5 key thoughts on the economics of outpatient spine surgery


Outpatient spine surgery is becoming more common as surgical techniques become less invasive and pain management evolves to give patients a less painful postoperative period. Patients are mobile quicker and can safely return home within 24 hours in some cases.

Spine surgery in an ASC can have economic benefits as well. ASCs typically cost less than hospitals, and studies show outpatient surgery centers are associated with a similar or lower complication rate than the inpatient setting.


Here are five key thoughts based on studies examining outpatient spine surgery:


1. "Safety and cost-effectiveness of outpatient cervical disc arthroplasty"
Surgical Neurology International, Dec. 2010


Richard Wohns, MD, authored this article based on data from 26 cases performed between February 2009 and May 2010 at an outpatient surgery center. There were 14 patients who underwent outpatient cervical disc arthroplasty at a freestanding ASC and 12 that had surgery at a hospital-based outpatient surgery center. The patients had cervical radiculopathy secondary to single-level soft disc herniation. Dr. Wohns found:


• No mortality or major complications
• No hospital transfers, postop ER visits or subsequent hospitalization
• All patients reported improvement during their first postop visit


The outpatient single level disc arthroplasties were 62 percent less costly than the outpatient single-level cervical anterior discectomy and fusion with allograft and plate. The procedures were 84 percent less costly than single-level cervical disc arthroplasty in the inpatient setting.


2. "Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases"
Journal of Neurosurgery: Spine, June 2016


Study authors examined 1,000 consecutive patients who underwent anterior cervical discectomy and fusion in outpatient surgery centers and compared the results with 484 patients who underwent ACDF at Nashville, Tenn.-based Vanderbilt University Hospital. The procedures were performed from 2006 to 2013 and patients were followed for 90 days. The study authors found:


• Eight patients were transferred from the surgery center to the hospital after surgery
• No perioperative deaths occurred
• Thirty-day readmission rate was 2.2 percent
• Ninety-day surgical morbidity was similar between the two groups for one- and two-level procedures


The study authors concluded, "Comparison with an inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in the outpatient ambulatory surgery setting without compromising safety. In an effort to decrease costs of care, surgeons can safely perform one- and two-level ACDFs in an ASC environment."


3. "Best Practices for Outpatient Anterior Cervical Surgery"
Spine, June 2017


A panel of spine surgeons and specialists who were involved with at least 100 outpatient spinal fusions or disc replacements during a two-year period conducted a three-round modified Delphi method to generate best practice statements. The statements achieved at least 70 percent consensus and covered patient indications, pain management and patient education in addition to ASC financial management.


The best practice statements for surgery centers on proactive negotiation for private payer contracts were endorsed by the panel and the panelists agreed on establishing procedure-specific reimbursement rates for each facility. The panelists also recommended ASC staff confirming patient coverage in the ASC setting and notifying patients about their cost obligation.


Best practices for ASC operations endorsed by the panel include:

• Creating self-pay policies for patients
• Accessing cost-accounting data
• Standardizing implants


4. "How consumers are saving with the shift to outpatient care"
BlueCross BlueShield, Feb. 2016


This study examined around 43 million BCBS commercially insured members under the age of 65 from 2010 to 2014. The researchers compared inpatient and outpatient utilization as well as costs for several procedures, including lumbar spine surgery.


BlueCross BlueShield reported during the study period, lumbar spinal procedures shifted toward the outpatient setting, growing from 61 percent to 82 percent. Lumbar spine surgeries went from $5,269 in 2010 to $8,475 in 2014, and plan members saved around $320 out-of-pocket by undergoing the outpatient procedure. Over the study period, costs of inpatient lumbar spine surgery rose 7.5 percent, compared to outpatient costs which increased 4.3 percent.


5. "A cost-minimization analysis in minimally invasive spine surgery using a national cost scale method"
International Journal of Surgery, March 2015


The cost analysis included 46 patients, 24 of which underwent open surgical procedures and 22 who underwent percutaneous osteosynthesis for degenerative lesions and thoraco-lumbar fractures. Patients who underwent the percutaneous procedure reported a shorter length of stay, decreased hospital charges and lower medical device costs than the open procedure with similar clinical results.


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