Becker's ASC Review

18 ASC MANAGEMENT Spinal fusions and ASCs: 8 notes for 2021 By Laura Dyrda T he number of spinal fusions per- formed in ASCs is growing as more surgeons, patients and payers become comfortable with the procedure in the outpa- tient setting. Eight points on spinal fusions and ASCs: 1. ere are about 180 ASCs in the U.S. that offer minimally invasive spine surgery. 2. Medicare pays less for spine procedures in ASCs than hospital outpatient departments, but patient copay is oen higher in the ASC. e total cost of posterior or posterolateral spinal fusion of lower spine bones in the ASC is $10,267, with Medicare paying $8,214 and patients paying $2,053 out of pocket. In the hospital outpatient department, the total cost of the procedure is $13,560 with Medicare paying $11,820 and patients paying $1,740. 3. Sg2, a healthcare intelligence and analyt- ics company, predicts 88 percent of spinal decompressions and laminectomies and 67 percent of cervical spinal fusions will be performed in an outpatient setting by 2028. Overall, cervical fusions are projected to grow 20 percent from 2018 to 2028, while motion preservation is expected to jump 133 percent. 4. Beginning Jan. 1, CMS made changes for payment of multiple orthopedic and spine procedures, including Vertos Medical's minimally invasive lumbar spinal stenosis procedure. ASC reimbursement for Vertos' minimally invasive lumbar decompression procedure jumped 41 percent. 5. CMS began requiring preauthorization for cervical fusion with disc removal and implanted spinal neurostimulators in the ASC on Jan. 1. 6. Adding spine procedures to ASCs can have a positive financial impact on the cen- ter. National Medical Billing Services CEO Nader Samii outlined the advantages in a 2020 article. A multispecialty surgery center performing 300 cases per month with the average cash per case totaling $2,000 would generate $600,000 in revenue monthly and $7.2 million annually, he said. Using a 20 percent EBITDA profit margin, the center would have $120,000 per month of EBITDA, or $1,440,000 annually. If that ASC added 15 lumbar fusions per month, a 5 percent increase in overall case volume, at an average cash per case of $20,000 and a 50 percent EBITDA margin, the ASC would have increased its overall revenue by 50 percent while more than doubling its profitability. "Simply put, in this example, the ASC more than doubled its value by adding a small number of spinal fusions per month," Mr. Samii wrote. 7. e following spine procedures are among the 20 most common for Medicare-certified ASCs, accordingto a March 2020 MedPac report: • Inject foramen epidural: lumbar, sacral: 4.6 percent of all procedures • Inject paravertebral: lumbar, sacral: 3.4 per- cent of all procedures • Injection spine; lumbar, sacral: 2.7 percent of all procedures • Destroy lumbar/sacral facet joint: 1.7 per- cent of all procedures • Injection procedure for sacroiliac joint, anesthetic: 1.4 percent of all procedures • Inject paravertebral: cervical or thoracic: 1.1 percent of all procedures • Inject spine, cervical or thoracic: 1 percent of all procedures 8. Some spine surgeons and centers are mov- ing toward bundled payments. "We started with Blue Shield and United and are rapidly adding more to our global billing strategy," Robert Bray Jr., MD, founder of DISC Sports & Spine Center in Newport Beach, Calif., recently told Becker's. "While this does entail some risk-sharing, it struc- tures a known price without the hassles to us or the insurer of multiple codes. We have in- cluded the complete care, surgeon, assistant, the ASC and all aspects of the bill." n Biden administration cancels Trump administration plan for opioid treatment drug By Eric Oliver P resident Joe Biden's administration rolled back a plan by former President Donald Trump's administration to allow physicians to prescribe buprenorphine to treat opioid-use disorder, the Washington Post reported Jan. 27. What you should know: 1. Health and Human Services announced a guideline focused around buprenorphine Jan. 14, the White House said in a message obtained by the Post. "Unfortunately, the announcement was made prematurely. Therefore, the guidelines previously announced cannot be issued at this time," the message read. 2. The Trump administration's plan was heavily supported by lawmakers and physician groups. However, the plan had legal and operational issues and was not cleared by the White House budget office. "The Biden-Harris administration absolutely supports broader access to medication-based treatment for opioid- use disorder and is working to find ways to lift burden- some restrictions on medications for opioid-use disorder treatment," a spokesperson for the White House's drug policy office said to the Post. 3. The plan would have made some physicians exempt from a waiver that required physicians to undergo a daylong train- ing before they could prescribe buprenorphine by exempt- ing those physicians with a Drug Enforcement Administra- tion narcotics-prescribing license, according to the Post. 4. Legislators are introducing policies in the House and Senate to eliminate the waiver. n

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