work. is has been
a model for success
in several different
practices and centers.
e Orthopedic
Surgery Center of
Orange County in
Newport Beach,
Calif., for example,
practices price trans-
parency by listing
all-inclusive prices
for 54 procedures,
including six spine procedures. e charges include:
• Minimally invasive discectomy, laminectomy, laminotomy:
$14,225
• Two-level MIS discectomy, laminectomy, laminotomy: $16,200
• Single-level MIS lumbar fusion with overnight stay: $30,000
• Two-level MIS lumbar fusion with overnight stay: $38,000
• MIS discectomy and/or fusion with overnight stay: $31,500
7. Another interesting statistic about outpatient spine relates to
the fact that it's estimated that inpatient costs are approximately
five times those of outpatient costs. A study published in Surgical
Neurology International reports outpatient single-level cervical
disc arthroplasty was 84 percent less than inpatient cervical disc
arthroplasty and 62 percent less expensive than outpatient sin-
gle-level cervical anterior discectomy with fusion using allogra
and plate.
us, there has also been great movement driven by the differ-
ence in cost to doing procedures in surgery centers versus hospitals.
8. Finally, surgeons have a great ability to be the leaders in proj-
ects and bundles. ey need enough infrastructure and strength
to be able to lead on such projects. Spine surgery costs drastical-
ly vary, which impacts spine-focused bundled payments. A 2014
study published in Spine reported 30-day bundles range from
$11,180 to $107,642. e post-discharge care accounted for 4
percent to 8 percent of the overall costs in 90-day bundles. e
largest portion of the bundled cost were hospital payments; 76
percent of the bundle went toward hospital payments on aver-
age. Bundled payments are beginning to catch on among large
companies as well. Wal-Mart established bundled payments for
six specialties, including spinal surgery, in 2013.
As to bundled payments, the surgeon has (1) great control
over implants; (2) the time spent in the operating room; (3) time
under anesthesia; (4) length of stay; and (5) recovery time. us
the surgeons are in a great spot to engineer the actual savings and
cost-savings of doing a case in a surgery center versus in a hospital
or elsewhere. e surgeons are also in a great place to be in charge of
the evolution of the management of the total cost of the procedure.
9. Outpatient spine is also growing due to the evolution in
recovery care settings. More and more states are more flexible
about allowing patients to go home or go to a different venue
for recovery care time. It is not so much that payers are increas-
ingly paying for those. Oen they are paid for out of the surgery
center bundle or the
surgeons' bundle.
However, more and
more states are more
permissive about a
patient being released
to a hotel, a home
or some other place
where they will have
postsurgical care.
e state of Flor-
ida is one example of
the expanding legis-
lation. Legislators have attempted multiple times over the past
few years to extend surgery center patient stays. Earlier this year,
bills in the Florida House and Senate were introduced to allow
ASCs to keep patients up to 24 hours as well as 72 hour stays at
recovery care centers. n
"From 2005 to 2015, there has been a
movement to a place where nearly 45
percent of all spine cases are done on an
outpatient basis."
37
ADVERTISINGINDEX
Note: Ad page number(s) given in parentheses
ADVERTISER
Bioventus.
www.osteoamp.com / (919) 474-6700
(pg. 32)
Centinel Spine.
cs@centinelspine.com / www.
centinelspine.com / (484) 887-8810
(pg. 38)
ChoiceSpine.
info@choicespine.net / www.
choicespine.net / (865) 246-3333 (pg.
15)
eSutures.
info@esutures.com / www.esutures.com
/ (888) 416-2409 (pg. 17)
Globus Medical.
www.globusmedical.com/deformity /
(610) 930-1800 (pg. 5)
Invibio.
info@invibio.com / www.invibiospine.
com / (866) 468-4246 (pg. 9)
L3 Healthcare Design, Inc.
www.l3asc.com / (866) 929-5353 (pg.
31)
Medicrea USA.
www.medicrea.com / (646) 490-2360
(pg. 1)
Mizuho OSI.
www.mizuhosi.com/trios / (800) 777-
4674 (pg. 33)
National Medical Billing
Services.
info@nationalascbilling.com / www.
nationalascbilling.com / (636) 273-6711
(pg. 6)
Orthofix.
comments@orthofix.com www.orthofix.
com / (888) 298-5700 (pgs. 3, 11)
Ortho Kinematics.
www.orthokinematics.com / (512) 334-
5490 (pg. 35)
Pacira Pharmaceuticals, Inc.
www.exparel.com / (855) 793-9727
(pgs. 7-8)
Stryker.
www.stryker.com / (269) 385-2600
(pg. 36)
Titan Spine.
tsinfo@titanspine.com / www.titanspine.
com / (262) 242-7801 (pg. 34)
Xodus Medical.
info@xodusmedical.com / www.
xodusmedical.com / (724) 337-5500
(p. 13)
Zyga.
www.zyga.com/simmetry / (855) 374-
6050 (p. 16)
