Jennifer Butterfield, RN, MBA, CNOR, is the administrator of Lakes Surgery Center in West Bloomfield, Mich. She describes how spine surgery was taken from an idea to an established program at her surgery center. Here are steps that ambulatory surgery center leaders can take to add spine surgery as a specialty line in their centers.
1. Listen to physicians. Lake Surgery Center is a large multispecialty surgery center with 25 physician partners. The idea of adding spine surgery was first brought to the table by a neurosurgeon that was performing a large amount of pain management cases. He spoke with Ms. Butterfield and convinced her to see a demonstration of Mazor Robotics' Renaissance System in Dallas.
Ms. Butterfield and the neurosurgeon returned after the demonstration to discuss the idea with the center's partners. The partners decided to purchase the guidance system. Spine surgery officially came to Lakes Surgery Center in 2012. "That was a large financial commitment, but we thought it would be a big kick off for spine," says Ms. Butterfield. "We knew spine was going to be headed more and more towards the ASC."
The neurosurgeon that sparked the idea of a spine program presented an opportunity. Another surgeon at the center was curious about the potential of such an idea. After the purchase of the Renaissance System, the surgery center held an educational event for the newly arrived robotic technology. Three additional surgeons expressed interest in the opportunities the technology offered.
2. Don't be afraid to seize the opportunity. Purchasing technology as complex and expensive as the Renaissance System was a risk, but a calculated risk. "It has been a year and a half a now and we have five physicians performing spine procedures," says Ms. Butterfield.
Ambulatory surgery centers are often cited for having advantages over a hospital; this represents another opportunity. ASCs are smaller, more nimble organizations. Leaders can make decisions quickly. "If a physician wants to do something innovative, we can accommodate that. What sets an ASC apart from a hospital is the lack of bureaucracy preventing new technology and ideas from being approved," says Ms. Butterfield.
3. Continually work with payers. "Reimbursement for spine procedures is our biggest hurdle. In Michigan, only BCBS and Auto procedures allow fusions and other spine procedures in the ambulatory setting. Medicare does
not," says Ms. Butterfield. Ms. Butterfield is working with insurance providers to achieve carve outs for spine procedures, but it is a long process.
Find provider representatives and work on renegotiating your contracts. Explain that patient outcomes in the outpatient setting are very good. The shift toward the minimally invasive makes spine surgery in the ASC a logical shift. "There is an education curve for both the providers and the payers, but if you can't show payers on paper the potential savings the process is difficult," says Ms. Butterfield. "Someone has to be a pioneer and begin accepting insurance for spine procedures so we can prove that there are savings."
If insurance companies will cover outpatient spine surgery for appropriately indicated patients, savings for payers will become evident. There will be no overnight stay, whereas in the hospital patients are not inclined to go home immediately and will not be discouraged from staying overnight.
4. Allow the program time to grow. Spine surgery in the outpatient setting has been gaining traction, but slowly. The hurdles of reimbursement and misconceptions about outpatient spine surgery are not entirely past, but these obstacles will not stem the steady flow of spine surgeries moving to ASCs.
Ambulatory surgery center leaders testing the waters of spine or taking the plunge, as Ms. Butterfield and Lakes Surgery Center have done, must allow time for a spine program to grow. Of the five spine surgeons at Lakes Surgery Center, all five are trained on the Renaissance System and three have already used it to perform procedures at the center. "We trusted that this was something we could do and were willing to take those steps," says Ms. Butterfield.
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