Issue link: https://beckershealthcare.uberflip.com/i/1468175
44 ASC Robots keeping the next generation of spine surgeons out of ASCs By Laura Dyrda R obotic technology is growing among spine surgeons, and fellows are learning to use the technology for more precise outcomes. But if they become too reliant on robotics for spine surgery, the transition to outpatient surgery centers could be problematic. Most spine ASCs don't have the budget for robotic technology since it increases the cost per procedure without commanding higher reimbursement from payers. Hospitals are willing to pay for the robotic systems to attract surgeons and patients to their spine centers, but that isn't an option for ASCs operating on thin margins, especially if the technology is proven to provide only mini- mal value for experienced surgeons. "Currently advanced enabling technology, including intraoperative 2D imaging, navi- gation, robotics and augmented reality, are cost-prohibitive in the ASCs," said Frank Phillips, MD, director of the division of spine surgery at Rush University Medical Center in Chicago. "Many younger spine surgeons are dependent on these tech- nologies to perform more complex spinal procedures. Evolution of these platforms with an eye on the ASC will undoubtedly allow for more migration of more complex cases to the ASC." Kern Singh, MD, co-director of the Mini- mally Invasive Spine Institute at Rush said he thinks it will be challenging for young surgeons to transition spine cases to the ASC unless they are confident performing the procedures without robotics, which could hinder spine's overall outpatient migration. "If you become too heavily reliant on expen- sive technology, then the transition to the outpatient arena will be very difficult," said Dr. Singh. "ASCs don't have the resources or capital to spend a million dollars on the ro- bot when the procedures can be performed without that system. Unless the price drops, which I doubt since hospitals are willing to pay it, the transition will be more painful." ere are seven spine robots on the market today competing for surgeons' attention. e technology aims to limit radiation exposure and improve precision for less invasive spine procedures, which means quick recovery for patients. Beyond the high costs, there is a steep learning curve for spine surgeons incorporating the technology into their practices. n ASCs must give cost estimates to patients: 7 details By Laura Dyrda A SCs and physician practices are required to provide cost estimates for expected charges to self-pay patients when scheduling procedures or services as part of the No Surprises Act, which went into effect Jan. 1. There are other aspects of the law that don't apply to ASCs and physician practices, but the good faith estimate regulations do, according to a report from JDSupra, a legal analysis company. Seven things to know: 1. Patients are considered "self-pay" if they are uninsured or decide not to submit the claim to their insurance provider. ASCs are required to ask all patients about their payment plans and then provide estimates to self-pay patients accordingly. 2. ASCs and physician practices must have a written notice of self-pay patients' right to a good faith estimate of antic- ipated charges. The facility is required to post the notice in the office, on its website and on-site where services are scheduled. 3. Any discussion or question about the cost of services the patient may undergo should be treated as a "good faith estimate" request. 4. The ASC must provide a written good faith estimate complying with federal regulations to self-pay patients upon request or when scheduling the primary service. The estimate must include the patient's name, primary service in clear language, an itemized list of services, diagnosis codes and anticipated additional services not reflected in the estimate. 5. The estimate must also provide a disclaimer that the actual charges may differ, and instructions on how the patient can dispute billed charges if they are at least $400 more than the initial estimate. 6. Good faith estimates must be provided within one day of scheduling a procedure if the procedure is scheduled at least three business days in advance. Facilities have three business days to provide good faith estimates if the procedure is scheduled at least 10 days in advance. 7. If ASCs or physician groups need to change the esti- mate, they must provide a change at least one day before services are rendered. n