William Tally, MD, an orthopedic surgeon with Athens (Ga.) Orthopedic Institute, discusses outpatient spine surgery trends and how new physicians can begin bringing cases into the ASC.
Question: How has technology and technique development made it possible to bring spine procedures into the outpatient setting?
Dr. William Tally: The technology allows us to be much quicker during the surgery, which decreases anesthesia requirement and allows us to do less tissue damage, which makes the patients' early recovery smoother. Those two factors make patients more functional within 24 to 48 hours and because of that we can perform the same complexity of procedures in the outpatient setting.
Q: What advantages are there for surgeons and patients to performing the spinal cases as outpatient procedures?
WT: Our patient satisfaction rates are much higher in the surgery center. It's a better experience for patients overall because it's much less daunting than the big hospital environment. Patients seem happier and more likely to resume daily activities sooner when discharged into a home as opposed to being 'institutionalized' by a hospital stay.
Q: Are there any benefits from the physician's perspective to performing the cases in the ASC?
WT: From the surgeon's perspective, as reimbursement goes down, the ASC is an opportunity to capture additional revenue. That is going to be crucial for surgeons in private practice. Additionally, in the future, spine surgery is going to be driven more and more to a cash basis and the more you can contain costs, the more value you can offer patients. Then you can really maneuver in the cash realm.
Q: What is the economic impact of being able to perform spinal surgeries in the outpatient setting?
WT: From a societal perspective, it's significantly cheaper to do these procedures in the ASC, which charges [often] less than the hospital. The payers know that and respond very quickly.
Q: Where do you see the most opportunity for outpatient spine surgery to grow and develop in the future?
WT: As we have more surgeons trained in this setting, I think we are going to see a higher volume of both cervical and lumbar procedures, but I think there's more of an opportunity to grow these percentages on the lumbar side. We are able to streamline our surgical technique enough to have less than two hours of anesthesia. Better instrumentation that requires fewer steps — like the OOLIF — will facilitate that.
I think we'll also begin to see more multilevel surgeries done as people become more comfortable in that space.
Q: What is the best piece of advice you have for spine surgeons just beginning to consider performing cases in the outpatient setting?
WT: The biggest thing is when you are comfortable and can do the procedure in less than two hours routinely in the hospital, you may be ready to bring these cases to the ASC. Assuming you can proficiently perform the surgery and the patient will be able to go home, then the most important thing to do is manage patient expectations.
Educate the patients on their level of pain, what they are expected to do and what is normal in terms of pain. Sometimes patients think because their surgery is done in the ASC, it isn't a big deal but when they feel pain at home they panic. However, when they know what to expect, I've had very few people have problems with pain outside of surgery. Let them know they can contact your office if they are worried about their pain after returning home.
Q: Have you been satisfied with your experience in an ASC setting?
WT: I have been very happy with my transition into the outpatient setting. Obviously there are bumps in the road, but I would never go back to doing 100 percent of my cases in the hospital.
More Articles on Spine Surgeons:
Minimally Invasive Spine Surgery: 4 Quality of Life Findings for TLIF
5 Biggest Payment Problems in Spine & Pain
Spinal Revision Surgery: Why Patient Expectations Matter