5 Trends Impacting Outpatient Spine in 2012: Thoughts From Dr. Thomas Schuler

Written by Rachel Fields | January 27, 2012 | Print  |
Thomas Schuler, MD, spine surgeon and president and CEO of Virginia Spine Institute, discusses the outlook for outpatient spine surgery in the next few years.
1. Patient demand for — and physician acceptance of — minimally invasive techniques. In the last few years, Dr. Schuler has seen a growing acceptance of minimally invasive techniques on the part of patients and physicians. "Minimally invasive techniques mean different things to different people, but the goal is to minimize surgical trauma to the patient while accomplishing the desired goal," he says. "For physicians, that means forgetting their old, pre-conceived biases and expanding to the new reality that can happen if we are able to accomplish things with less surgical dissection." He says physician bias partially originates from medical training programs that do not teach minimally invasive techniques. He says medical training programs must stop clinging to traditional methods of surgery in order to develop more advanced minimally invasive techniques and provide patients with physicians who can perform the procedures.

He says as more physicians adopt minimally invasive techniques, patients are requesting the less-invasive surgeries as well as the option for outpatient surgery. "Patients are demanding for us to continue to evolve minimally invasive techniques," he says. "As patient demand continues to evolve to less-invasive procedures, it will open up the door for more people to be treated that way."

2. Medicare's hesitation to accept outpatient spine.
Medicare currently does not reimburse for spine surgery in the outpatient setting, meaning surgery centers must contract with commercial payors if they want to perform spine surgery. Dr. Schuler believes Medicare should start reimbursing for outpatient spine in order to support the progression of more complex surgeries into a low-cost, high-quality setting.

He says the length of stay required by Medicare for spine surgery procedures is not accurate and should be amended to allow same-day surgery. "In this area for cost savings, Medicare is prohibiting patients from benefitting from the modern options that are available," he says. "They're increasing costs because they're requiring the procedure is done as an inpatient procedure."

3. Gradual ratcheting down of payment for spine centers. As spine surgery becomes more widespread in surgery centers, Dr. Schuler believes commercial reimbursement rates will drop considerably. He says the increase in spinal procedures has driven up the expenditure of healthcare dollars on spine, and the procedures have come onto the public's collective radar screen. "Now that it's on the radar screen, it's looked at as an area for cost savings by insurance companies," he says. "They want to cut costs, so they look at areas with a growth in utilization and incorrectly conclude that there's a growth because surgeons are making money from the procedures."

He says the next 10 years will see a significant increase in the difficulty of patients being able to receive appropriate services, both non-operatively and operatively. "As time moves forward, it will be harder and harder to get authorization of services and harder for surgery centers and physicians to get paid for it," he says.

4. Movement of lumbar fusions into surgery centers. Dr. Schuler says lumbar fusions are the most recent procedure to move into outpatient surgery centers. The goal of lumbar fusion surgery is to restore nerve function, prevent abnormal motion and relieve pain by fusing the vertebrae together. Dr. Schuler says lumbar fusions are moving into surgery centers because new approaches decrease patient pain and increase safety.

"The surgical dissection required to perform these procedures often requires inpatient management for patient safety and patient pain control," he says. "As our technical skills allow us to be much less destructive of the surrounding tissues, patients experience much less pain and the procedure can be done on an outpatient basis." He says the procedure should be performed in ASCs only for single-level or possibly two-level lumbar fusions.

5. Increased revenue for ASCs that have not started spine yet. The good news: For surgery centers that have not added spine to their list of specialties but plan to do so, the next few years should see a boost in revenue and volume. "The gradual push of inpatient procedures to outpatient procedures may drive an increased surgical volume for surgery centers," he says. "The ASCs would benefit from getting in this line, since the trend is to push things out of inpatient settings."

He says surgery centers that already have an established spine program will likely see a decrease in revenue due to falling reimbursement rates from commercial payors. However, surgery centers that have not yet added spine should see increased revenue because spine reimbursement is still quite good compared to other specialties.

Learn more about Virginia Spine Institute.

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