HCA chooses Capital Medical Center and Virginia Mason as Centers of Excellence for spinal fusions

The Health Care Authority (HCA) today announced that Capital Medical Center and Virginia Mason Hospital & Medical Center will serve as the Centers of Excellence for spinal fusion bundled episodes of care. Premera Blue Cross will continue to administer the program. The Centers of Excellence Program is part of HCA’s continued efforts to pay for value instead of volume.

Beginning January 1, 2019, members enrolled in the Public Employees Benefits Board (PEBB) Program’s Uniform Medical Plan (UMP) Classic and UMP Consumer-Directed Health Plan (CDHP) will be able to choose the Centers of Excellence Program for spinal fusion evaluation and surgery. Members of the two plans who meet medical and other criteria can receive their spinal fusion procedure, including pre- and post-operative care, at Capital Medical Center or Virginia Mason at low to no cost.  The program also includes a travel and lodging benefit for eligible expenses.

Spinal fusion surgery treats several conditions. The Washington Health Alliance has identified spinal fusion as a procedure with great variation in both patient complications and cost. HCA considers it important to identify the highest-quality providers, and makes it possible for PEBB members to receive their care from them. This is HCA’s second bundle using COEs (the first focused on total knee and hip replacement). By using COEs, HCA is increasing consistency in quality and cost of care.

In the Centers of Excellence model:

  • Capital Medical Center and Virginia Mason use evidence-based best practices as recommended by the Bree Collaborative.
  • Capital Medical Center and Virginia Mason assume financial risk for preventable surgical complications and infections.
  • The Centers’ clinical teams—including physicians, hospitals, and others involved in spinal fusion—coordinate patient care, keeping the member involved in every step of the decision-making about their care choices.
  • HCA reimburses in what is called a “bundled payment,” one sum for the entire range of care, including diagnosis, surgery and rehabilitation.

“This value-based payment model of bundling is yet another success for our state as we strive for a more efficient, affordable, person-centered health care system,” said HCA director Sue Birch.

“Spinal fusion surgery can improve quality of life for our PEBB members, reducing pain and disability. But this procedure also has the potential for serious complications and poor outcomes. We expect high quality, evidence-based care for our members, not just paying for services,” said Dr. Dan Lessler, HCA’s chief medical officer.

“We are pleased to have been chosen by the Washington State Health Care Authority as a Center of Excellence for Spine Fusion bundles,” said Sue Anderson, president of Virginia Mason. “The HCA is an important partner in the journey towards value-based care, and we applaud their willingness to take bold steps towards health care transformation. The HCA’s willingness to invest in value-based programs, such as bundle care contracts, demonstrates an ongoing commitment to continuously improving the quality, value, and experience for their employees and dependents. We have been partners with the HCA in their bundle care journey since it began in 2017 and we look forward to expanding the bundle care services offered to HCA employees and dependents.”

“Given our location here in Olympia, we are particularly proud to be designated a Center of Excellence to provide public employees and their families with needed spinal fusion treatment,” said Capital Medical Center CEO Mark Turner. “We applaud the Health Care Authority’s focus on value, and its recognition of Capital’s longstanding commitment to best practices in orthopedic care. In partnership with Olympia Orthopedic Associates, we look forward to delivering high-quality, cost-effective services to our neighbors in the region and those from around the state.”

“We look forward to working with the HCA, Capital Medical Center and Virginia Mason to improve spine care in Washington,” said Dr. John Espinola, executive vice president of health care services at Premera Blue Cross.  “Individuals considering back surgery of any kind, but especially fusion, need support, empathy and careful decision making to ensure that they get the most out of their care.  Premera’s experience with similar programs allows us to help individuals consider options that fit their clinical needs and their personal situation to ensure their needs are met safely and effectively.”

HCA chose Capital Medical Center and Virginia Mason after a competitive bidding process, which included a requirement for demonstrating high-quality outcomes. The effort is part of HCA’s Healthier Washington initiative. House Bill 2572, passed in 2014, requires HCA “to increase the use of value-based contracting, alternative quality contracting, and other payment incentives that promote quality, efficiency, cost savings, and health improvement for Medicaid and public employee purchasing.” Creating Centers of Excellence for Spinal Fusion is one way HCA is working to meet this goal.

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