Outpatient spine: 10 insights, stats and more

Practice Management

Here are 10 things to know about outpatient spine surgery in 2024:

1. Outpatient spine procedures grew among Medicare patients between 2010 and 2021, with significant yearly growth at ASCs. The findings, published in the March 2024 issue of the North American Spine Society Journal, found the total number of outpatient spine procedures rose about 193% from 2010 to 2021. The compound annual growth rate for outpatient cases per year was 9.9% for hospital outpatient departments and 15.7% for ASCs. 

2. While spine surgery is growing in the ASC setting, some factors are slowing its momentum. One of those is pain management, Harel Deutsch, MD, of the Rush Spine Center in Chicago, said. 

"Spine surgeries are painful and different patients have different responses to surgeries, with some patients having exaggerated pain responses requiring more immediate nursing care," he said. "While generally, most patients could have outpatient surgeries, it can be difficult to predict which patient will need a longer stay."

3. The most common spine procedures done at ASCs include back injections and spinal fusions, according to U.S. News & World Report.

4. There are more than 200 ASCs that offer spine surgery in the U.S.

5. 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.

Total cost: $10,267
Medicare pays: $8,214
Patient pays: $2,053

Total cost: $13,560
Medicare pays: $11,820
Patient pays: $1,740

6. On average CMS covers more for the costs of a cervical disc replacement through the anterior approach (Code 22856) at a hospital outpatient department compared to an ASC.

Total cost: $13,515
Medicare pays: $10,812
Patient pays: $2,702

Total cost: $17,655
Medicare pays: $15,905
Patient pays: $1,749

7. Spine and orthopedic robots can pose a barrier to ASCs that want to invest in the technology. But a strategic approach can turn the heavy upfront cost into a smart investment.

"Ambulatory surgery centers should consider factors such as cost-effectiveness, patient outcomes, surgeon experience with robotics, and potential for increased efficiency and precision in surgeries," Brian Fiani, DO, of Mendelson Kornblum Orthopedic & Spine Specialists in West Bloomfield, Mich., said. "Conducting a cost-benefit analysis and consulting with surgeons and industry experts can help inform the decision-making process."

8. Spine surgeons are eyeing complex cases for the outpatient setting, but it will likely be a gradual process, Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, said.

"More ASCs will need to get special exemptions to hold patients greater than 23 hours. Some ASCs should stick to the simple, safer, and better margin surgeries. For those wanting to push the envelope, I recommend doing a careful safety analysis with a multidisciplinary team of anesthesiologists, pain physicians, internal medicine, nursing, and surgery staff to decide what is safe and feasible. Just because you can do a surgery in an ASC setting does not mean you should. Any transformation into a higher acuity center should take place gradually, with very careful consideration of each patient case and its appropriateness for the ASC setting."

9. Orthopedic surgeons working at outpatient care centers are paid more than their counterparts in any other practice setting on average, according to May 2023 data from the Bureau of Labor Statistics. While the mean annual wage for orthopedic surgeons — excluding pediatric surgeons — is $378,250, the mean wage at outpatient care centers reaches $429,450. 

10. Center of Excellence designations and direct-to-employer contracting could play a key role in ASC growth for spine surgery. 

"As the healthcare landscape is pushing toward an eventual value-based care model (and potential smaller population-based models), outpatient surgery centers need to better harness data and analytics," said Philip Louie, MD, of Tacoma, Wash.-based Virginia Mason Franciscan Health. "Precision analytics and time-driven activity-based costing will be crucial for driving clinical and financial performance in these outpatient surgery programs."

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