Spine surgeons investing in surgery centers have the potential to realize significant profit in the coming years as procedures continue to shift from inpatient to outpatient settings.
A recent survey of academic spine surgeons found that 49 percent had investments in ASCs, with the surgeon-owned market segment projected to increase at a compound annual growth rate of 4.9 percent between 2017 and 2024.
Currently, there are more than 180 ASCs that perform minimally invasive spine surgery in the U.S. The effects of the COVID-19 pandemic, the need to reduce healthcare costs and physicians' desire to control the surgical environment are expected to drive outpatient growth in the next five years.
ASCs tout faster recoveries and more specialized care, particularly for specialties such as spine and orthopedic surgery, which are often provided in private and boutique healthcare environments.
This year, CMS removed 67 spine codes from its inpatient-only list, compared to six the previous year, and plans to completely phase out the list by 2024.
Recognizing that higher acuity cases can be performed safely and at lower costs at ASCs, both CMS and commercial payers are encouraging more cases to be done at outpatient settings.
Multilevel cervical disc replacements, multilevel fusions and complex spinal reconstructions are some of the procedures that surgeons are migrating to ASCs in 2021. Recent advances in technology have helped make this possible.
Augmented reality technologies are beginning to break into the spine industry, offering enhanced visualization designed to help surgeons perform procedures in less time with less complication risks. Augmented and virtual reality technologies also have the added benefit of facilitating training of staff and surgeons.
"Medical device companies will have to adapt to this new normal and offer services to surgeons to help them transition their practice to the outpatient space," said Alok Sharan, MD, of NJ Spine and Wellness in East Brunswick. "This will include not only minimally invasive tools, but also digital training tools, AR/VR technologies to train surgeons and staff, along with digital tools that will allow surgeons to do remote patient monitoring postop."
Robotic-assisted surgery is also picking up speed, but spine robots cost roughly 10 times the price of current AR systems on the market and take up far more space in the operating room. But many surgery centers see these technologies as necessary tools to attract top surgical talent.
The price and size factors of spine robots will not deter ASCs from investing in robots, but may affect hospitals that "expect to lose an increasing number of spine cases over the next five years," Vladimir Sinkov, MD, of Sinkov Spine Center in Las Vegas, told Becker's.
"Hospitals still have a lot of capital they can invest, where surgery centers are typically starved of capital, which is why it makes sense to partner," Dr. Sinkov said. "Outpatient migration of spine surgery will encourage surgery centers to rent or purchase surgical robots and other advanced technology to drive that exodus even faster."
Robots and other surgical technologies are set to become more prominent at ASCs, as surgeons, payers and patients continue to push more procedures to the outpatient environment.