Value-based care has been embraced by some spine groups as an alternative to fee-for-service payments, and its prevalence hinges on multiple elements.
Value-based care has the two main objectives of trying to drive down costs while delivering quality care for patients. Hyun Bae, MD, of Los Angeles-based Commons Clinic, said he thinks that one crucial element will help value-based care succeed for spine surgeons.
"We want to do it with the physician in control," Dr. Bae said. "Not the hospital in control and not other third parties in control, but really the physician in control who takes ownership and somewhat, we say, the risk. I'm not sure if that's the right word for it. But value-based care is typically tied to bundles. So there's a certain fee or a metric that we're trying to get to. The best way we can do that is really trying to have the physician take ownership. The physician and the patient are both equity holders and making sure that we make the right decisions for the patient. That drives the best quality, the best outcome and hopefully we can actually save the cost of their healthcare system."
Private insurance can also support the growth of value-based care and bundled payments in spine surgery, as researchers learned in a study published in the January 2024 issue of Spine.
Researchers looked at lumbar spinal fusion patients from October 2018 to December 2018 who used CMS' Bundled Payments for Care Improvement Advance model, and compared that data with private bundle data from 2018 to 2020 to analyze the transition away from BPCI-A. The study found readmissions fell under private bundled payment models compared with CMS' Bundled Payments for Care Improvement initiative. The net surplus was lowest in 2018 but didn't differ between the years in private bundles.
"[Bundled] payments have recently started to gain traction in the private insurance realm," Alexander Vaccaro, MD, PhD, and Jose Canseco, MD, PhD, who were authors in the study, said in a statement to Becker's. "As suggested in our study, partnering with private insurers is crucial for the success of these models. By working together, healthcare providers and payers can achieve the ultimate goal of improving patient care while also achieving financial success in a healthcare environment with ever-rising costs. Risk stratification adjustment tools will have to be a key feature of these new bundles in order to allow surgical practices to remain financially viable while attempting to meet the higher demands and associated costs of caring for patients with significant comorbidities."
However one factor may hold back value-based care's advancement — its definition.
"To a payer it means one thing; to a patient maybe it means another, and to a provider maybe it means another thing," Michael Havig, MD, an orthopedic surgeon with Naples, Fla.-based OrthoCollier said. "It's probably a Venn diagram where they all intersect in the middle. But the question is what is that intersection like? What are the key components of it for a provider, for a patient and for a payer? That's not easy to determine."
Finding that overlap will be important to the payment model's future, and then deciding on reasonable goals for the payers, patients and physicians.
"I think the reason this confusion exists in part is because we're trying to fit a square peg into a round hole in that we're taking the existing incumbent healthcare system with all the headaches and inefficiencies and saying, 'OK, here's this thing over here — value-based care — let's take that and layer it on to this old system or vice versa,'" Dr. Havig said. "I think that's been part of the challenge."