Spine procedures are making their way to the outpatient setting, and leaning into certain aspects could help quicken the pace of migration.
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. Becker’s invites all spine surgeon and specialist responses.
Next question: What will motion-preserving spine surgery look like in 3 years?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Aug. 12.
Editor’s note: Responses were lightly edited for clarity.
Question: What will bolster the pace of spine surgery migration to ASCs?
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): Outpatient spine surgery is a particular interest of mine and its adoption into the ASC setting will require a multitude of drivers. I think a combination of developing more tissue sparing techniques, minimally invasive technology and implants, financially accessible navigation, perioperative multimodal pain control and predictive and careful patient selection will be critical to moving spine surgery into the outpatient setting.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I think the bundling movement will drive spine surgery into physician-owned or co-owned ASCs. Ultimately I think the hospital lobby will overplay (and may have already overplayed) its own hand by trying to grab larger chunks of that pie and be left with high-risk, low margin, and high cost cases. Their own greed will drive doctors out in order to get a larger share of the bundled payment. At the end of the day, that market will drive itself.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): My perspective is somewhat different, based on both observational and recent profit reporting nationwide by larger healthcare systems. Ultimately what drives any shift in patient superintendence will be cost and (hopefully) safety. Physician/broker owned surgical centers neither adhere to the federal regulatory oversight nor metrics for outcomes while few provide urgent complex services like intensive care medicine following complex surgical procedures. Profit-driven patient management is the benchmark of this business through exclusion and touted cost savings. The trends are changing with market saturation and health systems’ responding to competitive contract negotiations based on complex patient services being readily available when needed.
