Spinal fusions can be performed in ASCs or hospitals but there are different considerations when deciding the best setting for the procedure.
Five notes:
1. On average CMS covers more for the costs for fusion of lower spine bones, posterior or posterolateral approach (Code 22612) at a hospital outpatient department compared to an ASC.
ASC
Total cost: $10,267
Medicare pays: $8,214
Patient pays: $2,053
HOPD
Total cost: $13,560
Medicare pays: $11,820
Patient pays: $1,740
2. Fusion of lower spine bones, posterior or posterolateral approach also costs more at an ASC compared to an HOPD.
ASC: $3,016
HOPD: $1,944
3. Anterior cervical discectomy and fusion costs 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. Total costs for spinal fusion in the ASC at one year were $5,879.46, compared with $12,873.97 for procedures in the hospital. Researchers concluded, "The ASC setting is a dominant option from a health economy perspective for first-time one-level to two-level ACDF in select patients compared to the inpatient hospital setting."
4. 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. Researchers analyzed 226 consecutive anterior lumbar surgeries in an ASC or inpatient tertiary care hospital. They found 90-day readmission rates were lower for outpatient spinal fusion patients and concluded that, "Our results demonstrate that anterior lumbar procedures, including single-level and multilevel ALIF, ADR, and hybrid procedures, can be performed safely in an ASC. This has significant cost savings implications for the ASC setting."
5. Outpatient cervical and lumbar fusions grew at hospital outpatient departments after CMS approved the procedures for ASCs while the procedure rate had little or no growth in surgery centers, according to a 2022 Advisory Board report. Researchers found that procedures typically shifted outpatient slowly, and HOPD use increased at a higher rate than ASCs.