Natalie Soule, RN, administrator of Nashville, Tenn.-based Premier Orthopedic Surgery Center, shares insight on spine and total joints in the outpatient setting as well as offers key advice for boosting ASC growth.
Question: Which spine procedures are typically preformed in the outpatient setting and why? With CMS approving 10 new spine codes for the ASC payable list in 2017, do you believe spine will continue to grow in the outpatient setting?
Natalie Soule: From other conferences, industry magazines and peers, I believe scheduling of spine procedures is dependent on how the surgery center is set up. For example, my center is two rooms with no overnight stay. We do simple laminectomies, and two-level ACDFs. Larger centers that are more equipped are doing fusions and more complicated spine procedures. I also believe the complexity of spine procedures has to do with the expertise of the surgeon and the level of experience by the ASC team.
I do believe spine will continue to grow in the outpatient setting based on the approval by CMS and the acceptance of patients wanting to go home the same day.
Q: What would you advise administrators consider before adding total joints to their ASCs?
NS: As the administrator, you would need to ensure your surgical staff is trained in total joints, and your pre-op/PACU staff is trained as well. These patients may or may not go home in an hour and may be staying all day. The staff needs to be prepared to handle the needs of a patient who is staying in a facility all day. If physical therapy is involved, the nurses need to know when to call therapy to assist the patient.
Another important aspect of performing total joints is deciding the cost for equipment. Is your center performing a volume that would require you to purchase instruments, new drills, helmets and all other items required for total joints? Are your managed care contracts reimbursing a rate that would provide you an incentive to continue to perform total joints?
Of course, these are just a few items pertaining to total joints. Many centers will set up a team for total joints to ensure all aspects of quality and safe care have been covered.
Q: If you could offer one piece of advice for administrators trying to boost growth in their ASCs, what would it be?
NS: I am not sure if there is one piece of advice that can answer this question. If there are physicians in the community who may be a candidate for your center, by all means go out and try to recruit that surgeon. If your practice is primarily with one group, sometimes it is hard to boost their growth depending on if business is down for the group.
You can always try to add a new service. If you are orthopedic and are not performing pain or spine, consider adding this to your mix. If you are multispecialty and are not doing ENT, etc., consider adding this specialty to your center.
Learn more from Ms. Soule at the 24th Annual Meeting: The Business and Operations of ASCs in October 2017. Click here for more information.