Lisa Austin, RN, CASC, vice president of ASC operations for Pinnacle III, identifies five critical questions ambulatory surgery centers should ask before investing significant money or time into adding spine.
1. Do you already have the spine surgeons identified who would bring the cases or will you be recruiting those physicians? If you need to recruit those surgeons, you must do your due diligence and ensure you have quality physicians doing cases in your facility, says Ms. Austin. "These cases can come with high risk, and you want to ensure that you have quality physicians providing surgical services and adhering to your mission of providing high quality care" she says.
2. If you're only recruiting one spine surgeon, can you financially justify the addition? "If you only have one spine surgeon, what is their volume?" says Ms. Austin. "That's going to make a big difference on the initial outlay of the equipment expenditure of how quickly you get that return on investment."
3. Can your operating rooms properly handle spine cases? ASCs typically need larger ORs to do spine cases than they would for many other specialties. "If you have an older facility with 500-square-foot ORs, you need to consider that spine cases require a lot of equipment and sometimes additional staff is needed, so you might need a larger room," says Ms. Austin. "I've seen that a lot of groups building ASCs who already know they are incorporating spine going for 550- to 600-square-foot ORs."
4. Do you have staff knowledgeable or willing to be educated in performing spine cases? "A big consideration for ASCs looking to add spine is looking at the existing staff; oftentimes that is overlooked," she says. "Prepping for spine cases is hard work. It requires a little more than setting a room up for a general surgery case. We get the costs of all of the equipment, we've got the doctor all set and then all of a sudden you find out that your staff really hasn't bought into bringing this type of new case into the facility. You just want to assess your staff, get them involved from the beginning and provide any education they need to feel confident in doing these types of cases."
5. Will you be paid and paid appropriately for your spine cases? This is something people often think about more on the back end than on the front end, says Ms. Austin. "You see all the published numbers about what spine brings in but you need to find out if your carriers are willing to bring spine payment into your contracts," she says. "You need to talk to your managed care payors. Start those conversations very early on before you even determine you're going to bring in spine."
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