More physician groups and ambulatory surgery centers across the country are adding outpatient spine surgery to increase patient volume and drive profits. However, there are several aspects of adding spine the group or ASC should consider before recruiting a new spine surgeon. Dan Beuerlein, regional vice president of operations at Symbion Healthcare, discusses five considerations for adding outpatient spine surgery.
1. Focus on the physician group dynamic. Physician groups often decide to incorporate spine surgery to expand the number of services and increase patient volume, says Mr. Beuerlein. Most groups recruit spine surgeons from residencies, through merging with other groups or recruiting an independent spine surgeon. However, the chief physician or surgery center CEO must pay close attention to potential territory issues between the existing physicians and a new spine surgeon. "An orthopedic surgeon in the practice might feel comfortable doing some things, but based on their intense focus on spine or pain management, the spine surgeon may take the strong position of feeling they are the most qualified surgeon to do the treatment," says Mr. Beuerlein.
2. Weigh the increased upfront costs. Bringing on a spine surgeon to perform outpatient spine procedures may bring in a higher case volume, but there are also increased costs associated with those procedures. Even if the surgery center already has the equipment for orthopedic surgery, additional technology and devices are necessary for spine. "The imaging equipment, microscopes and instrument trays for spine surgery are unique and expensive," says Mr. Beuerlein. The surgery center should weigh the costs of purchasing spine-specific imaging equipment and surgical devices with the potential market for that service in the community before bringing on a new surgeon.
3. Invest in ample sterilization equipment. Due to the size and quantity of instruments needed for spine surgery, the average instrument tray can be anywhere from 50-100 percent larger than the standard orthopedic tray. If the surgery center's washer isn't large enough to handle the increased volume of instruments, you may need to disinfect those instruments in multiple cycles. "You can run into inefficiencies in your system or delays in the event that you might be waiting for instruments to be cleaned," says Mr. Beuerlein.
4. Evaluate your payor contracts. Spine is a device and implant-intensive specialty and the contracts you have with private payors for general surgery or orthopedics may not be adequate for spine. "Many times, if you are looking to add spine to your center, the representative from the payor might be resistant to allowing changes in the contract to ensure you are fully reimbursed for your expenses," says Mr. Beuerlein. "Many payors will have a maximum amount of what they will pay for a procedure. If your implants and hardware aren't covered as a separate line in the contract, you could find that you're doing those cases at a loss." Surgery centers can spend months negotiating carve-outs for spine surgery or renegotiating existing contracts to get spine cases into the center.
5. Evaluate the capabilities of the entire surgical team. In many surgery centers, the surgical technicians, nurses, anesthesiologists and other team members are familiar with the existing procedures and work efficiently with those cases. However, even the most experienced staff members may have difficulty adding spine into the mix. "You have to be cautious not to outstrip your staff's capabilities," says Mr. Beuerlein. "You might not have the right talent at the center to accommodate a far more aggressive and complicated specialty like spine." If the staff members aren't experienced with spine surgery, consider investing in nurses, physicians' assistants, anesthesiologists and radiologists with training in spine surgery to assist the surgeon.
Learn more about Symbion Healthcare.
Read other coverage on outpatient spine surgery:
- Outpatient Spine: 6 Big Questions
- 7 Strategies to Negotiate In-Network Carve-Outs for Outpatient Spine
- 10 Steps to Take to Add Spine to an Existing Orthopedic Surgery Center
1. Focus on the physician group dynamic. Physician groups often decide to incorporate spine surgery to expand the number of services and increase patient volume, says Mr. Beuerlein. Most groups recruit spine surgeons from residencies, through merging with other groups or recruiting an independent spine surgeon. However, the chief physician or surgery center CEO must pay close attention to potential territory issues between the existing physicians and a new spine surgeon. "An orthopedic surgeon in the practice might feel comfortable doing some things, but based on their intense focus on spine or pain management, the spine surgeon may take the strong position of feeling they are the most qualified surgeon to do the treatment," says Mr. Beuerlein.
2. Weigh the increased upfront costs. Bringing on a spine surgeon to perform outpatient spine procedures may bring in a higher case volume, but there are also increased costs associated with those procedures. Even if the surgery center already has the equipment for orthopedic surgery, additional technology and devices are necessary for spine. "The imaging equipment, microscopes and instrument trays for spine surgery are unique and expensive," says Mr. Beuerlein. The surgery center should weigh the costs of purchasing spine-specific imaging equipment and surgical devices with the potential market for that service in the community before bringing on a new surgeon.
3. Invest in ample sterilization equipment. Due to the size and quantity of instruments needed for spine surgery, the average instrument tray can be anywhere from 50-100 percent larger than the standard orthopedic tray. If the surgery center's washer isn't large enough to handle the increased volume of instruments, you may need to disinfect those instruments in multiple cycles. "You can run into inefficiencies in your system or delays in the event that you might be waiting for instruments to be cleaned," says Mr. Beuerlein.
4. Evaluate your payor contracts. Spine is a device and implant-intensive specialty and the contracts you have with private payors for general surgery or orthopedics may not be adequate for spine. "Many times, if you are looking to add spine to your center, the representative from the payor might be resistant to allowing changes in the contract to ensure you are fully reimbursed for your expenses," says Mr. Beuerlein. "Many payors will have a maximum amount of what they will pay for a procedure. If your implants and hardware aren't covered as a separate line in the contract, you could find that you're doing those cases at a loss." Surgery centers can spend months negotiating carve-outs for spine surgery or renegotiating existing contracts to get spine cases into the center.
5. Evaluate the capabilities of the entire surgical team. In many surgery centers, the surgical technicians, nurses, anesthesiologists and other team members are familiar with the existing procedures and work efficiently with those cases. However, even the most experienced staff members may have difficulty adding spine into the mix. "You have to be cautious not to outstrip your staff's capabilities," says Mr. Beuerlein. "You might not have the right talent at the center to accommodate a far more aggressive and complicated specialty like spine." If the staff members aren't experienced with spine surgery, consider investing in nurses, physicians' assistants, anesthesiologists and radiologists with training in spine surgery to assist the surgeon.
Learn more about Symbion Healthcare.
Read other coverage on outpatient spine surgery:
- Outpatient Spine: 6 Big Questions
- 7 Strategies to Negotiate In-Network Carve-Outs for Outpatient Spine
- 10 Steps to Take to Add Spine to an Existing Orthopedic Surgery Center