Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2015; 6(5): 409-412
Published online Jun 18, 2015. doi: 10.5312/wjo.v6.i5.409
Economic factors in the future delivery of spinal healthcare
Vincent J Rossi, Junyoung Ahn, Daniel D Bohl, Ehsan Tabaraee, Kern Singh
Vincent J Rossi, Junyoung Ahn, Daniel D Bohl, Ehsan Tabaraee, Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, United States
Author contributions: All authors made significant contributions toward the preparation of this manuscript.
Conflict-of-interest: Author Kern Singh has received fees for serving as a consultant for DePuy, Zimmer, Stryker and Globus, royalties from Zimmer, Stryker, Pioneer, Lippincott, Thieme, Jaypee Publishing, and Slack Publishing, and as a board member for Vital 5 LLC, TruVue Surgical, Avaz, and Bijali. The other authors have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kern Singh, MD, Associate Professor, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, Chicago, IL 60612, United States. kern.singh@rushortho.com
Telephone: +1-312-4322373 Fax: +1-708-4925373
Received: March 6, 2015
Peer-review started: March 8, 2015
First decision: April 10, 2015
Revised: April 22, 2015
Accepted: May 7, 2015
Article in press: May 8, 2015
Published online: June 18, 2015

The current trajectory of healthcare-related spending in the United States is unsustainable. Currently, the predominant form of reimbursement is the form of a fee-for-service system in which surgeons are reimbursed for each discrete unit of care provided. This system does factor the cost, quality, or outcomes of service provided. For the purposes of cost containment, the bundled episode reimbursement has gained popularity as a potential alternative to the current fee-for-service system. In the newer model, the spinal surgeon will become increasingly responsible for controlling costs. The bundled payment system will initially offer financial incentives to initiate a meaningful national transition from the fee-for-service model. The difficulty will be ensuring that the services of surgeons continue to be valued past this initiation period. However, greater financial responsibilities will be placed upon the individual surgeon in this new system. Over time, the evolving interests of hospital systems could result in the devaluation of the surgeons’ services. Significant cooperation on behalf of all involved healthcare providers will be necessary to ensure that quality of care does not suffer while efforts for cost containment continue.

Keywords: Affordable care act, Spine surgery, Economics, Future, Access, Payments, Reimbursement

Core tip: Following the enactment and implementation of the patient protection and affordable care act, healthcare providers will witness significant changes in how payments are made for their services. In this editorial, the authors describe the potential benefits and the risks associated with a transition toward the bundled reimbursement system for patients and spine surgeons alike.