5 Keys to Success With Spine Surgery in ASCsWritten by Laura Miller | February 10, 2012
Here are 5 keys to success with spine surgery in an outpatient surgery center.
1. Invest in a spine-focused medical team. In many surgery centers, the surgical technicians, nurses, anesthesiologists and other team members are familiar with the existing procedures and work efficiently with those cases. However, even the most experienced staff members may have difficulty adding spine into the mix. "You have to be cautious not to outstrip your staff's capabilities," says Dan Beuerlein, regional vice president of operations at Symbion Healthcare. "You might not have the right talent at the center to accommodate a far more aggressive and complicated specialty like spine." If the staff members aren't experienced with spine surgery, consider investing in nurses, physicians' assistants, anesthesiologists and radiologists with training in spine surgery to assist the surgeon.
2. Select the right cases to perform 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. Dr. Naraghi 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.
"Tough cases should always be in the hospital," says Chris Zorn, vice president of sales for Spine Surgical Innovation and executive director of Minimal Incision-Maximum Sight (MIMS) Institute. "Don't risk and complicate your practice and reputation."
Fred Naraghi, MD, director of the Comprehensive Spine Center in San Francisco, follows this rule: "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."
3. Have site-specific pain management available. It's important to have spine-appropriate pain management tools available to you in the ASC, which includes anesthesiologists who are experienced with spine cases. Dr. Naraghi typically has a facet block and a median branch block performed to the level of surgery and the level above the surgery. He also recommends being generous with the anesthetics so the patient will be able to tolerate the pain. "Using these techniques gives the surgeon good pain control so the patient is able to return home as quickly as possible," he says.
4. Contracts with payors must address implant costs. Just as with orthopedic cases, considering implant costs are critical to profitable spine cases. In fact, they may even be more important for spine cases because implant costs typically run higher with spine — as much as $2,000-$5,000 per case — than in traditional orthopedic cases, says Jay Rom, president of Blue Chip Surgical Center Partners.
Mr. Rom says spine cases must be carved out or the case rate must be built to assume implant costs. Since implant costs can vary from physician to physician — sometimes by as much as $3,000 — rates must also cover the most expensive physician, he says.
"While we do a lot of work trying to minimize cost differences, there are practice differences that are going to exist. Some physicians are trained with different materials that just cost more," says Mr. Rom.
5. Regularly assess and audit the QI program. A strong quality and infection control program should include regular audits and assessments to make sure staff members are following protocol. These assessments could include appointing someone to watch staff members while they complete their handwashing routine to see who is following the rules and who isn't. The center should also complete audits on the night cleaning crew. Create a checklist for the night staff so they know their part in your center's infection prevention program. Complete surgery center annual assessments are also necessary and can help you identify new and different problems at the center.
"Take a look around and make sure there aren't any issues with facility design or flaws in the process and protocols that contribute to infection," says Valerie Maxam-Moore, RN, MN, Vice President, ASC Operations & Quality at Laser Spine Institute. Once the audits are complete, share them with the staff. "You can't just do the audits and assessments and keep them to yourself. You have to report the results to the leadership team and staff, and challenge them to improve."
Related Articles on Spine Surgery:
Dr. Frank Cammisa: 8 Top Challenges for Spine Surgeons This Year
5 Trends Impacting Outpatient Spine in 2012: Thoughts From Dr. Thomas Schuler
7 Top Concerns for Spine Surgeons in 2012
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