Spine in ASCs continues to grow with the January 2015 addition of nine spine codes to the ASC-payable list. Bolstering spine offerings in outpatient surgery centers could result in profitable businesses.
Quality of spine
More is riding on spine operations in ASCs than in hospitals. According to Richard N. Wohns, MD, JD, MBA, of NeoSpine in Washington, any problem arising during a spine surgery in the outpatient setting would be disastrous.
"There's no room for error in the outpatient environment," says Dr. Wohns. "You have to have the perfect surgery, everything leading up to it and after it."
In an ASC, the bar is set higher, requiring an experienced surgeon to enter the operating room. Without the cushion of additional hospital staff and equipment, ASCs must perform flawlessly. Experienced surgeons are necessary to handle the volume at NeoSpine for example, where specialists perform about 300 to 350 surgeries annually.
NeoSpine's outpatient spine surgery offerings include anterior cervical fusions, artificial disc surgery, posterior cervical nerve root decompression, lumbar microdiscectomy, lumbar laminoforaminotomy, lumbar laminectomy and minimally invasive fusions and decompressions.
With disposables for spine costing $500 and implants costing about $5,000, outpatient surgery centers should focus on crafting strong contracts.
Currently, some payers prove to be spine's greatest roadblock in ASCs. Solidifying contracts with payers to include more complex spine procedures is sometimes an arduous process. Dr. Wohns finds the system baffling because performing surgeries in ASCs instead of hospitals will save insurance companies money.
"Some payers are willing to spend four times as much in the hospital for the same procedure," says Dr. Wohns. "That's one of the biggest frustrations."
Instead of working with ASCs to add value to outcomes and cost of patient care, some payers take as long as a couple years negotiating prices and implants before clearing a new procedure and writing codes into contracts.
SI joint fusion is a relatively new procedure that illustrates this payer imbroglio well. At present, few payers approve this procedure in ASCs despite its profile as a highly suitable and appropriate outpatient procedure. The cost of this procedure performed in a hospital could be 200 percent to 400 percent more than in an ASC, due to implant markups in hospitals.
Dr. Wohns sees value in regular meetings between payers and ASC representatives to discuss updates.
Spine is here to stay
The outpatient surgery center environment often yields lower infections rates, higher patient satisfactions rates and lower costs, according to Dr. Wohns. With those benefits, he sees spine continuing to gain momentum in ASCs. Additionally, ASCs provide opportunities for physicians to protect their independence outside of the hospital influence.
"The future is a reflection of what is going on now, with more and more interested parties recognizing the value of outpatient spine surgery," says Dr. Wohns, "These parties include payers, government agencies, patients and providers."
With the addition of spine codes, CMS realized the benefits of performing spine surgeries in outpatient surgery centers, recognizing the procedures as safe and cost-effective for the Medicare beneficiaries.
"We no longer need a hospital for the majority of spine surgeries — it's an old way to do it," says Dr. Wohns. "In general, everything is higher quality, less costly, more efficient and less complicated in ASCs, and that's what people want."
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