Five spine surgeons give advice on controlling the cost of spine procedures.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Question: What are some best practices for controlling spine surgery costs?
Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): Minimally invasive surgery is a great option for controlling costs. These procedures allow for faster recovery and minimal complications, which limits costs. Additionally, performing procedures in the outpatient setting whenever possible prevents costs associated with hospital-level care. Furthermore, I think it is important to carefully select patients that will benefit from spine surgery to avoid performing unnecessary procedures.
Alden Milam, MD. Spine Surgeon at OrthoCarolina (Charlotte, N.C.): Evaluating all of the various physical components of an operation is key for containing costs.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Keeping disposables to a minimum and keeping cases as simple and short as possible.
Turnover time should also be as short as possible. Additionally, surgeons should work with vendors to keep costs down, but hospitals and ASCs should reward those surgeons for their efforts and let them share in the savings.
J. Brian Gill, MD. Spine Surgeon at Nebraska Spine Hospital (Omaha): Cost containment is an ongoing trend in spine surgery as it is within any high-utilization specialty such as orthopedics. Using limited vendors at a hospital/ambulatory surgery center tends to allow better pricing for the entity as there is consolidation to limited vendors.
Additionally, limiting what is used during surgery is beneficial. For example, using bone morphogenic protein and stem cell allografts for a single-level lumbar fusion whereby the costs exceed the DRG allotted amount for the procedure is not a sustainable model. Aligning with a hospital system or ASC where there is a vested interest from the surgeons and the system is the best way to control costs as each party is part of the solution and not contributing to the problem.
Plas T. James, MD. Spine Surgeon at Atlanta Spine Institute: I think that if a patient has a spine problem, and they can do a procedure in an outpatient setting as opposed to an inpatient hospital, the cost for the patient is usually much less. For example, one-level discectomy, lumbar discectomy, cervical fusions and ACDFs can all be done effectively, and you won't have to pay a facility fee for the operation if you are at an outpatient versus an inpatient facility.
I think another issue is in ordering tests such as MRI scans. Doing it at an outpatient center can cost you four times less than doing it at a hospital. So, if you are a candidate for an outpatient procedure, or what we call a 23-hour stay where you stay overnight, and it's an affordable operation, you may be able to do it at a controlled cost.