Georgia Sports Medicine & Orthopaedic Surgery, formerly the practice of Mark Cullen, MD, has been acquired by the Gainesville, Ga.-based Longstreet Clinic, according to an AccessNorthGa report.
Dr. Cullen has moved out of state and selected Stephen Fisher, MD, and Amy Borrow, MD, of the Longstreet Clinic to assume responsibility for the Georgia Sports Medicine & Orthopedic Surgery practice.
The Miami Project to Cure Paralysis has successfully grown Schwann cells from the nerve tissue of a subject's leg and transplanted them back into the subject's body, according to a Sun Sentinel report.
The subject has gone beyond the critical postoperative period without experiencing any complications.
American Spine & Surgery Center, a pain management center based in Maryland, has opened its 10th location in Gettysburg, Pa., which will begin seeing patients on April 1.
The Gettysburg location, which is American Spine's second location outside of Maryland, will be staffed by Atif Malik, MD, Sandeep Sherlekar MD, Mike Yuan, MD, and Malini Narayan, MD.
Hillcrest Baptist Medical Center in Waco, Texas, announced the opening of its new outpatient surgery center that offers orthopedic surgery services.
The center is more than 13,000 square feet and features four operating rooms. It offers numerous surgical services, including general orthopedics, hand procedures, spine procedures and pain management procedures.
Stryker has launched its ES2 Spinal System to build on its current Xia 3 pedicle screw.
The screw is designed for one-step, percutaneous placement with increased efficiency and security, according to the release. It is made for minimally invasive spine procedures.
The ES2 is a part of Stryker’s Less Invasive Technologies platform of 13 products.
Zimmer Holdings currently has exposure of 75 percent for hip and knee orthopedic device markets, and the company is looking to grow., according to the Wall Street Transcript.
The company has been improving manufacturing processes and fixed costs over four years and could expect to see 8 to 10 percent free cash flow yield, according to the report.
Zimmer has also been investing in emerging markets, such as China and India.
A study, published in the Journal of the American Board of Family Medicine, has found that the gender of a healthcare provider does not have any significant effect on healthcare costs or mortality.
Researchers studied responses gathered from 21,365 patients, aged 18 years and older, as part of the U.S. Medical Expenditure Panel Survey project between 2002 and 2008.
According to the study, the gender of the respondents' usual healthcare providers did not affect total expenditures, prescription expenditures, number of office visits or mortality.
Prices at all hospitals were up 0.6 percent in February compared with January, and compared with February 2012, hospital prices were up 2.6 percent, according to the most recent Producer Price Index from the Bureau of Labor Statistics.
General medical and surgical hospitals saw their prices jump 0.7 percent from January to February.
Prices at physician offices increased 0.2 percent from January to February, and they are up 1 percent year-over-year.
However, 41 percent reported they would not drop the low-paying insurer, and 32 percent said "it depends." Physician comments on the report show those who would drop the payor see little option if reimbursement wouldn't cover their expenses, but some would offer to continue seeing the patient for a reduced rate.
ONE Brain & Spine Center, focusing on concierge patient care and minimally invasive spine surgery, has opened in New Port Beach, Calif.
Procedures at the center will be performed by Todd W. Peters, MD, and Burak M. Ozgur, MD.
Dr. Peters, a board certified orthopedic surgeon, specializes in regenerative biologics, minimally invasive joint replacements and minimally invasive spine surgery.
Dr. Ozgur, a board certified neurosurgeon and spine surgeon, focuses on minimally invasive surgery.
On May 9, Michael Joyce, MD, will perform surgery on WNBA Seattle Storm's Sue Bird in order to remove a cyst from her left knee, according to a report by USA Today.
Dr. Joyce, MD, an orthopedic surgeon, has performed knee surgeries on Ms. Bird in the past.
1. Obtain correct physician documentation. Obtain full documentation for spine procedures, operative notes, anesthesia and medication list before you begin coding.
"You have to make sure all is in order before starting to code," says National Medical Billing Service's Senior Vice President, Coding Angela Talton. "There are several challenges, especially when we have more than one procedure. We have to ensure we are assigning the level of specificity for any spine procedure and the correct modifiers. Claims can be denied because modifiers are not affixed to the second tertiary procedure. That can be very costly and time consuming from a revenue cycle point of view."
