Although spine procedures are considered to be a bread and butter service of hospital business units, there are a number of challenges that will affect the pace at which these procedures are poised to grow in the future. The traditional growth drivers of the past, such as demographics and advances in technology, may actually temper growth in coming years. The utilization of certain spine procedures, spinal fusion in particular, may begin to slow as baby boomers continue to age—the utilization of spine surgery peaks between ages 45 and 64.
Advances in technology and treatment techniques may also reduce inpatient volumes by pushing procedures to outpatient settings (see the Marketing and Planning Leadership Council’s Service Line Forecast Compendium for inpatient and outpatient forecasts).
Commercial payers and government agencies are also increasing their scrutiny of spine surgery utilization, putting additional pressure on growth prospects. For example, CMS recently announced (and then postponed) plans to launch a demonstration in 11 states evaluating the appropriateness of high-end procedures, including common spine procedures, by conducting prepayment reviews to ensure medical necessity before providers are reimbursed. Such efforts, along with news coverage putting “unnecessary” utilization of spine procedures in the spotlight, are likely to push providers to offer more conservative therapies as penalties and denied payments increase.
Expanding spine services across the care continuum
The mandate to elevate the value of care across our service lines—the key driver behind service line transformation—requires organizations to first strengthen their service line infrastructure and then make use of the improved infrastructure to redesign their care processes. To that end, we have recently added to Blueprint for Service Line Transformation, updating the study with a section on Re-Designing Care Processes for Value. This second section complements the earlier piece, which provides guidance for Building a Dynamic Leadership Structure. Together, the two sections detail near-term imperatives facing hospitals and health systems, providing actionable steps that yield improved performance under today’s fee-for-service incentives while also preparing organizations for future value-based incentives.
The role of service lines in re-designing care processes
We regularly hear from hospitals seeking to better engage physicians in quality improvement and utilization management efforts. At a service-line level, hospitals have seen some success increasing physician engagement through co-management arrangements. Co-management arrangements pay physicians at fair-market value for administrative responsibilities and provide additional incentive payments based on achievement of quality and cost goals.
Hospitals find this alignment model to be particularly attractive for orthopedics service lines, given the independence of orthopedic surgeons and the substantial potential for both quality gains and cost reduction within orthopedics. In a survey of 258 hospital and health system leaders, 11% reported co-management of orthopedics service line, the third highest among service lines after cardiology (13%) and imaging (12%). Tight alignment with orthopedic surgeons will be even more critical as hospitals seek to balance two competing influences on volumes: Demographics will drive growth of joint replacement even as scrutiny of appropriateness increases.
Co-management models especially promising for orthopedic service lines