7 Tips for Bringing Spine Cases to an Ambulatory Surgery Center

Helene Medley, administrator of Charleston (S.C.) Surgery Center, an affiliate of Surgical Care Affiliates (SCA), recently introduced spine cases to her surgery center. Here she shares seven ideas she picked up through the process of implementing the new specialty.

1. Ask other facilities and/or your management company for guidance. Ms. Medley decided to bring spine to her facility after noticing that other surgery centers in her region had started performing the specialty. Her center was already a multi-specialty facility with orthopedics, so the addition of spine was not overly burdensome. "I started doing some research about patient safety and the kind of procedures that can be done in the outpatient setting, and I used the resources through SCA and my colleagues who were already doing spine," she says.

Ms. Medley recommends letting your primary spine surgeon take the lead on introducing procedures to the ASC; once her surgeon saw how smoothly his laminectomy went, he immediately scheduled an anterior cervical discectomy. These procedures have been done in an outpatient setting for years and have proven to be safe in this setting.

2. Make sure you understand your physician's implant preferences. Implant costs vary from procedure to procedure and brand to brand, Ms. Medley says. Before you add up costs to determine how much reimbursement you will need from your payors, make sure you know which implant brands your spine surgeons will be using. "One of our surgeons used a different implant than  another surgeon, and it turned out to be $1,000 more," Ms. Medley says. Also make sure you are familiar with the CPT codes and that you have a good coder. A different approach to the procedure can change the CPT code and that code may change reimbursement rates.

She says, if possible, surgery centers should request an instrument list from the hospital where the physician performs his or her cases. Work with your surgeon during this step to make sure the preference list is up to date.  

3. Target physicians looking for opportunities in your region. New physicians may be arriving in your  city, meaning they're probably looking for opportunities to develop relationships with facilities and contribute case volume. Spine cases may not have migrated to the ASC arena in your area, so you may have to change the mind set in your community. Ms. Medley was lucky to find an enthusiastic spine surgeon who was happy to introduce some of his case volume to her facility.

She made this surgeon the focus of her new spine program, knowing she could recruit more physicians once the specialty was more established. "I brought him to the center and gave him a tour of the facility, we looked at the pre-op bays and the size of our ORs and discussed the equipment needs in relation to the room size," she says. Now that her primary surgeon has performed several procedures at the ASC, Ms. Medley says she is "actively recruiting" other spine surgeons. She says that one strategy could be to target surgeons recently out of training, who may be more comfortable with the concept of outpatient spine.

4. Pick a vendor who will work with you through implementation. Ms. Medley says it helps to choose a vendor who is willing to let you trial various instruments before choosing which to purchase. "We showed our surgeon multiple options so he could choose his preference ," she says. "I was lucky I had vendors who were willing to bring in drills, instruments, positioning equipment,  and retractors to let the surgeon try them out first.”"

She says it's tantamount to work with a vendor who is willing to spend time with the surgeon at the facility. Her vendor came for the initial cases and provided a variety of instruments for the physician to trial. "We ended up purchasing only what we absolutely needed, instead of all these extras," she says.  

5. Make sure staff are ready to handle the new procedures. You may already have staff members in your facility with spine experience — but even if you do, a refresher course is always helpful when starting a new specialty. "I had some team members here who had done spine, but it had been a while," Ms. Medley says. She says she depended on her relationship with other facilities in the region to provide spine training for her team.

Her teammates visited another SCA facility and observed some spine cases there, and they sent an experienced  team member to her surgery center to train and assist on the first spine cases.. You may have to hire a few nurses with spine experience if no one in your facility is familiar with the specialty.

6. Prove your worth to payors. Some payors may be hesitant to negotiate contracts for spine cases in the outpatient setting. However, Ms. Medley says SCA has helped her partnership negotiate for fair reimbursement for spine with many payors for spine procedures.

Negotiating carve-outs for spine is essential because implants are so expensive, so make sure you understand the costs of your implants for every case when going into the negotiation. It can also help to bring along a physician who can speak to the safety of the procedure in your facility. "You just have to show the payers your efficiencies, your low infection rate, and the other benefits you provide these patients," she says.

7. Ensure PACU bays are  availability for longer cases. When you're starting spine cases in your facility, make sure you have the room availability to keep patients in PACU after the procedures. "Some of the spine cases would be kept longer than other cases, so we had to make sure we had adequate nutrition available for the patients. We also wanted to ensure that we had a comfortable environment for the family members who are in our center for a few hours," Ms. Medley says.

Her spine surgeon currently has block time in the center every week, and she expects him to perform two to three cases a week once the facility is accustomed to the new procedures. She recommends starting spine cases early in the morning to ensure patients have enough time to recover.

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