Impact of a bundled payment system on resource utilization during spine surgery

Association for Collaborative Spine Research Investigators

Research output: Contribution to journalArticle

Abstract

Background In a bundled payment system, a single payment covers all costs associated with a single episode of care. Spine surgery may be well suited for bundled payments because of clearly defined episodes of care, but the impact on current practice has not been studied. We sought to examine how a theoretical bundled payment strategy with financial disincentives to resource utilization would impact practice patterns. Methods A multiple-choice survey was administered to spine surgeons describing eight clinical scenarios. Respondents were asked about their current practice, and then their practice in a hypothetical bundled payment system. Respondents could choose from multiple types of implants, bone grafts, and other resources utilized at the surgeon's discretion. Results Forty-three respondents completed the survey. Within each scenario, 24%-49% of respondents changed at least one aspect of management. The proportion of cases performed without implants was unchanged for four scenarios and increased in four by an average of 8%. Use of autologous iliac crest bone graft increased across all scenarios by an average of 18%. Use of neuromonitoring decreased in all scenarios by an average of 21%. Differences in costs were not statistically significant. Conclusions 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 peri-operative costs solely related to surgical practice may not yield substantive savings while rationing potentially beneficial treatments to patient care. Level of Evidence: 5.

Original languageEnglish (US)
Article number19
JournalInternational Journal of Spine Surgery
Volume10
DOIs
StatePublished - 2015

Fingerprint

Spine
Episode of Care
Costs and Cost Analysis
Motivation
Transplants
Bone and Bones
Surveys and Questionnaires
Patient Care
Surgeons
Therapeutics

Keywords

  • Bundled payments
  • Cost
  • Health care reform
  • Patient protection and affordable care act
  • Resource utilization
  • Spine surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Impact of a bundled payment system on resource utilization during spine surgery. / Association for Collaborative Spine Research Investigators.

In: International Journal of Spine Surgery, Vol. 10, 19, 2015.

Research output: Contribution to journalArticle

Association for Collaborative Spine Research Investigators. / Impact of a bundled payment system on resource utilization during spine surgery. In: International Journal of Spine Surgery. 2015 ; Vol. 10.
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abstract = "Background In a bundled payment system, a single payment covers all costs associated with a single episode of care. Spine surgery may be well suited for bundled payments because of clearly defined episodes of care, but the impact on current practice has not been studied. We sought to examine how a theoretical bundled payment strategy with financial disincentives to resource utilization would impact practice patterns. Methods A multiple-choice survey was administered to spine surgeons describing eight clinical scenarios. Respondents were asked about their current practice, and then their practice in a hypothetical bundled payment system. Respondents could choose from multiple types of implants, bone grafts, and other resources utilized at the surgeon's discretion. Results Forty-three respondents completed the survey. Within each scenario, 24{\%}-49{\%} of respondents changed at least one aspect of management. The proportion of cases performed without implants was unchanged for four scenarios and increased in four by an average of 8{\%}. Use of autologous iliac crest bone graft increased across all scenarios by an average of 18{\%}. Use of neuromonitoring decreased in all scenarios by an average of 21{\%}. Differences in costs were not statistically significant. Conclusions 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 peri-operative costs solely related to surgical practice may not yield substantive savings while rationing potentially beneficial treatments to patient care. Level of Evidence: 5.",
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AU - Schoenfeld, Andrew

AU - Isaacs, Robert E.

AU - Vaccaro, Alexander R.

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