5 Factors for Success With Spine Surgery in ASCs
1. Factors contributing to the move toward outpatient spine surgery. Dr. Villavicencio discussed several factors contributing to the move toward performing spine surgery in the ASC, including:
• Increasing cost of healthcare
• Less invasive surgical techniques
• Advancements in anesthesia
• Growing confidence in medical staff and surgeon abilities
• Increased complications in the hospital setting
Minimally invasive spine surgery allows surgeons to perform a procedure with less trauma, blood loss, epidural scarring and postoperative pain. Recovery times are also quicker with the less invasive procedures.
2. Comparing the hospital to ASC environment. In one of his studies, Dr. Villavicencio discovered that patient stays at the hospital were longer than at the surgery center for the same procedures. "If you take the same surgeon, surgical assistant and technique from the ASC to the hospital, the hospital staff aren't trained to encourage patients to get out of there," he said. "It takes 21 hours for patients to leave the hospital, compared to four in the ASC."
He also compared costs for patients undergoing spinal fusions in both environments. The cost analysis for the average inpatient surgery in the hospital for a one-level transforaminal lumbar interbody fusion was $45,184, compared to $29,983 in the ASC. These costs include implants with rhBMP-2 to promote fusion.
3. Do big cases later in the day. During his years in practice, Dr. Villavicencio found that it works better to perform the bigger cases later in the day so patients who need 23 hour stays can spend the night without having to leave the center in the early hours of the morning. "We used to do the big cases in the morning and smaller cases later, but we found that if a patient checks in at 6 am, you have to have them out the door by 5:59 am the next morning," he said. "Rolling patients out at that time isn't so good, so we reversed it; the big cases are performed later in the day and smaller cases are performed in the morning."
4. Mentally prepare patients to leave the ASC. Patients should understand how long they will be staying at the center postoperatively. If they know they'll be leaving, and understand they will be in some pain, they are more likely to have a smooth transition out of the surgery center. "The biggest hurdle to doing these procedures in the outpatient setting is mental preparation," said Dr. Villavicencio. "When you tell the patient they are leaving in one day, they'll be ready to go in one day. It's also good to have them mentally prepared because if you don't, they'll give you a bad patient satisfaction rating."
5. Select the right patients for outpatient procedures. Not every patient will be a good candidate for spine surgery in the ASC. "Appropriate patient selection is paramount to good outcomes," said Dr. Villavicencio. "There should be an absence of significant comorbidities, younger age and the ability to have adequate care after surgery. For these patients, it's safe and efficacious to perform spine surgery in an outpatient setting and there is a cost savings."
More Articles on Spine Driven ASCs:How to Assess the Profitability of Orthopedic and Spine Cases
Key Business and Clinical Issues With Moving Spine Procedures to ASCs
5 Best Clinical Practices, Business Strategies for Spine-Driven Centers
© Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
- Physicians Participating in ACA Exchanges: 57% Say They Will to Remain Competitive
- Bipartisan Budget Would Delay 20.1% Medicare Pay Cut to Physicians, Give 0.5% Raise
- Dr. Richard Edelson Performs ACL Surgery on Portland Timbers Forward at Oregon Outpatient Surgery Center
- Job Opening: Administrator at Norwalk Surgery Center – Norwalk, CT
- 10 Statistics on ASC Management & Development Company Ownership Preferences