Roundtables

hospital environment. Patients seem happier and more likely to resume daily activities soon- er when discharged to home as opposed to being 'institutional- ized' by a hospital stay. GS: One key advantage of this is surgery is reduced anesthe- sia time. Since the procedures do not involve dissecting or retracting tissue, the patients spend less time under anesthe- sia, experience less blood loss, thus substantially lowering the risk of the surgery. Further- more, the outpatient setting is far less costly than the hospital setting. Q: Excellent point — what exactly is the economic im- pact of being able to perform spinal surgeries in the outpa- tient setting? RB: ere is no doubt that performing spinal sur- gery in an outpatient setting provides marked re- duction in cost of care. Not only is the actual sur- gery less expensive secondary to better efficiency, there are no additional costs that may come about with hospitalization such as nosocomial infec- tions and medication errors. BB: With so much focus on the cost of medicine today, many procedures will move to the outpa- tient setting as insur- ance companies, employers and patients push back on expen- sive hospital stays. Overall, the migration to outpatient surgery is positive in a time where so much emphasis is being placed on medical economics. WT: In the future, spine sur- gery will become more of a cash business. You can control cost much more effectively in the outpatient setting which provides more value to the patient. Once the value of the procedure is known by the pa- tient, volume will increase exponentially. Q: Medicare doesn't current- ly reimburse for outpatient spine surgeries in ASCs. Are commercial payers any better? BB: Yes, that is true, Medicare currently does not cover spi- nal fusion in the ASC setting. Many times, commercial insur- ers will not approve inpa- tient procedures, but will approve the same pro- cedures in the outpatient setting. If we can safely do a procedure, such as OLLIF, in the outpatient set- ting, and have patients return home the same day with a much lower risk of post-op- erative complications, then more insurance companies will move in this direction. Spine surgeons will need to adapt to the movement of these types of procedures to the ASC. Q: Are there any benefits from the sur- geon's perspective to performing the cas- es in the ASC? WT: As reimbursement contin- ues to erode, the ASC is an op- portunity to capture additional rev- enue for the surgeon. is will be crucial for surgeons in private practice. Furthermore, employers and cash paying patients are starting to avoid insurance companies altogeth- er and come directly to the surgeon. If you are an efficient surgeon operating in an ASC, "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 Outpatient Spine Surgery 3 Roundtable out- con- the cas- performed in will sur- for percent of could for The outpa- out- being microd- the being opportunity is higher outpatient proce- anes- number of fusions the advantag- subspecial- more positive

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