"One of the first things that a spine surgeon should do is conceptually define their current practice in the ASC," says Marcus Williamson, president of the spine division of Symbion Health Care. "He or she must think of the ASC as an extension of their practice."
Here, Mr. Williamson discusses what surgeons should know before taking the leap from inpatient settings to the outpatient setting for patients who qualify.
Moving forwardBefore spine surgeons make a definitive decision about taking cases into a surgery center, Mr. Williamson suggests they visualize how their practice will change and decide whether the transition would work for them. He categorizes several changes as "Inside the House" or "Outside the House" — the house being the surgical environment — and asks surgeons to conceptualize what their best days would look like.
"Inside the House" factors include:
• Room turnover
• Implant costs and utilization
• What supply shelves look like
• Patient outcomes
• Optimal reimbursement, with the right exclusions and implant parameters
• Personnel needed for the business office
• Billing and collections staff
• Case types which will migrate soon to a 23 hour (overnight discharge) stay
"Outside the House" factors include three equally important groups:
• Development of vendor relationships
• Development of a cross-pollinated network
• Commitment to an introduction educational series
While "Inside the House" factors are relatively straight forward, there are several steps surgeons must take for success with the "Outside the House" factors. These should be considered carefully as they move forward.
Vendor relationshipsCarefully choose which vendors to form the strongest relationships with as you transition cases into an ASC. There may be five main implant vendors occupying the outpatient spine space, but it would benefit you to trim your preferences down to two. "Create a loyalty to one or two vendors to help with pricing," says Mr. Williamson. "As you look at the cost of the implants, for you and your patients' out-of-pocket expense, you want to work exclusively with fewer than three vendors for surgical cases.
Vendors can also help introduce spine surgeons into the market. "If they have a cervical fusion product, implant or cement, they can co-brand the device with you, which helps you make an introduction into that market," says Mr. Williamson. There are three types of outside-the-house arenas surgeons focus on as they break through into the market:
• Direct-to-physician — vendors can help coordinate meetings or lab that physicians receive educational credits because vendors have the CEU designation for diagnosing and treating conditions.
• Direct-to-patient — vendors can co-brand the surgeon's name with their marketing materials for direct-to-consumer efforts.
• Direct to health plan — vendors can work with you to present information about procedures and technology used during spine surgery for better coverage and the patient's utilization of benefits in the surgery center setting.
Cross-pollinated networkThere are some pretty strong loyalties within a group of orthopedic, spine, neurosurgery and pain management physicians, and all of these physicians are potential referral sources. For example, if a patient shows up at an orthopedic surgeon's office with leg pain but their problem stems from spine issues, the orthopedic surgeon can refer these patients to local spine or neurosurgeons in their area.
"Once the referral occurs, physicians have a relationship with each other," says Mr. Williamson. "We are learning that networking is what the future of healthcare is all about. Independent physician groups are identifying specialists to help them contend for larger managed care contracts and cost controls."
After the initial relationship is formed from one referral, the physicians begin to become familiar with each other and tend to stay within their networks for referring patients as much as possible. "There has to be a champion to make sure the loyalty within the network is maintained; it's a quid pro quo system," says Mr. Williamson. "Networks are the future, and practice administrators can assist their physicians with that."
Introduction educational seriesPhysicians are the experts at performing spine surgery, so they must impart their expertise to the other crucial members of the healthcare system: patients, health plans and referring physicians. Meet with these groups and give them educational presentations to bring them on-board with performing cases in a surgery center.
In meetings with referring physicians, bring along vendors and anesthesiologists to reassure physicians that every aspect of care is provided. In discussions with health plans, bring in the business office manager for the best results. The business officer should invite several key people to the meeting:
• Medical director of the orthopedic and spine services of the health plan
• Clinical compliance representative from the health plan
• Billing and revenue department lead
• Local managed care or provider relations representative
It's necessary for all of these people to attend the meeting. "Set up meetings with the local provider relations representatives for each of the large health plans and have a presentation prepared in paper or power point," says Mr. Williamson. "It's educational in terms of what happens during the case, with regard to the conditions and outcomes you achieve with surgery. At the same time, it's an introduction of what you plan to do and what your planned outcomes are."
Additionally, surgeons should present a comparison of the cost-to-charge ration of the average reimbursement in their markets for hospitals and surgery centers. "You want to do a comparison of average reimbursement in that market and you want to really focus on all of the proprietary instruments that are used in a case and their costs," says Mr. Williamson. "The focus on variable cost can make or break your contract with that certain health plan."
At the end of the presentation, it helps to get real pictures and comments from patients to represent the human element of your practice. "The patients make it real for the people viewing your presentation," says Mr. Williamson.
Physician gut checkWhile it's tempting to make your decision about investing in a surgery center based on the extra revenue it could generate, surgeons must place more importance on patient care to really succeed. "It's a mistake to just think about how much money you'll be making," says Mr. Williamson. "Focus on the type of staff you are willing to acquire; focus on the referring physicians you'll attract. Conceptualize your practice."
As they spend time in the surgery center, physicians will need to monitor their outcomes in the outpatient setting. Mr. Williamson says 50 percent of their focus should be on their ability to promote their own outcomes, while the other 50 percent is on risk management. A few of the metrics to monitor for patient outcomes include:
• Surgery time
• Amount of prescription drugs patients are on before the surgery
• Blood loss during surgery
• Surgical recovery
• Return to work time
Many surgeons find benefits in bringing on a corporate partner or entity to help them cross the bridge from concept to reality. "The corporate partner should have success rates, success stories and physicians you can talk to about their experience of developing market entry strategies," says Mr. Williamson. "Tap into those resources and you'll have an easier transition."
More Articles on Spine Surgery:
6 Steps to Prepare for the Future of Outpatient Spine Surgery
The Making of a Minimally Invasive Spine Institute: Q&A With Dr. Frank Phillips of Midwest Orthopaedics at Rush
5 Points on Benefits & Challenges of Spine and Neurosurgeon Partnerships