This documentation will become even more specific after the transition to ICD-10 in October 2014.
"Physician education is going to be critical during the upcoming days, weeks and months leading up to ICD-10 conversion," says Ms. Talton. "Physicians need to be made very aware of how they are noting procedures. They need to be very specific and aware of how they are wording their reports to avoid ambiguity in their operative findings. I suspect there will be physician queries when the operative notes are not clear, so if there is an opportunity for physician education, start now and continue through implementation. Otherwise, there is a huge drop in reimbursement because of that." Image may be NSFW. Clik here to view.2. Avoid using unlisted codes. Whenever ASCs use an unlisted code they are challenged for reimbursement because the unlisted code signifies "experimental" to the payor. Payors often don't want to reimburse for "experimental" treatments in the outpatient or inpatient setting.
"When you are doing procedures with unlisted codes, you have to make sure the carrier covers them," says Barbara Cataletto, founder and CEO of Business Dynamics. "Most carriers clearly identify non-covered items on their websites. Trying to sneak the procedure in the back door and then fighting for reimbursement afterwards isn't the way to go because then the patient is charged for the service." 3. Watch for payor coverage updates closely. Surgeons and spine practices have begun to receive coverage denials for procedures and practices that were previously covered by insurance companies. One big example has been biomaterials, such as the new bio grafting materials which are now classified as non-covered services, even though they have been recognized and covered in the past.
"It's not the entire procedure, it's just the biomaterials that were being denied in most cases," says Ms. Cataletto. "They were covered in applications for several years, but now they are considered experimental, therefore, not covered. This doesn't make sense because bone marrow aspirates had minimal physician reimbursements — $100 or so — now if you include it in your surgical case, insurance companies won't approve reimbursement for the entire case. This is unusual and I haven't seen anything like this in the past."
Keep a close eye on the insurance company website for policy updates and make sure your office staff notifies you of any changes in claim denials. 4. Argue for medical necessity. Payors are increasingly denying spinal procedures based on "medical necessity," or lack thereof. Insurance companies claim surgery isn't medically necessary for a variety of reasons, including in situations where approval was readily granted in the past.
"There have been class action settlements in recent years — approved at various times between 2003 and 2006 — that have penalized insurers for unethical and unfair business practices," says Sean Weiss, vice president and chief compliance officer for DoctorsManagement. "The Second Circuit Court of Appeals decided numerous cases where medical necessity is mentioned. However, only one case actually described what the term means in absence of a definition in an insurance plan's documentation, saying 'unless the contrary is specified, the term medical necessity must refer to what is medically necessary for a particular patient, and hence entails an individual assessment rather than general determination of what works in the ordinary case."
Insurance companies such as Aetna, Cigna and Humana have entered into settlement agreements with more than 900,000 physicians and state and county medical societies in a class action lawsuit. However, settlements have expiration dates and vary by payor, so at some point the payors will not be bound by the definition of medical necessity within the settlements.
"I encourage physicians to play an active role in writing the appeal letters for claims that have been denied due to medical necessity, as you do not want to leave that to the discretion of a non-clinician," says Mr. Weiss. "However, for the practices that still cannot get the physician to write the appeal letter of medical necessity, there is simple language practice staff can use." Image may be NSFW. Clik here to view.5. Re-submit or appeal denied claims. Don't leave money on the table by tossing denied insurance claims. If the claim was denied for a coding error, fix the mistake and resubmit; if it was denied for another reason, appeal the payor's decision as far as possible.
"Insurance companies are making up bogus algorithms to deny surgery, and I don't know where they are coming from," says Hooman Melamed, MD, an orthopedic spine surgeon with DISC Sports & Spine Center in Marina Del Rey, Calif. "They aren't paying attention to the clinical notes and they are saying surgery isn't indicated, when clearly the findings are there. They are doing it hoping the patient and surgeon will give up and the surgery won't be performed. I've had denials for fusion in scoliosis and other deformity procedures where patients failed conservative therapy and they are still telling me the patient isn't a surgical candidate."
It's important to fight for coverage from the preauthorization stage, but just receiving the go-ahead for surgery doesn't mean your work is over.
