The number of spinal fusions performed in ASCs is growing as more surgeons, patients and payers become comfortable with the procedure in the outpatient setting.
Eight points on spinal fusions and ASCs.
1. There are about 180 ASCs in the U.S. that offer minimally invasive spine surgery.
2. Medicare pays less for spine procedures in ASCs than hospital outpatient departments, but patient copay is often higher in the ASC. The total cost of posterior or posterolateral spinal fusion of lower spine bones in the ASC is $10,267, with Medicare paying $8,214 and patients paying $2,053 out of pocket. In the hospital outpatient department, the total cost of the procedure is $13,560 with Medicare paying $11,820 and patients paying $1,740. Click here to see the comparisons for other spine procedures.
3. Sg2, a healthcare intelligence and analytics company, predicts 88 percent of spinal decompressions and laminectomies and 67 percent of cervical spinal fusions will be performed in an outpatient setting by 2028. Overall, cervical fusions are projected to grow 20 percent from 2018 to 2028, while motion preservation is expected to jump 133 percent.
4. Beginning Jan. 1, CMS made changes for payment of multiple orthopedic and spine procedures, including Vertos Medical's minimally invasive lumbar spinal stenosis procedure. ASC reimbursement for Vertos' minimally invasive lumbar decompression procedure jumped 41 percent.
5. CMS began requiring preauthorization for cervical fusion with disc removal and implanted spinal neurostimulators in the ASC on Jan. 1.
6. Adding spine procedures to ASCs can have a positive financial impact on the center. National Medical Billing Services CEO Nader Samii outlined the advantages in a 2020 article. A multispecialty surgery center performing 300 cases per month with the average cash per case totaling $2,000 would generate $600,000 in revenue monthly and $7.2 million annually, he said.
Using a 20 percent EBITDA profit margin, the center would have $120,000 per month of EBITDA, or $1,440,000 annually. If that ASC added 15 lumbar fusions per month, a 5 percent increase in overall case volume, at an average cash per case of $20,000 and a 50 percent EBITDA margin, the ASC would have increased its overall revenue by 50 percent while more than doubling its profitability.
"Simply put, in this example, the ASC more than doubled its value by adding a small number of spinal fusions per month," Mr. Samii wrote.
7. The following spine procedures are among the 20 most common for Medicare-certified ASCs:
- Inject foramen epidural: lumbar, sacral: 4.6 percent of all procedures
- Inject paravertebral: lumbar, sacral: 3.4 percent of all procedures
- Injection spine; lumbar, sacral: 2.7 percent of all procedures
- Destroy lumbar/sacral facet joint: 1.7 percent of all procedures
- Injection procedure for sacroiliac joint, anesthetic: 1.4 percent of all procedures
- Inject paravertebral: cervical or thoracic: 1.1 percent of all procedures
- Inject spine, cervical or thoracic: 1 percent of all procedures
8. Some spine surgeons and centers are moving toward bundled payments.
"We started with Blue Shield and United and are rapidly adding more to our global billing strategy," Robert Bray Jr., MD, founder of DISC Sports & Spine Center in Newport Beach, Calif., recently told Becker's. "While this does entail some risk-sharing, it structures a known price without the hassles to us or the insurer of multiple codes. We have included the complete care, surgeon, assistant, the ASC and all aspects of the bill."