Value-Based Approaches to Spine Care : Sustainable Practices in an Era of Over-Utilization

206 Pages·2020·2.617 MB·English

by  Rajiv K. Sethi, Anna K. Wright, Michael G. Vitale

Value-Based Approaches
to Spine Care
Sustainable Practices
in an Era of Over-Utilization
Rajiv K. Sethi
Anna K. Wright
Michael G. Vitale
Editors
123
Value-Based Approaches
to Spine Care
Rajiv K. Sethi • Anna K. Wright
Michael G. Vitale
Editors
Value-Based
Approaches to
Spine Care
Sustainable Practices in an Era
of Over-Utilization
Editors
Rajiv K. Sethi, MD Anna K. Wright, PhD
Neuroscience Institute Neuroscience Institute
Virginia Mason Medical Center Virginia Mason Medical Center
Seattle, WA Seattle, WA
USA USA
Michael G. Vitale, MD, MPH
Columbia University
New York, NY
USA
ISBN 978-3-030-31945-8 ISBN 978-3-030-31946-5 (eBook)
https://doi.org/10.1007/978-3-030-31946-5
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Preface
As our society moves from volume to value in the treatment of
spinal disorders, we will be increasingly faced with the challenge
to move away from yester-care where fee for service healthcare
has demanded large volumes of spinal procedures. The aim of this
text is to gather thought leaders and provide an up-to-date synop-
sis of efforts to enhance value in the care of spinal conditions.
The first portion of this book will describe the macro issues
around value-based healthcare initiatives that bring together the
principles of health economics along with the topic of utilization
of spinal procedures. While there is no standard for utilization of
any given procedure, we are clearly seeing an upward trend in the
United States coupled with increasing costs and stagnant out-
comes in certain procedures. In others, such as the treatment of
adult spinal deformity, we are seeing a group of patients who can
show dramatic improvement in quality of life with successful sur-
gery. At the same time, many centers experience high complica-
tion rates and significant morbidity and mortality in patients who
have not undergone risk stratification and optimization of those
factors that can be improved. The Seattle Spine Team approach is
published in peer review as the first value-based paradigm to
improve short-term complication rates in the treatment of some of
the most complex spinal conditions from a multidisciplinary per-
spective. This approach was later applied to all patients receiving
elective lumbar fusion. This work has led to selective referrals
from all regions of the United States by private payors where
patients are flown to Seattle for spinal specialty care. Private pay-
v
vi Preface
ors are no longer willing to allow the fee for service principles of
yester-care to dominate their own healthcare arena.
The main sections of this book describe specific efforts to
enhance value in an era of overutilization of spinal procedures in
the United States. Some of this will involve collaboration with
registries, and we have asked our Dutch colleagues in Nijmegen
for their expertise. We have also looked at technology and how
this will help us in the future as we move to more value-based
paradigms. The reader will also understand the essence of a mul-
tidisciplinary spine model as the answer to many of our current
conundrums.
I would like to thank my coeditors, Anna K. Wright, PhD, and
Michael G. Vitale, MD, for their collaboration and expertise in
forming this book. They have both been essential players in the
field of spine safety and value, and I am grateful to them for their
camaraderie and team spirit. Michael G. Vitale, MD, has been my
brother in the spine safety movement for many years, and my
admiration for him continues to grow. I dedicate this book to my
mother and father (Brahm and Chander), my wife (Aya), and my
four kids (Ariya, Suriya, Anika, and Karina). Particularly, this
book is meant to highlight principles that will make spinal care
sustainable for the next generation who will undoubtedly need
access to high-quality surgeons and teams. As an American patriot
and spinal surgeon, I worry that this access will suffer in an era
where the costs are growing out of proportion to GDP growth. We
