Q: Would you ever consider bundled payments for spine surgery at your practice?
Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.: If we surgeons could have significant input in the distribution of the bundle, we would consider it. If not, we remain highly skeptical.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: Yes. I think it's a great idea. We are currently providing spine surgery in our surgery center for a bundled payment. We bundle the facility fee, anesthesiology, surgeon and surgical assistant fees all together. Payors pay one charge for all care related to the surgical episode.
Raj Rao, MD, Director of Spine Surgery, Medical College of Wisconsin, Milwaukee: Bundling may be a reasonable option provided the bundled fee is fair and covers the cost of providing care, and the orthopedic surgeon has control over the distribution of this bundled payment to the various components. This would allow the surgeon to carry out the surgical procedures at a facility where he or she feels the patient would benefit the most and select appropriate ancillary services, anesthesia and medical care that would be in the patient's best interest.
Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: Yes. Surgeons can make meaningful impacts on episodes of care (bundled payments) cost reductions as they drive the majority of the specific care orders (implants/ procedure types/ lengths of stay). If surgeons are empowered to be the drivers of cost containment and can share in the financial rewards of these savings, then bundled payments can work. There are several companies emerging on the spine and total joint landscape that will drive this model forward.
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