Marissa Seligman, MD, is chief clinical and regulatory affairs and compliance officer and senior vice president for Pri-Med Institute, accredited provider division of M|C Communications. She is responsible for managing M|C's compliance program and activities and oversees the Pri-Med Institute. She also directs the company's clinical & medical affairs services. Dr. Seligman has more than 20 years experience in healthcare and continuing education.
Here Dr. Seligman discusses challenges and education efforts regarding physician opioid dosing and prescribing.
Question: What are the current concerns regarding physician dosing and prescribing of opioids?
Dr. Marissa Seligman: At the center of current concern is the number of overdoses and unintentional deaths associated with the non-medical use of opioids for non-cancer pain, which has steadily soared since the 1990s. For example, recent data shows between 2009 and 2010 almost one million people 12 years and older reported non-medical use of opioids for 200 days or more, and more than four million people reported such use for 30 days or more. Additionally, in 2009 there were almost 425,000 emergency department visits involving non-medical use of opioids and 15,597 deaths. Factors that have been identified as increasing the risk of opioid overdose-related deaths include higher opioid doses, male sex, greater age, overlapping opioid and sedative/hypnotic prescriptions, and increased number of prescriptions, particularly extended-release and long-acting opioid products, lack of awareness and understanding by prescribers and dispensing pharmacies.
The gaps between the guideline recommendations for safe prescribing practices of extended-release and long-acting opioids and current performance of primary care clinicians in particular, are due in part to overall inadequate training in pain medicine. To deliver better outcomes for patients, physicians and other healthcare providers who prescribe ER-and LA-opioids need better training on when and how long to prescribe these medications.
Q: What steps are being taken to address these concerns?
MS: There are a number of steps being taken by healthcare provider associations, patient advocacy groups, state and federal governments to curb misuse and promote safer patient care and by accredited providers of continuing education for healthcare providers to conduct training and education programs for prescribers of ER/LA-opioids.
Specifically, in July 2012, the FDA took an important and new step to address the concern by issuing a Risk Evaluation and Mitigation Strategy for ER and LA opioids by including, among many safety measures, a mandate that manufacturers of ER/LA opioid analgesics (there are about 20 of affected) fund accredited continuing medical education activities that will be made available to prescribers of ER/LA opioids. Each CME activity must be created and implemented based on an FDA Blueprint for prescriber education. To provide these education programs to the medical community, the group of manufactures, called the REMS Program Companies, created a process whereby accredited CME providers can submit for grants from the PRC.
Q: What type of education should physicians undergo to safely prescribe opioids? Is this training limited to pain management physicians?
MS: First, it is important to note that primary care clinicians, including internists, general medicine physicians, family physicians, osteopathic physicians, nurse practitioners and physician assistants, play a critical role in delivering effective pain management, including the prescribing of opioids. The U.S. uses 75 percent of all prescription opioids in the world, according to recent studies. In fact, primary care clinicians comprise the largest group of ER/LA prescribers at 54 percent.
As practitioners on the frontline of care, PCPs are in the best position to become a key part of the solution to address the current epidemic of opioid overdoses and deaths by undergoing in-depth and clinically-relevant training on current evidence-based guidelines for prescribing opioids, which cover how to appropriately screen patients, manage dosage, monitor use, as well as communicating and working with their patients to reduce the abuse and dangers associated with ER/LA-opioid use. ER/LA prescribers can also benefit from learning about addiction and how to assess the risk of abuse, as well as side-effects and drug-drug interactions. Clinician barriers to effective opioid prescribing include a fear of causing harm due to side effects to patients (reported by 77 percent of clinicians in a Pri-Med survey of 26 PCPs).
A survey of Pri-Med PCP learners from several regions of the U.S. on ER/LA opioid prescribing practices was conducted in 2011. In response to the question "How frequently do you use a written screening tool to assess risk for opioid misuse?" 61 percent answered "never" and only 15 percent said "always," with 12 percent indicating they assess for misuse "most of the time." Interestingly, 9 percent of responders indicated they used risk assessment tools "only in patients who strike me as potential opioid abusers." With best-practices education, prescribers can feel more confident that the treatment strategy they put in place is what is best for the patient and work with them to achieve shared management outcomes goals while reducing the risk of abuse, addition and death due to overdose.
