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?