Becker's 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine took place in Chicago June 22-24. During the meeting, Jeffrey Simmons, chief development officer of Westchester, Ill.-based Regent Surgical Health, and Pierce Nunley, MD, director of the Spine Institute of Louisiana in Shreveport, discussed spine cases in the ASC setting during a panel moderated by Bart Walker, partner with McGuireWoods.
Here are three key takeaways from their discussion.
The biggest obstacles to spine cases in the ASC
Dr. Nunley said he finds the biggest barriers to performing spine procedures in the ambulatory setting are patient acuity or case complexity, patient preference or other factors that make certain cases more appropriate for the acute care setting. Not all cases are suited for the ASC, he said, and he advised surgeons to exercise great discretion when making those determinations.
Compared to a decade ago, Mr. Simmons said payers — not physicians — today represent the primary challenge.
"If you asked me 10 years ago, I'd say [the biggest obstacle is] finding enough surgeons who will come to do procedures in the surgery center," said Mr. Simmons. "Today the obstacle is getting paid and getting paid appropriately so the technology is advanced and the surgeon is highly skilled. That involves having payers recognize these cases can be done safely and inexpensively in the ASC."
Data and Medicare policies: Key pieces in payer-provider relationships
To follow up on Mr. Simmons' thought, Mr. Walker asked the panelists how ASCs can effectively deliver the message to payers that the ambulatory setting is cost-effective and safe for spine procedures.
Dr. Nunley shared a concise suggestion on how providers can endorse that: "Through evidence. In the end it's all about costs, yet that is the simplest evidence because it costs us a lot less to do a surgery in the ASC than a hospital," said Dr. Nunley. "A lot of medical directors for payers don't get it."
In addition to data illustrating the cost difference, Dr. Nunley said ASCs spend one to five years collecting data from clinicians to effectively communicate individual surgeon outcomes for the ASC in addition to broader facility outcomes. He also underscored the importance of infection rates, and how this information should be made public to payers as well as patients. "Our infection rate is less than 1 percent for major procedures, and the patient being aware of that is No. 1."
But commercial payers are the second wave of reimbursement ASCs are concerned about — Medicare is the first. Mr. Simmons noted that commercial payers go the way of Medicare, which is why he hopes the federal health insurance program reimburses more types of procedures in the near future. "We could triple spine cases in the ASC if Medicare would expand the list of cases they approve," said Mr. Simmons. "Even some of the payers will then allow this, since they follow Medicare."
Different levels of hospital partnerships
As the healthcare landscape grows more consolidated and system-centric, ASCs commonly face decisions about whether — or in what capacity — to partner with hospitals or health systems. Mr. Simmons and Dr. Nunley collaborate with hospitals in different capacities.
Dr. Nunley's ASC has an agreement with a nearby hospital, which accepts cases of high acuity or complexity and serves as a 24-hour safety-net to the ASC should any complications arise during a patient's procedure.
Regent Surgical Health manages and owns 23 ASCs, 17 of which are joint ventures with hospitals. "About four-fifths of our facilities now have hospital partners," said Mr. Simmons. "Ten years ago, we used to fight the hospitals all the time."
One factor that may influence an ASC's decision to partner with a hospital is whether its state requires a certificate of need to construct new facilities or expand services. Looking at the landscape market by market, Mr. Simmons noted a drastic difference in states with CON laws and those without. "In non-CON states, the number of surgeons for various specialties are slim. In CON states, it boggles my mind how many surgeons are available to join."