Performing complex spine surgeries in an ASC provides both financial and quality of care benefits to the facility, its surgeons and, most importantly, to its patients. ASCs offer flexibility of scheduling, on-time starts, low infection rates, reduced costs and high overall satisfaction with patient outcomes. Hospitals who partner with ASCs are able to decompress their OR schedules when these highly technical elective surgeries are performed in the ASC setting. Here are five essential business considerations for performing complex spine surgeries in an ASC.
1. Facility capability
Complex spinal surgeries are technically difficult. While these procedures allow an ASC an opportunity to recruit new, highly skilled surgeons, they also present some facility considerations. Review the clinical strengths of your staff members and their prior exposure to spine cases. If they are not familiar with spine surgeries, ensure they are willing to learn and want to be involved in these highly technical procedures. Is your anesthesia support up to the challenge of handling these types of procedures? Review your safety procedures and critically assess your facility's capability to handle unexpected admissions and pain control. Do you have a transfer agreement in place with a nearby hospital? Can you handle blood transfusions? Assess your facility offerings. Do you have overnight observation? Do you have the staffing, space and licenses necessary to capably handle extended stays?
2. Initial capital costs
Adding complex spine surgeries to an ASC's offerings requires an investment into new equipment and instrumentation. Assess your current inventory and talk to the spine surgeons about what you will need to purchase. Because equipment is a capital investment, you must consider how many cases will have to be performed to pay off the purchases. If you have new surgeons in your ASC who need to build their practice, it may take longer for the forecasted payoff to occur.
3. Patient factors
Consider patient expectations, age, co-morbidity levels and payor guidelines. Does the patient expect to stay overnight or be able to go home the same day? What expectations does the patient have for pain management and rehabilitation? Is the patient motivated to do well and follow-through with the recommended rehabilitation plan? Does the payor allow the planned procedure to be performed in an ASC setting? If so, are there any age or health status restrictions?
4. Payor considerations
Ensure your center's third-party payor contracts include coverage for these procedures. Consider negotiating carve-outs for procedures that are grouped into categories where reimbursement does not adequately offset the costs incurred and create the necessary margins on the expensive implants that may be used. Carefully evaluating the billing and reimbursement structure for complex spine surgeries before you bring these cases to your center will ensure an appropriate return on your investment.
5. Medicare
Become familiar with Medicare's definitions of outpatient surgery. Medicare has placed length of time limitations on procedures performed in ASCs. Very few spine surgeries are on the Medicare ASC-approved procedure list.
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