Gary P. Cram Jr., MD, of Carolina Neurosurgery & Spine Associates in Charlotte, N.C., and medical director of Greensboro (N.C.) Specialty Surgery Center, an affiliate of Surgical Care Affiliates, discusses outpatient spine protocols and procedures, and what to expect in the future.
Question: From the surgeon's perspective, what is different about performing spine cases in the ASC versus the hospital? How did you prepare to first bring spine cases into the ASC?
Dr. Gary Cram Jr.: Performing spinal surgery in an ASC is a much more pleasant experience. The surgery itself is performed exactly the same. Where the real benefit is realized is in perioperative efficiencies and patient satisfaction. We have turnover times that are 2/3 less than we experience in the inpatient hospital. Lower infection rates, quicker mobilization postoperatively, and more expedient transition to oral pain medication have lead to improved outcomes and higher patient satisfaction.
Q: What are the key elements to your center's success with spine patients?
GC: The key elements in the success of our center have been the dedication and commitment of the surgeons, anesthesiologists and ASC staff. We had a hospital partner that helped with our staff training and in equipment management. As a corporate partner, SCA has a culture of physician-centric management that has facilitated and enabled this growth as well.
Q: How do you approach patient selection and education for spine in the ASC?
GC: Patient selection is critical in deciding which patients are appropriate for an ASC. It should go without saying that patients with multiple or significant medical comorbidities will often not be appropriate. Any patient that we feel we would not be able to send home same day or early the next morning, or that may require ancillary services or consultants postoperatively, we still manage them in the inpatient setting. Educating the patients to the benefits of having their surgery performed at the ASC is also critical. One of the most important roles as physicians in counseling both medical and surgical patients is to manage their expectations. Promoting the ASC is easy, the lower infection rates, improved outcomes, higher patient satisfaction scores all resonate very well with our patients.
Q: Do you think more spine procedures will go outpatient in the future? What are the biggest challenges and opportunities for spine in ASCs?
GC: I strongly believe that ASCs are going to play an increasingly more important role in the future for all procedural based medicine, especially spinal surgery. We are practicing in a time where evidence based medicine and outcome-driven practice and reimbursement are going to drive more and more procedures to centers focused on delivering high quality care in the most cost efficient manner. If we can perform surgery on patients at a place focused on providing the same or higher quality of care at a reduced cost to patients and insurers, then we have a responsibility to explore and develop those practices.
CMS is staring to recognize this and re-classifying many of their spinal procedures to make them allowable at an ASC. Private insurers will follow suit with allowing a greater number of appropriate procedures to be moved over to the ASC as well. We, as physicians and surgeons, bear the responsibility of appropriate patient selection and maintaining high quality and efficient care in these centers as they grow.