Optimizing discectomies in the ASC: How a novel device can help

Enormous changes are taking place at ambulatory surgery centers (ASCs). The orthopedic procedures landscape is transitioning to outpatient at an unstoppable pace and ASCs are working to improve the value of the care they deliver while containing costs.

During Becker's ASC Review and Becker's Spine Review 19th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference, in a workshop sponsored by Barricaid, two healthcare professionals discussed a new approach to performing discectomies that minimizes the risk of reherniation and improves ASC efficiency. Panelists were:

  • Betsy Grunch, MD, Neurosurgeon, Longstreet Clinic in Gainesville, GA
  • Janet Carlson, MSN, BSN, RN, President, Best Health System in Cincinnati, OH

Four key insights discussed:

  1. Discectomies are one of the highest-volume spine procedures performed in an ASC. With more than 400,000 discectomies annually — a number that exceeds spinal fusions — discectomies can be a major revenue stream for ASCs. However, many discectomy patients run the risk of reherniation, which is correlated with the size of the annular defect left in the disc post-surgery. "If you have a large annular defect, the risk of reherniation is up to 25 percent," Dr. Grunch said. 

Patients who experience reherniation may require a reoperation, for which there are essentially three choices: revision microdiscectomy,  total disc replacement (TDR), or fusion. Studies show that avoiding reoperation is the best possible outcome for patients.

  1. Annular closure devices substantially reduce the risk of needing a reoperation. To reduce the risks of reherniation and reoperation, physicians can consider the use of devices that are implanted into the annular defect to close the hole and stabilize the discectomy. Although previous companies tried and failed to create annular closure devices, Barricaid is the only FDA-approved device on the market today. As part of Barricaid’s PMA, a 554 patient RCT was completed proving the reduction of reoperations. Evidence of its effectiveness in reducing the need for reoperation by up to 81 percent has been published in seven studies. "I've tried some other annular closure devices, but Barricaid has definitely been a tremendous asset to my practice," Dr. Grunch said.
  1. Barricaid is ideally suited for the ASC setting. Using a minimally invasive technology such as Barricaid allows ASCs to instantly differentiate themselves in the market, since a majority of patients prefer such procedures. As far as operating expenses, it is a simple four-step surgery that only uses one tray and can be performed in a flip room to maximize surgeon efficiency, has minimal start-up expenses, and requires no extensive training for staff.

"It basically takes a lunch or a breakfast in the break room with your team to explain this to everybody and it is very easy to adopt," Ms. Carlson said. "And as a PACU nurse, I love the fact that it has a short recovery time."

  1. There is a reimbursement pathway for ASCs with device-intensive status. The Barricaid procedure is considered a device-intensive procedure and is reimbursable under a newly created CMS HCPCS code C9757, with an average national Medicare reimbursement of $7,830. This sets the stage for ASCs setting up managed care contracts with commercial payers, improving cost containment and — due to the fast recovery properties of the device — initiating worker compensation and direct-to-employer discussions. 

"It's a triple win: a win for the patients, a win for the company and a win for [ASCs] operationally," Ms. Carlson said.

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