Two neurosurgeons, Praveen Mummaneni, MD, and Ciro Randazzo, MD, discuss the future of bundled payments in spine.
Question: What does the future hold for bundled payments in spine?
Praveen Mummaneni, MD. Neurosurgeon and co-director of the University of San Francisco Spine Center: Bundled payments may work for a portion of spine cases done annually. The one-level degenerative case in a healthy patient has a predictable outcome and could be bundled. However, many spine cases do not easily fit into a bundle. How does one predict outcomes and potential complications for a scoliosis correction in an elderly patient with diabetes and a history of heart disease? How to do a bundle for a spinal metastatic tumor causing paraplegia on a weekend?
There are so many variables due to comorbidities and surgical approaches. If such complex cases are bundled, then the elderly and sick patients may not be able to easily access care. We should not set up a system where these patients have barriers to care.
Ciro Randazzo, MD. Chief of neurosurgery at Hudson Regional Hospital in Secaucus (N.J.): After successful models of bundling for other surgical classes, this will also spread to spine surgery. This will lead to a reduction in the use of hardware with a return to non-fused decompression surgeries and outcome studies directly comparing implants across different manufacturers.