Regional Brain and Spine in Cape Girardeau, Mo., is a multidisciplinary spine practice with a unique operating agreement in an ambulatory surgery center: the physicians lease the ASC one day per week to perform their cases.
"We lease the facility and staff at the ASC, which allows us to provide neurosurgical and pain care in a way that's affordable for our patients and for us," says Dr. Vaught. "This arrangement has worked out very well. We wouldn't have enough cases to operate our own ASC, but we are able to pay the approved expenses on our leased day and it's up to us to ensure we are busy and active throughout that day."
ASCs are typically lower cost settings to provide care and the cost savings is passed on to the patients. Until recently, most spine procedures were preformed in the hospital, but minimally invasive techniques and technology allow surgeons to take some procedures and patients into the outpatient setting.
Additional benefits in the ASC include:
• Lower infection rates
• Surgeons have more control over their cases
• Quicker room turnover times/less surgeon downtime
• Higher patient satisfaction
"Patients appreciate the ASC because there is more of a personal touch from the nurses and staff," says Dr. Vaught. "There are fewer people in the ASC than in the hospital, so patients get more individual attention. It really improves the patient's experience."
Most patients return home the same day of their procedure, but cervical fusion patients are allowed to stay over night — up to 23 hours — to recover. The nurse-to-patient ratio is one-to-one for overnight stay patients. This is the third year Dr. Vaught and his colleagues have provided services at the ASC, and they enjoy providing services there.
However, the surgeons experienced a learning curve when it came to operating the center. Before bringing cases there, they'd never considered the individual cost of instrumentation, implants and other expenses that are part of the surgical process.
"We looked at our expenses line-by-line and were surprised by the instrumentation costs," says Dr. Vaught. "There were so many costs for using the operating room that we weren't accustomed to incurring in a hospital setting. Just seeing how expensive things were really made an impact on how we used our time and resources."
Now the surgeons are constantly looking for ways to improve efficiencies, and find it rewarding to see how their efforts positively impact the business.
Another challenge was contracting with insurance companies. At first, many of the payers quoted rates that were too low for the surgeons to consider, but after they worked together to lower costs and prove the effectiveness of their care, they were able to go in-network.
"Initially, there were several payers that wouldn't work with us that we now have contracts with," says Dr. Vaught. "We have the data showing our case costs are down and performance is outstanding.
Narrowing networks are causing stress for providers across the spectrum, and competitive pricing for insurance companies could provide additional opportunities for ASCs as a low cost provider when cases are appropriate.
In the future, Dr. Vaught would like to explore a partnership with an extended stay facility to increase the number of patients who would be potential candidates for surgery at the ASC. If the surgeons contract with a recovery/observation facility, patients could be discharged there instead of home if necessary.
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