Here are five coding and documentation tips for spine surgeons to optimize reimbursements.

Executive Vice President Global Marketing of spine device company LDR Joe Ross discusses the non-fusion cervical spine surgery market and where technology is headed in the future.

Spine surgery is increasingly moving into the outpatient setting, which can provide both quality and cost benefits. After the surgeon has learned minimally invasive technique, here are five tips to begin bringing cases into the outpatient setting.

Here are five thoughts on managing online presence for a spine surgeon.

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1. Make sure your website or profile is first in SEO. When patients conduct a search on your name, practice or hospital, you want them to see your website or profile first instead of physician rating websites such as HealthGrades or Rate MDs. This way, patients are more likely to look at the information you've put forth about yourself, such as your accomplishments or professional interests, before clicking on these outside sources. Work with a web manager who is skilled in search engine optimization to provide regular updates on your site, says Bill Rabourn, founder and managing principal of Medical Consulting Group. These updates could include press releases or cross-posting of content such as video from sites like YouTube.

1. Focus on a professional look for your practice website. It's very important to have a professional-looking website that is up-to-date, user friendly and talks about your practice and what you have to offer. "You have to differentiate your practice from other physicians," says Bryan Oh, MD, a neurosurgeon who focuses on spine surgery with BASIC Spine in Orange, Calif. "Have patient testimonials on your website and new technology you use. People have been very impressed with my website and they felt because it looked like it was technologically advanced it reflected how I think about my practice. It’s much more important than some surgeons think. I’ve had multiple patients tell me how much they liked our website."

2. Ask patients to give feedback on rating websites. Google yourself and you'll likely see those stars that are popping up under HealthGrades, Ucompare, and other physician directory sites. They reflect the opinions of whoever decided to rate you, for better or worse. "You need to start asking your patients to rate you on these sites," says Dick Pepper, a medical marketing specialist who blogs at VoxMD.com. "They matter more and more every day and are perceived to be quality. Check sites like Yelp and other free directories. Do NOT spend money on a paid version of Reputation.com or other reputation 'management' sites. They do not provide the value you think they do. The free version is great, and gives you a heads up on a situation, but the easiest way is to Google yourself and check yourself on Bing. That's what 90 percent of all people looking you up will see. It's easy to fix. Check with your medical marketing specialist for more information."

4. Dominate your presence through positive press. One way to take control of your online reputation is through creating regular news releases or updates on your practice or procedures. Compose new releases on new or "revolutionary" procedures you are performing, an upcoming event at your practice or a particularly heartening surgery you performed. Patients are able to connect with the human interest stories, and having them regularly appear on the Internet will increase your credibility. "Consumers often assume providers that advertise are more qualified simply by virtue of the fact that they advertise," says Daniel Weinbach, executive vice president of The Weinbach Group, a healthcare marketing firm. You can also lend your expertise to a news publication that prints online. If you ask somebody about how they heard about you or who referred them, if it isn't traced back to word-of-mouth marketing it can often be a well-placed article online or in a magazine.

5. Expand your presence with educational platforms. There is a huge opportunity for spine surgeons to expand their online presence with general patient education efforts. "I think the internet is going to be the next wave for spine care," says Donald Corenman, MD, a spine surgeon with The Steadman Clinic in Vail, Colo. "Patients are coming into the office having significant fear and not understanding anything about spine surgery, and they are hungry for knowledge. Unfortunately, there is not a lot of education in typical spine offices, and that's where I think the internet is really going to shine."

Dr. Corenman has a website that includes a forum where anyone can ask general questions about spinal conditions and he answers to the best of his ability. One common problem is patients receiving different diagnoses and treatment recommendations from multiple spine surgeons and specialists; he tries to help patients sort through this information and find the right pathway to care.

"There is a significant lack of continuity for different problems," says Dr. Corenman. "When I'm interacting with them online, I'm not practicing medicine, it's purely education. When you can gain accurate and succinct education, it makes patients more confident and empowers them in their own decisions."

Dr. Corenman receives two to seven questions per day on his forum and spends around an hour answer the questions daily. He also writes articles for the website and uploads videos of procedures. He has nearly 40 videos on his YouTube site, which receives about 100,000 hits per month. While the website has gained traction, it takes significant time and effort to maintain.

"It's still uncommon for surgeons to have a vast online presence," says Dr. Corenman. "The problem is that it takes a tremendous amount of time to write these things and an understanding of how patients think so you can write in a way they will understand. Even though there are a lot of plug in sites where you can purchase information and publish it on your webpage, it might not be accurate or accessible to patients. It behooves you to write that information yourself."

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This is a list of 35 ambulatory surgery centers that exclusively or primarily host spinal procedures. Please contact Laura Miller at This e-mail address is being protected from spambots. You need JavaScript enabled to view it for questions, comments or updates for this list.