must do everything possible to improve our industry for the ben-
efit of our children and generations to come.
Seattle, WA, USA Rajiv K. Sethi, MD
Contents
1 Macro Trends in Healthcare Delivery . . . . . . . . . . . . . . 1
Stephen L. Ondra
2 Evaluating Policy Effects in the Treatment
of Lumbar Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Brook I. Martin, Sohail K. Mirza, and Daniel J. Finch
3 The Bree Collaborative Bundle for Lumbar
Fusion: Evolution of a Community Standard
for Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Andrew S. Friedman and Robert S. Mecklenburg
4 Multidisciplinary Evaluation Improves
the Value of Lumbar Spine Care . . . . . . . . . . . . . . . . . . 61
Vijay Yanamadala, Anna K. Wright,
Andrew S. Friedman, Reza Yassari,
Andrew I. Gitkind, Robert S. Mecklenburg,
and Rajiv K. Sethi
5 Using Lean Process Improvement to Enhance
Safety and Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Michael A. Bohl and Gary S. Kaplan
6 The Seattle Spine Team Approach . . . . . . . . . . . . . . . . . 97
Jean-Christophe A. Leveque
7 Modifiable Factors in a Standard Work Protocol
for Adult Deformity Surgery . . . . . . . . . . . . . . . . . . . . . 117
Douglas C. Burton
vii
viii Contents
8 Measuring Outcomes in Adult Spinal Deformity . . . . . 155
Sayf S. A. Faraj, Tsjitske M. Haanstra,
Anna K. Wright, Marinus De Kleuver,
and Miranda L. Van Hooff
9 Spine Safety: Optimum Integration
of Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Richard Menger, Han Jo Kim,
and Michael G. Vitale
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Contributors
Michael A. Bohl, MD Department of Neurosurgery, Barrow
Neurological Institute, St. Joseph’s Hospital and Medical Center,
Phoenix, AZ, USA
Douglas C. Burton, MD Department of Orthopaedic Surgery,
Kansas City Medical Center, Kansas City, KS, USA
Marinus De Kleuver, MD Department of Orthopaedic Surgery,
Radboud University Nijmegen Medical Center, Nijmegen, The
Netherlands
Sayf S. A. Faraj, MD Department of Orthopaedic, Radboud
University Medical Center, Nijmegen, The Netherlands
Daniel J. Finch, BA Department of Orthopaedic, University of
Utah, Salt Lake City, UT, USA
Tufts University, Boston, MA, USA
Andrew  S.  Friedman, MD Neuroscience Institute, Virginia
Mason Medical Center, Seattle, WA, USA
Department of Physical Medicine and Rehabilitation, Virginia
Mason Medical Center, Seattle, WA, USA
Andrew  I.  Gitkind, MD Division of Interventional Spine,
Department of Rehabilitation Medicine, Montefiore Medical Cen-
ter, Albert Einstein College of Medicine, The Bronx, NY, USA
Tsjitske  M.  Haanstra, PhD Department of Orthopaedic,
Radboud University Medical Center, Nijmegen, The Netherlands
ix
x Contributors
Gary S. Kaplan, MD Virginia Mason Medical Center, Seattle,
WA, USA
Han Jo Kim, MD Department of Orthopaedic, Hospital for Spe-
cial Surgery, New York, NY, USA
Jean-Christophe  A.  Leveque, MD Neuroscience Institute,
Virginia Mason Medical Center, Seattle, WA, USA
Department of Neurosurgery, Virginia Mason Medical Center,
Seattle, WA, USA
Brook  I.  Martin, PhD, MPH Department of Orthopaedic,
University of Utah, Salt Lake City, UT, USA
Robert S. Mecklenburg, MD Center for Healthcare Solutions,
Department of Medicine, Virginia Mason Hospital and Seattle
Medical Center, Seattle, WA, USA
Richard Menger, MD Department of Neurosurgery, New York-
Presbyterian Hospital-Columbia and Cornell, New York, NY,
USA
Sohail  K.  Mirza, MD, MPH Department of Orthopaedic,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
Stephen L. Ondra, MD North Star Healthcare Consulting, LLC,
Williston, FL, USA
Rajiv K. Sethi, MD Neuroscience Institute, Departments of
Neurosurgery Health Services, Virginia Mason Medical Center,
Seattle, WA, USA
Miranda L. van Hooff, MD Department of Orthopaedic S urgery,
Radboud University Medical Center, Nijmegen, The Netherlands
Michael G. Vitale, MD, MPH Pediatric Spine and Scoliosis
Service, Division of Pediatric Orthopaedic, Quality & Strategy,
Orthopaedic Surgery, Columbia University Medical Center/
Morgan Stanley Children’s Hospital, New York, NY, USA
Anna K. Wright, PhD Neuroscience Institute, Virginia Mason
Medical Center, Seattle, WA, USA