5 Keys to Success for Spine-Focused ASCs

Here are five key concepts for success with spine-driven surgery centers.

1. Select the right patients for success in the ASC. Selecting the appropriate patient for spine surgery in the ASC is crucial for optimizing your success rate. Patients who have comorbidities, such as cardiac problems, shouldn't be brought to the ASC. Fred Naraghi, MD, director of the Comprehensive Spine Center in San Francisco, also steers patients with a body mass index of more than 30 or a significant dependence on pain medication (taking more than eight narcotics per day) to the hospital setting. These patients are at a higher risk for complications, so it's too risky to perform their surgeries in an ASC.

"For every case it is different, but as a rule I tend to have lower risk patients for outpatient spine surgeries," says Dr. Naraghi. "An important part of that is pain management for the patient. If the patient has a high pain management requirement, I would be very careful about doing those procedures as outpatient procedures because controlling the pain is going to be hard."

2. Do big cases later in the day. During his years in practice, Alan Villavicencio, MD, of Boulder Neurological & Spine Associates, found that it works better to perform the bigger cases later in the day so patients who need 23 hour stays can spend the night without having to leave the center in the early hours of the morning. "We used to do the big cases in the morning and smaller cases later, but we found that if a patient checks in at 6 am, you have to have them out the door by 5:59 am the next morning," he said. "Rolling patients out at that time isn't so good, so we reversed it; the big cases are performed later in the day and smaller cases are performed in the morning."

3. Track procedure times and make sure surgeons follow them. When surgeons schedule cases for an hour, but they are constantly taking one hour and 40 minutes to perform their cases, you must be prepared for delays, says Larry Teuber, MD, chief medical officer and president of Medical Facilities Corporation and founder and physician executive of Black Hills Surgery Center.

"Continually track the time it takes surgeons to perform procedures," says Dr. Teuber. "Typically it takes a certain length of time and if the surgeon schedules it for less, that's inefficient. Surgeons will seldom schedule their cases for longer than it typically takes, but you have to make sure the schedule reflects the actual time it takes them to do the procedure."

For example, if an ACL repair usually takes 45 minutes, surgeons might schedule a case for 30 minutes because they are optimistic. Most surgeons predict they will need less time for a procedure because they don't foresee complications; however, statistics say complications occur.

4. Using more disposables can save money on supplies long-term. "Some countries want you to do everything disposable," says Chris Zorn, vice president of sales at Spine Surgical Innovation. "Since the pressure is on everybody to deliver more for less, switching your capital investment into a disposable method makes a lot of sense. The problem is that disposables are still outrageously priced in the U.S."

5. Manage employee benefits and compensation. ASCs should consider offering wellness programs and consumer-directed health plans combined with a health savings account or health reimbursement arrangement to reduce the cost of employee benefits, according to Thomas H. Jacobs, president and CEO of MedHQ. The Ambulatory Surgery Center Association's salary survey is a good starting point for determining employees' compensation, Mr. Jacobs said. ASC administrators can then develop point factors, in which employees receive points for their performance in certain areas, and these points translate to a salary range.

Related Articles on Spine Surgery:

Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery

6 Reimbursement and Business Concepts for Spine in ASCs

8 Design Specifics for Development of Spine Surgery Centers

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