Key trends in outpatient spine: 4 spine specialists weigh in


Four specialists discuss the growth of outpatient spine surgery.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.


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Question: What are some key trends in the movement toward outpatient spine care?


Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: The advent of bundled payment models will assist in moving more procedures to outpatient facilities. Many regular insurers are sticking to CMS guidelines regarding the usage of these facilities for spine care. The self-insured companies are catching on to the fact that these outpatient facilities provide significant value to their employees and to the company itself when surgical interventions are required.


Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: The key trends are stakeholders assuming more risk and being rewarded by payers for bringing cases to outpatient facilities. With the incentives of profit-sharing of facility fees and the ease and convenience of a well-equipped and well-staffed surgery center, we will see more and more cases done as outpatient procedures. We will see more surgery centers getting accredited for overnight stays, and more complex cases (and likely poorer-insured ones) go to the hospitals.


I think the hospitals will then be more incentivized to enter into joint ventures with physicians to mitigate the potential losses that the trend brings. The insurance companies, I think will need to, if they have not already, increase reimbursements for surgery center work, and add more covered CPT codes, like hardware implant CPTs to their payable codes. Medicare, in particular, will need to step up if they don't want to go bankrupt before mid-century.


Jeffrey C. Wang, MD, Chief, Orthopedic Spine Service, Co-Director USC Spine Center, Keck Medical Center of USC, Los Angeles: I think the key movement in outpatient spine care is that we can do many of our smaller procedures as an outpatient. We already do many surgeries where we send the patients home the same day, or with a short overnight stay. It is natural to move many of these surgeries to an outpatient setting. With the development of better pain management, more minimally invasive procedures and better immediate physical therapy, many more surgeries could be done in this setting.


Medhat Mikhael, MD, Pain Management Specialist, Medical Director, Center for Spine Health at Orange Coast Memorial Medical Center, Fountain Valley, Calif.: Patients feel more open and comfortable with outpatient spine care, and surgeons and physicians are becoming more comfortable with the outpatient setting, as some were trained in this setting. Also, payers are more willing to cover and pay for outpatient procedures and minimally invasive surgeries.


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