Although procedures are increasingly performed in an ASC setting, many providers and patients have reservations about spine surgery in an ASC, as opposed to a hospital.
"There is a stigma to spine," says Richard Kube, MD. "When people think of spine, they think of long hours, complex cases, and sometimes, a lot of blood loss."
Dr. Kube is a spine surgeon who practices at Prairie Spine & Pain Institute in Peoria, Ill. His ASC is one of the select few in the area that routinely performs spine in an ASC setting, and his practice has been performing minimally invasive spine procedures for the last several years.
Although minimally invasive surgery is gaining traction in the spine field, a large majority of spine surgeons were not trained in the procedures as most spine surgeons are between the ages of 35 to 65. Widespread minimally invasive spine surgery is rather new, although the techniques have been developing over the past few decades. Nearly two-thirds of spine surgeons practicing today never encountered MIS in their training. Based on the lack of training, it is not surprising many surgeons opt to perform spine procedures in a hospital, even if ASCs pose a more convenient, cost-effective option.
Often, when patients think of spine surgery, they associate the procedure with pain. To perform surgeries in an ASC, pain management is key as a patient cannot walk out of a center the same day if he/she is experiencing a substantial amount of pain. Dwight Tyndall, MD, a spine surgeon at Orthopaedic Specialists of Northwest Indiana, advises ASCs to improve their pre- and postoperative protocol for pain management so they can readily perform various spinal procedures.
"Spine surgeons who are trying to perform surgery in ASCs have to adjust or find the right kind of cases," says Dr. Tyndall. Not every patient serves as an optimal candidate for an ASC, so surgeons must carefully assess patients prior to performing the procedure. When considering candidates for outpatient procedures, ASCs must look at a patient's coexisting medical conditions, the invasiveness of the procedure, anesthetic technique and post discharge factors such as a patient's ability to manage pain, according to the American Society of Anesthesiologists.
Surgeons are constantly fine-tuning their skills and advancing their techniques to enhance patient outcomes. The advancements minimize the amount of pain a patient encounters postoperatively, therefore ASCs are a not only a viable option, but often a better option, than a hospital.
Although many professionals understand the benefits of ASCs, payers need more convincing, and reimbursement for spine varies between markets. The stigma associated with spine surgery often deters payers from covering various spine procedures. In the past, the Centers for Medicare and Medicaid Services have claimed there is not sufficient data supporting spine in an ASC is safe, leading more payers to be hesitant about covering those procedures.
However, CMS has developed codes for spine in ASCs in the past year and surgeons in some markets are seeing private payers more willing to negotiate coverage.
Going forward, ASCs will continue to provide data supporting their claims about the safety of spine in an ASC setting. As more data pours in, the stigma concerning spine will eventually dissipate. "Over time, payers will recognize there is a cost savings in performing procedures in an ASC setting," says Dr. Tyndall.
Until payers get onboard, ASCs may consider directly recruiting cash pay patients or patients with health savings accounts. Dr. Kube explains viable markets for ASCs include patients with high deductibles and the self-insured population. Small ASCs who have good control of their pricing and have the ability to coordinate pricing can seek these types of patients.
As data continues to confirm surgeons can spine can safely and effectively perform spine in ASCs, more payers, providers and patients will become onboard. ASCs are a cost effective option, and hospitals will struggle to compete with ASCs' prices. However, the healthcare industry needs to get over the initial fear to fully understand the benefits ASCs pose for patients, providers and payers.
"People are scared to jump in. Nobody wants to go first," says Dr. Kube. "ASCs' outcomes prove that we have the ability to give more value. It is all about getting over the initial fear. Everybody wants to be the first second."
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