Issue link: https://beckershealthcare.uberflip.com/i/240733
Spine Roundtable 46 geons in private practice. Furthermore, employers and cash paying patients are starting to avoid insurance companies altogether and come directly to the surgeon. If you are an efficient surgeon operating in an ASC, you can provide tremendous value to these stakeholders. The value proposition is only going to become more important in the changing healthcare landscape. Q: What differences are there for surgeons when they first start doing cases at the ASC as opposed to the hospital? AS: Surgery centers are usually run differently than hospitals. Typically there are fewer resources available and there is emphasis on only using what is needed for the surgery. It is also important to make sure there is adequate follow-up with patients postoperatively. Finally, it is important in the ASC to be comfortable and familiar with equipment and instrumentation provided by the facility. Q: Many surgeons are considering the adoption of new spine surgeries and minimally invasive techniques into their practices. Do you have any tips for them? GS: As surgeons start to move minimally invasive spine surgery to the outpatient setting, there should be adequate training, including case observations, with experienced surgeons. During the first few procedures in the ASC, surgeons should have access to teaching physician to answer any questions that may develop while observing the patient. Patient selection is a key factor in successful outpatient surgery. Knowing which patients are candidates, and more importantly which patients are not, is critical in the outpatient setting. Having been a busy spine surgeon for the last 25 years and now doing these procedures for about 10 years, in my mind the absolutely best way for spine surgery to be done is with minimally invasive techniques in the outpatient setting. Performing cases at the ASC with the right technique and the right context is the future of spine surgery in our country. WT: Patients needed to be educated on the level of pain they will experience, what they are expected to do postoperatively, and what is within the range of normal with regards to pain. Sometimes patients think that because their surgery is performed in the outpatient setting, their pain levels should be lower, and they panic. When patients know what to expect, it greatly reduces postoperative problems with pain. Let them know they can still contact your office after surgery with any questions or worries — this reduces the urge to head straight to the ED if they become concerned about their pain levels after returning home. BB: Surgeons and patients have to feel comfortable in this setting. When first starting, it may be helpful to keep patients in the hospital for one night to assess how well they do. Additionally, patients need to be educated about the timeline for discharge. Either speak with them directly, or have a staff member from the office educate them. "The advantages of using an outpatient center for the performance of spine surgery yields similar advantages to what has been demonstrated in other subspecialties. An outpatient surgery center provides for a more personal level of patient care which is a strong positive for both patients and surgeons." — Dr. Randolph Bishop Provide patients with educational materials about what to expect from outpatient spine surgery and be available to answer their questions and concerns. The outcomes will follow; patients will be discharged earlier from the hospital and the transition to the ASC will be successful. Q: Do you think more spine surgeons will begin performing cases in the ASC going forward? RB: The performance of most routine spinal surgeries will be performed in an outpatient setting in the future. Surgeons that do not prepare for this will be unable to compete effectively against those that do and these same surgeons may in fact be viewed as "less capable" as a result. GS: Right now, it seems like the drivers of cost in the hospital costs are for procedures, including spine surgery. I am currently able to do 80 percent of my major spinal surgeries in an ASC. If 80 percent of all spine surgeries could be done in outpatient surgery centers, I would think this could be huge for the country which is currently drowning under the cost of medical care. The timing is perfect for this type of procedure to start the precedent of outpatient spine surgery. Q: Where do you see the most opportunity for growth in the outpatient spine surgery center setting in the future? AS: Endoscopic spine surgery is become an interesting avenue that is being reevaluated after falling out of favor. Simple decompressions and microdiscectomies are moving to the outpatient departments at hospitals, so the ASC setting is the next logical choice. One-level ACDF procedures are being routinely performed in the outpatient setting, but the biggest opportunity is lumbar fusions in non-complex patients. WT: As more surgeons are trained in this setting, we are going to see a higher volume of both cervical and lumbar procedures performed in the outpatient setting. A bigger opportunity in the outpatient setting are lumbar procedures. When surgical techniques can be streamlined enough to reduce anesthesia time, and instrumentation is developed that can reduce the number of steps in a procedure (like OLLIF), we will facilitate the move of spinal fusions to the outpatient setting. n Headquartered in Marietta, Georgia, Amendia is quickly becoming a recognized leading provider of innovative Class II and Class III medical devices used in spinal surgical procedures. As a specialty-device manufacturer, Amendia collaborates with surgeons to develop, manufacture, and market minimally invasive spine and orthopedic implants and instruments.