Many healthcare plans today drive patients toward select "in-network" physicians, with less choice for patients unless they purchase expensive insurance. However, there is still a large group of people who want to make their own decisions and will be willing to pay for their treatment, but they'll expect a certain level of quality and favorable outcomes.
"In that world, I think you have to be able to offer something different to the person that is making their own healthcare choice," says Michael C. Weiss, DO, FAOAO, Chairman, Department of Surgery at Laser Spine Institute. "To do that, you have to be able to reach the patients and convince them you're the right provider. We've been doing that by building our reputation in minimally invasive spine surgeries."
Here are a few key trends on the current and future state of outpatient spine surgery:
1. In addition to clinical services, spine groups — including Laser Spine Institute — focus on providing patient-centric experiences from interactive websites to friendliness on the phone and in the waiting room before and after procedures.
"From the first phone call, we deliver a red carpet service, which is our gold standard — the platinum level service model — where we focus on the patient," says Chairman Weiss. "It's refreshing to be able to engage the patient and let them know from the first contact that we're there for them."
2. Surgeons will need a goal-oriented team. "If you are looking at surgeons in a private practice who are seeing a lot of patients every day and you're busy, it's hard to break the routine; it's even harder if you're the only spine surgeon in your practice," says Chairman Weiss. "You might want to do minimally invasive stabilization surgery in an outpatient setting where other procedures are being done — like knee arthroscopy — but it still takes great effort to set up a spine program."
If you decide to move forward with outpatient spine in an ASC, be ready for push back. "It takes a lot of manpower and capital to bring spine into the outpatient setting. That's why it's so difficult and part of the reason you don't see it very often," says Chairman Weiss. "It's not a path of least resistance; it's the path of considerable resistance. You'll also be working closely with the hospital, surgery center and other stakeholders. There are a lot of heads involved that have to have a single goal in mind, and that's hard."
3. Physicians are being pushed into the corporate world and it's harder for small groups and solo practitioners to survive without a larger partner. Reimbursements are low and centers have to make sure they are covering costs.
"There is a new procedure gaining traction — the minimally invasive sacroiliac joint fusion," says Chairman Weiss. "The CPT code pays the surgeon a lower rate than one would expect. In order for the practice to survive, and to take proper care of the patient, you need to coordinate the procedure with the surgeon and facility so it's reasonable for everyone involved."
4. The truly "minimally invasive" procedures will survive. "There is a lot of variability right now in what is truly minimally invasive," says Chairman Weiss. "One man's MIS procedure is another man's mini-open. Over the next five years, you'll see more standardization in MIS technique. I think you'll see more literature on the technique."
Younger doctors are now training on minimally invasive techniques and will bring their training into regular practice. Additionally, more data will be released over the next few years to support less invasive procedures.
5. More surgeons will bring their cases outpatient. Despite being a challenge to set up an outpatient ambulatory surgery center spine program, more surgeons will do so. Having ownership in an ASC will supplement practice revenue and efficiency at the ASC is preferable to hospital operating rooms. The outpatient setting of an ASC is also beneficial for patients looking to avoid a lengthy hospital stay.
"There will be more people doing spine surgery in the outpatient world and it will become a larger part of the mainstream landscape, like we saw in the late 1970s with knee arthroscopy," says Chairman Weiss. “It was standard then to perform these knee procedures in the hospital. Now, virtually no one requires this surgery to be performed in an inpatient hospital setting. I anticipate minimally invasive spine surgery to follow this trend."