Moderator: Kris Radcliff, MD
With reporting of outcome and cost data gaining traction, detailed information from payers and providers about spine care will be increasingly available. The purpose of this session is to discuss publicly reportable outcome, coverage, and cost data relevant to spine care.
Since value is defined as the relationship between outcome and cost, both corporate entities and providers recognize the need to provide patients with meaningful outcome data instead of process measures. Patient satisfaction has emerged as an important outcome measure in public reporting due to the ease of collection, the technical complexity of disease specific measures, and patient centered nature of the data. Patient satisfaction can be framed as satisfaction with symptoms or satisfaction with treatment. Advantages of a patient satisfaction outcome measure in spine care are that it is a general health measure that is comprehensive and easily comparable. However, patient satisfaction may not correlate directly with relief of spine-specific symptoms and may be somewhat dependent on patient expectations. Additionally patient satisfaction may conflict with professional responsibilities, such as counseling about weight loss or smoking cessation or avoidance of opioid pain medication. In this section, we will review the existing patient satisfaction data in spine care, discuss factors that influence patient satisfaction, and identify future trends in patient satisfaction.
The other part of the value equation in spine is controlling costs. Payers have long attempted to control expenditures by coverage of specific procedures through precertification. As corporate accountability and transparency increases in spine care, the rationale for such decisions has evolved from internal, confidential guidelines to specific systematic reviews that are accessible online by providers and patients. Levels and grades of evidence are provided to establish medical necessity or experimental status. Similarly, NASS has created a set of coverage recommendations based on a systematic review approach to readily summarize the supporting evidence for common spine procedures. In this section, we will review the different types and processes for coverage recommendations, discuss what levels of evidence are reasonable and necessary to justify spine care, and discuss strategies to handle conflicting systematic literature reviews.
Finally, provider-specific cost information has become readily available online. Such public reporting of information may enable patients to identify variability in provider costs and to make cost-informed choices. Disadvantages of such charge and reimbursement reporting include the possibility of misinterpretation of case complexity and provider numbers. Additionally, there is a possibility that providers may choose to eschew high cost patients with medical comorbidities or high cost procedures such as spinal osteotomies. In this section, we will debate the provider-specific implications of participating in high cost or low cost care.
Upon completion of this session, participants should gain strategies to:
- Discuss suitability of patient satisfaction as a measure of quality of spine care;
- Review current evidence and insurance practice patterns regarding coverage;
- Identify potential effects of healthcare bundling on coverage and authorization policies;
- Discuss whether future innovations in spine surgery should emphasize cheaper, short term solutions or more expensive, long term solutions.
Agenda
- Introduction
Kris Radcliff, MD
Patient Satisfaction
- Patient Satisfaction: What Does the Literature Demonstrate? Is it a Reliable Benchmark of Our Care?
Ryan Spiker, MD
- Patient Satisfaction: What Factors Influence Patient Satisfaction? Can I Select Patients Who Will Have High Satisfaction Scores?
Clinton Devin, MD
Corporate Accountability
- Debate: Insurance Denials: Medical coverage decisions are based on rational, systematic reviews of the evidence. If you don’t like the decision, we need better evidence.
Alan Hilibrand, MD
- Debate: Evidence-based Recommendations Enable Providers to Overturn Denials When Appropriate
Jim Youssef, MD
- Debate: The Entire Model of Coverage and Denials Will Change, Bundling Will Lead Providers to Deny or Perform Cheaper Care
Barrett Woods, MD
Provider Accountability and Cost Reporting
- Debate: Get It Right the First Time: Fusion in the Appropriate Sagittal Balance is the Best Solution to Controlling Long-Term Deformity Costs
Frank Schwab, MD
- Debate: Complications Drive Costs, We Should Emphasize Simple Procedures with Low Complication Rates
Adam Pearson, MD
- Discussion