December 26, 2024
Time flies. In 2015, Medicare began to reimburse ambulatory surgery centers for a small list of spine surgery procedures. Just ten years later, spine is one of the fastest growing ASC service lines, with more than 200 ASCs performing spine surgeries. In a recent VMG survey, 53% of ASC leaders said they were considering spine service line expansions for 2025.
Is your health system on the leading edge of this spine surgery shift?
Or are you behind the curve?
Read on to gain insights on the clinical advancements driving spine surgery case migration, as well as payer, patient, and provider preferences that are accelerating outpatient spine surgery demand. And don’t miss our tried-and-true tips for launching and operating high-performing spine surgery ASCs.
Advancements in minimally invasive spine surgery (MISS) are the prime movers for spine surgery case migration from inpatient to outpatient settings. Because MISS involves smaller incisions and less tissue disruption than traditional open surgery, there is less postoperative pain and faster recovery times, which eliminates the need for overnight hospital stays for procedures like discectomy, laminectomy, and spinal fusion.
ERAS protocols before, during, and after procedures facilitate high-quality same-day surgeries in multiple facility settings and specialties, including spinal surgeries performed in ASCs.
Preoperatively, ERAS recommends optimizing nutrition and managing pre-surgery jitters by providing clear instructions for spine surgery patients. Interoperative ERAS management focuses on MISS, minimizing blood loss, and maintaining normal body temperature.
Postoperatively, ERAS for spine surgery patients emphasizes early mobilization, pain management with multimodal analgesia, and eating and drinking as soon as possible. For example, spine surgeons have embraced alternatives to opioids to control post-operative pain, which reduces nausea, vomiting and other opioid-related side-effects that used to keep patients in the hospital longer.
ERAS improves outcomes for spine surgery patients and enhances their experiences overall. “ERAS in spine surgery may provide reductions in complications, readmissions, length of stay, and opioid use, in combination with improvements in patient-reported outcomes and functional recovery,” concludes a recent World Neurosurgery literature review. Combined, these ERAS benefits help to make ASC spine surgeries more feasible for more patients.
ERAS-recommended prehabilitation and rehabilitation physical therapy and exercise programs are also a factor in the inpatient-to-outpatient spine surgery shift. Spine ASCs have specialized staff who work with patients prior to surgery, and many have invested in software programs to supplement prehab care and personalize patient journeys.
Compass’ orthopedic and spine ASCs deploy STREAMD to supplement and enhance the personalized coaching that surgeons and ASC staff provide for patients before and after their procedures. Patients receive text messages containing content that is informative, customized for their procedure and patient journey stage, and empathetic. STREAMD supports 20 languages, which means that patients receive guidance and can query chatbots in the language they are most comfortable with.
MISS, ERAS and other clinical advancements will continue to make more and more ASC spine surgeries possible. Spine surgeries currently performed in ASCs include:
Many spine surgeons prefer to work in ASCs when they can. Because ASCs specialize in lower risk procedures, surgery schedules are more predictable. If surgeons are working in a well-managed ASC, they can perform more procedures during the day than they can in an HOPD, which means more revenue for their practice. The opportunity to work with specialized equipment and surgical teams is also appealing.
ASCs also offer physicians the opportunity to be financial stakeholders, an income opportunity many doctors crave as physician fee schedules flatten. The chance to work in a physician-led facility or take a facility leadership role is also attractive.
Patient choice is also a factor driving more cases to ASCs. In 2023, patient experience scores for ASCs hit a five-year high, according to a June 2024 Press Ganey report. Around 85% of patients who received surgical care at an ASC were likely to recommend the facility to others.
Patients pay less out-of-pocket for some spine procedures when they are performed in ASCs, but affordability isn’t the only factor encouraging patients to explore their ASC options. Many patients want to avoid the hassle of navigating a large hospital campus, overnight stays, and the risk of hospital-acquired infections. The specialized, personalized care that spine ASCs are equipped to provide drives patient demand — and satisfaction.
Payers welcome spine surgery case migration. Moving spine procedures from an HOPD to an ASC can result in up to a 60% reduction in facility fees. That is quite a value proposition!
As you plan your health system’s spine ASC strategy, don’t assume you will need to “trade away” current HOPD revenue to negotiate favorable ASC contracts with payers. If you successfully demonstrate a case migration value proposition to payers, you can secure sound ASC reimbursement and preserve favorable terms for spine procedures best suited for your HOPD.
Facility planning is important, but you should also look ahead to making sure that the work happening inside the facility is as efficient as it can be. At Compass, this means providing focused, spine surgery-specific guidance our center administrators, physician partners, anesthesia team and staff.
A day in the ASC is like an orchestrated dance. If one or two team members don’t know the proper steps, it can bog down operations and cost the team an additional case or two per day. As with other ambulatory surgery service lines, you can track spine surgery operating room performance metrics against external benchmarks to discern areas for improvement such as:
A spine service line expert can recommend other metrics that help physicians, staff, and anesthesia incrementally improve broader metrics, such as ‘in room to incision time.’ A metric like this can help the team discern whether prepping and draping are optimally efficient and find ways to work more efficiently.
Comparing each physician’s supply costs per case can illuminate opportunities to run leaner without compromising quality of care. For example, one physician’s supplies preference card might cost $750 per case and another physician’s request might cost $1,500 for the same case. Curating preference card data, sharing it with physicians, and guiding a peer-to-peer discussion can work wonders for lowering supplies costs.
There’s never been a better time for health systems to develop spine ASCs and surgery networks. This move expands what you offer patients in your service areas and frees up your outpatient and inpatient settings to focus on complex spine cases.
As Vice President of Orthopedic and Spine Growth and Strategy, Stacy Danahy, RN is the backbone of spine surgery facility excellence at Compass Surgical Partners. Don’t miss the opportunity to tap into her intel as you plan your health system’s spine surgery ASC strategy? Contact us to schedule a time to talk.