Q: How can clinician prescribers better determine who may or may not be a good candidate for prescription opioids?
MS: There are published screening mechanisms and tools in place to help clinicians assess whether a patient is an appropriate candidate for opioid therapy. Prescribers of ER/LA opioids should seek out tools from licensed accredited providers including risk assessment questionnaires, samples of opioid agreements and ACCME-compliant CME programs on ER/LA opioids. Effective screening and patient assessments are critical to safe prescribing.
Q: What progress has been made in the last few years in regard to physician opioid training?
MS: The good news is, thanks to the rise in online learning, physicians now have more ready access to resources and education on opioids and pain management strategies, as well as support from other clinicians and leaders in the field. Due to the availability of interactive technologies online, physicians can now compare how they do in post-tests against their peers, which has not always been possible.
Q: What challenges remain?
MS: A considerable amount of education is still needed to close the gaps in patient care relative to non-cancer pain and ER/LA opioid prescribing. We should also see more emphasis placed on pain management in medical school and residency. For example, in a survey by O'Rorke and colleagues of community and university-based PCPs in internal medicine, family practice, and internal medicine residency programs in which 572 physicians completed an 84-item questionnaire, 24 percent to 32 percent of the respondents reported receiving "limited" education in pain management during medical school, residency and thereafter; 45 percent to 55 percent received "in depth" education, while about 20 percent received no education in pain management whatsoever during their training.
The PCPs who received education in chronic pain management were more comfortable in caring for patients with chronic pain; this increased level of comfort was correlated with training after residency. The authors concluded that training in pain management should be a key component of Internal Medicine and Family Medicine continuing medical education curricula.
Image may be NSFW. Clik here to view.More spine practices today are looking to expand beyond just neurosurgeons and spine surgeons to include non-operative care and pain management. Founder of BASIC Spine in Orange, Calif., Ty Thaiyananthan, MD, talks about expanding his practice into a multispecialty spine care center and where he sees this model heading in the future.
Q: How has your practice grown from a spine surgery-focused practice into a comprehensive, multispecialty group? Dr. Ty Thaiyananthan: We are a multispecialty group that includes both orthopedic and neurospine surgeons along with pain management specialists. Our model also includes physical therapy, chiropractors and pain management psychologists all under one roof. We were all single practitioners and we decided to come together so we can offer more comprehensive care and better care for patients who walk through the door. Q: What advantages do you find in the multispecialty spine care model? TT: We found from looking at our outcomes measures we are able to produce better results with this model. Patients are happier and they have several different specialists working with them to relieve their pain. When the patient comes in with a spine problem, based on what treatments they've had in the past, we can work them up the ladder of conservative management to interventional pain management, diagnostic evaluations and then provide surgery for surgical candidates.
If a patient who isn't quite ready for surgery comes to my office, I don't have to reschedule them. I can actually walk the patient across the hallway to the pain clinic and help them get something definitive done. I can also work with the pain physician on a single case to make sure the patient is getting the right treatment. Having two sets of eyes optimizes care, and we can do it all in real time. Q: What is the most challenging part of having all the different spine specialists under one roof? TT: The toughest part is logistics because you have to coordinate multiple different specialists and service lines into one center. That was a really big functional change and you have to have close collaboration to make a model like this work.
When we first came together, we wanted to develop protocol for new patients, as well as follow up with our current patients to make sure they are seen by the right specialists at the right stage in their treatment. To coordinate that has been challenging, and we actually hired a consulting service to sit in the room with us as we talked about putting together a treatment plan; they were able to solidify our thoughts into something concrete.
Now we have a check-in process and vetting process to see where people would fit based on past treatment. We try to figure out whether the patient needs physical therapy, pain management, chiropractic care or another conservative treatment. Having everyone in the same room as we devised the treatment pathway and protocol was absolutely vital. Q: How has this multispecialty model changed your practice of spine surgery?
