5 Techniques to Make Spine Profitable at Your Orthopedic Practice

Practice Management

Here are five ways to successfully make spine profitable at your orthopedic practice.

1. Improve workflow by focusing on specific procedures. Successful orthopedic and spine practices should consider focusing on specific types of procedures, rather than try to offer everything, to eliminate distractions and make sure the institution runs effectively, says John Grossmith, MD, a board certified neurosurgeon at The Bonati Spine Institute in Hudson, Fla. A focused facility has a specific workflow to keep the patients moving through the pre-, intra-, and postoperative process. At The Bonati Spine Institute, the spine surgeons only perform minimally invasive endoscopic laser spine surgery involving the thoracic, lumbar and cervical spine. The surgeons and medical staff have extensive experience treating patients undergoing these specific procedures, therefore the process is able to run smoothly, says Dr. Grossmith.

From "7 Key Elements for Achieving High Patient Satisfaction and Better Outcomes for Orthopedic and Spine Surgery."

2. Hire spine-specific staff members.
"You need to find staff who can hit the ground running," Lynn S. Feldman, RN, MBA, administrative manager of Eastwind Surgical, a two-OR ASC for spine surgery and pain management in Westerville, Ohio. Since spine surgery only recently became an outpatient procedure, staff will have to come from hospitals. One silver lining in the current recession is that talented spine-surgery staff members are easier to find. When the ASC recently added another nurse of the recovery area and two more per diems, it had a wide range of applicants. They must also be able to tolerate bumpy schedules. A hospital is a very structured work environment, but spine surgery in an ASC in particular has variable hours. Spine surgeons may come in and do five cases in one day and then not come back for many days. "You work when they want to work," Ms. Feldman says.

From "6 Best Practices for Spine Surgery in Surgery Centers."

3. Research reimbursement for spine procedures at hospitals before payor negotiations. Since Medicare does not reimburse spine cases in the outpatient setting, negotiating ASC rates for spine cases with private payors can be more difficult than other specialties because payors often set rates at a percent or multiple of Medicare rates. "Negotiating for spine is much more difficult than orthopedics because payors don't really know how to pay for spine — Medicare doesn't reimburse it in the ASC," says Jay Rom, president of Blue Chip Surgical Center Partners. "You should negotiate off of what payors are paying the hospital. You want to be less expensive than the hospital and sell that to the payors."

Mr. Rom suggests administrators check payor Web sites for information on estimated costs for spine procedures at the hospital. This will give them a better sense of current payor costs as insurers are increasingly making cost estimates available to their members. Blue Chip ASCs are typically able to offer a 30-40 percent discount over hospital costs to payors while still covering costs and building in a profit, says Mr. Rom.

From "6 Reimbursement and Business Concepts for Spine in ASCs."

4. Maintain strict patient selection to reduce the risk of infection. Infection rates are usually higher when procedures are performed at university and teaching hospitals because patients are generally sicker when undergoing surgery there, says Donald Corenman, MD, of The Steadman Clinic in Vail, Colo. Be aware of the patient's chronic conditions, such as autoimmune deficiencies ore diabetes, and take the appropriate precautions against infections. "If a patient is chronically ill, work extra hard with the primary care physician to make sure the patient is ready for the procedure," says David McKalip, MD, a neurosurgeon practicing in St. Petersburg, Fla. The surgeon can also consider different types of operations for chronically ill patients, such as choosing an anterior instead of posterior procedure for a diabetic patient.

From "7 Steps Spine Surgeons Should Take to Prevent Infections."

5. Treat workers' compensation patients. Spine surgeons should be aware of the workers' compensation programs in their state to best work with employers and case managers to return patients as quickly as possible to work. Many times, workers' compensation patients have back pain or injuries that need treatment. Surgeons and employers can work together to create a return-to-work program for the employee, which keeps the workers' compensation premium cost down, says Patrick Hinton, executive director of the Jacksonville (Fla.) Orthopaedic Institute. Having low premiums in workers comp cases is an attractive statistic for payors.

From "6 Best Practices to Create a Thriving Orthopedic Practice."

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