Drs. Richard Kube & David Rothbart: 3 Key Considerations for the Transition of Spine to ASCs

At the 11th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference on June 13, Richard Kube, MD, chief of executive officer, founder and owner of Prairie Spine & Pain Institute; and David Rothbart, MD, medical director of Spine Team Texas, discussed core business and clinical issues involved in moving spine procedures to the ambulatory surgery center setting. Jeff Leland, chief executive officer of Blue Chip Surgical Center Partners, moderated the presentation, "Moving Spine Procedures to ASCs – Key Business and Clinical Issues."

1. Trends driving outpatient spine
. The progression of technology and technique is the main force making the shift from the inpatient setting to the outpatient setting in spine possible. Cost in the outpatient setting is huge; ambulatory surgery centers offer a time and cost effective alternative to hospitals. Minimally invasive procedures are shaping the way spine is practiced. "Patient expectations play a huge role. If you tell a patient they will get up sooner and easier, the impact is huge," said Dr. Kube. Spine surgeons can offer patients minimally invasive surgeries that promise less collateral damage to tissue and therefore less pain and a quicker recovery. "Minimally invasive procedures lend themselves to the outpatient setting, because of there is less postoperative discomfort," said Dr. Rothbart.

2. Transitioning inpatient cases to the outpatient setting. Many spine procedures are being performed on an outpatient basis, but the key is to choose procedures that can be easily done and result in a quick patient recovery. Procedures, such as lumbar fusion, can result in more than a 23-hour stay. Ambulatory surgery centers should be prepared by having overnight capabilities or an agreement with a facility that does. Be aware of a patient's history and know whether or not they will be a likely to require a longer stay. "Do not place yourself at risk. You take your time and get comfortable with the number of procedures you are doing in a day. Feel confident that patients will be able to go home that day," said Dr. Kube.

"The business side is just as important as the clinical," said Mr. Leland. "You need to get key strategic partners. It is hard to be a small, independent ASC. You need a partner that knows the system and can negotiate," said Dr. Rothbart. Forming relationships with the decision-making entities can be difficult, but necessary. Strategic relationships help to build those connections.

3. Recruiting spine surgeons for ASCs. Spine surgeons that will do well in the outpatient setting and continue to facilitate the transition of the field either were trained in minimally invasive techniques during their fellowship or are open-minded and willing to learn the new techniques. "ASCs offer surgeons the opportunity for control, independence, return on investment and the opportunity to create wealth," said Mr. Leland.

It is often difficult to recruit surgeons that will perform procedures at a surgery center without investment playing a role. "I want a surgeon to be a owner in my center. It is helpful if everyone's goals and compensation models are aligned. Everyone needs to have a concept of risk, efficiency and cost. I want them to have a stake in the game, like I do," said Dr. Kube.

More Articles on ASC Issues:
Recruiting Orthopedic Surgeons: 3 Key Talking Points
8 ASC Accreditation Pitfalls & Their Solutions
Applying SCOPE Method for Improving Interventional Pain Management at ASC

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