Lawrence Dickinson, MD, an neurosurgeon with Pacific Brain & Spine Medical Group in Castro Valley, Calif., discusses minimally invasive spine surgery and where he sees the field heading in the future.

Here are five ways spine surgeons and practices can stay on the cutting edge.

Here are five efficient and effective ways for spine practices to increase patient volume.

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1. Use marketing tools to brand your practice. Surgeons must market their private practices to drive patient volume and promote brand recognition. Khawar Siddique, MD, a fellowship-trained spine surgeon with Beverly Hills Spine Surgery in California, says it's important for practices to have a moniker that reflects their commitment to high level care, which is why his group decided to practice under the name "Beverly Hills Spine Surgery."

"Beverly Hills denotes a quality of care," says Dr. Siddique. "The name of your corporation should tell patients about the level of care you provide; such as Premier Spine Surgeons, Inc."

Focus on any aspects that make your group special in your marketing efforts. For example, if your group includes all fellowship-trained spine surgeons, tout your expertise to show you are a quality organization.

2. Develop an internet strategy. Online space can bring in new patients to the practice and provide additional information for patients who are referred by friends or primary care physicians.

"I think clearly the internet is going to be front and center in terms of driving patients into the practice," says Bryan Oh, MD, a neurosurgeon who focuses on spine surgery with BASIC Spine in Orange, Calif. "You can still go out and shake the hands of primary care physicians, but I think the Internet is the new frontier in terms of marketing practices and bringing patients in. We work with a practice management group to help us be more successful. I’ve gone from a practice of zero to a full clinic in almost nine months and I attribute this to Internet marketing."

If you are out there with targeted ads and other internet marketing, whoever is doing your marketing campaign should be able to give you concrete data about how many hits your website gets and what your conversion rates are. They can also tell you the patient demographics who are clicking through. If you are spending those marketing dollars, you need to make sure it’s translating into a good return for you.

3. Become involved with community events. Since it is important for a spine center to have patients and make a profit, external marketing is necessary. One method is to gain exposure for the practicing physicians.

"Consider what organizations or societies in your community physicians should be involved with. Organizations like the chamber of commerce or non-profits," says Stephen Hochschuler, MD, founder of Texas Back Institute in Plano. "Look into areas of children education, sports and disadvantaged individuals. You have to keep your eye on everything."

Physicians that become involved with community groups may not only meet potential patients but also other physicians who could drive patient volume through referrals. Relationships are integral for acquiring patient referrals and driving patient volume whether those relationships are community or medical based.

4. Go beyond clinical excellence. Success for your business in a competitive market depends upon differentiating you product from others on the shelf. The same rings true for orthopedic practices. When launching their practice, the original Rothman partners were keenly aware of this concept. "In order to be a sustained leader in our market, we had to differentiate ourselves," says Alexander Vaccaro, MD, PhD, a spine surgeon and one of the founding partners of Rothman Institute. "Instead of just being the best surgeons clinically, we had three additional criteria our partners strove to meet: we had to be clinically productive, a good citizen and active in academic work."

Maintaining clinical productivity meant the surgeons were seeing an appropriate patient volume and optimizing their time; being a good citizen meant respecting all employees, being a team player and contributing to the positive culture at the practice; having a focus on academics meant the surgeons were also required to research and write papers, deliver lectures at professional meetings and participate in community events such as sitting on the sidelines at youth sporting activities.

"You can't just be a productive orthopedic surgeon because everyone does that, and their practices can still fail," says Dr. Vaccaro. "If you give back to the community and participate academically, that's different."

5. Add new specialists or services. Bringing on pain management physicians and other back pain specialists can increase patient flow to the practice. At The Southeastern Spine Institute, physicians do more than 1,000 injections and rhzotomies per month. Overall, the pain management physicians have performed spinal cord stimulator implantations for 7,000 patients since joining the practice.

The increased patient flow means additional revenue, and if the patients reach a point where non-operative care isn't effective, they will use your surgical services as well.

"It's convenient because we are in the same building, so the surgeons will send patients to the pain management physicians, but it's also not unusual for pain management physicians to send us their patients who have developed more complex problems, such as disc degeneration," says Don Johnson, MD, medical director at Southeastern Spine Institute. "When their patients have a new trauma, I get a call from the pain management physician saying they have a patient they need the surgeon to see right away. We can deal with those patients here as well, so it's not a one-way referral street."

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The Food and Drug Administration granted 22 spine-related 510(k) clearances in February.

Growth is an important aspect of any surgery center's strategic plan, whether they are looking to replace a retiring surgeon or bring more cases into the facility. It's important to understand your long term goals when recruiting new physicians, and bring on the right surgeons for your center, says Gary Brazina, MD, a board-certified orthopedic surgeon at DISC Sports & Spine Center.