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18 OUTPATIENT SPINE Spine & Total Joints in ASCs — Premier Orthopedic Surgery Center Administrator Weighs In By Megan Wood N atalie Soule, RN, administrator of Nashville, Tenn.-based Premier Orthopedic Surgery Center, shares insight on spine and total joints in the out- patient setting as well as offers key advice for boosting ambulatory surgery center growth. Question: Which spine procedures are typically preformed in the out- patient setting and why? With CMS approving 10 new spine codes for the ASC payable list in 2017, do you believe spine will continue to grow in the outpatient setting? Natalie Soule: From other conferences, industry magazines and peers, I believe scheduling of spine procedures is dependent on how the surgery center is set up. For ex- ample, my center is two rooms with no over- night stay. We do simple laminectomies, and two-level ACDFs. Larger centers that are more equipped are doing fusions and more complicated spine procedures. I also believe the complexity of spine procedures has to do with the expertise of the surgeon and the level of experience by the ASC team. I do believe spine will continue to grow in the outpatient setting based on the approval by CMS and the acceptance of patients wanting to go home the same day. Q: What would you advise adminis- trators consider before adding total joints to their ASCs? NS: As the administrator, you would need to ensure your surgical staff is trained in total joints, and your pre-op/PACU staff is trained as well. ese patients may or may not go home in an hour and may be staying all day. e staff needs to be prepared to handle the needs of a patient who is staying in a facili- ty all day. If physical therapy is involved, the nurses need to know when to call therapy to assist the patient. Another important aspect of performing total joints is deciding the cost for equipment. Is your center performing a volume that would require you to purchase instruments, new drills, helmets and all other items required for total joints? Are your managed care contracts reimbursing a rate that would provide you an incentive to continue to perform total joints? Of course, these are just a few items pertain- ing to total joints. Many centers will set up a team for total joints to ensure all aspects of quality and safe care have been covered. Q: If you could offer one piece of ad- vice for administrators trying to boost growth in their ASCs, what would it be? NS: I am not sure if there is one piece of ad- vice that can answer this question. If there are physicians in the community who may be a candidate for your center, by all means go out and try to recruit that surgeon. If your prac- tice is primarily with one group, sometimes it is hard to boost their growth depending on if business is down for the group. You can always try to add a new service. If you are orthopedic and are not performing pain or spine, consider adding this to your mix. If you are multispecialty and are not do- ing ENT, etc., consider adding this specialty to your center. n Laser Spine Institute Cleveland ASC Welcomes New Spine Surgeon: 5 Things to Know By Laura Dyrda Brad M. Picha, MD, joined Laser Spine Institute's Cleveland ambulatory surgery center. Here are five things to know: 1. Dr. Picha is an Ohio native who completed medical school at Case Western Reserve University in Cleveland. He underwent a residency at Dayton, Ohio-based Wright State University Department of Medicine and a fellowship at OrthoIndy in Indianapolis. 2. A member of Dr. Picha's family underwent treatment at one of Laser Spine Institute's centers, which inspired him to join the practice. He underwent additional fellowship training at Laser Spine Institute, which is required of all new surgeons joining the group. 3. In 2010, Dr. Picha was among the volunteers traveling with InterVol, a nonprofit organization affiliated with Roch- ester (N.Y.) Regional Health, to aid victims of the earth- quake in Haiti. 4. At Laser Spine Institute, Dr. Picha will treat a variety of conditions with minimally invasive spine procedures. 5. He is a member of the Ohio State Medical Association and American Academy of Orthopaedic Surgeons. n "The staff needs to be prepared to handle the needs of a patient who is staying in a facility all day." -Natalie Soule, RN