TT: The people I'm seeing in my practice are truly surgical, so I'm not spending time sending patients to a pain management specialist. It's a more efficient use of our time and integrating the different service lines brought additional profit lines into our practice as well. Q: When new patients arrive at the center, who guides them to make sure they are seeing the right specialist? TT: We have a nurse navigator who coordinates our new patients. We also have customized software that helps coordinate and fast track patients into different treatment plans. For example, if a new patient who is 30 years old and has only had back pain for a few months, our clinical coordinator will work with that patient on a physical therapy program. However if a 65-year-old with prior history of back surgery and chronic pain comes in, and an MRI shows disc herniation, that patient will be screened by a nurse navigator and likely schedule an appointment with one of the surgeons.
There is an intuitive algorithm in our software to help us identify these patients and set them on the right track. The patients are happy because it's the shortest route to giving them treatment and they aren't wasting their time with the wrong specialist. Q: Where do you see the multispecialty spine care model headed in the future? TT: I think it's going to be mandated by accountable care organizations. As more of healthcare is determined by outcomes and quality measures, as well as cost savings, it's really going to be efficiency and making sure you get quality care for the patients. Minimize wait times and optimize the patients' healthcare dollars, which is what multispecialty practices do. We can give patients a definitive answer about their care without having them go through the medical mill. More Articles on Spine Surgeons: 5 Ways for Spine Practices to Stay on the Cutting Edge Innovative Trends in Spine Surgery Technology: Q&A With Dr. Lawrence Dickinson 5 Factors Influencing Spine Fellows Turn Towards Academia
The University of Rochester (N.Y.) Medical Center announced that its department of orthopedics and rehabilitation has been ranked Number 1 in the nation in National Institutes of Health funding for orthopedic research, according to data released by the Blue Ridge Institute for Medical Research.
The URMC Center for Musculoskeletal Research received $4.86 million in peer-reviewed NIH research grants in 2012. Since 2000, the center has consistently ranked among the top five NIH-funded musculoskeletal programs in the country.
Here are seven hospitals that are expanding the orthopedic or spine programs.
Osceola Regional Medical Center in Kissimmee, Fla., is building a $52.6 million, 60-bed, three-floor expansion that will contain the hospital's Orthopedic and Spine Center.
Hillcrest Baptist Medical Center in Waco, Texas, opened its new outpatient surgery center that offers orthopedic surgery services.
St. Francis Hospital in Hartford, Conn., is launching the Spine Institute of Connecticut.
Soin Medical Center in Beavercreek, Ohio, which performs orthopedic and spine surgeries, is building on its fourth floor to add 32 private patient rooms.
Wenatchee (Wash.) Valley Medical Center in Wenatchee, Wash., opened a new spine center on February 18 to help accommodate the 25,000 to 30,000 patients that come in with back pain each year.
The Central Peninsula Hospital spine program brings $12 million to $15 million in net revenue per year to the hospital and the program is to expand in 2013 and years to come.
SpineMark and Quiron Hospital Group partnered to open the Quirón Torrevieja Spine Center in Torrevieja, Spain.
Physician turnover has hit its highest rate since 2005, the first year the data was collected, according to the 8th annual Physician Retention Survey from Cejka Search and the American Medical Group Association.
In 2012, the average rate of medical group physician turnover was 6.8 percent, up slightly from 6.5 percent in 2011, but much higher than the 2009 rate of 5.9 percent, according to the survey.
Also, medical groups do not expect a reprieve from losing physicians this year: 36 percent of the groups expect the physician retirement rate to increase in 2013.
The survey reflects responses from 80 physician groups that collectively employ 19,596 physicians.
Joseph Zavatsky, MD, is an orthopedic spine surgeon and section chief of spine in the department of orthopedics at Ochsner Medical Center in New Orleans, where he works collaboratively with other orthopedic spine surgeons, neurosurgeons, pain management and PM&R physicians, anesthesiologists and radiologists at the new Back & Spine Center at Ochsner Baptist Hospital. He was fellowship trained at the New York University Hospital for Joint Diseases.
Dr. Zavatsky's research primarily focuses on improving minimally invasive spine surgery. A majority of his patients suffer from adult degenerative deformity conditions so, through research, he strives to find the safest ways to perform these corrective procedures.
Recently, he has been involved with several different minimally invasive spine research studies. Here Dr. Zavatsky details three of those projects and how they may impact the future of spine surgery.
