What spine surgeons expect for the future of value-based care

Value-based care has seen some growth in spine and orthopedics, with some groups embracing the payment model.

Unlike fee-for-service, value-based care encourages a greater emphasis on patient outcomes. Spine surgeons discuss their outlook on value-based care and how it can expand.

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. Becker’s invites all spine surgeon and specialist responses.

Next question: What is one key lesson from a mentor that you pass along to spine residents and fellows now?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, May 8.

Editor’s note: Responses were lightly edited for clarity and length.

Question: What’s needed to broaden value-based care’s reach? How do you predict it will look in 10 years?

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I think value-based care’s goals have to be defined in their most basic sense: bringing value to whom. As of right now, the only people getting value are the billion-dollar quarterly profits for the insurers. It’s time we stopped feeding into it, and make our care better, safer and more efficient. Value will then be a desirable byproduct by doing a good job first.

Emeka Nwodim, MD. Centers for Advanced Orthopaedics (Bethesda, Md.): The purpose of value-based care is to optimize quality, performance and the [global] patient experience to control what has become unsustainable healthcare costs. I believe in order for this to be successful and truly fulfill what is intended, it will require all parties involved in the healthcare system to be willing to compromise and be intentional about finding solutions.

At this point in time, the most tangible and effective compromise to optimize VBC will have to come from payers, large healthcare systems and hospitals. This does not preclude the responsibility of physicians and multi-specialty practices, such as my own (CAO), which have the responsibility of managing ancillary use and expenses. However the majority of money spent on healthcare is consumed by payers, large healthcare systems and hospitals. Rather than continuing to decrease reimbursements to physicians and medical staff responsible for direct patient care, our society must recognize where most expenses are consumed — and those parties have to be accountable with controlling their consumption. 

This is not to demonize payers, large healthcare systems or hospitals as their good will and participation are paramount to establishing true value-based care. One of the first steps, and what I believe is the most important, is to establish trust amongst all parties involved, including patients, providers, medical staff, payers, healthcare systems and hospitals. I believe compromise would soon follow.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Value-based care is a healthcare delivery model under which all providers are contracted and reimbursed on the health outcomes of their patients and services rendered. Under some value-based contracts, there is shared financial risk and potential incentives for providing high-quality, efficient care. While quality care can be provided under both a VBC and Traditional Model, the aggregate management in VBC’s management/paid and theoretically saved healthcare dollars streamline the process. In my opinion, the failure of this system is lack of participation by all physicians especially in the for-profit, physician-owned surgical system where metrics are neither collated nor applied.  

The over-lengthened pandemic and its financially disastrous effects to the entire healthcare system are more semblant as reimbursements from federal, state and private insurers have diminished, resulting in capital project and purchase curtailment has waned. The foreboding trends of unrealizable VBC are being redefined as prohibitive and withholding of care, especially in regard to the underserved and the complicated/chronic disease affected. Fine tuning of healthcare delivery is no longer the objective but rather a resource management issue for all physicians, fraught with delays and added scrutiny.