Spinal Surgery

Ugiliweneza, Beatrice; Kong, Maiying; Nosova, Kristin; Huang, Kevin T.; Babu, Ranjith; Lad, Shivanand P.; Boakye, Maxwell

doi:10.1097/brs.0000000000000378

Cited by 115 publications

(28 citation statements)

References 9 publications

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“…Indeed, many believed that such a law would cause a large disruption in the manner health care is delivered, including spine surgery. The changes to the current health care system are already underway with the experimentation of bundled payment solutions 5,6,22,23 and a clear outline to move toward value-based reimbursement incentives over the coming years. 24 In our study, in the years following the implementation of the ACA there was a negative impact on the rates of elective lumbar spine surgeries, both on the aggregate and individual elective surgery types.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the early 2010s led to the passage of a new health care law, Affordable Care Act (ACA), which aimed at improving health care delivery by reducing costs, focusing on patient outcomes, and improving efficiency. 5–8 Analyzing national trends from 2003 to 2013 will yield valuable information, as prior research of this time frame has only addressed state-level trends and impacts of insurance changes but not national implications. 9,10 …”

Section: Introductionmentioning

confidence: 99%

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Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

Bernstein

Brodell

et al. 2017

Global Spine Journal

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Study Design:Retrospective database analysis.Objective:The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States.Methods:The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques.Results:From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R 2 value between the number of surgeries and the S&P 500 Index was statistically significant (P ≤ .05).Conclusions:The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

Bernstein

Brodell

et al. 2017

Global Spine Journal

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“… 8 Although this volume is quite low compared with adult total joint arthroplasty (TJA), it is among the most common orthopedic procedures performed in children. 9 In terms of expenditures, costs for PSF are substantial: the projected total 30-day health-care cost for a PSF without complications or comorbidities is $43,363. 9 Adding comorbidities or complications increased this average to $65,124.…”

Section: Application Of the American College Of Surgeons’ Criteria Fomentioning

confidence: 99%

“… 9 In terms of expenditures, costs for PSF are substantial: the projected total 30-day health-care cost for a PSF without complications or comorbidities is $43,363. 9 Adding comorbidities or complications increased this average to $65,124. 9 …”

Section: Application Of the American College Of Surgeons’ Criteria Fomentioning

confidence: 99%

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Feasibility of Episode-Based Bundled Payment for a Pediatric Surgical Condition: Posterior Spinal Fusion

Shaughnessy

Sturm

Sitzman

2017

Pediatric Quality &Amp; Safety

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Introduction:Episode-based bundled payment (EBBP) is an alternative model of health-care payment that aims to align providers’ and hospitals’ incentives toward delivery of more coordinated, higher quality, and lower cost care. EBBP programs have been studied for numerous adult conditions over the past decade, yet there have been no studies exploring the use of EBBP in pediatric conditions.Methods:This article explores the feasibility of EBBP for a relatively common, costly, pediatric surgical procedure: spinal fusion for adolescent idiopathic scoliosis. We begin with a review of successful EBBP programs in the United States. We then apply American College of Surgeons criteria for bundled payment episode selection to identify benefits and challenges of using EBBP for this condition.Results:We identify several features of pediatric spinal fusion that make it an attractive EBBP target: high variability in costs with multiple distinct targets for cost reduction, high variability in quality across hospitals, and proven methods for improvement via application of standardized, evidence based pathways. We find that challenges to EBBP may arise due to the relatively low incidence of the procedure, which limits overall savings to the health-care community.Conclusions:Our results suggest that spinal fusion for adolescent idiopathic scoliosis is an attractive pediatric target for EBBP, with potential benefits to patients, providers, health systems, and payers if limitations in procedure volume and administrative expense are overcome. The framework presented may also be useful for analyzing feasibility of EBBP for other pediatric conditions.

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The introduction of a value‐based reimbursement programme—Alignment and resistance among healthcare providers

Eriksson

Levin

Nedlund

2022

Health Planning & Management

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Reimbursement programmes are used to manage care through financial incentives. However, their effects are mixed and the programmes can motivate behaviour that goes against professional values. Value-based reimbursement programmes may better align professional values with financial incentives. The aim of this study is to analyse if and how healthcare providers adapt their practices to a value-based reimbursement programme that combines bundled payment with performance-based payment.Forty-one semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden. Data were analysed using thematic analysis with an abductive approach and a conceptual framework based on neo-institutional theory. Healthcare providers were positive to the idea of a value-based reimbursement programme. However, during its introduction it became evident that some aspects were easier to adapt to than others. The bundled payment provided a more comprehensive picture of the patients' needs but to an increased administrative burden. Due to the financial impact of the bundled payment, healthcare providers tried to decrease the amount of post-discharge care. The performance-based payment was appreciated. However, the lack of financial impact and transparency in how the payment was

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Spinal Surgery

Abstract: N/A.

Cited by 115 publications

References 9 publications

Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

Feasibility of Episode-Based Bundled Payment for a Pediatric Surgical Condition: Posterior Spinal Fusion

The introduction of a value‐based reimbursement programme—Alignment and resistance among healthcare providers

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