from insurance companies for traditional fee-for-service reimbursement," says Jed Vanichkachorn, MD, of Tuck- ahoe Orthopaedics in Richmond, Va. "With healthcare reform hitting their margins and profitability, insurers are encouraging providers to integrate more and move away from the fee-for-service model. We are used to being reimbursed for the number of CPT codes billed, but now there is a movement to integrate with hospital systems and deliver value-based care." Spine surgeons are working with hospitals to develop spine centers of excellence and preparing to accept bun- dled payments. Many hospitals have worked on bundles for hip and knee replacement and are now targeting spine as the next successful bundle. "Nobody really knows exactly what you'll have to produce for value-based care," says Dr. Vanichkachorn. "Value is defined as the outcomes divided by your costs. We have to be more sensitive to costs for the various im- plants and biologics we use in the spine. Right now, there is significant variability of utilization and this increases costs. e other side is that we have to start collecting data to show improved outcomes for our patients even with lower costs." Dr. Vanichkachorn's group is collecting outcomes data to prepare for the future. "It used to be that only the big spine centers collected data, but slowly we're being told that if you don't have outcomes [data], you won't gain approval," he says. "Urgent care and primary care physi- cians are coming to us to make sure we have outcomes data before referring their patients because they want to make sure they're sending patients to the best people with a value-based mind set." ere is also movement toward outpatient spinal surgery. is includes laminectomies, discectomies, one-level disc replacements and fusions. "Our goal is to get 40 percent of our procedures to an outpatient facility over the next few years," says Dr. Vanichkachorn. "When healthcare reform came in, a lot of providers were hoping it wouldn't work well and they wouldn't have to change. But now it's the law of the land and we have to realize that value-based care is the future." Dr. Vanichkachorn understood if his practice didn't develop bundled payments with hospitals or specialty conveners, they'd be le out of the coverage networks in the future. e hospital in his community began hiring primary care physicians and put them in the Medicare shared savings program. e physicians still refer to several spine surgeons within their network, but seek out specialty providers that can save money for their referrals. "As surgeons and patients take on more risk — pa- tients are paying more out-of-pocket and surgeons are paid based on quality data — both sides are paying more attention to outcomes and cost," says Dr. Vanichkachorn. "You have to show value with your data, not just clinical effectiveness, to survive down the road." is was partially driven by the sustainable growth rate repeal as well. "e SGR repeal was great for orthopedic surgeons, but we also saw that by 2019, alternative payment models will gain significant reimbursement bonuses and exemp- tions from reporting requirements," he says. "If you try to do pure fee-for-service, you might not survive." Dr. Vanichkachorn's group picked lumbar and cervical fusions as their initial episodes for bundled care. Surgeons control several aspects of care and cost for these proce- dures, including: • Cost of implants and material • Time spent in the operating room • Time spent under anesthesia • Length of stay at the hospital • Recovery time and resources New less invasive procedures may reduce blood trans-