Although many procedures are already performed routinely in ASCs, the performance of more complex procedures, including a number of advanced spine procedures, are less common. However, some physicians in the United States are performing these surgeries at outpatient facilities and are still able to provide a great cost savings to patients and payors.
Procedures safely performed at ASCs
A recent study performed by Kenneth Pettine, MD, a spine surgeon at Loveland (Colo.) Surgery Center, found that a number of complex spine cases can be safely performed at an ASC. Specifically, his data indicates that the following procedures, when performed at an ASC, resulted in below-national-average complication rates, required less than 24-hour stays and were clinically effective at reducing disability and pain:
- Non-instrumented spine surgery, microdiscetomies and/or nerve decompressions;
- Anterior cervical decompression;
- Anterior cervical fusion — 1 & 2 Levels;
- Cervical artificial disc replacements — 1 & 2 Levels;
- Anterior lumbar fusion — 1 Level; and
- Lumbar artificial disc replacement — 1 Level.
Additionally, posterior lumbar fusion surgery performed in the standard midline technique with pedicle screws may be performed at ASCs with a convalescent license. This procedure typically requires a 2-3 day inpatient stay, but can be performed safely and with clinical efficacy at ASCs with licenses allowing stays of more than 24 hours, according to the study. ASC-based spine surgeries also appear to provide high patient satisfaction, with scores at Loveland consistently above 97 percent.
Increased daily case volume
In addition to offering clinically effectiveness and safety, ASCs can allow surgeons to perform cases more efficiently. Comparison of similar spine surgeries performed at the hospital indicates there is 20 percent less time spent in the operating room at the ASC, according to the study.
The turnaround time between procedures is also significantly less at an ASC than at a hospital. According to Dr. Pettine, the turnaround time between procedures at his ASC is 12 minutes, compared to a turnaround time of one hour and 20 minutes at the hospital. Reduced turnaround times allow physicians to treat more patients in a day, increases patient access to care, provides physicians with greater control over their day and gives increased opportunities for generating revenue.
Spine patients treated at ASCs also require shorter post-surgery stays than patients treated at hospitals. The average patient is discharged within two days after a lumbar fusion from the Loveland Surgery Center versus 3-5 days for a similar patient at the hospital.
Reduced cost to patients and insurers
Spine surgeries performed at an ASC may also be significantly less expensive than the same surgeries performed at a hospital. Outside insurance cost analysis, which was completed as part of Dr. Pettine’s study, indicates that instrumented spine surgery in an ASC, including anterior cervical decompressions and fusions, cervical disc replacements and lumbar fusions, can be performed at a 60 percent cost savings as compared to a hospital. According to the study, most of this savings is a result of reduced time associated with the procedure and implant cost.
“Hospitals often take the cost of an implant and double or triple it when billing the insurer and patient, while Loveland simply takes the implant costs and adds 10 percent. This creates a huge costs savings,” says Dr. Pettine. “We add 10 percent because we feel it’s reasonable. There is no storage fee for these implants and doubling or tripling the costs seems like a lot of money for nothing.”
Dr. Pettine says that this type of cost-conscious pricing benefits the center overall. “[Lower pricing] is a way of endearing yourself to the insurance companies,” says Dr. Pettine. “It’s a good way to convince them to contract with you.”
Future of spine
Although many complex spine surgeries are already performed at the ASC and even more can performed at this setting if the ASC holds a convalescent license, Dr. Pettine predicts that even more spine surgeries currently performed in the hospital will move to the ASC setting in the next few years.
“Future advances in minimally invasive techniques such as the XLIF procedures and the TranS1 approach may allow one- and even multi-level lumbar fusions to be performed at an ASC,” he says. “I would estimate that 80 percent of all spine cases will be performed at ASCs in the next five years.”
These advances, coupled with healthcare-reform efforts to reduce costs while providing high quality-care, are likely to bring more spine procedures to the ASC setting.
“ASC spine surgery fits perfectly with Obama’s vision of healthcare,” says Dr. Pettine. “A big focus of current healthcare reform is rewarding providers that provide quality care at low prices, and that’s the definition of doing spine surgery at an ASC.”
ASC spine surgery benchmarking data
Click on the following links to view benchmarking data from Dr. Pettine’s study of spine surgery in ASCs:
Contact Dr. Pettine at kpettine@rmaortho.com and learn more about Loveland Surgery Center at www.lovelandasc.com.
