Two professors of neurosurgery weigh in on how cost-effectiveness can be improved in spine.
Question: Do you have any theories as to how cost-effectiveness in spine can be improved?
Raj Narayan, MD. Professor and Chairman of Neurosurgery at Zucker School of Medicine at Hofstra/Northwell (East Garden City, N.Y) and Director of the Northwell Health Institute of Neurology and Neurosurgery (Manhasset, N.Y.). There are several options — none of which are likely to be popular with the surgeons: (1) bundled payments for the surgery and the implants; (2) at-risk contracts for large employed groups; (3) uniform reimbursement regardless of the number of levels done; and (4) some portion of the payments being linked to patient satisfaction.
However, each of these strategies could, and likely will have unintended consequences.
James Harrop, MD. Professor of Neurosurgery at Thomas Jefferson University Hospital (Philadelphia). I think another way to approach this question is how do we improve and maximize the value of spine surgery. Since value equals quality/cost, you can either cut costs or improve quality to get increased value. We as spine surgeons need to better understand how to maximize our patient outcomes. There has been great work on this in terms of outcome measures and better defining patient populations but more needs to be done.