9 things to know about spine in ASCs


Here are nine things to know about spine in the ASC setting.

1. Richard N. Wohns, MD, of NeoSpine offered the following statistics about spine in the outpatient surgery setting:


  • Disposable for spine — $500
  • Total cost of eight nursing hours per patient, factoring in multiple staff in room — $300 to $350
  • Average implant costs — $5,000
  • Average annual number of surgeries — 300 to 350
  • Average annual number of pain procedures — 2,000


2. Procedures typically performed in the outpatient spine surgery center include:


  • Anterior cervical fusions
  • Artificial cervical disc surgery (arthroplasty)
  • Posterior cervical nerve root decompression
  • Lumbar microdiscectomy 
  • Lumbar laminoforaminotomy 
  • Lumbar laminectomy 
  • Minimally invasive fusions and decompressions
  • Lateral spinal fusion


There are some surgery centers where surgeons perform multi-level fusions and artificial disc replacement as well.


3. Although spine is one of the most profitable procedures performed in ASCs, they are not the most efficient due to surgery duration and setup time. Turnaround cases eat up more time, and if an ASC does not possess certain contracts, the surgeries are not profitable.


4. As more patients continue to choose ASCs for cost-effective procedures, spine must meet demands for multilevel fusions, disc replacement and hybrid procedures. These procedures will need to be offered in addition to the simpler surgeries, like single-level spinal fusions.


5. Payers present a major problem for spine in ASCs, as insurance companies do not want to pay for spine procedures in outpatient settings. However, CMS added nine spine codes to the ASC-payable list, effective Jan. 1, 2015:


  • Neck spine fuse & remov bel c2 (22551)
  • Neck spine fusion (22554)
  • Lumbar spine fusion (22612)
  • Neck spine disc surgery (63020)
  • Low back disc surgery (63030)
  • Laminotomy single lumbar (63042)
  • Removal of spinal lamina (63045)
  • Removal of spinal lamina (63047)
  • Decompression spinal cord (63056)


CPT codes 22551, 22554 and 22612 were moved to codes APC 0425, which means higher reimbursement.


6. Five percent of spine surgeries in the United States occur in ASCs, according to the Society for Ambulatory Spine Surgery.


7. North American Spine (Houston) surgeon Neil Badlani, MD, said "spine surgery is still a frontier."


Dr. Badlani believes educating patients about the benefits of outpatient spine surgery will be the key to the successful future of spine in ASCs. "When transitioning surgery from the inpatient to the outpatient setting, it is prudent to have a stepwise approach and start with more straightforward procedures in healthier patients first and expand indications later," he says.


Lumbar decompression and anterior cervical procedures lead the outpatient spine industry, but Dr. Badlani said minimally invasive lumbar fusion will be the next big endeavor for spine surgeons to tackle in ASCs.


8. Kenneth Hancock, president and development officer, and Catherine Kowalski, executive vice president and COO, of Meridian Surgical Partners shared six considerations for physicians interested in opening spine ASCs, according to the Society for Ambulatory Spine Surgery.


  1. Patient selection: Patients should be within ASA 1 or 2, and possess a strong support system for recovery.
  2. Pre-op process: Offer an in-depth questionnaire to patients, so anesthesiologists can make the best-educated decision about whether patients should undergo surgeries in ASCs.
  3. Managing expectations: Educate patients early on, describing the components of an outpatient surgery and recovery time.
  4. Pain control: Assure patients that they will leave surgery with pain control and an understanding of how to deal with pain. 
  5. Anesthesia program: Outpatient spine surgeries require shorter-acting anesthetics. To run a successful spine outpatient center, choose expert anesthesiologists who effectively manage complications, recovery and post-discharge pain control. 
  6. Equipment costs: A budget range of several hundred thousand dollars to $1 million will be necessary to start-up a spine ASC. Spine requires a C-arm, neuro microscope, pneumatic drill set, headlamp, cervical lumbar instruments, cautery unit and lumbar table. 


9. Lumbar discectomy complications are decreased for outpatient patients versus inpatient patients, according to a study by MedScape. The overall complication rate for the inpatient group was 5.4 percent, compared to the outpatient group's 3.5 percent. Patients who underwent lumbar discectomy between 2005 and 2010 were chosen from The American College of Surgeons National Surgical Quality and Improvement Program database.


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