7 Ways to Achieve Great Results for Spine Surgery in an ASC

"Spine surgery is very doable in a surgery center with the right kind of surgery and the right kind of patient," says Joan F. O'Shea, MD, neurosurgeon and orthopedic spine surgeon at the Spine Institute of Southern New Jersey in Marlton, N.J. Here she lists seven ways to achieve great results for spine surgery in an ambulatory surgery center.

1. Pick cutting-edge surgeons. Surgeons who feel comfortable with cutting-edge techniques would fit well into an ASC. "Not everyone wants to learn the newest techniques," Dr. O'Shea says. Furthermore, surgeons accustomed to the slower pace of a hospital will need to be more efficient in an ASC. Dr. O'Shea, who has taught spine surgeons on how to be more efficient, estimates that 70-80 percent can be taught to improve their times in the OR.

2. Provide for extended stays. Some spine patients will need to remain in the facility for longer times than other ASC patients. Having the capacity for a 23-hour extended stay will help boost the types of spine cases the facility can handle and therefore boost volume.

3. Develop the right case mix. Focus on neck operations and lower back. In an ASC, spine surgeons should be able to handle up to three levels for anterior cervical discs, lumbar discectomy, spinal cord and lumbar fusions. Cases that are generally not good for ASCs involve comoribidities, redo operations and complex scoliosis surgeries, such as Kyphoplasty, which are usually performed on the elderly. "We don't want high-risk patients in the ASC," Dr. O'Shea says. Another example would be overweight patients over ASA grade 2.

4. Build on orthopedics staff. "It is easier to teach spine to clinical staff who are already doing orthopedics," Dr. O'Shea says. Clinical staff in an ASC who are geared toward orthopedics will recognize similar challenges and learn the new specialty relatively fast.

5. Demonstrate advantages of ASCs. Let spine surgeons know how much easier it will be for them to work in an ASC than in a hospital. "In a hospital, the neurosurgeon is frustrated with getting equipment and instrumentation," Dr. O'Shea says. "The hospital might say you can only use one company, even if it costs just a couple hundred dollars to buy it."

6. Push for insurance coverage. So far, Dr. O'Shea has been unable to get insurance coverage for spine in her ASC. She has not even been able to get an appointment to meet with insurers to make her case, even with the help of ASC management companies. "Insurance companies won't even have a discussion with you," she said. "It's unfortunate for them because of the total cost savings they could realize." But she will keep on trying.

7. Get in before the crowd. Surgery centers' interest in adding spine surgery is getting more intense. Spine surgery centers are proliferating. Dr. O'Shea says there are already other centers hosting spine near her center outside of Cherry Hill, N.J.

Learn more about Spine Institute of Southern New Jersey.

Related articles on moving spine surgery into ASCs:

Spine Surgeon Robert Bray Predicts a Major Shift of Volume into ASCs

Secret to Spine Surgery Center Success: The "5 + 3 C's"