{"id":75494,"date":"2025-02-25T15:44:56","date_gmt":"2025-02-25T23:44:56","guid":{"rendered":"https:\/\/www.qualityhealth.org\/bree\/?page_id=75494"},"modified":"2026-02-19T09:17:15","modified_gmt":"2026-02-19T17:17:15","slug":"surgery","status":"publish","type":"page","link":"https:\/\/www.qualityhealth.org\/bree\/implementation-guide-home-page\/surgery\/","title":{"rendered":"Surgery Bundles and Payment Models"},"content":{"rendered":"

[vc_row overlay_dotted=”” el_id=”surgery-guidelines-row”][vc_column][vc_column_text css=””]Please see information on the Hysterectomy Report<\/em> under the “Reproductive Health” section.[\/vc_column_text][vc_separator color=”custom” border_width=”10″ css=”” accent_color=”#145E61″][vc_tta_tour style=”outline” shape=”square” color=”black” spacing=”20″ active_section=”1″ no_fill_content_area=”true” title=”Bariatric Surgery Bundle and Warranty”][vc_tta_section title=”Guideline Information” tab_id=”1714676881845-ff02c3b2-9b49″][vc_column_text css=””]<\/p>\n

Guideline title: Bariatric Surgery Bundle and Warranty Report and Guidelines<\/h4>\n

Publication Status: <\/strong>Needs minor revisions – to be scheduled
\n<\/strong><\/p>\n

Date of publication<\/strong>: 2016<\/p>\n

Date of last evidence search: <\/strong>2016<\/p>\n

Scope: <\/strong>Diagnosis, assessment for surgery fitness, procedure, post operative care
\n<\/strong><\/p>\n

Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n

Description: <\/strong>The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the intent of the warranty is to distribute financial risk across professional and facility components in proportion to the revenue generated by the procedure. \u00a0Our bundled payment model includes bariatric surgery as a treatment option for select individuals and requires a holistic approach in which surgery is but one possible component of care. We organize our bundled payment model into four cycles including: appropriateness outlining requirements for a trial of non-surgical care, requirements for fitness for surgery, elements of best practice surgery and components of care aimed at our ultimate outcome, rapid return to function.<\/span><\/p>\n

Supporting Materials:<\/strong><\/p>\n

Letter from Health Care Authority Accepting Bariatric Surgical Bundle and Warranty<\/span>
\n<\/a>Evidence Table for Bariatric Surgical Bundle<\/span>
\n<\/a><\/span>Accountable Payment Models: Bariatric Surgery Charter<\/span><\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Read On-line” tab_id=”1714676882153-864377cb-2e77″][vc_column_text]<\/p>\n

    \n
  1. \n

    Bariatric Surgery Bundle Report and Guidelines<\/a><\/h3>\n<\/li>\n
  2. \n

    Bariatric Surgery Warranty Report and Guidelines<\/a><\/h3>\n<\/li>\n<\/ol>\n

    [\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Resources and Tools” tab_id=”1714676882435-cb2b6332-5b35″][vc_toggle title=”Resources and Tools”]Appendix C: Detailed Quality Standards<\/a><\/p>\n

    Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program<\/a><\/p>\n

    WA HCA Bariatric Society\u00a0<\/a><\/p>\n

    American Society\u00a0 for Metabolic and Bariatric Surgery\u00a0<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Metrics and Eavluation Tools” tab_id=”1714676882711-4396316f-ccfe”][vc_column_text]In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).[\/vc_column_text][vc_toggle title=”Delivery Sites and Health Systems”][\/vc_toggle][vc_toggle title=”Health Plans”][\/vc_toggle][vc_toggle title=”Health Care Purchasers”][\/vc_toggle][vc_toggle title=”Washington State Health Care Authority”][\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Examples of Implementation – IN DEVELOPMENT” tab_id=”1714676883708-6ba1001d-5eeb”][\/vc_tta_section][vc_tta_section title=”Work Group Members” tab_id=”1740526948787-d2fc77c1-f709″][vc_column_text css=””]<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    Member<\/strong><\/td>\nTitle<\/strong><\/td>\nOrganization<\/strong><\/td>\n<\/tr>\n
    Sharon Eloranta, MD<\/td>\nMedical Director, Quality and Safety Initiatives<\/td>\nQualis Health<\/td>\n<\/tr>\n
    Kristin Helton, PhD<\/td>\nConsumer<\/td>\n<\/td>\n<\/tr>\n
    Jeff Hooper, MD<\/td>\nMedical Director, Weight Loss Program<\/td>\nMultiCare Health System<\/td>\n<\/tr>\n
    Dan Kent, MD<\/td>\nChief Medical Officer<\/td>\nUnited Health Care<\/td>\n<\/tr>\n
    Saurabh Khandelwal, MD<\/td>\nBariatric Surgeon<\/td>\nUniversity of Washington<\/td>\n<\/tr>\n
    Robert Mecklenburg, MD (Co-Chair)<\/td>\nMedical Director, Center for Health Care Solutions<\/td>\nVirginia Mason Medical Center<\/td>\n<\/tr>\n
    Robert Michaelson, MD, PhD, FACS, FASMBS<\/td>\nPresident<\/td>\nWashington State Chapter, American Society for Metabolic and Bariatric Surgery<\/td>\n<\/tr>\n
    Thien Nguyen, MD<\/td>\nBariatric Program Medical Director<\/td>\nOverlake Medical Center<\/td>\n<\/tr>\n
    Tom Richards<\/td>\nConsumer<\/td>\n<\/td>\n<\/tr>\n
    Kerry Schaefer (Co-Chair)<\/td>\nStrategic Planner for Employee Health<\/td>\nKing County<\/td>\n<\/tr>\n
    Jonathan Stoehr, MD\/Jeff Hunter, MD<\/td>\nEndocrinologist\/ Bariatric Surgeon<\/td>\nVirginia Mason Medical Center<\/td>\n<\/tr>\n
    Brian Sung, MD<\/td>\nBariatric Surgery Director<\/td>\nSwedish Medical Center<\/td>\n<\/tr>\n
    Tina Turner<\/td>\nSenior Internal Consultant<\/td>\nPremera Blue Cross<\/td>\n<\/tr>\n
    Richard Thirlby, MD<\/td>\nMedical Director<\/td>\nSurgical Care and Outcomes Assessment Program (SCOAP)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    [\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=”custom” border_width=”10″ css=”” accent_color=”#145E61″][vc_tta_tour style=”outline” shape=”square” color=”black” spacing=”20″ active_section=”1″ no_fill_content_area=”true” title=”Cardiovascular Health”][vc_tta_section title=”Guideline Information” tab_id=”1714681833407-46d94675-082d”][vc_column_text css=””]<\/p>\n

    Guideline title: Cardiovascular Health – Appropriateness of Percutaneous Coronary Interventions Report and Guidelines<\/h4>\n

    Publication Status: <\/strong>Needs minor revisions – to be scheduled
    \n<\/strong><\/p>\n

    Date of publication<\/strong>: 2013<\/p>\n

    Date of last evidence search: <\/strong>2013<\/p>\n

    Scope: <\/strong>clinical scenarios and indications
    \n<\/strong><\/p>\n

    Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n

    Description: <\/strong>The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty includes no reimbursement for complications resulting from poor care. Percutaneous coronary intervention (PCI), also known as angioplasty, is a non-surgical procedure used to treat excess plaque in the arteries. While the majority of these procedures are done appropriately and successfully as needed for emergency cardiovascular conditions, a significant number are done electively and may not benefit patients in the same way. One way to improve care given to patients is to look at the data on whether past PCI procedures were appropriate. The availability and transparency of this data is a major issue across Washington State hospitals.<\/span><\/p>\n

    Supporting Materials:<\/strong><\/p>\n

    Appropriate Use of PCI, 2012, by hospital<\/a><\/span>
    \n    Letter from Health Care Authority Accepting Spine SCOAP and Cardiology Recommendations<\/a>
    \n<\/a><\/span>    Article on Appropriateness of PCIs, Journal of the American Medical Association, June 2011<\/a>: <\/span>A<\/span><\/span>ppropriateness of Percutaneous Coronary Interventions in Washington State; S. Bradley, C. Maynard, C. Bryson; Circulation \u2013 Cardiovascular Quality and Outcomes – Journal of the American Heart Association<\/em>; May 8, 2012[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Read On-line” tab_id=”1714681833741-fd2824f3-d5bf”][vc_column_text]<\/p>\n

