Bundle payment model in spine surgery: Current challenges and opportunities, a systematic review.

Bundle payment model in spine surgery: Current challenges and opportunities, a systematic review.

World Neurosurg. 2018 Dec 12;:

Authors: Dietz N, Sharma M, Alhourani A, Ugiliweneza B, Wang D, Nuño MA, Drazin D, Boakye M

Abstract
INTRODUCTION: Bundled payments offer a lump sum for management of particular conditions over a specified time period that has the potential to reduce healthcare payments. Additionally, bundled payments represent a shift toward patient-centered reimbursement that has the upside of improved care coordination among providers and may lead to improved outcomes.
AIM: To review the challenges and sources of payment variation and opportunities for restructuring bundled payments plans in context of spine surgery.
MATERIALS AND METHODS: We reviewed the current landscape of episodes of care over the past 10 years. We completed a search using PRISMA guidelines and the PICO model in PubMed and Ovid databases to identify studies that met our search criteria.
RESULTS: A total of 10 studies met search criteria that were retrospective in design. The primary recipient of reimbursement was the hospital associated with the index procedure (59.7-77% of the bundled payment), followed by surgeon reimbursement (12.8-14%) and post-acute care rehabilitation (3.6-7.3%). On average, the index hospitalization was $32,467, ranging from $11,880 to $107,642, depending on number of levels fused, complications, and malignancy. Readmission was shown to increase the 90-day payment by 50%-200% for uncomplicated fusion.
CONCLUSION: The implementation of spine surgery in bundled payment models offers opportunity for healthcare cost reduction. Patient heterogeneity, complications, and index hospitalization pricing are among factors that contribute to the challenge of payment variation. Development of standard care pathways, multi-disciplinary coordination between inpatient and outpatient postoperative care, and empowerment of patients are also key elements of progress in the evolution of bundled payments in spine surgery. We anticipate more individualized risk-adjusted prediction models of payment for spine surgery, contributing to more manageable variation in payment and favorable models of bundled payments for payers and providers.

PMID: 30553071 [PubMed - as supplied by publisher]

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