The most exciting opportunities in outpatient spine


Five spine surgeons weigh in on the opportunities outpatient procedures afford providers.

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. We invite all spine surgeon and specialist responses.

Next week's question: What advice do you have for young surgeons who want to attain management roles in their facilities?

Please send responses to Anuja Vaidya at by Wednesday, Aug. 16, at 5 p.m. CST.


Question: What are the biggest opportunities for spine surgeons in the outpatient arena?


Payam Farjoodi, MD. Spine Surgeon at Center for Spine Health at Orange Coast Memorial Medical Center (Fountain Valley, Calif.): We need to provide excellent outcomes while containing cost and risk. Monitoring these measures to determine the breadth and number of surgeries that can be safely done in the outpatient setting is vital to helping us achieve these goals.


Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): Minimally invasive surgery is an evolving field of study that has shaped the trajectory of spinal practice. Lumbar decompressions and cervical fusions are common spinal procedures used to treat degenerative spine disease that have moved to the outpatient area more in recent years. A reduction in hospitalization time is cost-effective, but, more importantly, reduces the chances of in-hospital complications.


The combination of risk management and faster recovery has addressed concerns for many patients who are considering spinal surgery. Lumbar fusions (which are already being done) will be the next step in the outpatient arena. Currently, I prefer the vast majority of my single-level lumbar fusions in the surgery center environment — MIS TLIF and XLIF.


Plas T. James, MD. Spine Surgeon at Atlanta Spine Institute: I think that patients can do well with outpatient operations, which could allow the opportunity to have, for instance, a 23-hour stay where patients can stay the night if necessary. It drops the cost of the total bill for patients overall, because they pay less money for the office facilities than they do for a hospital stay. It also gives them the opportunity to come when they want to.


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: With the advent of new outpatient ALIF codes and the active role Medicare has taken in the outpatient spine sector, there are huge opportunities for well-positioned centers to do well with some of these more complex surgeries. We will see who is willing to and able to take the risks.  


The rewards I think will be adequate but my concern is that unqualified centers will start taking on cases that either should not be done in the outpatient setting at all (i.e. multilevel ALIFs, large deformity corrections or tumor) and set a bad precedent for those that are doing good work. Further, if Medicare decides to start cutting reimbursement for outpatient surgery again, we will see that business dry up as fast as it is set.


Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I believe there is great opportunity in the bundled payment arena. This holds true especially for cash type models. There are increasing deductibles, and also cash type payers and self-insured businesses that look to cut the cost on large ticket items such as spine surgery. Having the ability to control cost and outcomes without the burdensome bureaucracy of the large hospital systems make small centers highly competitive and able to deliver value. As healthcare costs continue to rise, more patients are seeking value for their dollars and we are seeing inquiries with greater frequency all the time.


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