Becker's Spine Review

46 Practice Management Regional Brain and Spine's Innovative Business Strategy: Leasing One ASC Day Per Week By Laura Dyrda R egional Brain and Spine in Cape Girardeau, Mo., is a multidisci- plinary spine practice with a unique operating agreement in an am- bulatory surgery center: the physicians lease the ASC one day per week to perform their cases. "We lease the facility and staff at the ASC, which allows us to provide neuro- surgical and pain care in a way that's affordable for our patients and for us," says Dr. Vaught. "This arrangement has worked out very well. We wouldn't have enough cases to operate our own ASC, but we are able to pay the ap- proved expenses on our leased day and it's up to us to ensure we are busy and active throughout that day." ASCs are typically lower cost settings to provide care and the cost savings is passed on to the patients. Until recently, most spine procedures were pre- formed in the hospital, but minimally invasive techniques and technology al- low surgeons to take some procedures and patients into the outpatient setting. Additional benefits in the ASC include: • Lower infection rates • Surgeons have more control over their cases • Quicker room turnover times/less surgeon downtime • Higher patient satisfaction "Patients appreciate the ASC because there is more of a personal touch from the nurses and staff," says Dr. Vaught. "There are fewer people in the ASC than in the hospital, so patients get more individual attention. It really im- proves the patient's experience." Most patients return home the same day of their procedure, but cervical fu- sion patients are allowed to stay over night — up to 23 hours — to recover. The nurse-to-patient ratio is one-to-one for overnight stay patients. This is the third year Dr. Vaught and his colleagues have provided services at the ASC, and they enjoy providing services there. However, the surgeons experienced a learning curve when it came to op- erating the center. Before bringing cases there, they'd never considered the individual cost of instrumentation, implants and other expenses that are part of the surgical process. "We looked at our expenses line-by-line and were surprised by the instru- mentation costs," says Dr. Vaught. "There were so many costs for using the operating room that we weren't accustomed to incurring in a hospital setting. Just seeing how expensive things were really made an impact on how we used our time and resources." Now the surgeons are constantly looking for ways to improve efficiencies, and find it rewarding to see how their efforts positively impact the business. Another challenge was contracting with insurance companies. At first, many of the payers quoted rates that were too low for the surgeons to consider, but after they worked together to lower costs and prove the effectiveness of their care, they were able to go in-network. "Initially, there were several payers that wouldn't work with us that we now have contracts with," says Dr. Vaught. "We have the data showing our case costs are down and performance is outstanding. Narrowing networks are causing stress for providers across the spectrum, and competitive pricing for insurance companies could provide additional opportunities for ASCs as a low cost provider when cases are appropriate. In the future, Dr. Vaught would like to explore a partnership with an extend- ed stay facility to increase the number of patients who would be potential candidates for surgery at the ASC. If the surgeons contract with a recovery/ observation facility, patients could be discharged there instead of home if necessary. n As spine surgeons bring more cases into the out- patient surgery center, they'll be able to lower costs and achieve better outcomes. A study published in the May edition of Health Affairs showed ASCs provide a cost-efficient surgical environment and could save Medicare and its beneficiaries up to $57.6 billion over the next decade. This bodes well for spine surgeons and patients, but many hospitals are weary of the change because spine has been a big part of their revenue in the past. "It's a concern for those hospitals that frankly aren't competitive from an innovation point of view," says Dr. Tyndall. "If they could learn how to run effectively and adopt techniques to become more cost efficient and improve the patients' ex- perience, then the whole system would be better off. Instead, some are being reactionary and rath- er than collaborate with physician run entities are simply trying to shut down physician-owned facilities." n Becker's ASC 21st Annual Meeting - The Business and Operations of ASCs October 23-25, 2014 • Chicago For more information, call (800) 417-2035 30 Great Surgeons, 36 Leading Administrators and 80 Surgery Center Speakers in Total

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