10 things to know about spine surgery in ASCs for 2019

Here are 10 key facts and studies on outpatient spine surgery and spine procedures in ASCs:

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1. Over 145 ASCs in the U.S. offer minimally invasive spine surgery.

2. Around 90 percent of patients who underwent anterior cervical discectomy and fusion at an ASC consumed less than or equal to the 30th percentile of oral morphine equivalents, compared to 57 percent of hospital patients. Additionally, hospital patients consumed greater average doses of fentanyl and oxycodone.

3. A study published in Military Medicine examined the return-to-duty rates for military patients who underwent minimally invasive spine surgery in an ASC. All of the participants returned to duty three months postoperatively. Patients experienced a significant reduction in self-reported pain and disability 12 months postoperatively.

4. As more spine surgeries transition to the outpatient setting, surgeons and researchers continue to study the cost differences between inpatient and outpatient procedures. After examining the national administrative data, researchers found more modest cost savings for outpatient spine surgery over inpatient spine surgery.

5. A study published in Spine investigated the adverse event profile of cervical total disc replacements performed in the outpatient versus inpatient setting. Study authors found no difference in perioperative complications between the inpatient and outpatient CTDRs.

6. Research published in Neurosurgery found outpatient spine procedures are just as safe as — or safer than — procedures performed in an inpatient setting.

7. CMS released a new tool allowing patients to compare the average payment of select orthopedic and spine procedures in hospital outpatient departments and ASCs.

A few examples on reimbursement for spine procedures:

Total disc arthroplasty with discectomy (22856)
ASC:
• Average Medicare pays: $8,970
• Average total cost: $11,213
• Amount patient pays on average: $2,243

HOPD:
• Average Medicare pays: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340

Sacroiliac joint fusion (27279)
ASC:
• Average Medicare pays: $9,965
• Average total cost: $12,456
• Amount patient pays on average: $2,491

HOPD:
• Average Medicare pays: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340

Anterior cervical discectomy (22551)
ASC:
• Average Medicare pays: $5,870
• Average total cost: $7,337
• Amount patient pays on average: $1,467

HOPD:
• Average Medicare pays: $8,783
• Average total cost: $10,123
• Amount patient pays on average: $1,340

8. Baptist Medical Park Surgery Center, an ASC located in Pensacola, Fla., is the first surgery center in the Southeast to purchase Mazor Robotics' Renaissance System. Mark Giovanini, MD, a surgeon who is using the Mazor Robotics' Renaissance System for all SI fusions procedures, said the technology provides patients with the full advantages of spinal surgery with the convenience of an outpatient facility.

9. Bill Stewart, area vice president of value-based purchasing of DePuy Synthes, a Johnson & Johnson company, said spine is a specialty to watch in ASCs.

"What we've seen with spine is that surgical procedures that are migrating outpatient, typically one- to three-level ACDF and discectomy, are moving outpatient. But lumbar spine is much slower to move outpatient. What we've seen with lumbar spine is a small number of sites are doing it. A lot of that is because it's capital intensive to do lumbar spine," he said at Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs in Chicago Oct. 18, 2018.

10. Anterior cervical discectomy and fusions are safe in the outpatient setting for properly selected patients, according to new research from the New York City-based Hospital for Special Surgery presented at the American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas.
https://www.beckersasc.com/outpatient-spine/spinal-fusions-safe-in-the-outpatient-setting-study-finds-3-details.html

"The results suggest that multi-level ACDF can be performed safely in the outpatient setting without an increased risk of complications in appropriately selected patients," said Hospital for Special Surgery surgeon Sheeraz Qureshi, MD. "Specifically, the patient's age, additional health conditions and number of levels being fused should be taken into consideration when deciding whether to perform multi-level ACDF in an outpatient setting."

More articles on outpatient spine:
Full-endoscopic laser spine techniques effective for back pain patients treated in ASCs: 3 study details
Spinal fusions safe in the outpatient setting, study finds: 3 details
App-users less likely to cancel outpatient & inpatient spine surgeries — 5 study insights

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