As spine practices face mounting reimbursement pressure, surgeons are looking more closely at opportunities to strengthen financial performance without compromising patient care. Five spine surgeons discuss the areas they say practices may be overlooking, from nonoperative care and coding to minimally invasive surgery, bundled payments and cost efficiency.
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.
Next question: Plenty of hospitals never see a return on their spine robotics investment. What separates the programs that get real value out of robotics from the ones that don’t?
Please send responses to Sophie Eydis at seydis@beckershealthcare.com by 5 p.m. Central time Sunday, Sept. 20.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Endoscopic spine is being called an arms race for health systems. Where does it actually belong on a program’s priority list, and what do you think people are getting wrong about it?
Bryce Basques, MD. Spine Surgeon and Director, Minimally Invasive and Endoscopic Spine Surgery, Brown University (Providence, R.I.): The nonoperative side of the practice. The large majority of people who walk into a spine clinic do not need surgery, and most practices treat that entire population as the cost of finding the ones who will. They see them once, refer them out, and every bit of therapy, imaging, injection and follow-up that comes afterward leaves the building for good, along with the patient. Practices that build a real nonoperative arm, with physiatry, pain management, therapy, imaging etc. Inside the group, keep that value and retain patients who may ultimately become surgical.
Brian Gantwerker, MD. Neurosurgeon and President of The Craniospinal Center of Los Angeles: I’ve spoken a lot about the three C’s, and it’s important for spine surgeons to do all three well: secure good contracts if you want to stay in network, and renegotiate using data when you have it; code accurately and according to guidelines; and, lastly, collect on each and every line item.
Issada Thongtrangan, MD. Endoscopic and Minimally Invasive Spine Surgeon at MicroSpine (Scottsdale, Ariz.): I’m focusing on what we can control: appropriate patient selection and optimization, standardized perioperative pathways, efficient use of implants and resources, and close follow-up after discharge to avoid preventable emergency department visits and readmissions.
What many surgeons underestimate is that a “spinal fusion” is not one uniform procedure. A straightforward one-level case and a complex revision or multilevel reconstruction may be treated similarly in a bundle, despite very different risk and cost profiles. We need to be at the table with hospitals, review our own outcomes and costs and make sure these models do not limit access for complex patients.
Jacky Yeung, MD. Neurosurgeon at Yale Medicine (New Haven, Conn.): I think many spine practices underestimate the financial value of expanding minimally invasive spine surgery. For appropriately selected patients, less-invasive techniques can shorten hospital stays, reduce complications and accelerate recovery while lowering the overall cost of care.
From a hospital perspective, improving efficiency within a fixed diagnosis-related group can create meaningful financial value without compromising outcomes. The biggest barrier is the investment in surgeon training and the willingness to move beyond established techniques, which is why many practices are slower to adopt these approaches than the evidence and economics would support.
Christian Zimmerman, MD. Spinal Neurosurgeon at St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): This question was posed to a number of our coding specialists, who represent seven practitioners of neurosurgical and endovascular care. Their declaration, from decades of experience, was that opportunities are rarely overlooked because diligence and expertise in this time of extreme scrutiny supersede inattention. The actual art and science of surgical coding is a standalone specialty of its own, requiring regular updates and application.
The disputation of microscope use and modified billing did come into discussion as to its supplemental codes and surgical justification. Irreproachably, the exceptional use in documented dissections and epidural decompressions/extirpations, whereby removal of compressible lesions is stated as decompressed or removed, allows for a modifier coded as such to reflect one’s additional and more sophisticated work.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
