Hines Kevin, Mouchtouris Nikolaos, Getz Charles, Gonzalez Glenn, Montenegro Thiago, Leibold Adam, Harrop James
Department of Neurosurgery, 6559Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
Department of Orthopedic Surgery, Rothman Institute, Philadelphia, PA, USA.
Global Spine J. 2021 Apr;11(1_suppl):7S-13S. doi: 10.1177/2192568220974977.
The following is a narrative discussion of bundled payments in spine surgery.
The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery.
Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts.
Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine surgery, it is important to understand concepts such as value-based purchasing, episodes of care, prospective versus retrospective payment models, one versus two-sided risk, risk adjustment, and outlier protection. Strategies for implementation underscore the importance of risk stratification and modeling, adoption of evidence based clinical pathways, and data collection and dissemination. While bundled care models have been successfully implemented, challenges facing institutions adopting bundled care payment models include financial stressors during adoption of the model, distribution of risks, incentivization of treating only low risk patients, and nuanced variation in procedures leading to variation in costs.
An alternative for fee for service payments, bundled care payments may lead to higher cost savings and surgeon accountability in a patient's care.
以下是关于脊柱手术捆绑支付的叙述性讨论。
美国医疗保健成本持续上升。为降低医疗保健成本，正在研究报销模式，将其作为通过在脊柱手术等领域推动激励措施和质量改进来实现潜在成本节约的干预措施。
对与脊柱手术捆绑支付相关的文献进行叙述性综述，综合来自计算机数据库和权威文本的研究结果。
由于成本高度可变以及手术决策细微差别，脊柱手术的支付模式难以界定。在脊柱手术中实施捆绑式护理支付时，理解诸如基于价值的采购、护理阶段、前瞻性与回顾性支付模式、单边与双边风险、风险调整和异常值保护等概念非常重要。实施策略强调了风险分层和建模、采用循证临床路径以及数据收集与传播的重要性。虽然捆绑式护理模式已成功实施，但采用捆绑式护理支付模式的机构面临的挑战包括采用该模式期间的财务压力、风险分配、仅治疗低风险患者的激励措施以及手术细微差异导致成本变化。
作为服务收费支付的一种替代方式，捆绑式护理支付可能会在患者护理方面带来更高的成本节约和外科医生问责制。
