Moving spine surgery to the ASC brings a wealth of advantages including cost savings, but there are some prominent challenges to migration.
Five spine surgeons discuss the roadblocks.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
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Editor’s note: Responses were lightly edited for clarity.
Question: What is the biggest challenge and biggest advantage of moving more spine and orthopedic procedures into ASCs?
Jordan Iordanou, MD, PhD. McHugh Neurosurgery (West Islip, N.Y.): The biggest challenge in shifting spine procedures to ASCs is ensuring complex cases have adequate support without hospital-level resources. The primary advantage is cost-efficiency and faster patient recovery in a streamlined setting. My practice leverages ASCs for select procedures, improving patient satisfaction while triaging cases requiring inpatient care.
Michael Oh, MD. UCI Health (Orange, Calif.): One of the biggest challenges in moving spine fusion cases to an ASC is, of course, patient selection. Ensuring patient safety in a setting with limited postoperative monitoring and resources compared to a hospital requires the surgeon to carefully select patients who are medically stable, with minimal comorbidities, and ensure that their facilities are equipped with the right technology, and trained staff capable of managing outpatient spine procedures. Additionally, effective postoperative pain control and protocols for rapid transfer to a hospital in case of complications are essential to maintain safety standards and regulatory compliance.
The biggest advantage of performing spine fusion cases in an ASC is improved efficiency and cost savings for both patients and payers without compromising outcomes for appropriately selected cases. ASCs typically offer shorter wait times, more personalized care, and streamlined workflows that enhance both surgeon productivity and patient satisfaction. From a financial standpoint, the overhead costs are lower than those in hospitals, allowing for reduced reimbursement rates while maintaining profitability. Moreover, many patients appreciate the convenience of same-day discharge and recovery in the comfort of their own homes, which has been shown to support faster rehabilitation and lower infection risks. As technology, minimally invasive techniques, and anesthesia methods continue to advance, the ASC setting becomes an increasingly viable and advantageous option for select spine fusion procedures.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The advantages of ASCs for appropriate spine cases include cost efficiency (typically 20% to 40% lower than hospital settings), improved patient satisfaction scores, reduced infection rates in some studies, and more predictable scheduling. However, significant challenges persist around case selection criteria — determining which procedures are truly appropriate for outpatient settings requires careful risk stratification. Emergency response capabilities vary widely among ASCs, and the lack of immediate ICU backup limits complex case eligibility. Regulatory oversight differs from hospital standards, and insurance coverage for ASC procedures isn’t universal. The challenge lies in balancing cost reduction with maintaining safety margins for complications that, while rare, can be serious.
Jacky Yeung, MD. Yale School of Medicine (New Haven, Conn.): The biggest challenge in shifting more spine procedures to ASCs is patient selection and infrastructure. Not every patient or case is appropriate for an outpatient environment, and maintaining the same safety standards we expect in the hospital requires rigorous protocols, experienced teams, and seamless transfer pathways. Reimbursement and regulatory inconsistencies also remain barriers in some markets. The biggest advantage is efficiency and patient experience. In an ASC, surgeons can deliver the same quality of care with lower infection risk, better scheduling, and a more personalized environment. Patients recover faster, surgeons have more control over workflow, and the overall value equation, quality outcomes at lower cost, aligns perfectly with where healthcare is heading.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Collective reasoning and lessons learned from the now distant pandemic did usher in a paradigm shift in caring for post-surgical patients. Prioritization, selection and a substantive mind-set about hospital admitting and ‘need to treat’ bolstering an already growing process of same-day surgery. In this purview, the cultural transformation of both patients and providers became a conversion to management and expectations. Clearly the biggest challenge remains more complex, higher acuity patients and incorporation of intensive services necessary to manage accompanying comorbidities. The heartier patient requiring much less assistance and preferred outcomes then becomes the benchmark.
