For several specialists, spine procedures appear to be the next frontier for ASCs. From new technologies to additional minimally invasive procedure options, it is becoming increasingly possible for patients to undergo same-day spinal procedures.
Here are eight notes for ASC leaders to know about spine's outpatient migration:
1. Outpatient spine procedures grew among Medicare patients between 2010 and 2021, with significant yearly growth at ASCs. The findings, published in the March 2024 issue of the North American Spine Society Journal, found the total number of outpatient spine procedures rose about 193% over 2010 to 2021. The compound annual growth rate for outpatient cases per year was 9.9% for hospital outpatient departments and 15.7% for ASCs.
2. The most common spine procedures done at ASCs included back injections and spinal fusions, according to U.S. News & World Report.
3. More than 200 ASCs offer spine surgery in the U.S.
4. On average, CMS covers more for the costs for fusion of lower spine bones, posterior or posterolateral approach (Code 22612), at a hospital outpatient department compared to an ASC.
ASC
Total cost: $10,267
Medicare pays: $8,214
Patient pays: $2,053
HOPD
Total cost: $13,560
Medicare pays: $11,820
Patient pays: $1,740
5. On average, CMS covers more for the costs of a cervical disc replacement through the anterior approach (Code 22856) at a hospital outpatient department compared to an ASC.
ASC
Total cost: $13,515
Medicare pays: $10,812
Patient pays: $2,702
HOPD
Total cost: $17,655
Medicare pays: $15,905
Patient pays: $1,749
6. Spine surgeons are eyeing complex cases for the outpatient setting, but it will likely be a gradual process, Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, said.
"More ASCs will need to get special exemptions to hold patients greater than 23 hours," Dr. Gantwerker told Becker's. "Some ASCs should stick to the simple, safer, and better margin surgeries. For those wanting to push the envelope, I recommend doing a careful safety analysis with a multidisciplinary team of anesthesiologists, pain physicians, internal medicine, nursing, and surgery staff to decide what is safe and feasible. Just because you can do a surgery in an ASC setting does not mean you should. Any transformation into a higher acuity center should take place gradually, with very careful consideration of each patient case and its appropriateness for the ASC setting," he added.
7. The increasing difficulty of independent physicians operating in hospitals will drive spine procedures to the ASC, Brandon Hirsch, MD, a surgeon at DISC Sports & Spine Center in Newport Beach, Calif., said.
"Over the past two decades, it has also become more and more challenging for spine surgeons to work in the hospital setting, particularly if they're not an employee of the hospital" Dr. Hirsch told Becker's. "It is also difficult for a traditional hospital to give a high-quality patient experience around spine surgery because the facility has to be able to provide care for many different health conditions at varying levels of acuity. Some inpatient facilities do this well because spine surgery is the main focus of the hospital. Unfortunately, nationwide this is more the exception than the rule. A highly specialized center that routinely does outpatient spine surgery every day is going to provide a better experience for both patients and their surgeons," he said.
8. A small study from Newport Beach, Calif.-based Hoag Orthopedics found more patients preferred to have spine surgery at an ASC than a hospital. Of the 58 people surveyed, 30 said they would prefer to undergo a spine operation in an ASC, while 28 said they would prefer a hospital.