Issue link: https://beckershealthcare.uberflip.com/i/172341
Executive Brief: Paradigm Spine, Minimally Invasive Spine Surgery mean a large start-up cost of equipment with lingering costs of implants, so to succeed I suggest building off of what you have." 3. What will be the reimbursement and insurance challenges? The biggest and most challenging obstacle has been securing in-network contracts with commercial payers, Ms. Sanchez says. Ms. Sanchez encourages other ASCs to be data-driven when presenting the benefits of performing spine procedures in a surgery center to insurance negotiators. The practice obtained hospital-based explanation of benefits for specific outpatient procedures that were then analyzed and presented to the commercial payers to show the drastic cost savings ASCs bring all parties. Surgery center administrators should also work with payers and surgeons to make implant costs as affordable as possible. Many payers do not cover implants, which are a huge expense for spine. "Being able to negotiate good pricing on implants and supplies and having a surgeon who is cost conscious are the two key components in generating revenue with spine procedures," Ms. Doverspike says. Ms. Doverspike says a spreadsheet helps her track expected revenue and against cases expenses. She will watch a new procedure intently for three months to make sure the center is profiting from the surgery or if adjustments need to be made. It is never too late to renegotiate supply costs and implant costs, she says. Often, payers will negotiate carve-outs for high-cost implants. Other challenges to keep in mind include whether the patient population's insurance includes out-of-network benefits. If patients cannot go to an out-of-network provider, then the ASC is not a viable option. Additionally, the beginning of the year is always a challenging time because most health plans renew and patients have not yet met their deductible. Keep this in mind for planning and cash flow purposes. 4. Which cases work best in an ASC? Different spine procedures and patients can work well in an outpatient setting; it's largely dependent on the comfort level of the surgeon, Ms. Sanchez says. The office staff members at the Center for Spine Care will often analyze specific procedure to identify trends. For instance, maybe the majority of one-level TLIF patients within a specific age range were all discharged from the hospital within 23 hours. Surgeons' staffers can research these trends to help them decide which cases to consider moving from inpatient to outpatient. "It's the office paying close attention to what the physician does," she says. It's also crucial to hire operating room staff members who have spine experience or has worked with your surgeons previously. Having adequate resources who understand the needs of these patients preoperatively and postoperatively will make a significant difference in your ability to have a successful program out of the gate. 17 Patient education and physician mindset are also big factors in which cases ultimately are performed at the ASC. Patient preparation is key to your success, so it's important to inform patients and manage expectations. Physicians should be comfortable with the outpatient arena, motivated and understand the enhanced patient outcomes and satisfaction rates represented by an ASC-based program. Surgeons should be experienced with MIS techniques, a shorter period of post-op care and modified discharge criteria. Ms. Doverspike keeps ASC-appropriate cases in mind when marketing the surgery center and looking for potential physicians to recruit. When she gets the name of a physician who might be interested in joining her center, she will inquire as to the procedures the physician performs and how that fits with the codes and reimbursements currently operating in the ASC. This information tells her from the start if the physician will be a good fit clinically. "Appearing knowledgeable and prepared gives a confidence to the new recruit that they will be in good hands and enables a working relationship," she says. "Our surgeons and their offices are customers, like our patients. Treat them with respect, offer a good ear and show results and a wonderful experience can be expected." 5. What will the business structure look like? Surgery center or practice leaders should consider the business and ownership structure to decide what additional partners may be required. Ms. Sanchez's center decided to partner with an ASC development and management company to help drive the planning and delivery of the facility and handle the center's operations, allowing the surgeons and other staff members to focus on the clinical aspects. Surgeons may choose to develop and manage the ASC without external assistance or partners, while aligning with a hospital or health system meets the needs of other surgeons based on their market demographics. Other options exist, including ASC owners outsourcing their billing and revenue cycle operations on a temporary or permanent basis to alleviate management burden. Look at all aspects of ownership and management to find the best fit. Regardless of ownership structure, patient experience should always be the focal point of bringing spine to an ASC. While spine will be a revenue generator for the center, it will also serve as a vehicle for giving patients higher-quality, more cost-effective care. Patients undergoing spine surgery at Thomas Johnson Surgery Center will spend approximately 65 percent less time from pre-op through post-op than at the local hospital, Ms. Doverspike says. Their recovery time will be quicker and the same nurse will likely see them through the entire operation spectrum, which can be calming and reassuring during a typically stressful experience. n PARADIGM SPINE Paradigm Spine, LLC, a Delaware limited liability company, was founded in 2005 to be the leading provider of novel posterior non-fusion spinal implant technologies for the global spine market. The Company is the first to U.S. market with its proprietary coflex® inter-laminar technology to treat moderate to severe spinal stenosis. Today, Paradigm Spine, LLC has offices in New York, NY and Wurmlingen, Germany and employs over 76 people worldwide. The Company sells its four core medical device products in more than 45 countries worldwide.