Can you guarantee your spine surgery outcomes? One surgeon in Florida is doing just that, and he thinks it's the future of medicine.
Ara Deukmedjian, MD, founder of Deuk Spine Institute in Melbourne, Fla., and Surgery Center of Viera, worked with Millennium Medical Management and a group of expert advisers to develop a warranty program for spine care. The group is guaranteeing they will eliminate back pain, both chronic and otherwise, as many patients come to the center with failed neck and back procedures or surgeries.
"We have very successful treatment algorithms for spine surgery," he says. "These treatment algorithms include multimodality treatments that begin with conservative care — chiropractic, yoga, strengthening, interventional pain management — and then surgery if necessary. We are offering a warranty saying we are sure the surgery works and we are willing to cover any additional treatment for the patient at that level."
Dr. Deukmedjian and his team were able to develop the warranty program because the Deuk Spine Institute includes comprehensive spine care in addition to an ambulatory surgery center. Having all elements under one roof allows providers more control over the quality and cost of care and keeps the patient under a provider umbrella.
"We are willing to say the surgical outcome will be very good, so if the patient doesn't have a good outcome we'll cover the costs," he says. "If patients develop pain in the region of the spine we operated on after surgery, we are willing to treat that inclusive without additional costs to the patient. That means we are doing diagnostic testing, therapy, medication, interventional pain management and surgery as part of the package."
The warranty is still new, but Dr. Deukmedjian thinks it will be attractive to payers and patients because it mitigates risk and streamlines care. If the payer and patient purchased a warranty, patients don't have to wait for payer approval to undergo diagnostic testing, imaging or additional treatment; their care is already covered. The insurance company saves on additional care expenses, or has a happy member who needs no extra care.
"The Deuk Spine Institute would assume risk for all care for the patient's spine in the same region where surgery was done from postop day one onward for however many years the warranty is purchased; it could be one year increments up to the patient's lifetime," Dr. Deukmedjian says.
The key elements of the program include:
• The warranty covers the region of the spine where patients have surgery; either the cervical or the lumbar, but not both.
• The warranty only covers services provided at the Deuk Spine Institute and Surgery Center of Viera.
• Patients don't have to make co-pays after the initial payment per the agreement.
• Overhead is reduced because the practice doesn't have to deal with administrative costs of gaining approval and billing for treatment.
• The warranty comes with payment-in-full from the payers.
The warranty could be especially attractive for workers compensation patients, since they own the injury for the rest of the patient's life.
"We're just rolling it out after developing the program three months ago," says Dr. Deukmedjian. "This could certainly be developed around the country wherever the practice has clinical capabilities, diagnostic imaging, therapy and rehabilitation, and is affiliated with the hospital. They don't have to be owned by a hospital, just affiliated in case there is a complication."
Data also plays a huge role in developing the program. Dr. Deukmedjian's data on few infections and complications gave him the confidence to guarantee his procedures, and has become a great marketing tool when attracting patients and payers to the program.
"We believe this is a win-win-win situation for the patient, payer and Institute," he says. "It's an attractive option for any payer and patient because it mitigates the risk to the payer to a quantifiable amount. It allows patients to get high quality spine care delivered in an efficient manner."
There are few other programs around the country assuming risk by offering warranties for post operative complications only or bundled payments for orthopedic procedures, but Dr. Deukmedjian sees this risk sharing becoming more popular among spine surgeons as well. However warranty programs aren't for everyone, and sticking to the data can show whether it's right for your practice.
"To offer this type of program, the surgeon has to have very predictable surgical outcomes that are high patient satisfaction and low complications as well as minimize the need for additional treatment after surgery," he says. "We are quite pleased to be the first in the nation to offer a guarantee on the effectiveness of our spine surgery and quality of the outcome as judged by the patient."