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PRACTICE
MANAGEMENT
15 Things to Know About Spine in ASCs
By Adam Schrag
Here are 15 things to know about spine in ASCs.
1. e following spine procedures are typically performed in ASCs:
• Anterior cervical fusions
• Artificial cervical disc replacement
• Posterior cervical nerve root decompression
• Lumbar microdiscectomy
• Lumbar laminoforaminotomy
• Lumbar laminectomy
• Minimally invasive fusions and decompressions
• Lateral spinal fusion
2. Spine surgery is oen considered one of the most profitable and
cost-effective ASC procedures, but it is far from being the most effi-
cient. Spine procedures typically take longer and require much more
preparation and organization than other operations offered in ASCs.
3. Pain control protocols differ for ASC spine surgeries. Cathy Kow-
alski, RN, executive vice president and COO of Meridian Surgical
Partners said in a 2008 interview with Becker's, "In addition to vastly
improved technology, anesthesia has progressed, letting us do spine in
the outpatient setting — anesthesiologists use shorter-acting anesthet-
ics, and patients can go home with improved pain control, including
programmable pain pumps." Since patients return home so soon aer
surgery, they must be educated on what they can expect in terms of
protocols, complications and pain control.
4. ASCs are oen forced to decide whether it's in their best interest to
have a hospital partner. In August 2016, Regent Surgical Health part-
nered with West End Surgical in Beaverton, Ore., to develop the first
surgery center in the northwest United States designed specifically
for total joint and spine disorders. e partners broke ground on the
15,000-square-foot multispecialty facility. Regent is currently partner-
ing with 23 surgery centers with 17 hospital partners.
5. A January 2017 study published in the International Journal of Spine
Surgery examined the readmission rate for outpatient anterior cervical
discectomy and fusion patients. e study included 1,528 patients and
found that fewer than 6 percent of outpatient one- to two-level ante-
rior cervical discectomy and fusions require readmission. No patients
requiring readmission needed to stay longer than one day.
6. ASCs offer several benefits that patients won't find at standard hos-
pitals, according to Seattle-based Microsurgical Spine Center:
• Over 50 percent of U.S.-based ASCs have a 0 percent infection
rate
• ASCs can save some patients 50 percent in expenses
• Physician ownership makes facility and resource scheduling
more efficient, leading to fewer surgical delays.
7. CMS approved 10 new ASC spine codes in 2017:
• Spine bone autogra local add-on (20936)
• Spine bone autogra morsel add-on (20937)
• Spine bone autogra struct add-on (20938)
• Additional neck spine fusion (22552)
• Insert spine fixation device (22840)
• Insert spine fixation device (22842)
• Insert spine fixation device (22845)
• Insj biomechanical device (22853)
• Insj biomechanical device (22853)
• Insj biomechanical device (22859)
8. Richard Wohns, MD, founder of Neospine in Puallup, Wash., con-
ducted a study titled "A Comparison of the Safety of Lumbar Fusions
Performed as Outpatient (<25-Hour Discharge) or Inpatient (>24-
Hour Discharge) Procedures" and presented his findings at the 2012
North American Spine Society Annual Meeting. His study included
187 patients who underwent transforaminal lumbar interbody fusion;
46 percent were discharged within 24 hours or less. He found:
• Operative time: 90 minutes on average for outpatient procedures
and 120 minutes on average for inpatient procedures.
• Blood Loss: 140 mL with outpatient procedures and 353 mL for
inpatient procedures.
• Exposure levels: 46 percent with minimally invasive procedures
and 19 percent with inpatient procedures.
• Complication rate: ree patients experienced complications in
the outpatient group and seven patients experienced complica-
tions in the inpatient group. ere were four in-hospital com-
plications for the inpatient group and none with the outpatient
group.
9. In discussing how spine surgeons may optimize their outpatient
procedures during a 2015 interview with Becker's, Neil Badlani, MD,
of Houston-based North American Spine said, "Patient education and
patient selection is the most important aspect of this." In the July/
August publication of Spine Surgery Today, John C. Liu, MD, of Los
Angeles-based Keck Medicine of USC said, "Healthy patients with
straightforward surgical plans usually will be good candidates when
the surgeries are performed by experienced spine surgeons at a well-
equipped and well-staffed ASCs."
10. In December 2016, Medgadget reported substantial lumbar spine
fusion market growth through 2020, attributing the phenomenon to
the growing number of physician-owned ASCs. Surface-modified ti-
tanium in spinal implants will also stimulate the market's expansion.
11. e global surgical navigations systems market is also expected to
grow exponentially due to increased demand for spine surgery in an
outpatient setting, according to a Technavio report.
12. Spine Health reports that microdiscectomies and endoscopic dis-
