Why spine surgery is a key outpatient growth opportunity


The evolution of minimally invasive techniques, cost savings and an aging baby boomer population are some of the factors contributing to the spine market becoming a key outpatient growth opportunity in the coming years.

Spine surgery is among the higher-acuity specialties that many ASCs are migrating to their facilities. Integrating spine care into a multispecialty surgery center can significantly boost the growth rate and profit margin of an ASC, which ultimately leads to a considerable increase in the center's equity value.

Cost savings continues to be a priority for the U.S. healthcare system as it transitions from a fee-for-service toward a value-based model. CMS and commercial payers are adopting new policies to push these procedures from the inpatient setting to outpatient environments.

Patients also are advocating for this from a cost-savings standpoint, and, more recently, to avoid the risk of COVID-19 infection by having procedures performed at hospitals.

Today, the most common types of procedures being performed at ASCs are lumbar decompressions, lumbar discectomies and one-level anterior cervical discectomies and fusions. Cost savings for these procedures in the outpatient setting can be huge, according to Nader Samii, CEO of National Medical Billing Services.

"Medicare and insurance carriers also generate significant savings when spine surgeries are performed in an ASC. Spine surgeries in an ASC typically cost 45 to 60 percent less than a hospital, and can be as much as 90 percent less," Mr. Samii said. "Anterior cervical discectomy surgery, for example, costs Medicare $7,688 in an ASC versus $10,713 in hospital outpatient departments. Thus, this procedure costs 39 percent more in an HOPD than in an ASC." Here is a breakdown of what CMS pays for 15 spine procedures at ASCs and HOPDs.

While cost savings is driving many procedures to the outpatient setting, many spine surgeries — complex cases historically done at hospitals with patients staying overnight — would not be possible in an outpatient setting without recent innovations in minimally invasive technology.

Robotics, endoscopy, improved navigation and more durable and biocompatible implants are some of the technologies that have allowed for more spine surgeries to be done at ASCs with fewer complications, reduced blood loss and quicker recoveries.

"Minimally invasive surgery and technologies that enable MIS procedures will continue gaining popularity. There is more scientific evidence on the benefits of minimally invasive surgery, and patients demand it," Vladimir Sinkov, MD, of Las Vegas-based Sinkov Spine Center, told Becker's. "These technologies also make it easier to do more advanced spine surgery, such as lumbar fusions, at an ASC."

Earlier this year, one of the first outpatient three-level lumbar interbody fusion in the U.S. was performed by Jeffrey Carlson, MD, at Newport News-based Coastal Virginia Surgery Center. Evolutions in surgical techniques, care protocols and technology can significantly reduce trauma and make it possible to do these complex cases in the outpatient environment.

"Over the years, we've gone from single-level to two-level and now three-level all, through a small incision. The pandemic certainly pushed us more toward outpatient surgery so as not to overburden hospitals," Dr. Carlson told Becker's. "Now we are doing major spine procedures like this one on an outpatient basis. That has been a real silver lining."

Minimally invasive technology, cost savings and the effects of the pandemic will continue to speed the migration of spine procedures to the outpatient setting, where a rising elderly population will likely be receiving their care in the coming years.

According to the U.S. Census Bureau, more than 54 million adults aged 65 and older live in the U.S., accounting for about 16.5 percent of the country's population. And the older adult population is growing; by 2050, the number of adults aged 65 and older is projected to increase to 85.7 million — roughly 20 percent of the overall population.

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