Cervical disc replacement in hospitals vs. ASCs: Which is better?


Cervical disc replacements can be performed in ASCs or hospitals. However there are different considerations to know when deciding the best setting for the procedure.

Six notes:

1. On average CMS covers more for the costs of a cervical disc replacement through the anterior approach (Code 22856) at a hospital outpatient department compared to an ASC.

Total cost: $13,515
Medicare pays: $10,812
Patient pays: $2,702

Total cost: $17,655
Medicare pays: $15,905
Patient pays: $1,749

2. Cervical disc replacement also costs less at a hospital outpatient department compared to an ASC. Here are the costs for insertion of artificial upper spine disc, anterior approach (Code 22856).

ASC: $2,958
HOPD: $1,953

3. After adjusting for inflation, reimbursements for cervical disc replacement have fallen 12.9 percent between 2009 and 2021, according to an analysis in the International Journal of Spine Surgery. Cervical disc replacements jumped 183 percent from 2007 to 2017, and Medicare beneficiary utilization increased 149 percent. Inflation-adjusted hospital charges for cervical disc replacement grew 22.4 percent, and inflation-adjusted Medicare reimbursement fell 1.2 percent per year.

4. A study published in Spine found there weren't any significant differences in complication rates between outpatient and inpatient cervical disc replacement. Patients having single-level outpatient CDR had lower odds of a decompressive laminectomy after a year compared to the inpatient cases. There were no significant differences in one- or two-year complications or 90-day postoperative complications in the analysis of multilevel CDR for inpatient and outpatient cases.

5. Another study published in October 2018 in the International Journal of Spine Surgery compared one- and two-level cervical disc replacements in ASCs and hospitals. Researchers looked at 145 ASC patients, 348 hospital outpatient department patients and 65 hospital inpatient cervical disc replacement patients. The study found that one- and two-level cervical disc replacements in ASCs tended to be shorter and were completed with less blood loss without increased adverse events.

6. Spine surgeons are optimistic about the outlook of outpatient spine care. 

"The outpatient spine surgery landscape will greatly expand beyond what we are seeing currently," Don Park, MD, of UCI Health in Orange, Calif., said. "With the increased adoption and utilization of endoscopic spine surgery in the U.S., more surgeries can be performed in the ASCs using these ultra-minimally invasive techniques. In addition, awake spine surgery techniques with epidural, spinal and fascial blocks can allow more patients to undergo spine surgery without the need for general anesthesia. This will allow older patients with more medical comorbidities to have endoscopic spine surgery performed in the outpatient setting. Also, surgeries typically performed at the hospital as an inpatient, such as lumbar fusions, can be transitioned into the outpatient setting by combining both endoscopic and awake surgery techniques.Through the use of Enhanced Recovery After Surgery protocols and standardized 'prehab' classes, these surgeries can then be optimized for improved patient outcomes and greater safety in the outpatient setting. In five years, more and more spine surgeries will be performed in the ASCs, and mainly complex spine surgeries that require inpatient services will be performed in the hospital setting." 

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