Becker's ASC Review

26 ORTHOPEDIC SECTION The Best Way to Prepare for the Future in Spine By Laura Dyrda D ata collection is the best way for spine surgeons to prepare for suc- cess in the future. Hospitals and physicians are already gathering quality data to Medicare that's reported publicly. Cost data isn't far behind as payers and patients are engaging in more cost-comparisons to de- cide where they'll spend their healthcare dollars. In the past surgeons largely focused on clinical success — selecting surgical or non-surgical patients based on their experience and expertise. However, electronic medical records and other data gathering mechanisms make it possible to track treatment trends and decipher likely outcomes for patients based on previous pa- tients with similar conditions and situations. e data can also show which treat- ments provide the best outcomes for patients, and which deliver similar results. When technologies and techniques yield similar results, patients and payers look toward cost as the next variable to determine value. Spine surgery is costly, with the hospital fees and surgical implants comprising the largest por- tion of the bill. Even though the spine surgeon is the least costly they oen can have the largest impact on costs. "e days when surgeons could say they want a particular implant regard- less of the cost and quality effectiveness is certainly coming to an end," says Hyun Bae, MD, director of spine education at Cedars-Sinai Medical Center in Los Angeles. "If you work at a small hospital, you may be able to make deci- sions, but most major hospital organizations are consolidating and making decisions based on cost-utility. ey are using leverage with large purchasing organizations to cut costs across the board." e larger implant companies have more leverage to cut costs for spinal im- plants because they provide package deals with other instrumentation, sup- plies and hard goods needed at the hospital. Smaller implant companies can't offer the same deals, but may be able to lower prices on commodity implants. However, it's the surgeon's responsibility to ensure the implants available have the appropriate effectiveness for repeatable results. Surgeons who are already contrib- uting to management decisions at the hospital will have the opportunity to take on those responsibilities and decide what implants will be used. "It's hard for surgeons to be on the management side, but they are going to have to align themselves with the hospital — whether through employment agreements or comanagement — to make themselves administratively avail- able to participate in the decision making process. Otherwise decision will get made for them," says Dr. Bae. Independent spine surgeons will have the opportunity to gather data as well, but unless they align with larger groups and other spine practitioners their data probably won't carry much weight. "e only way outcomes matter is with the big organization or group; a center of 10 to 15 surgeons or a hospital program tracking outcomes," says Dr. Bae. "Or- ganizations will then promote the metrics most important to payers. e large employers like Boeing or Home Depot with 10,000, 20,000 or 100,000 employ- ees are looking at those outcomes and deciding where to send them for care." Solo physicians won't have much leverage, says Dr. Bae. "I think there has to be some sort of alignment between the solo physicians, especially since physicians are already at a disadvantage in payer negotiations. Payers have been collecting data for years and we're just beginning to conduct similar data collection." Spine surgeons can grow their outcomes databases quickly through partner- ships between orthopedic spine and neurospine surgeons. ere aren't cur- rently many organizations with collaboration between orthospine and neu- rospine surgeons across the country, but spine practitioners could be take the lead in aligning the two specialties. "We have to find a way to align and gain leverage with larger groups," says Dr. Bae. Another method for lowering costs and gathering data is through outpa- tient surgery. Surgeons can move smaller cases to the ASC setting where they control the patient environment, control costs and collect data at the ASC as well as through a corporate partner's larger ASC network. ASCs typically are paid less per case than hospitals, but surgeon typically are al- ready aligned at the ASC with ownership. is allows ASC to be more cost efficient all the while delivering care in an environment that the pa- tient and the surgeon prefers over a hospital. It is a win-win for everyone. "Everyone is bullish on outpatient surgery and there is no question a lot of cases are going to move to the outpatient spine center," says Dr. Bae. "One- hundred percent of spine cases won't go to the ASC. ere are surgeons who estimate that 50 percent of cases could be performed in the outpatient center, but I think the real number is between 25 to 33 percent." Complex spine procedures must be performed in the hospital setting. e number of Medicare patients needing spine surgery will likely increase over the next decade as the number of people 65 years and older increases. "ere will still be a lot of patients who undergo spine surgery in the hospital because complex spine surgery is the fastest growing segment in spine today," says Dr. Bae. n The Center for Minimally Invasive Surgery in Illinois Partners With SCA: 5 Key Notes By Laura Dyrda The Center for Minimally Invasive Surgery in Mokena, Ill., partnered with Surgical Care Affiliates. Here are five key notes: 1. The partnership went into effect on Jan. 1, 2016 and expands SCA's presence in the Chicago area. 2. SCA now has five locations in the Chicago area. 3. The Center for Minimally Invasive Surgery includes 17 surgeons. Services include spine surgery, orthopedics, ophthalmology, plastic surgery, pain management, gyne- cology and general surgery. 4. Through the partnership, SCA will help The Center for Minimally Invasive Surgery navigate ongoing changes in the healthcare system while still providing quality care to patients. 5. SCA reports operating 194 surgical facilities and part- nerships with 2,600 physicians as of Sept. 30, 2015. "We are excited about collaborating with the center's clinical and business teams and physician partners to serve the community's outpatient needs," said SCA Vice President David Spaccarellli. "The new relationship with SCA provides CMIS a platform from which to increase its impact on the Chicagoland community by leveraging SCA's systems, expertise and scale." n

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