The cost savings associated with outpatient spine surgery is likely to accelerate its adoption in ASCs, Steven Girdler, MD, said.
Dr. Girdler, of Newport Beach, Calif.-based DISC Surgery Center, spoke about the potential of spine surgery in ASCs with Becker’s.
Note: This conversation was edited for clarity.
Q: How are you approaching insurers when it comes to outpatient spine surgery?
Dr. Steven Girdler: The DISC surgery centers accept all major PPO insurance, and some of them still accept Medicare. One thing I will say about patient selection when it comes to outpatient surgery is that input gets down to essentially a younger group of patients with less complex medical history and comorbidities, because not all the facilities accept Medicare.
Once you accept Medicare, you start accepting people into their 60s, 70s and 80s, who may come with more complex medical requirements that might not be suited for an outpatient surgical setting. Now that’s not true for everyone, but having the patients selected who you think will succeed in this setting is absolutely paramount. The way that the insurers have worked at some of the facilities tends to skew the population to a group that is often, but not always, under 65 years of age. I think the payers love the ASC model because it substantially decreases cost for them by cutting out hospitalizations that could extend into days.
I think that’s a huge reason that hospitals and insurance companies will force spine surgery into an ASC in the future. I’m very proud that DISC is at the forefront of this. But I expect in 10 years, it’s going to be a completely different landscape where if you’re getting a one- or two-level lumbar decompression, you’re not going to be at a hospital
Q: Are there any more complex spine procedures that you think might need more innovation to get into the outpatient setting?
SG: The goal of outpatient surgery is to have safe and effective surgery that can be done with one-day discharge. There are definitely a group of surgeries that may never fit into that mold. Myself and a few of the physicians who work here have a personal interest in things like scoliosis, spinal deformity, complex revision surgery. These are things that can possibly occasionally be done in a limited way in a surgery center, but may never be suited for that outpatient setting.
That being said, that group of complex spine surgeries is less than 10% of all spine surgery. The vast majority of cases are routine degenerative conditions that require things like decompression at one or two levels, fusion at one or two levels and disc arthroplasty at one or two levels. That is the majority of all spines are being performed. So the majority of spine surgery being performed can be transitioned to a surgery center for healthy patients.
