Providing quality care while staying cost-efficient can be a tough balance for spine surgeons. But there are some tactics spine surgeons can take advantage of to lower costs.
1. Utilize the ASC.
Taking spine procedures to the ASC when possible can save costs. For anterior cervical discectomy and fusion, costs were significantly less when done at ASCs than the hospital setting for Medicare and privately insured patients, according to a study published in the Dec. 15 edition of Spine.
"The biggest opportunity to reduce the immediate costs of surgical procedures is to move the surgery from a hospital to an ASC setting (when safe and appropriate)," Vladimir Sinkov, MD, said. "Being considerate with the choice of implants and bone grafting materials could also have a significant effect on the overall cost of the procedure (whenever safe and clinically appropriate)."
In some instances, spine procedures can also be as safe in the ASC compared to the hospital setting. A study published in Spine found there weren't any significant differences in complication rates between outpatient and inpatient cervical disc replacement. And outpatient and inpatient complications rates for anterior lumbar spinal surgery were similar, according to a study published Dec. 3 in the International Journal of Spine Surgery.
2. Adopt minimally invasive surgeries.
Minimally invasive surgeries can be beneficial to practice margins and patient recovery. A 2021 study in the Global Spine Journal found overall cost-savings with minimally invasive techniques. Minimally invasive spine techniques had lower reimbursements than open procedures for both lumbar posterior fusion and discectomy.
"Performing a spine surgery in a minimally invasive fashion can also substantially reduce the cost of care by significantly reducing the length of hospital stay, the risk of complications such as infection and the duration of time the patient will need to take prescription pain medications after the surgery," Dr. Sinkov said. "The patients also typically return to full function and work significantly faster after a minimally invasive procedure. This will reduce the nonclinical and societal costs associated with the loss of productivity."
3. Optimize perioperative care.
Enhanced recovery protocols in spine surgeries are designed to improve patient recovery after procedures.
For spinal fusions ERAS saved an average of $3,444 per case, according to a 2018 study in Neurosurgery. A 2020 study in the International Journal of Spine Surgery found ERAS can improve cost-effectiveness and reduce overall opioid consumption.
"Implementing enhanced recovery protocols and standardized care pathways can help minimize variations in postoperative care and improve patient outcomes," Brian Fiani, DO, said. "This can potentially shorten hospital stays, reduce complications and lower costs."
4. Consider value-based reimbursement models.
Value-based care models can help a spine or orthopedic practice reduce costs and focus on outcomes. The model has worked for Philadelphia-based Rothman Orthopaedic Institute, which extended its value-based care agreement with Independence Blue Cross.
For Rothman, the agreement helped Rothman lower clinically-related costs by more than $3,000 per case, reduce hospital admissions by 38% and reduce emergency department visits by 29%.
"Emphasizing quality outcomes and value-based reimbursement models can incentivize spine surgeons to focus on improving patient outcomes while reducing unnecessary costs," Dr. Fiani said.