Outpatient spine surgery in the United States has exploded during the past decade – and it’s showing few signs of letting up. From 2001 to 2011, ASC-based spinal fusion surgeries alone increased 70 percent, according to the Dartmouth Atlas of Health Care series. During the next three years, the Agency for Healthcare Research and Quality predicts the rate of spine procedures performed in ASCs will grow by more than 20 percent. In a recent interview with Becker’s Spine Review, Dr. Robert S. Bray Jr., of DISC Sports & Spine Surgery, predicted that 75 percent of spine physicians will have some degree of ASC ownership, and up to 50 percent of all spine surgeries will be performed in an ASC facility. From clinical to financial, there are a variety of reasons for the rapid growth in spine surgery. As with many procedures, outpatient spine surgery can be safer, cheaper and more convenient for patients than its hospital-based alternative, making it extremely popular with physicians, patients and payers alike. Here are four reasons why:
Greater surgeon control
In almost all circumstances, an ASC requires navigating less bureaucracy than a hospital. Spine surgeons within an ASC can more easily request equipment, technology and other necessary materials from the appropriate contact. This control extends to choosing staff, placing instrumentation orders and other key areas of daily clinical operations that would remain outside a surgeon’s control in a hospital setting. By allowing surgeons to drive the procurement process, ASCs afford spine surgeons the autonomy necessary to offer highly effective and efficient care.
More discharge, recovery options
In an outpatient setting, patients enjoy timely discharge and a variety of options for their recovery period, depending on state regulations and subject to physician preference. Patients can elect to return home post-op, provided they have arranged for a home care professional to monitor their recovery. Or, they can choose to be transferred with a family member or friend to a nearby hotel that is staffed with medical professionals. Though this option comes with additional costs, many patients and their families prefer it. Patients also can be transferred to a skilled nurse facility (SNF) to recover in a safe, monitored environment. Patients are responding positively to this array of options regarding their discharge and recovery period, and can benefit from having a voice in their overall treatment plan.
Increased cost controls
As the healthcare industry continues to shift toward a value-based care and reimbursement model, spine surgeons are using this opportunity to work with hospitals and utilize a bundled payment strategy. Spine surgeons are collaborating with hospital partners to develop “Spine Centers of Excellence” to utilize the bundled payment model that is already in use for hip and knee replacements. In order for the strategy to be effective for spine procedures, physicians must deliver the data to demonstrate not only the clinical effectiveness of performing these surgeries in an ASC setting, but also the operational efficiencies and cost savings involved.
Enhanced patient satisfaction and safety
Patients are increasingly seeing the benefits of receiving care in an outpatient setting. According to U.S. Centers for Disease Control and Prevention data, patients are twice as likely to develop a surgical site infection (SSI) when operated on at a hospital versus an ASC facility. The reduced risk of infection is critical to keeping patients safe and healthy when recovering from their procedures. Patients also enjoy significant cost savings in an ASC setting. The Surgery Center Network reports that the cost of a procedure at an ASC is typically 45-60 percent less than at a hospital, though that number can soar as high as 90 percent. Patient surveys also report an average satisfaction rate of 92 percent in an ASC setting, versus 70 percent at a hospital.
In an era of patient-consumerism, price transparency and the delivery of cost-effective care is key. The greater accessibility built into ASCs is also essential to this concept of the patient-consumer; due to their smaller size and targeted area of focus, ASCs are better able to market themselves to their community. This increases patients’ awareness of the local ASC’s services, its “brand,” and helps to form a stronger bond of trust between physicians and patients. With patients enjoying same-day discharge plans and greater options for recovery periods, ASCs are built to deliver optimized, efficient, high-quality care. Remember, not all patients fit the profile to undergo surgery in an outpatient setting. It is important to implement an extensive patient screening process to evaluate patient age, current medical condition and past medical history to ensure the procedure can be safely performed in the ASC. For more information on spine procedures and spine surgeon ownership within ASCs, please email peiseman@regentsh.com.
