How an orthopedics-focused ASC corralled implant issues & makes big spine surgeries cost-effective

DISC Sports & Spine has two ambulatory surgery centers — one in Marina del Rey and the other in Newport Beach, Calif. — and both centers are thriving due to a dedicated team of medical specialists constantly looking for opportunities to improve. The centers are a joint venture between the physician owners of DISC and Surgical Care Affiliates.

Keeping spine cost-effective
Spine surgery is the most profitable and cost-effective procedure at the surgery center, but it isn't the most efficient. Spine procedures take longer and require more diligent preparation and organization. The potential risk is heightened, so surgical teams are paying extra attention setting up these cases.

"The challenge with making these cases profitable is managing the costs and non-billable costs," says Karen Reiter, COO of DISC Sports & Spine. "If there are higher acuity cases, there are a lot of associated costs insurance companies don't take into account, like neuro-monitoring or overnight care. Biologics are also an issue since they aren't the actual implant so some contracts don't cover them. You have to manage those costs because they are necessary for the case."

Spine-focused centers are now seeing higher acuity cases, which increases the potential patient pool. Technology has evolved to make it possible for surgeons to safely perform bigger cases outpatient, and perform surgery for patients with more comorbidities than in the past.

"Implants and techniques are progressing in spine, and spine fellowships are emphasizing more and more minimally invasive procedures," says Ms. Reiter. "It used to be all complex spine was multilevel fusions. Now we are seeing hybrid procedures which are exciting."

Eliminating implant workflow issues
The biggest workflow issue for the DISC Sports & Spine surgery centers is managing implants and the process of ordering and receiving those trays. The surgery center focuses on implant-heavy orthopedic and spine procedures. It's crucial for the administrative staff to know what implants are coming in, the number of trays arriving at the center, processing new equipment and ensuring the right implants for the right case are at the center.

DISC surgery centers recently implemented a new automated system for ordering and managing implants and adding company representatives. Before automating the system, the staff would order trays and process them, but sometimes a company rep would bring in different materials or implants that weren't originally approved for that case.

"The automated system now allows us to order the implant trays and the company representatives aren't allowed to bring in additional items without having all the information on file," says Ms. Reiter. "The implant representatives need to have their credentials in our system and if a new person comes, we need the paperwork in place. Our system prints out a badge for anyone in our facility and that's a way we can make sure only the approved materials and reps are entering our facility."

The automated system allows for better materials tracking as well as for inventory.

Efficient scheduling
The surgery center is also implementing workflow technology for scheduling at the ASC.

"We have a surgery scheduling platform that the scheduler can fill in electronically with the patient's information and then the patient gets an email to confirm their appointment," says Ms. Reiter. "The preoperative education is sent to them in an attachment so we know every patient receives the information when they confirm. We can track if the patient opens those documents so we know if they really have that information."

There is also an online tool for patients to complete their medical history before the day of surgery.

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