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ORTHOPEDICS
10 things to know about spine surgery in ASCs for 2019
By Rachel Popa
H
ere are 10 key facts on spine in ASCs:
1. Over 145 ASCs in the U.S. offer
minimally invasive spine surgery.
2. Around 90 percent of patients who under-
went anterior cervical discectomy and fusion
at an ASC consumed less than or equal to the
30th percentile of oral morphine equivalents,
compared to 57 percent of hospital patients.
Additionally, hospital patients consumed
greater average doses of fentanyl and oxyco-
done, according to a study published in the
International Journal of Spine Surgery.
3. A study published in Military Medicine
examined the return-to-duty rates for military
patients who underwent minimally invasive
spine surgery in an ASC. All of the partici-
pants returned to duty three months postop-
eratively. Patients experienced a significant
reduction in self-reported pain and disability
12 months postoperatively.
4. As more spine surgeries transition to the
outpatient setting, surgeons and researchers
continue to study the cost differences be-
tween inpatient and outpatient procedures.
Aer examining the national administrative
data, researchers found more modest cost
savings for outpatient spine surgery over
inpatient spine surgery.
5. A study published in Spine investigated
the adverse event profile of cervical total disc
replacements performed in the outpatient
versus inpatient setting. Study authors found
no difference in perioperative complications
between the inpatient and outpatient CTDRs.
6. Research published in Neurosurgery found
outpatient spine procedures are just as safe
as — or safer than — procedures performed
in an inpatient setting.
7. CMS released a new tool allowing patients
to compare the average payment of select
orthopedic and spine procedures in hospital
outpatient departments and ASCs.
A few examples on reimbursement for spine
procedures:
Total disc arthroplasty with
discectomy (22856)
ASC:
• Average Medicare payment: $8,970
• Average total cost: $11,213
• Amount patient pays on average: $2,243
HOPD:
• Average Medicare payment: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340
Sacroiliac joint fusion (27279)
ASC:
• Average Medicare payment: $9,965
• Average total cost: $12,456
• Amount patient pays on average: $2,491
HOPD:
• Average Medicare payment: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340
Anterior cervical discectomy
(22551)
ASC:
• Average Medicare payment: $5,870
• Average total cost: $7,337
• Amount patient pays on average: $1,467
HOPD:
• Average Medicare payment: $8,783
• Average total cost: $10,123
• Amount patient pays on average: $1,340
8. Baptist Medical Park Surgery Center, an ASC
located in Pensacola, Fla., is the first surgery
center in the Southeast to purchase Mazor
Robotics' Renaissance System. Mark Giovanini,
MD, a surgeon who is using the Mazor Robot-
ics' Renaissance System for all SI fusions pro-
cedures, said the technology provides patients
with the full advantages of spinal surgery with
the convenience of an outpatient facility.
9. Bill Stewart, area vice president of value-
based purchasing of DePuy Synthes, a
Johnson & Johnson company, said spine is a
specialty to watch in ASCs.
"What we've seen with spine is that surgical
procedures that are migrating outpatient,
typically one- to three-level ACDF and dis-
cectomy, are moving outpatient. But lumbar
spine is much slower to move outpatient.
What we've seen with lumbar spine is a small
number of sites are doing it. A lot of that is
because it's capital intensive to do lumbar
spine," he said at Becker's ASC 25th Annual
Meeting: e Business and Operations of
ASCs in Chicago Oct. 18, 2018.
10. Anterior cervical discectomy and fusions
are safe in the outpatient setting for properly
selected patients, according to new research
from the New York City-based Hospital for
Special Surgery presented at the American
Academy of Orthopaedic Surgeons Annual
Meeting in Las Vegas.
"e results suggest that multi-level ACDF
can be performed safely in the outpatient
setting without an increased risk of complica-
tions in appropriately selected patients," said
Hospital for Special Surgery surgeon Sheeraz
Qureshi, MD. "Specifically, the patient's age,
additional health conditions and number of
levels being fused should be taken into con-
sideration when deciding whether to perform
multi-level ACDF in an outpatient setting." n
California neurosurgeon charged with
billing fraud: 4 points
By Laura Dyrda
A neurosurgeon in Carmichael, Calif., has been charged in billing fraud, ac-
cording to a report from KCRA 3, a local NBC affiliate.
Four quick notes:
1. Laura Anderson, MD, was charged with submitting more than $500,000 in
fraudulent insurance claims to the state Compensation Insurance Fund over a
five-year period.
2. Between 2013 and 2018, Dr. Anderson allegedly billed for procedures she
didn't perform.
3. Dr. Anderson is also accused of changing the billing codes for X-ray and
telephone consultations to codes for other procedures with higher reim-
bursement, according to a Fox report.
4. Dr. Anderson was arrested in April and released on bail. n