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The biggest challenges in spine from 9 surgeons: Drs. Alexander Vaccaro, Michael Musacchio & more

By Admin | April 18, 2021

From prior authorization requirements to value-based care initiatives and payer battles, nine spine leaders discuss the biggest challenges affecting their practice today.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.


Note: The following responses were lightly edited for style and clarity.

Question: What is the biggest challenge facing your practice now?

Alexander Vaccaro, MD, PhD. Rothman Orthopaedics (Philadelphia): The biggest challenge facing our practice is promoting value-based care with appropriate incentives for all stakeholders. Value-based care has been shown to provide savings to the payer and provider when utilizing appropriate incentives. This can be achieved through alignment of the payer, health system and provider through demand matching point-of-care strategies and strategic partnerships. These strategies can result in a reduction of cost by almost 20 percent per episode, which not only translates to savings for the provider, but also better outcomes for patients.

In these models, we have been able to discharge a much higher percentage of patients to home (97 percent discharged) as well as reduced infection rates (99 percent reduction) and reduce complications by more than half (56 percent reduction). Still, promoting value-based care remains challenging because of the payment structure and difficulties aligning all stakeholders. Because the baseline target in CMS bundles are adjusted from the previous year's total cost of care, providers experience diminishing return and are not incentivized to improve dramatically — as doing so could significantly alter target prices and potentially reduce share savings significantly. Therefore, under the current bundle payment scheme, the dramatic diminished marginal benefit to the provider must be rethought to maintain...(More)

For more info please read, The biggest challenges in spine from 9 surgeons: Drs. Alexander Vaccaro, Michael Musacchio & more, by Becker's Spine Review

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