Outpatient spine surgery: 8 things to know heading into 2020

Written by Eric Oliver and Laura Dyrda | January 06, 2020 | Print  | Email

Spine surgery in ASCs is becoming more common as procedures become less invasive and payers are more willing to reimburse for spine cases in the outpatient setting.

Here are eight things to know about outpatient spine surgery.

1. Over 160 ASCs in the U.S. offer minimally invasive spine surgery, which has seen a significant increase in the past decade.

2. Half of all outpatient spine surgery cases are expected to be performed in the ASC by 2020, up from 40 percent in 2015, according to data from L.E.K. Consulting.

3. Sg2 predicts 88 percent of spinal decompressions and laminectomies and 67 percent of cervical spinal fusions will be performed outpatient, in either the ASC or hospital outpatient department, by 2028.

4. The average total cost of anterior cervical discectomy for Medicare patients in the ASC is $7,668, compared with $10,713 for hospital outpatient departments. Total disc replacement in the ASC cost $11,340 on average for Medicare patients in the ASC, compared to $15,402 in the HOPD.

5. SurgCenter Development is among the ASC chains performing spine surgery. It's performed more than 2,200 complex spine cases in 2018, up from the 1,000 cases they performed in 2014. About 102 SurgCenter centers perform complex spine procedures with around 260 SurgCenter physicians having performed outpatient cervical and lumbar fusions as well as total disc replacement procedures.

6. To track the growth of outpatient spine cases, look no further than the anterior cervical discectomy fusion procedures. Based on a sample of data from 16 ASCs in seven states, the procedure has grown in the outpatient space over the past four years:

2015
Inpatient: 1,407
Outpatient: 381

2016
Inpatient: 1,560
Outpatient: 244

2017
Inpatient: 1,652
Outpatient: 352

2018
Inpatient: 1,504
Outpatient: 524

7. The emergence of ACDF is supported by a study published in the Journal of Neurosurgery: Spine. Researchers examined data from 272 consecutive patients who underwent ACDF. Approximately 172 patients underwent the procedure in a hospital and 100 had the surgery in an ASC. Researchers found that patients in the hospital setting were more likely to undergo more complex surgeries where patients had longer length of stays. In an inpatient setting, 48.3 percent of patients went home within 24 hours of their procedure and 43 percent more returned home within 48 hours.

Pain scores were similar between both groups of patients, but ASC patients were less likely to consume narcotics than hospital patients. Researchers concluded, "Based on the results of this single surgeon's experience, one- to two-level ACDFs may be performed successfully in the outpatient setting in appropriately selected patient populations."

8. ASCs offer patients access to high-quality care performed at a lower cost than inpatient cases. A study published in Clinical Spine Surgery directly compared how inpatient spine surgery compared to spine surgery in ASCs. Researchers examined outcome data for 2,159 patients from California, Florida and New York who had a spine surgery between 2009 and 2011. Approximately 1,789 patients had inpatient procedures while 370 had outpatient procedures.

While ambulatory patients were more likely to go to an emergency room within 30 days of surgery (5.14 percent compared to 4.2 percent of inpatient patients) 30-day readmission rates were down in the ambulatory patient base compared to the inpatient group (around 1 percent compared to 2.2 percent). Concerning costs, cumulative charges were around $46,404 on average for the ASC cohort compared to $80,0555 for the hospital inpatient group. Direct costs were also around $16,000 lower for ASC patients than inpatients.

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