The evolution of spine surgery is leaning more toward outpatient care. Here's what six spine surgeons are predicting for the near future.
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. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: What will the outpatient spine surgery landscape look like in five years?
Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): In five years, the outpatient spine surgery landscape is expected to continue its growth and evolution. There will likely be advancements in technology, techniques and patient care that allow for more efficient and effective procedures. I have already implemented these practices to help advance the care process for my patients.
One potential trend is the increasing utilization of minimally invasive techniques, which can lead to shorter or no hospital stays, faster recovery times and reduced healthcare costs. These procedures are typically performed on an outpatient basis, allowing patients to return home the same day, which is what I offer my patients.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Contracting and collection are critical. Assuming payers stop the headlong stumble into the abyss, resulting in their own demise and the installation of single payer, physicians will continue to innovate and do cool things in the surgery center. What might happen is more surgery centers will get special dispensation for 24-, 48- and 72-hour stays. This will of course engender great angst from hospitals and their mouthpieces, like the [American Hospital Association]. But, physician-owned and operated centers can out-operate, out-service and out-save any of the large bloated healthcare systems any day of the week. I think the physician-owned hospital ban will fall, and if CMS and HHS really want to save the public money and keep the Medicare Trust Fund solvent, they will make that happen.
Emeka Nwodim, MD. Centers for Advanced Orthopaedics (Bethesda, Md.): Although difficult to predict, I believe outpatient spine surgery in the next five years will see continued growth, consolidation of ASC centers and hopefully refinement in efficiency, workflow, staff recruitment and retention.
It is only practical for the healthcare industry to continue moving procedures and surgeries to the outpatient setting where they can be performed safely, efficiently and in a much more cost-effective manner. However, consolidation of centers is necessary to prevent what is currently happening in some regions of the country where there is over-saturation within the outpatient setting.
Regarding refinement in efficiency, workflow, staff recruitment and retention, success comes when those around you, at all levels, which include the staff, are appreciated and fulfilled. Running an ASC cannot solely be about profit but must also aim to accommodate the lives of those responsible for the day-to-day activities and patient care. Through all these measures, patients will continue to have quality care within the outpatient setting for the next five years and beyond.
Don Park, MD. UCI Health (Orange, Calif.): The outpatient spine surgery landscape will greatly expand beyond what we are seeing currently. With the increased adoption and utilization of endoscopic spine surgery in the U.S., more surgeries can be performed in the ASCs using these ultra-minimally invasive techniques. In addition, awake spine surgery techniques with epidural, spinal and fascial blocks can allow more patients to undergo spine surgery without the need for general anesthesia. This will allow older patients with more medical comorbidities to have endoscopic spine surgery performed in the outpatient setting.
Also, surgeries typically performed at the hospital as an inpatient, such as lumbar fusions, can be transitioned into the outpatient setting by combining both endoscopic and awake surgery techniques.Through the use of Enhanced Recovery After Surgery protocols and standardized "prehab" classes, these surgeries can then be optimized for improved patient outcomes and greater safety in the outpatient setting. In five years, more and more spine surgeries will be performed in the ASCs, and mainly complex spine surgeries that require inpatient services will be performed in the hospital setting.
Scott Raffa, MD. Cantor Spine Center at the Paley Orthopedic & Spine Institute (West Palm Beach, Fla.): In the next five years, the way physicians do spine surgeries outside the hospital is going to change a lot. This is because of new technology, what patients want and how healthcare works.
First, physicians will continue performing minimally invasive spine surgeries, which will make them hurt less and help people get better faster. This means more surgeries can happen without needing people to stay in the hospital.
People will also see their physicians on the computer more often, instead of going to the hospital. This makes things easier and saves time. Physicians can watch over patients from far away, which helps catch problems early. Physicians will listen more to what patients want and make treatment plans that fit each person. People will know more about their health and can decide with their doctors what's best for them.
Financial responsibilities will also be important. Physicians will try to give good care that doesn't cost too much. This will make healthcare better and more affordable for everyone.
Lastly, smart computers and technology will help physicians plan surgeries better and give advice. This will make surgeries safer and more precise.
So, in the next five years, spine surgeries outside the hospital will use smaller incisions, more computer visits, focus on what patients need, save money and use smart technology to make everything better.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In my estimation, short of comorbidities and associative shortcomings, the expectation of short stay and outpatient surgery will prevail. Centers for Medicare and Medicaid Services also expect these numbers to grow and persist as approvals and metrics are predicated on the essential fact that rehabilitation, short of neurological injury, is an outpatient phenomenon. Moreover, it's a new culture, new mindset, and typically expected from patients and family.