Caring for older patients, handling CMS codes are 2022's top challenges 2022, Dr. Ronjon Paul says

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Keeping up with the "moving target" of CMS coding in ASCs is one of the top challenges Ronjon Paul, MD, is concerned about this year.

Dr. Paul, chair of Downers Grove, Ill.-based Duly Health and Care's spine department, spoke on the "Becker's Healthcare Spine and Orthopedic Podcast" about what he anticipates in the months ahead.

This is an excerpt. Listen to the full episode here.

Question: What are the top challenges you're anticipating for your practice in 2022?

Dr. Ronjon Paul: There's been a number of ongoing changes in spine care. The biggest one that comes to mind is the CMS changes to ASC codes. That's been a moving target. We had cases that are really outpatient-oriented that we are now unable to do at our ASC until we get carve-outs and some other traction in that area because even a lot of our private payers have followed CMS guidelines. So that's a challenge. I think if the payers understand that they're actually increasing their cost substantially by keeping these cases out of the ASC, they've actually made things more difficult for themselves and for patients. We've been doing quite a bit of outpatient surgery all last year, and many of the patients were really enjoying the experience because it's smaller and more intimate. Our ASC is exclusively orthopedics and spine, so that means everyone from the preoperative nurses to the perioperative nurses, staff and the reception staff is very involved and understands the orthopedic and spine patients. There's not as many patients coming through so it's a very intimate environment. People enjoy it. We're having a tougher time getting people into that environment now. 

The other challenges revolve around the question: How do we do a better and better job at taking care of our older, more complex spine cases?" People are healthier now at an older age, but they have some medical issues obviously. Now we're seeing people that are 10, 20 or 25 years out from maybe a fusion a decompression or some kind of surgery in their cervical and lumbar spine, and as we know, adjacent level disease and fragile balance issues are oftentimes an issue, and we're stuck with some bigger dilemmas. 

I think we at least owe it to ourselves to explore those dilemmas in an evidence-based fashion. We are progressively trying to take surgical care of more and more of these patients, and that really goes to the opposite. I just started with the ASC portion, but am really going towards the more complex cases that are going to likely stay in a hospital and will also need very specific optimization, very specific protocols, algorithms and avenues that have to be multidisciplinary. So that involves anesthesia, the hospitalists, the patients cardiologist primary care and their rehab. That whole continuum needs to be really, it does for all a spine. But when you get to these older complex cases, older patients with complex spine disease, that's a big challenge. 

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