Roundtables

Outpatient Spine Surgery 6 "The technology allows us to be more efficient during the surgery, decreasing anesthesia time and allowing for less tissue damage. All of this makes the patients' early recovery smoother." -Dr. William Tally expect, it greatly reduces post- operative prob- lems with pain. Let them know they can still contact your office aer surgery with any questions or wor- ries — this reduces the urge to head straight to the ED if they become concerned about their pain levels aer returning home. BB: Surgeons and patients have to feel comfortable in this set- ting. 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 mem- ber from the office educate them. Provide patients with educa- tional materials about what to expect from out- patient spine surgery and be available to answer their questions and con- cerns. e outcomes will fol- low; 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 perform- ing cas- es in the ASC going forward? RB: e 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 sur- geons 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, includ- ing spine surgery. I am currently able to do 80 percent of my ma- jor spinal surgeries in an ASC. If 80 percent of all spine surgeries could be done in outpatient sur- gery centers, I would think this could be huge for the country which is currently drowning un- der the cost of medical care. e timing is perfect for this type of procedure to start the precedent of outpa- tient spine surgery. Q: Where do you see the most opportunity for growth in the out- patient spine surgery cen- ter setting in the future? AS: Endoscopic spine surgery is become an interesting ave- nue that is being reevaluated aer falling out of favor. Simple decompressions and microd- iscectomies are moving to the outpatient departments at hos- pitals, so the ASC setting is the next logical choice. One-level ACDF procedures are being routinely performed in the out- patient 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 pro- cedures performed in the out- patient setting. A bigger oppor- tunity in the outpatient setting are lumbar proce- dures. When surgical techniques can be streamlined enough to reduce anes- thesia time, and instru- mentation is developed that can reduce the number of steps in a procedure (like OLLIF), we will facilitate the move of spinal fu- sions to the outpatient setting.n 46 Spine Roundtable 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 land- scape. 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 ob- servations, 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 prob- lems 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 mem- ber from the office educate them. Provide patients with educational materials about what to expect from out- patient spine surgery and be available to answer their questions and con- cerns. 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 cas- es 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 sur- geons 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 outpa- tient spine surgery. Q: Where do you see the most opportunity for growth in the out- patient 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 microd- iscectomies 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 proce- dures. When surgical techniques can be streamlined enough to reduce anes- thesia 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 "The advantages of using an outpatient center for the performance of spine surgery yields similar advantag- es to what has been demonstrated in other subspecial- ties. 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 A DIFFERENT KIND OF HEALTHCARE ADVISORY… CORPORATE STRATEGIC AND OPERATIONAL REVIEW/PLANNING Clinical Service Line Development & Implementation REIMBURSEMENT CODING ANALYSIS & COVERAGE ACCESS SERVICES COMPLIANCE DESIGN, EVALUATION & IMPLEMENTATION RECOVERY AUDIT (RAC) PREPAREDNESS & DEFENSE SERVICES SPECIALTY HEALTHCARE ADVISERS - MISSION: To Provide Unparalleled Strategic & Operational Guidance for Healthcare Providers by: Improving Overall Profitability, Quality and Sustainability, While Reducing Risk Exposure. 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