What will come next in outpatient spine? 7 spine surgeon key thoughts


Seven spine surgeons discuss the latest trends in spine procedures performed in the outpatient setting.

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 the key trends in outpatient spine surgery?


J. Brian Gill, MD, MBA. Nebraska Spine Hospital (Omaha): The overall trend is trying to move more procedures to an outpatient setting. This varies on a state-by-state basis as each state has its own regulations. Some states define outpatient stays as 23 hours, so an overnight stay is acceptable. Other states mandate that patients must be discharged before midnight the day of the procedure. These legislative regulations dictate what can and cannot be done in an outpatient setting. Yet more insurers and health systems want more procedures performed in outpatient settings.


Innovative procedures, smaller procedures and multi-modal pain management techniques are enabling more procedures to be done in an outpatient setting. Moreover, patients want to go home from a procedure the same day or the following day. Patients are buying into outpatient procedures as a better, safer and more cost-effective delivery of healthcare and this is also driving the trend.


Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): As developments continue to occur in minimally invasive spine surgery, more procedures can be offered in the outpatient setting. Many new options are becoming available for patients instead of procedures that traditionally require a longer hospitalization. These minimally invasive procedures not only allow patients to return home the same day, but also have faster recovery times. This trend towards minimally invasive spine surgery improves patient satisfaction while reducing healthcare costs.


Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I think the bundled payment models are on their way. There are multiple companies now all trying to act as third-party administrators for the self-insured groups. The concept of doing [outpatient] spine cases is becoming more mainstream. As the self-insured folks start to realize that ambulatory settings are safe for spine procedures, I think there will be an even greater shift of elective spine cases to this setting. Value provision is in the wheelhouse of ambulatory spine, and we are only starting to scratch the surface of what can be done in terms of volume.


Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): As the postoperative pain management techniques and less invasive procedures become more advanced, more spine procedures are going to be done in an outpatient setting. This will drive down the cost of care and will shorten postoperative recovery.  Endoscopic procedures will become more accepted as the techniques and the instrumentation become more simplified and reliable.


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: The key developments revolve around increasing the number of cases being done as outpatient. As surgery centers provide a superior patient experience for less cost, we will see them become more profitable while being in network. Fewer ASCs will be out of network and I think the hospitals' appetite for the ASCs will increase as larger systems will try to acquire them. My belief is not all of these systems know how to let the ASCs do what they need to stay in the black.


Neel Anand, MD, Clinical Professor of Surgery and Director of Spine Trauma at Cedars-Sinai Spine Center in Los Angeles: The key trends that I am seeing are consolidation, in-network contracting as well as single-level fusion procedures and more complex surgeries being gradually moved to and performed at the outpatient surgery center.


Payam Farjoodi, MD. Spine Surgeon at Center for Spine Health at Orange Coast Memorial Medical Center (Fountain Valley, Calif.): Increasing minimally invasive techniques have allowed more types of spine surgery to be done in an outpatient setting. It is common now to see not only decompressions done in surgery centers, but also simple single-level fusions or disc replacements in young healthy patients. I think as more outcomes data is collected, we will see this shift accelerate if it demonstrates significant benefit to the patients and the health systems.


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