46
PRACTICE
MANAGEMENT
cectomies are the two common options in outpatient lumbar discec-
tomies.
13. Richard N. Wohns, MD, of NeoSpine offered the following cost data
on spine in the outpatient surgery setting during a 2015 interview with
Becker's:
• Disposable for spine — $500
• Total cost of eight nursing hours per patient, factoring in multiple
staff in room — $300 to $350
• Average implant costs — $5,000
• Average annual number of pain procedures — 2,000
14. Market.Biz reports that the global cervical total disc replacement
device market is expected to hit $1.75 billion by 2021, according to In-
vestDailyNews. is growth is predicted to significantly impact ASCs,
as more surgeons are performing minimally invasive cervical disc re-
placements in ASCs.
15. ASCs utilize MIS devices during spine surgeries. In December
2016, Englewood, N.J.-based e Center for Muscoskeletal Disor-
ders used the Mazor Robotic Renaissance System during a kyphoplas-
ty operation on a patient experiencing pain from a T12 fracture. e
surgery was successful and the patient le the facility two-and-a-half
hours aerwards. is is only one example of MIS devices increasing
ASC spine procedures today. n
Bundled Payments in Spine: Big Trends from Dr. Stephen
Hochschuler
By Laura Dyrda
S
tephen Hochschuler, MD,
co-founder of Texas Back In-
stitute in Plano, discusses bun-
dled payments for global episodes
of care and how the spine field is
adapting to value-based payments.
Question: Where do you see bun-
dled payments for orthopedics
headed in the future?
Dr. Stephen Hochschuler: It doesn't
matter what changes occur to Obamacare, I think global
fees and episodes of care are going to continue. Every-
body now is looking at value and value has to be deter-
mined in regards to cost as well as performance and re-
sults. Unfortunately, most insurance companies only care
about costs where we as physicians care about results and
patient satisfaction.
The bundled payments usually cover 30 days preop, sur-
gery, anesthesia, hospitalization and 90 days after surgery.
All of those elements are part of your bundle. In Texas,
we aren't pushed to do bundles because the system is
still cost-plus and everyone is squeezed. The margins for
the implant companies will go down and they'll have to
change their distribution model. In bundled payments, it
all comes together and in spine many procedures will be
transferred to the outpatient facility.
My feelings are that we're headed toward more bundled
payments and outpatient spine surgery. The migration has
been slow so far, but I think it will become more rapid in
the future.
Q: How can surgeons successfully navigate bundled
payment participation?
SH: Follow the money. There are around 70 percent of
the neurospine surgeons and 50 percent of the orthope-
dic spine surgeons who have sold to hospitals. In essence,
hospitals are expanding and opening ASCs, but they don't
know how to manage the surgery centers so they're part-
nering with physicians and companies like SCA and USPI.
Either the hospital will provide the service at the same cost
as the surgery center or they won't survive. Everyone is
trying to figure out what will happen, from the insurance
companies to the hospitals and physicians.
Everyone is nervous. My advice to physicians is to get start-
ed with bundled payments, even if most of your practice is
private pay. Get your feet wet. Hospitals move more quick-
ly than physicians, but we will all have to do it eventually.
Q: What are the biggest opportunities for physicians
with global episodes of care?
SH: I am so convinced that bundled payments are the fu-
ture that I helped start a new company called Spine Sys-
tems. What is going to happen is that data is going to run
the medical field. If you look at big data in the rest of the
world, data runs the world. Unfortunately, the medical
world is way behind the data world in other arenas. For
example, you can pull up your financial statements in 30
seconds on the internet.
In the future, quality measurements will rely more on data.
Right now we are measuring patient satisfaction by wheth-
er people like their physician, which is absurd. Healthcare
providers need to collect their data and use it to their ad-
vantage. The last thing you want is insurance companies
having data that you don't.
Our goal at Spine Systems is to really run your medical care
based on outcomes data, considering pre-injury, condi-
tioning of the patients, ergonomic analysis and other crite-
ria. We will track the patient from the time of injury through
rehab to develop terms for global payments and episodes
of care. n
Dr. Stephen
Hochschuler
