Regent’s Chief Development Officer Jeffrey Simmons discussed spine cases in the ASC setting as part of Becker’s recent 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in Chicago. He joined Pierce Nunley, MD, director of the Spine Institute of Louisiana in Shreveport, on a panel moderated by Bart Walker, partner with McGuireWoods.
Simmons said today, unlike a decade ago, the primary challenge to spine cases in the ASC setting is presented by payers, not physicians. “If you asked me 10 years ago, I’d say [the biggest obstacle was] finding enough surgeons who will come to do procedures in the surgery center,” said Simmons. “Today, the obstacle is getting paid and getting paid appropriately. That involves having payers recognize these cases can be done safely and cost effectively in an ASC setting.”
While not all cases are well suited for surgery centers, panelists advised surgeons to exercise discretion, factoring in patient acuity or case complexity, patient preference, and other factors when making determinations about site of care.
Simmons cited data and Medicare policies as important drivers in the quest to convince payers that ASCs are both safe and cost-effective for spine procedures. He said Medicare will lead the way for commercial payers where reimbursement for ASCs is concerned, noting that commercial payers typically go the way of Medicare. “That’s one reason the it is important that the federal health insurance program reimburses more types of procedures,” Simmons said. “We could triple spine cases in the ASC if Medicare would expand the list of cases they approve.”
The panel also discussed the impact of ASC-hospital partnerships on decisions regarding where to perform spine procedures. Regent Surgical Health manages and owns 23 ASCs, 17 of which are joint ventures with hospitals. “About four-fifths of our facilities now have hospital partners,” said Simmons, explaining that one factor that an ASC’s decision regarding to partner with a hospital may be influenced by whether its state requires a certificate of need (CON) to construct new facilities or expand services. “In non-CON states, the number of surgeons for various specialties are slim – in sharp contrast to CON states.”