Becker's Spine Review

36 The Growth of Outpatient Spine — 9 Key Points By Scott Becker and Megan Wood T he last 10 years have seen an immense growth in outpatient spine. is article briefly discusses some of the challenges, thoughts and observations on this growth. e growth has been driven by several top line factors including (1) surgeons becoming much more comfortable with outpatient spine including younger surgeons initially training up with outpatient spine; (2) patients becoming less scared of outpatient spine surgery and more concerned regarding hospital based infections; and (3) payers becoming more willing to allow spine cases to move from hospitals to ASCs. ere remains pushback from payers as to the amount of spine surgeries in total and from hospitals as to the movement of surgeries out of hospitals. 1. From 2005 to 2015, there has been a movement to a place where nearly 45 percent of all spine cases done on an outpa- tient basis. is compares to approximately 5 percent in 2005, according to the Society for Ambulatory Spine Surgery. 2. e total number of spine cases per year is nearly 650,000 to 700,000. Of these, approximately 280,000 to 300,000 are done on an outpatient basis. [Lumbar decompression and anterior cervical fusions, for example, are most commonly performed in the outpatient setting.] 3. e drivers of outpatient spine include several different factors. ese include (1) lower cost per case in an outpatient setting; (2) improved technology; (3) younger doctors who grew up on outpatient spine immediately out of (or in) their residencies and fellowships; (4) patient preferences for per- forming surgeries where they are in and out; (5) significant improvements in anesthesia; and (6) great improvements in postsurgical pain management. According to data published by NeoSpine founder Richard Wohns, MD, outpatient single-level cervical discectomy and fusion, average facility fee for the ambulatory surgery center is $28,365. e implants cost $1,800 and total bills charged are around $30,165. e average insurance payment is $11,065 and average patient copay was $1,122. 4. Medicare also has been a newer driver of outpatient spine. Recently, in 2014 and effective in 2015, Medicare approved nine different codes that could be used for outpatient spine procedures in the surgery center. is was the first time this was done. e nine new procedure codes on the ASC payable list in 2015 include: 1. [Neck spine fuse & remov bel c2 (22551)] 2. Neck spine fusion (22554) 3. Lumbar spine fusion (22612) 4. Neck spine disc surgery (63020) 5. Low back disc surgery (63030) 6. Laminectomy single lumbar (63042) 7. Removal of spinal lamina (63045) 8. Removal of spinal lamina (63047) 9. Decompression spinal cord (63056) 5. Payers have been very ambivalent about outpatient spine in surgery centers. is has oen been due to the fact that hospitals fought very hard with payers to keep those cases at hospitals. us, there has been some reluctance for spine surgeons to push hard to move cases to surgery centers. More recently, we have seen some of these payers relent. For example, one surgery center that was cut off from outpatient spine for years finally signed a contract with a Blue Cross entity that will now allow them to do a great deal of the cases in the surgery center. is reflects a significant change from years ago. 6. ere are also a great number of spine practices and spine surgery centers that are doing business on a cash or out-of-network basis. e patient may still bill the payer for reimbursement. However, on the upfront situation, the surgery center accepts cash or out-of-net- Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker. All other trademarks are trademarks of their respective owners or holders. 2 Pearl Court Allendale, NJ 07401 A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon must always refer to the package insert, product label and/or instructions for use before using any Stryker product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. Just a few of the exciting new products for 2016. Time to experience the difference.

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