How outpatient spine surgery will look in 2021 and beyond: 8 things to know


Spine surgery will continue to migrate to ASCs, arguably at a more rapid pace because of the COVID-19 pandemic, as minimally invasive techniques advance and more payers reimburse for spine procedures at outpatient settings.

Here are eight things to know about outpatient spine surgery in 2021:

1. There are more than 160 ASCs now performing minimally invasive spine surgery in the U.S., which has seen a significant uptick in the past decade. Florida has 15 ASCs offering minimally invasive spine surgery, the most of any state.

2. Sixty-seven spine codes will be removed from CMS' inpatient-only list in 2021, with plans to completely phase out the list by 2024. Patient demand, increasing adoption of minimally invasive techniques and CMS and commercial payers encouraging more cases to be done in an outpatient setting will accelerate outpatient spine surgery migration.

3. Outpatient spine surgery is likely to become the new normal, which medical device companies will have to adapt to, offering more services to help surgeons transition their practice to the outpatient space. Remote patient monitoring tools as well as augmented reality and virtual reality technologies to train surgeons and staff are expected to become more prominent.

4. More spine surgeons are expected to become involved in the leadership and ownership of ASCs. A recent survey of academic spine surgeons noted that 49 percent had investments in surgery centers. The surgeon-owned market segment is projected to grow at a compound annual growth rate of 4.9 percent between 2017 and 2024.

5. Outpatient spine surgery has increased dramatically at ASCs and hospital outpatient departments in the past decade. An article published in the Annals of Translational Medicine found:

  • Lumbar laminotomies — previously performed in the inpatient setting in 81 percent of cases — are now done in an outpatient hospital setting in 68 percent of cases and in an ASC in 10 percent of cases.
  • Posterior cervical laminotomies, performed in the inpatient setting in 76 percent of cases in 2003, are now performed in an outpatient hospital setting in 50 percent of cases and in an ASC in 23 percent of cases.

6. The aging population in the U.S. means that more Medicare patients will require spine care in the coming years, with the case mix continuing to shift away from commercial payers. However, many surgeons believe new CMS rules centering on decreased payments and increased prior authorization requirements will further limit access to care.  

7. CMS' Medicare Physician Fee Schedule outlined steep reimbursement cuts for many surgical specialties. Essentially, this will translate to spine surgeons being reimbursed about 10 percent less to do the same surgery in 2021 as they did in 2020. Additional reimbursement cuts from commercial payers are in the pipeline, as they typically base their payment rates on Medicare's.

8. Two spine devices that will see increased reimbursement at outpatient facilities in 2021 include Stryker's SpineJack and Vertos Medical's Mild lumbar spinal stenosis procedure. The Mild procedure will see its average ASC reimbursement increase 41 percent in recognition of the cost of the device associated with the procedure. CMS awarded SpineJack with its transitional pass-through payment status and new technology add-on payment, which provide added payments for new devices that have demonstrated significant clinical success. 

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