    Cardiovascular Health Report and Guidelines<\/a><\/h3>\n

    [\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Resources and Tools” tab_id=”1714681834020-e48eaa3c-e069″][vc_toggle title=”Resources and Tools”]Cardiac Care Outcomes and Assessment Program (COAP)<\/a><\/p>\n

    2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Metrics and Eavluation Tools” tab_id=”1714681834314-5cf36a04-65c6″][vc_column_text]In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).[\/vc_column_text][vc_toggle title=”Delivery Sites and Health Systems”][\/vc_toggle][vc_toggle title=”Health Plans”][\/vc_toggle][vc_toggle title=”Health Care Purchasers”][\/vc_toggle][vc_toggle title=”Washington State Health Care Authority”][\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Examples of Implementation – IN DEVELOPMENT” tab_id=”1714681835355-04e1da8d-1d1a”][\/vc_tta_section][\/vc_tta_tour][vc_separator color=”custom” border_width=”10″ css=”” accent_color=”#145E61″][vc_tta_tour style=”outline” shape=”square” color=”black” spacing=”20″ active_section=”1″ no_fill_content_area=”true” title=”Coronary Artery Bypass Graft Surgery Bundle and Warranty”][vc_tta_section title=”Guideline Information” tab_id=”1714679469232-26b382d1-365b”][vc_column_text css=””]<\/p>\n

    Guideline title: Coronary Artery Bypass Graft (CABG) Surgery Bundle and Warranty Report and Guidelines<\/h4>\n

    Publication Status: <\/strong>Needs minor revisions – to be scheduled
    \n<\/strong><\/p>\n

    Date of publication<\/strong>: 2015<\/p>\n

    Date of last evidence search: <\/strong>2015<\/p>\n

    Scope: <\/strong>Diagnosis, assessment for surgery fitness, procedure, post operative care
    \n<\/strong><\/p>\n

    Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n

    Description: <\/strong>The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the intent of this warranty is to distribute financial risk across professional and facility components in proportion to the revenue generated by the procedure. We believe the CABG bundle represents an incremental advance in helping to create a market for quality in health care. We will continue to refine and improve the bundle as new information becomes available. We encourage purchasers to contribute to the success of this bundle by reimbursing for essential services (e.g., health coach, care coordination)<\/span><\/p>\n

    Supporting Materials:<\/strong><\/p>\n

    Letter from Health Care Authority Accepting Coronary Artery Bypass Graft Surgical Bundle and Warranty<\/a><\/span>
    \n    CABG Bundle Public Comment<\/span><\/a><\/span>
    \n    Coronary Artery Bypass Graft Surgery Evidence Table<\/span><\/a><\/span>
    \n    CABG Bundle Public Comment<\/span><\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Read On-line” tab_id=”1714679469488-888734f0-ba12″][vc_column_text]<\/p>\n

      \n
    1. \n

      Coronary Artery Bypass Surgery Bundle Report and Guidelines\u00a0<\/a><\/h3>\n<\/li>\n
    2. \n

      Coronary Artery Bypass Graft Surgical Warranty Report and Guidelines<\/a><\/h3>\n<\/li>\n<\/ol>\n

      [\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Resources and Tools” tab_id=”1714679469764-3ed9ca1d-6398″][vc_toggle title=”Resources and Tools”]Appendix C: Detailed Quality Standards<\/a><\/p>\n

