RT Journal Article
SR Electronic
T1 Impact of a Bundled Payment System on Resource Utilization During Spine Surgery
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 19
DO 10.14444/3019
VO 10
A1 James M. Mok
A1 Maximilian Martinez
A1 Harvey E. Smith
A1 Daniel M. Sciubba
A1 Peter G. Passias
A1 Andrew Schoenfeld
A1 Robert E. Isaacs
A1 Alexander R. Vaccaro
A1 Kris E. Radcliff
A1 Association for Collaborative Spine Research Investigators
YR 2016
UL http://ijssurgery.com//content/10/19.abstract
AB 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 intra-operative 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.