1. Mechanomyography neuromonitoring. Mechanomyography neuromonitoring, or MMG, is a neuromonitoring technology that is an alternative to traditional electromyogram monitoring, or EMG, that can be used during spinal procedures. During Dr. Zavatsky's study, the MMG technology, developed by Sentio, was used to monitor the lumbar plexus in 100 patients undergoing trans-psoas lateral interbody fusion procedures.
"MMG measures the mechanical movement or firing of muscles which is recorded in the leads that are placed on the extremities," he says. "Instead of using needles and measuring the electrical activity through the leads with EMG, you are measuring the acceleration of muscle contraction with MMG. It can be more sensitive and specific since it is not affected by other machines being used simultaneously in the OR like electrocautery or body warmers."
Bear Hugger body warmers and the Bovie cautery used in the operating room can often obscure the surgeons' ability to detect nerve irritation because these machines can produce artifact seen on EMG. But this electrical artifact does not affect MMG monitoring.
"With EMG there are times that you may be operating blind and unable to detect potential nerve injury because of the electrical artifact produced by the Bovie and body warmer devices,” he says. "Using MMG, we found our thigh complication rates including pain, numbness and motor weakness to be less than the reported rates of 30 to 80 percent. Although MMG needs additional investigation, our 20 percent thigh complication rates are promising.
ENT has also been experimenting with MMG technology during surgery to monitor the facial nerve, and Dr. Zavatsky's research showed it can also be successfully used in spinal procedures, particularly those that use the trans-psoas lateral approach, where the lumbar plexus is at risk.
2. Y-wire from Safewire. Dr. Zavatsky conducted a study of 20 patients undergoing minimally invasive L5-S1 transforaminal lumbar interbody fusions. Ten patients had the Y-wire placed through Jamshidi needles to percutaneously place pedicle screws, and 10 patients had standard straight guide wires utilized.
"When you tap the pedicle pilot holes and place the percutaneous pedicle screws over standard guide wires, there is a risk of advancing these wires anterior to the vertebral body especially in osteoporotic bone and at S1 where many surgeons remove the physical anterior block by tapping the distal S1 cortex for bicortical S1 screw purchase," he says. "If you inadvertently advance the guide wire anterior to the vertebral body, you place structures anterior to the spine, including the vessels and bowel, at risk."
However, the Y-wire deploys its Y-shaped tip after it exits the Jamshidi needle and prevents inadvertent advancement of the wire through poor bone and even through the hole of the distal cortex that is made with tapping S1, he says.
Dr. Zavatsky's research showed the Y-wire also increased the safety of the procedure by significantly decreasing the amount of radiation both the patient and surgeon were exposed to when compared with the traditional method of placing percutaneous pedicle screws over standard guide wires. The additional security of the Y-wire means surgeons do not need to use as much fluoroscopy while tapping or placing the pedicle screws to confirm the guide wire did not advance inadvertently. Decreased radiation is important for spine surgeons, especially those who are performing more MIS procedures, as the risk of developing cataracts and thyroid cancer could increase. Dr. Zavatsky currently wears lead-lined glasses in the operating room to decrease the risk of developing cataracts, but even physical precautions are not always enough.
"I used much more X-ray prior to using Y-wire," he says. "I used to constantly check that I wasn't advancing or pulling out the guide wire. With the Y-wire you are able to apply a constant pressure on the guide wire without fear of it advancing, so you don't have to take so many X-rays."
He and other researchers concluded that the Y-wire guide wire makes percutaneous pedicle screw placement significantly safer for everyone in the OR by reducing the amount of radiation exposure.
3. Lateral interbody fusions. This research trial evaluated the effect of optimal cage size and placement on lateral interbody fusion rates. Although previous studies have mentioned the importance of spanning the ring apophysis, the strongest part of the vertebral body endplate, these studies have used various cages without mention of their size or placement, Dr. Zavatsky says. Studies which use thin-cut CT scan, which is the radiographic gold standard to evaluate fusion, for all subjects are also limited. Additionally, some studies have even advocated under-sizing the lateral interbody cage, on the premise that you are placing a rectangular cage on circular endplates, which can result in lateral overhang of the cage.
