In a presentation during Becker’s ASC Review’s 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + the Future of Spine, June 13 in Chicago, Paul Schwaegler, MD, a spine surgeon at Seattle Spine Institute and Thomas Johnson, owner and president of The Business Office, discussed clinical and business considerations for moving spine procedures into ambulatory surgery centers.
Dr. Schwaegler offered five clinical recommendations for physicians considering moving their spine procedures into an ASC.
1. Be a spine surgeon. Because so much can go wrong with spine surgery, it is important to be a spine, rather than an orthopedic, surgeon, he said. “If you’re not a spine surgeon, you won’t know how to manage [any complications],” he said.
2. Think minimally invasive. These procedures are often safer and more popular with patients, he said.
3. Have true outpatient anesthesia. Both the drugs and clinicians’ mentality differs between inpatient and outpatient anesthesia, he said.
4. Start small. He recommended spine surgeons start “with easy stuff you know how to do and then move into single level fusions and internal fixations.”
5. Learn new techniques. Spine surgeons should stay up to date on new techniques and research, he said.
However, receiving payment for spine surgery in an outpatient setting can almost be more difficult than the procedure itself, especially since ASCs are often out of network, said Mr. Johnson. He offered his five “building blocks” of a successful claims process:
1. Summary plan description document. Mr. Johnson recommended getting each patient’s insurer’s summary plan description document for a complete overview of the plan and what the insurer will cover out-of-network. Often, information provided over the phone or in a shorter summary is not sufficient to determine patients’ out-of-pocket costs and the center’s reimbursement.
2. Chargemaster. “It’s crucial to use this to benchmark cost data,” he said, to make the claims process as transparent as possible.
3. Claims submission. Mr. Johnson recommended submitting a ‘claims packet’ with more documentation than required by the insurer. “It’s a preemptive strike at stereotypical bundling issues,” he said.
4. Claims follow-up. “We put a lot of resources and effort into confirming claim receipt in payers’ systems,” he said. “It takes time and effort,” but it’s worth it to identify claims that could be about to be misprocessed by the insurer, he said.
5. Appeals. “Even after all that work, claims’ life cycles almost always involve both billing and appeals,” said Mr. Johnson.
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