Spine Center Development

Bundled rate pricing systems & medical tourism

Two patients in the same clinic. Same problem. Same symptoms. Different doctors beget different treatment plans. Two different charges. Why?

Employers and payors want to know. That fact is that while many healthcare providers boast a lot about quality, few measure their performance either on clinical outcomes and customer satisfaction. 

As part of a comprehensive quality management program, Prizm helps quality-minded healthcare companies, hospitals and physician groups reduce treatment variation through written clinical protocols and pathways that standardize the way each physician in a practice triage treats patients. It's true that the benefit of a pathway is in quality.

Prizm has proprietary clinical protocols that improve spine care triage and cross referralPrizm has proprietary clinical protocols that improve spine care triage and cross referralBut there is a bigger financial benefit as well. By developing consistent treatment guidelines, Prizm can create predictable bundled rate packages for spine surgery and even nonsurgical episodes of care that cover a month-long episode of care at a predictable price for health insurance companies and employers. 

These bundled rate prices also enable a spine center to provide their services to patients coming from other countries like Canada or Mexico. With medical tourism, patients coming from other countries desire access to the latest technology like artificial disc replacement or the most advanced minimally invasive surgical techniques. In Canada long waiting times for MRI diagnostic tests or spine surgery can motivate some patients to seek U.S. spine centers for relief of pain and to prevent permanent paralysis of nerves that can be caused by excessive long queues that cause herniated disc symptoms like numbness in a hand or foot to become permanent and lifelong.

Prizm, for example, has successfully contracted with health insurance plans using Prizm's bundled rate methodologies. Instead of getting reimbursed on a CPT-code basis, Prizm clients can be reimbursed on an ICD-9 code basis. For medical tourism for spine care, Prizm can help a spine center provide a predictable bundled price to the international patient for the following procedures:

  • Evaluation of SIMPLE/ACUTE back or neck pain
  • Bundled rate for a SPINAL INJECTION
  • Nonsurgical management of back or neck pain (month-long episode of care)
  • ACDF (Anterior Cervical Discectomy & Fusion)
  • Cervical discectomy
  • Cervical laminectomy
  • Lumbar Fusion
  • Artificial Disc Replacement - Cervical
  • Artificial Disc Replacement - Lumbar

Bundled “case rate packages" are a win-win situation for the quality-oriented provider and payor. In this way, the provider is rewarded for its efficiency rather than punished for it, which would occur under billing for a reduced number of CPTs.

Prizm's proprietary protocols enable a spine center to sort back pain patients into price-predictable categories—without X-rays, MRI or physician exam. 

DOWNLOAD WHITE PAPER:
2020 vision: Where is spine care headed for spine physicians & hospitals?

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Wouldn’t it be convenient if someone created a listing of spine centers of excellence across the United States that all emphasize non-surgical treatment options before surgery?

Finally, there is a place.

SpineCenterNetwork.com