Avoid these 7 mistakes when adding spine to your ASC

In a move that made spine ASCs around the country breathe a sigh of relief, CMS announced nine new procedure codes on the ASC payable list for 2015. With CMS paying for more spine procedures that ever before, the specialty is poised to become a new must-have ASC service line. Additionally CMS' decision to reimburse for more outpatient spine care, private payers will be encouraged to follow suit.

However, ASCs must not be hasty in their decision-making. "It is a strategic decision," says John Prunskis, MD, FIPP, founder and co-medical JohnVPrunskisdirector of the Chicagoland-based Illinois Pain Institute. "Centers need to perform an analysis to decide whether or not to include spine. They should look at cost of equipment and state-based laws including CON regulations. They need to ask themselves, is the timing correct?"

Here seven mistakes to avoid when adding spine services to a surgery center:

Debyoder1. Jumping in without good communication. According to Deb Yoder MHA, BSN, RN, CNOR, director of clinical services, HIPAA and compliance officer at Surgical Management Professionals, communication between the governing board, administration and clinicians is key when adding any new specialty, especially spine. Each department plays a unique but important part to the success of the whole. The board, for example, has to understand and drive the strategy. They need to understand the answer to questions such as:

•    Is this service line befitting to the long-term success of the organization?
•    Are the affiliated hospital partners in line or are they going to be resistant?
•    What other regional opportunities are there for this service line?
•    Who is our competition?
•    Do patients want or require this service in our area?

Obtain buy-in from the entire administrative team so all understand that spine procedures are worth investing in at the center, Ms. Yoder says. The clinical director or nurse leadership must be involved from the very beginning of the process and coordinate physician dialogue in order to ensure appropriate instruments, equipment, implants and preference cards, among other responsibilities.  

"Each spoke of the wheel needs to be in place prior to putting it on the wagon," says Ms. Yoder.

2. Failing to consider financial costs comprehensively. One of the first steps is to analyze the cost-effectiveness of adding spine to your center. According to Ms. Yoder, the following four considerations are especially vital:

•    The payer mix in the ASC's region  
•    The center's current contracts and coverage of the given CPT codes
•    Volume of future cases per given CPT code
•    Information on doing the added procedures, including fixed and variable costs to ensure that the procedure is profitable
•    Carve-outs required for the given  procedure

3. Not understanding procedure needs. Before starting spine procedures at a center, the ASC needs to understand the procedures that will be performed as well as volumes of the given procedures. Then consider the additional supplies needed — what will be the cost of equipment and where will it be stored?

4. Neglecting patient support. ASC management sometimes doesn't engage patients effectively before including a service line like spine. Ms. Yoder says that it's important to understand what patients want and need in a given region. It is also important to educate potential patients about their options. When they are in the surgeon's office, it is important that patients are given options and the information they need to understand the ASC environment.

5. Not aligning spine surgeons. Discuss all aspects of the spine service with the surgeons, says to Dr. Prunskis, to make sure surgeons are on the same page regarding equipment and operating room use. Obtain commitment from your spine surgeons, he says.

6. Failing to educate staff and schedulers. Inform surgeons' office staff and their schedulers about which procedures are appropriate for the ASC. Keeping schedulers abreast of the latest procedures that can be done in an outpatient setting will help increase case volumes at your center, says Ms. Yoder.

7. Not engaging the anesthesia team. Improved pain management is one of the key reasons why it is possible to offer high-acuity spine procedures on an outpatient basis. Involve the anesthesia team prior to bringing spine cases to the ASC. One needs to ensure that appropriate pre-selection patient criteria are in place before starting procedures, notes Ms. Yoder.

"Spine patients are typically in an airway-compromising position during their procedures," she says. "So it is important to make sure that the anesthesia providers are involved in creating the patient selection criteria, formulary of medication needs and have input into any additional medications and supplies they may require in order to perform these procedures. The goal is to provide best care for each patient each time."   

There are a number of moving parts in motion when adding a new service line to a center and keeping a detailed record of these and closely monitoring the process are essential for positive outcomes and long-term clinical and financial success, says Ms. Yoder.

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