Becker's ASC Review

5 THOUGHT LEADERSHIP 'No such thing as a free lunch': Spine surgeons on the promise, pitfalls of AI By Carly Behm Artificial intelligence in spine surgery is in its infancy, and physicians are discussing the exciting and nerve-wracking aspects of it. Editor's note: Responses were lightly edited for clarity and length. Question: When it comes to AI in spine surgery, what's one thing you're excited about and one thing you're nervous about? Neel Anand, MD. Cedars-Sinai Spine Center (Los Angeles): AI is paving the way for the type of innovation in spine surgery that will help our patients get the exact care they need, delivered with incredible precision, to the specific area of the spine where they need it, all while allowing for minimal invasion and faster recovery. It remains in the infancy stage, but the power and promise of AI in spine surgery are right here in front of us. In the diagnosis of spinal conditions – AI shows great promise in helping healthcare providers achieve more accurate and timely diagnoses of spinal conditions. Using predictive-modeling type AI applications, the ability to amass loads of clinical data and predict which patients may end up developing spine conditions is advantageous. As with most medical issues, the earlier the diagnosis, the earlier the intervention – before problems become catastrophic. In the surgical treatment of spinal conditions – When coupled with robot-assisted spine surgery, which is already in use, AI has the potential to predict which patients might benefit most from surgical intervention and can also help the precision and skill of surgeons when performing spine procedures. e predictive accuracy of AI in the operating room also offers the potential to help reduce surgeon fatigue. In many cases, most spine surgeries are relatively long – four hours or more. In the prediction of spine surgery outcomes – AI offers the potential for scientists and statisticians to predict spine surgery outcomes based on a patient's unique health metrics and circumstances. For example, the result of the same spine procedure on a 46-year-old sedentary female may not be the same or may be accompanied by additional considerations as the one performed on a 75-year-old active male. AI can help spine surgeons analyze the data available on both populations. In turn, spine surgeons can have honest conversations with their patients, and patients can make well-informed decisions about their spine surgery and health care decisions. In the recovery and return to daily living for spine surgery patients – With addiction to opioid pain relief medication at an all-time high, one of the timeliest promises of AI is in the prediction of which patients will need post-operative pain management, how much they will need, and which medications are best. As a spine surgeon, I must ensure my patients can manage their pain well aer surgery. Yet I don't want them to become addicted to the medication tools I prescribe during their healing. ere is a delicate balance between just What this CEO did to save an ASC slated for closure By Paige Haeffele Hilo Community Surgery Center in Hawaii was slated for closure — until Frederick Nitta, MD, took over as CEO. Dr. Nitta, an obstetrician-gynecologist, joined Becker's to share the most effective changes he made to financially revitalize his ASC. Note: Response has been lightly edited for length and clarity. Question: What are some investment opportunities in the ASC industry? Dr. Frederick Nitta: There are many opportunities, but backing up from this, the ASC needs to be run efficiently. Costs must be held down, supplies need to be researched and coders need to be able to get involved to ensure maximum reimbursement. Let me explain what I mean by the above. I was picked to become the CEO of Hilo Community Surgery Center in October 2023. The board had already voted to close it down. Once I took over the management of the surgery center, dozens of problems were identified. As far as the overhead side, employees were overpaying themselves every month, not negotiating contracts, charging for overtime when they did not even work 40 hours in that week, and hiring friends and family members to do repairs at hugely inflated prices. There also was no receipt book kept for cash. An example is a $2,000 charge to unclog a toilet. Another is that packs to do cataracts were $200 to $300 a case. We now pay less than $20 for similar packs. Maximum reimbursement was not pursued, as the coder was untrained. Multiple procedures were not paid, secondary insurance claims did not go out, and even patients' copays were never billed. Now, we have certified coding specialists who are accredited by the American Health Information Management Association on staff who are bringing in more than double what we received in the past. Now that the surgery center is doing better, we are adding plastic surgery, expanding orthopedics, and doing major gynecological procedures on an outpatient basis. There are opportunities, but ASCs need to be properly managed, run efficiently, and not used as a piggy bank for employees or its owners. n

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