However, the strongest portion of the endplate is at the very outer edge of vertebral body at the ring apophysis. The researching surgeons oversized the lateral cage by 5mm to ensure the strongest portion of the endplate was spanned. The theory was that there would be less subsidence resulting in increased stability thus affecting fusion rates. After performing lateral fusions on 63 levels, two independent musculoskeletal radiologists confirmed a 100 percent fusion rate by sagittal, coronal and axial thin-cut CT images on all patients.
"Reported fusion rates for laterals are typically high. But by over sizing the lateral cage to ensure ring spanning, further stability may be obtained, mitigating endplate violation by either endplate preparation or poor bone quality and thus improving fusion rates," Dr. Zavatsky says. "Over sizing the lateral cage along with posterior pedicle screw augmentation may be key factors in improving fusion rates."
Illinois Bone & Joint Institute, with locations in the Chicagoland area, announced it will participate in the Centers for Medicare & Medicaid Bundled Payments for Care Improvement program. IBJI is the only independent physician group practice in the state, and one of only a few in the country, participating in the program. The practice will participate in Model 3 and plans to take steps improving care management for orthopedic patients.
"We are excited to be selected to participate in Medicare's bundled payment program for joint replacement because we see an opportunity to improve care and improve service, which will ultimately lower the cost of care," says David J. Wold, COO of IBJI. "It's a win-win situation. We believe that when we are successful with the Medicare patients that this model will be very attractive to traditional payors as well."
Mr. Wold discusses the potential risks and rewards of bundled payments and where alternative payment models are headed in the future. Q: What are your goals with the bundled payment program? David Wold: Leading up to our decision to participate, we looked at what Medicare pays relative to joint replacement care. We found it really interesting that the cost is relatively similar for hospitals and physician fees, but where we saw a tremendous opportunity to lower costs was in managing the continuum of care. There are excessive dollars spent after the surgery is performed and we think we'll be able to improve those services and lower overall costs. Q: How do you plan to impact the post-surgical care costs? Where is the biggest opportunity for improvement there? DW: Historically, after physicians operate they see the patient for a follow up visit. At that point, the patient is really on their own and we've found that a lot of patients, as a matter of convenience, will go from three nights in a hospital to the skilled nursing home for 20 days which just happens to be the length of time Medicare pays for 100 percent of the costs without patient copays. We believe that providing better education and care coordination after surgery, we will be able to reduce the number of days patients stay there.
We also believe we'll reduce readmissions to the hospital. That is where there is a huge opportunity for savings. I think because of the need to follow patients through the process, it will become more personalized and enhance the patient experience. Q: How will daily practice change for the surgeons? What is their level of involvement with the continuum of care?
DW: We have appointed one of our joint replacement surgeons to serve as medical director and we are also looking to find an internist to help us manage this at the skilled nursing home and care coordinator to sit down with the patient before surgery. They will go through the whole experience with the patient and discuss our recovery expectations. We'll also work with the patients on their rehabilitation with our specialists. From our experience, having patients go to the IBJI facility for rehabilitation after they leave the nursing home and receive therapy from joint specialists who are in direct contact with the surgeons will enhance service. The bundled payment program won't burden surgeons with more administrative work. Q: Bundled payments pass risk from payors to providers. How are you handling this extra risk? DW: We are looking to mitigate some of this risk by partnering with all the key stakeholders who provide post-acute care to patients including SNFs, home health and outpatient rehab. We are working together at enhancing the quality and lowering the cost. As a partner, we can share risk as well as the reward. By getting our strategic partners involved, we can minimize risk and enhance our collective abilities to be successful. Our incentives are aligned with each of these stakeholders which improves quality and lowers cost.
If we are able to help Medicare lower their costs there is an upside to participating in the bundled payments with additional potential savings. Q: Where do you see bundled payments heading in the future? DW: In my discussions with third party payors, they are all intrigued with the concept of bundled payments and our plans are to go beyond just joint replacements. We would like to look at all surgical procedures we do and see whether we can replicate the bundled services to make them more attractive for insurance companies. We are fortunate, given our size and geographic penetration, that we have the resources to invest in people and technology to manage data. We can compare IBJI physicians to other physicians employed at the hospital and we estimate our care will cost about a third of the other providers.
