Developing Care Bundles for Complex Spine Surgery

Looking for a roadmap for creating successful complex spine surgery bundles.

My organization intends to develop care bundles for complex spine surgery.  As a primary care physician, I need to learn more about both bundle development and spine surgery.  I will also need to learn good managerial strategies for this type of work, because this department has not worked together in this manner before.

The organization is a multi specialty group serving patients from a rural area of the U.S.  Many of our patients are covered by Medicare or Medicaid, some with full capitation, and some have private insurance.  Our spine department includes nonsurgical (PM&R) spine physicians and physical therapists, as well as neurosurgery and orthopedic spine surgeons who perform an increasingly broad range of surgeries.  Care bundles for complex spine surgeries could potentially include a very broad range of procedures, so, as I understand it, this is a difficult area in which to achieve standardization and cost containment.  Although a few key members of our medical staff are interested in collaboration and innovation, relatively little standardization of workflows or equipment has been done so far.   In addition, because our patients come from a wide geographical area, they may receive elements of their care, such as imaging or physical therapy, outside our system or in satellite clinics, which could make it more challenging to control costs.

We will need to generate comprehensive  cost analyses of our current spine procedures.  We will also need to investigate our payer mix and identify specific procedures for which to generate bundles.  But I also have some basic questions:  What is the best way to get started working with a group of physicians on this kind of project?  Where can I learn about bundle development, and specifically about how these issues pertain to complex spine surgery?  What other questions should we be asking?


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Participant comments on Developing Care Bundles for Complex Spine Surgery

  1. I find the best way to start is to find other organizations who have entered into this type of initiative before and learn from them.
    One place to start may be the CMS site that has all the Bundled Payments for Care Improvement (BPCI) organizations listed:
    Some of the 48 DRGs listed there in the qualifying BPCIs are for spine, although will need your experience to understand if those are the correct ones.

    Another place I like to look is to review the IHI clinical pathway resources:

    And then, I think you use Epic, and I would recommend to review the clinical programs and past user’s group presentations to see if anyone has done this before.

    But I think you’re first idea is spot on – to engage with the physician group to garner their support and buy-in, and to have more folks participate in the development of this program!

    The only other question I would ask is “what does success look like?” Getting a clear definition of success, and for your customer (patient, payor, other physicians, etc.) will be important to keeping the program on the right path. Best of luck!

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