• Minimized blood loss;
• Less muscle and tissue disruption;
• Shortened hospital stays;
• Reduced recovery period.
2. Higher patient satisfaction. The key to making minimally invasive outpatient spine surgery more pervasive is touting a superior patient experience, says Walter Eckman, MD, founder of Aurora Spine Center in Tupelu, Miss. Citing data that shows patients are able to go home and become active the day after surgery; are less likely to have infections; and return to work more quickly with minimally invasive procedures is a good place to start. He encourages surgeons who have good outcomes for outpatient spine surgery to present and publish their outcomes data, and eventually transition their patients to an ASC. If payors and patients see they can have a better outcome with safe outpatient procedures than with traditional open procedures, they will begin to reimburse better and encourage the move.
"We have to convince people there will be a better patient experience with outpatient spine surgery," says Dr. Eckman. "I like to share my story to convince other surgeons to employ the minimally invasive technique. All I do is minimally invasive surgery in a small market, but I still have a good practice. It would be harder to survive if I didn't have this special capability. My situation is a bit of an inspiration for people who really want to do this and carve out a niche for themselves; it shows you what can be done."
3. Lower associated costs. There is a perception that minimally invasive procedures are more expensive and there is no incremental advantage to doing them; people think the money is not well spent. "I've spent a lot of energy looking at the economics and value provided by spinal surgery," says Frank Phillips, MD, director of the section of minimally invasive spine surgery at Rush University Medical Center and a founding member of the Minimally Invasive Spine Institute at Rush. "We recently looked at some of these parameters and presented them at the International Society for the Advancement of Spine Surgery annual meeting. "Our research showed that the costs related to minimally invasive surgery for the hospital is less than for open surgeries because the hospital stay is shorter, there are fewer ICU stays and fewer blood transfusions. With all these factors combined, there is a considerable savings to the hospital. Those are the kinds of studies and outcomes that become important in today's healthcare environment."
4. Surgeons can perform some procedures in outpatient ambulatory surgery centers. Spine surgery is a high acuity, low volume subspecialty for a surgery center, which can be a great business model when done appropriately, says Robert S. Bray, Jr., MD, neurosurgeon and CEO of DISC Sports & Spine Center in Marina del Rey, Calif. However, once you are able to perform spine cases, consider bringing on other specialists who perform high acuity cases, such as partial knee replacements, hip scopes and shoulder reconstructions.
"We are adding high acuity, love volume cases, which bring our centers higher revenue," says Dr. Bray. We are able to perform complex cases and deliver better outcomes than in other settings because the complication and infection rate is lower."
5. Elevates exposure in the community. Minimally invasive techniques increase your exposure inside and outside your community. If you can build a level of expertise where you become a respected minimally invasive surgeon, you may become involved in a variety of activities that increase your exposure.
"You can receive a teaching affiliation which could really get your name out there. If potential patients research you and see you teach courses at a local university or medical school, and that you are instructing other physicians regularly, they would have more assurance that you are skilled in those techniques," says Dr. Massoud. "That is how a teaching affiliation becomes valuable for patient referrals."
However, adding these cases to a multi-specialty surgery center that usually does low acuity cases requires significant investment of resources. You'll need to purchase additional equipment and revise your payor mix before adding high acuity cases.
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