Becker's ASC Review

12 ASC MANAGEMENT ASCs Band Together to Form North Carolina Ambulatory Surgical Center Association By Mary Rechtoris I n North Carolina, community- based ASCs have teamed up to form the North Carolina Ambula- tory Surgical Center Association. Here are four key points: 1. Kelli Collins, VP of operations at Deer- field, Ill.-based Surgical Care Affiliates, will be the association's president. 2. Raleigh, N.C.-based Compass Sur- gical Partners' President and CEO Sean Rambo will serve as NCASCA's secretary/treasurer. 3. Membership is eligible for any en- tity licensed as an ASC in North Caro- lina as well as physician practices that use ASCs. Throughout North Caroli- na, there are 118 licensed ASCs. 4. Next year, the association will hold its first meeting in Greensboro, N.C., and will launch a new website in Jan- uary 2017. "The formation of NCASCA will allow the state's ASCs to advocate on be- half of our community with a united voice before state licensure officials, the North Carolina Industrial Commis- sion and the General Assembly," Ms. Collins said. "I look forward to working with ASC administrators throughout the state to promote the value of North Carolina's ASCs as a critical component of the healthcare delivery system." n 8 Key Thoughts on Best Practices for Outpatient Cervical Spine Surgery By Laura Dyrda A panel of spine surgeons and clinicians published an article in Spine titled "Best Practices for Outpatient An- terior Cervical Surgery" to outline the best practices for selecting patients and perform- ing cervical total disc replacement and fusion procedures in the ASC. e study authors include Anita Mohan- das, MSc, Chris Summa, MD, W. Bradley Worthington, MD, Jason Lerner, PT, Kevin T. Foley, MD, Robert J. Bohinski, MD, PhD, Gregory B. Lanford, MD, Carol Holden, RN, and Richard N.W. Wohns, MD, JD, MBA. e study authors conducted a three-round modi- fied Delphi method to generate the best prac- tice statements and set the predetermined consensus for each statement at 70 percent. e panel evaluating the statements included five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon and a registered nurse. e panel defined outpatient spine sur- gery as safe discharge for patients four to eight hours aer arrival at the clinic. All panelists had participated in at least 100 outpatient spi- nal fusions or disc replacements over a two- year period prior to participating in the panel. In the first round, the panelists generated statements about outpatient cervical spine surgery and 61 statements immediately achieved consensus; nine additional state- ments achieved borderline consensus and eventually achieved consensus aer being up- dated; and 13 of 14 new statements generated in the round achieved consensus. In the second round, panelists rated their level of agreement and provided comments and edits for statements, as well as additional statements in the predetermined categories. e research- ers then moved along statements that achieved consensus based on frequency statistics and re- vised statements that were borderline. In the third round, panelists rated the up- dated and new statements from the second round and provided information on their rat- ings, as well as provided an additional rating for the updated statements. In total, the panel developed 83 consensus statements. General best practices in the consensus state- ments include: 1. e patient's age, BMI greater than 35 kg/m2 and previous anterior surgery alone shouldn't preclude outpatient surgery. Patients undergo- ing two-level procedures and those with my- elopathy that impairs their gait shouldn't be excluded from outpatient surgery. 2. Patients with severe cardiopulmonary comor- bidities are poor outpatient surgery candidates. 3. A majority of the panelists recommended short-acting anesthetic agents for outpatient spine surgery patients and avoiding opioids. 4. e panelists all agreed that preoperative analgesia plans were necessary and the state- ment on using mild analgesics for initial pain control before turning to opioids for persisting pain achieved consensus. All panelists agreed decisions about the type of nonopioid analge- sic should be based on the surgeon's preference and surgery type, according to the report. 5. A majority of the panelists agreed on pa- tient and caregiver education about: • Aim of surgery • Procedural details • Anesthesia-related issues e panelists also "emphasized the need to establish patient and caregiver expectations with respect to postoperative care, including smoking cessation, medication use, warning signs, access to emergency care, wound care and other aspects of the care pathway." Post- operative pain management and hematoma/ edema awareness education were a particular focus of the panelists. 6. Most panelists backed discharge checklist use from first- to second-stage recovery and 80 percent recommended observing patients for at least three hours aer surgery. All pan- elists backed postoperative nurse follow-up the morning aer surgery. 7. e best practice statements for surgery cen- ters on proactive negotiation for private payer contracts were endorsed by the panel and the panelists agreed on establishing procedure-spe- cific reimbursement rates for each facility. e panelists also recommended ASC staff confirm- ing patient coverage in the ASC setting and noti- fying patients about their cost obligation. 8. Best practices for ASC operations endorsed by the panel include: • Creating self-pay policies for patients • Accessing cost-accounting data • Standardizing implants n

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