5 Ways to Optimize Spine in Surgery Centers
1. Pick your team well. By selecting the team that works together, everything flows better, says Chris Zorn, vice president of sales for Spine Surgical Innovation and executive director of Minimal Incision-Maximum Sight (MIMS) Institute. You should rarely see rotation of OR staff during a procedure. "In many hospital ORs outside of the United States, a team has come together because they like the type of cases and who they work with it seems," he says. "Obviously no surgeon will be forced to work with team members he/she doesn't want in room, anywhere. In ASCs you are recruiting the best you know. It matters."
2. Maintain staff efficiency. Top-to-bottom efficiency ensures timely healthcare delivery, which eventually translates to greater profits. The core of any organization is its employees. Spine procedures and techniques as well as patient care responsibilities may be unfamiliar to many ASC personnel. An investment in staff training and education is an essential part of improving efficiency and productivity.
"It is equally important to involve your staff in your plans to improve efficiency," says Nicola Hawkinson, MA, NP, CEO and founder of SpineSearch. "Invite feedback from your staff. They know the issues of daily practice better than anyone else and can help improve workflow."
3. Consider 23-hour extended stays for high-risk procedures. For more complex procedures, such as the ACDFs and posterior lumbar fusions, have patients stay at the ASC overnight for 23 hours (if your ASC has been approved for it) and allow them to go home first thing in the morning, says Fred Naraghi, MD, director of the Comprehensive Spine Center in San Francisco. Additional measures might be needed, such as measuring neck circumference of the ACDF patients postoperatively, to make sure they aren't experiencing difficulties before discharge.
4. Evaluate your payor contracts regularly. Spine is a device and implant-intensive specialty and the contracts you have with private payors for general surgery or orthopedics may not be adequate for spine. "Many times, if you are looking to add spine to your center, the representative from the payor might be resistant to allowing changes in the contract to ensure you are fully reimbursed for your expenses," says Dan Beuerlein, regional vice president of operations at Symbion Healthcare. "Many payors will have a maximum amount of what they will pay for a procedure. If your implants and hardware aren't covered as a separate line in the contract, you could find that you're doing those cases at a loss." Surgery centers can spend months negotiating carve-outs for spine surgery or renegotiating existing contracts to get spine cases into the center.
5. Make sure codes are in the right order for claims. Once you've referenced the operative report and you know which codes to bill, it's essential to put your codes in the right order, says Lisa Rock, president of National Medical Billing Services. Make sure you record your codes from highest reimbursement to lowest reimbursement so that you don't lose money unnecessarily. For example, Medicare will reduce the procedure you list second by 50 percent, so if you have one procedure listed at $1,000 and another listed at $750, you want to take the cut on the $750 procedure so that you lose less money.
It may be possible to correct your reimbursement if you make this mistake, but Ms. Rock recommends doing it right the first time to save yourself a lot of hassle. "It's always possible [to fix it], but if you sequence properly the first time, you won't have that problem on the back end," she says.
Related Articles on Spine Surgery:
Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
6 Reimbursement and Business Concepts for Spine in ASCs
8 Design Specifics for Development of Spine Surgery Centers
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