Q: Do you foresee continued growth in outpatient spine surgery volumes?
Dr. Thomas Forget: I don’t think there’s any doubt that outpatient spine will continue to grow. In neurosurgery, we’ve moved past the perception that all procedures required inpatient settings. Obviously, that’s true for brain tumors and very complex surgeries, but we were trained to think everything had to be done in the hospital, including routine spine cases. This traditional thinking created a barrier to the development of outpatient spine ASCs, but today it’s much less of an issue.
Advances in technology and techniques have enabled us to safely deliver quality care, and that’s why more neurosurgeons are comfortable performing spine cases in outpatient environments. Because of the nuances and need for specialized staff, I think neurosurgeons in general prefer spine-focused ASCs over multi-specialty facilities.
Q: What do you see as the major challenges facing outpatient spine ASCs?
TF: Obviously, healthcare reform legislation may have a large impact on the overall market, but it remains a black box for now. I think another significant challenge for neurosurgeons in particular is to resist the temptation to automatically do every case at their ASC. Just because you can do a case on an outpatient basis doesn’t mean you should. Lumbar decompressions and basic cervical cases generally don’t pose significant risks, but the more complex spinal procedures must be evaluated very carefully. It sounds like a basic concept, but there’s some risk for spine-focused ASCs and patients in doing these complex cases in an outpatient setting.
Q: Your ASC, the St. Louis Spine Surgery Center, includes both neurosurgeons and orthopedic spine surgeons. How have you built a partnership between the two groups?
TF: It was a very natural progression for our team. We all knew each other from the hospital and wanted to go into business together. We also had very candid discussions about the exact types of procedures we wanted to do at the surgery center, and defined those cases carefully. The initial planning effort has contributed significantly to our success. If there was any conflict, it was around OR time. Of course everyone wanted to schedule surgeries in the morning, but we’ve managed to work that out.
Q: What other factors have been critical to your success?
TF: Being able to hand-pick our staff. We formulated a team of skilled and experienced nurses who know how to identify potential problems and handle any complications that arise. Having OR nurses who grasp the nuances of neurosurgery gives our surgeons confidence that pre-, post- and intra-op care are all delivered at the level of quality we expect. I know my patients are well screened before surgery and properly monitored afterward.
The efficiency of our ASC is another key element. The fact that I can do three or four spine procedures in the morning and still be in my office for clinic by early afternoon gives me a great deal more control than if all of my surgeries are scheduled at the hospital.
Q: What advice would you give younger surgeons considering involvement in an ASC?
TF: It’s important to work with partners whom you respect and trust. That includes your OR nurses and support staff, as well as your business partners and fellow surgeon-owners.
But, the most important idea is to be completely honest with your patients, and yourself. Patients should understand clearly the financial interest you have in the ASC, as well as why you perform the procedures there. The good news is that patients like many of the same aspects of surgery centers — namely comfort and convenience. It all comes back to patient selection: For every single case, you have to ask yourself, ‘Is the ASC the best place to perform this surgery?’ The good news is that in many cases it will be.
Thank you to Blue Chip Surgical Center Partners for arranging this article. Blue Chip developed St. Louis Spine Surgery Center, along with Dr. Forget and other surgeon-owners. You can learn more about Blue Chip and read more surgeon stories at www.bluechipsurgical.com/insights.