      Cardiac Care Outcomes and Assessment Program (COAP)<\/a><\/p>\n

      ACCF\/AHA Guideline for Coronary Artery Bypass Graft Surgery<\/a><\/p>\n

      2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Metrics and Eavluation Tools” tab_id=”1714679470068-92fcf1fc-f63d”][vc_column_text]In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).[\/vc_column_text][vc_toggle title=”Delivery Sites and Health Systems”][\/vc_toggle][vc_toggle title=”Health Plans”][\/vc_toggle][vc_toggle title=”Health Care Purchasers”][\/vc_toggle][vc_toggle title=”Washington State Health Care Authority”][\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Examples of Implementation – IN DEVELOPMENT” tab_id=”1714679471010-4b580cbf-c91b”][\/vc_tta_section][vc_tta_section title=”Work Group Members” tab_id=”1740527007649-0dfe8bb2-8783″][vc_column_text css=””]<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
      Member<\/strong><\/th>\nTitle<\/strong><\/th>\nOrganization<\/strong><\/th>\n<\/tr>\n
      Drew Baldwin, MD, FACC<\/td>\nCardiologist<\/td>\nVirginia Mason Medical Center<\/td>\n<\/tr>\n
      Glenn Barnhart, MD<\/td>\nCardiac Surgeon<\/td>\nSwedish Medical Center<\/td>\n<\/tr>\n
      Marissa Brooks<\/td>\nDirector of Health Improvement Programs<\/td>\nSEUI Healthcare Northwest Benefits<\/td>\n<\/tr>\n
      Susie Dade, MS<\/td>\nDeputy Director<\/td>\nWashington Health Alliance<\/td>\n<\/tr>\n
      Gregory Eberhart, MD, FACC<\/td>\nMedical Director, Cardiology<\/td>\nCHI Franciscan Health<\/td>\n<\/tr>\n
      Theresa Helle<\/td>\nManager of Health Care Quality and Efficiency Initiatives<\/td>\nThe Boeing Company<\/td>\n<\/tr>\n
      Bob Herr, MD<\/td>\nPhysician<\/td>\nUS HealthWorks<\/td>\n<\/tr>\n
      Jeff Hummel, MD<\/td>\nMedical Director, Health Care Informatics<\/td>\nQualis Health<\/td>\n<\/tr>\n
      Dan Kent, MD<\/td>\nMedical Director, Quality & Medical Management<\/td>\nPremera Blue Cross<\/td>\n<\/tr>\n
      Robert Mecklenburg, MD (Co-Chair)<\/td>\nMedical Director, Center for Health Care Solutions<\/td>\nVirginia Mason Medical Center<\/td>\n<\/tr>\n
      Vinay Malhotra, MD<\/td>\nCardiologist<\/td>\nCardiac Study Center<\/td>\n<\/tr>\n
      Kerry Schaefer, MS (Co-Chair)<\/td>\nStrategic Planner for Employee Health<\/td>\nKing County<\/td>\n<\/tr>\n
      Gregg Shibata<\/td>\nManager, Accountable Health Implementation<\/td>\nRegence\u00a0Blue Shield<\/td>\n<\/tr>\n
      Shilpen Patel, MD, FACRO<\/td>\nMedical Director<\/td>\nClinical Outcomes Assessment Program<\/td>\n<\/tr>\n
      Thomas Richards<\/td>\nManaging Director, Employee Benefits<\/td>\nAlaska Airlines<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      [\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=”custom” border_width=”10″ css=”” accent_color=”#145E61″][vc_tta_tour style=”outline” shape=”square” color=”black” spacing=”20″ active_section=”1″ no_fill_content_area=”true” title=”Lumbar Fusion Surgical Bundle and Warranty”][vc_tta_section title=”Guideline Information” tab_id=”1714674560433-1df769be-689d”][vc_column_text]<\/p>\n

      Guideline title: Lumbar Fusion Surgical Bundle and Warranty Report and Guidelines<\/h4>\n

      Publication Status: <\/strong>Needs minor revisions – to be scheduled
      \n<\/strong><\/p>\n

      Date of publication<\/strong>: 2018<\/p>\n

      Date of last evidence search: <\/strong>2018<\/p>\n

      Scope: <\/strong>Diagnosis, assessment for surgery fitness, procedure, post operative care
      \n<\/strong><\/p>\n

      Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n

      Description: <\/strong>The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty* is against avoidable hospital readmissions. We selected lumbar fusion due to a disproportionate rise in lumbar fusion compared to other spine surgeries, high variation in quality and billed charges, and evidence that for many patients considered candidates for elective lumbar fusion, there was no clear benefit of surgery compared to non-surgical care. <\/span><\/p>\n