CMS plans to drop the inpatient-only list.
The change does not mean CMS will pay for more procedures in the ASC and surgeries still need to appear on the ASC payable list before acheiving CMS reimbursement.
Two spine surgeons told Becker's Spine Review what the change could mean for spine surgery in ASCs.
Note: Responses were edited for style and clarity.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: [I believe] more fusions will be moved to the ASC, and more ASCs will apply for extended stay status. The ASC will function as a mini-hospital in some ways, probably keeping patients up to 48 hours. Hospitals and venture capital firms will become even more involved in setting up and running ASCs.
The major downside will be some surgeons softening indications to do surgeries in their ASCs. Some surgeons have ownerships in their ASCs, and the opportunity to do more cases will invariably tempt some surgeons to bring higher acuity and higher risk patients, perhaps inappropriately, to the ASC. Patient complication rates may go up and not improve quality of care. This may offset any savings by moving the inpatient codes to outpatient only.
Issada Thongtrangan, MD. Microspine-PLC (Scottsdale, Ariz.): I have been doing spine surgery over the past several years, and my staff and I are very familiar with the setting.
Here is how I prepare myself and my practice:
1. The surgeons have to be comfortable performing outpatient surgery. Everyone has different skill sets and comfort zones.
2. Patient selection is a key in successful outpatient surgery. Unhealthy patients or the patients with several comorbidities are not suitable in an outpatient setting.
3. Staff in ASCs have to adapt and change their mindset. Postoperative pain control with fewer narcotics is the key. There is no more giving lots of narcotics pain medications and sending them to the floor. The enhanced recovery after surgery pathway is very helpful.
4. The facility must have all the same instruments as if the surgery was done in the hospital including the sterilization department. The ASC, surgeons and vendors have to work as a team so we have efficient turnover time and to sterilize instruments if we are doing several cases in a day. Another issue is the implant costs and necessary expenses as the reimbursement in the ASC is much lower than the hospital. We want to have quality products at a reasonable price.
5. We need to educate the patients and their family on troubling post-operative troubling signs and symptoms because they are essentially acting as a nurse for their loved ones after the surgery.
My staff and I are routinely calling patients and their family immediately after surgery to make sure everything is okay, especially in the first 24 hours after surgery. We also continue to contact them on a daily basis to check and make sure they are progressing in the right direction and answering their questions and concerns.