Could Spine Become the Backbone of Your Center?

Spine procedures in the outpatient setting are here to stay. And everyone wants to get in on the deal. With the advances in both technology and anesthesia, plan to see a steady migration of spine from the inpatient to the outpatient setting. It makes perfect sense – the patients enjoy the advantages and ease of having their procedures done at an outpatient center, the physicians enjoy it because of the efficiencies they experience over the hospital setting, and the management company likes it because, if done right, a spine program can be financially beneficial for a center. While all of this sounds great, it does present quite a few things that the team at the center level must consider.

First, you need to consider your surgeons and whether or not, 1) they are open to outpatient spine procedures and 2) they have experience performing minimally invasive spine surgery. The medical staff needs to be accepting of the concept and the differences between the center and the hospital setting. We would suggest starting your program around a physician(s) who has been performing MIS and is comfortable in that skin. That confidence and experience will rub off on everyone.

Prior to adding spine cases to your center, make sure three important aspects are covered. These three areas are coding, billed charges, and payor agreements.

1. Coding - The coding for spine cases is unique and can certainly be difficult. Spine fusions are particularly tricky due to a single case having five to seven CPT codes.

2. Billed Charges - Once the case is coded, having appropriate billed charges will be a key to the success of these cases. Many of the spine procedures are not considered approved by Medicare, and as such, typically fall to the unlisted reimbursement methodology located in your managed care agreements. If the unlisted pay at a percentage of billed, maximizing revenue opportunities is important.

3. Payor Agreements - If the agreement’s unlisted methodology is a flat rate, expect to have your agreement renegotiated prior to performing cases. Aside from the costs for equipment, these procedures are expensive due to length of OR time, supplies, and implants. Having the agreements in place to accommodate these costs can ensure a successful addition of spine to your existing book of business.

Equipment - This is an important consideration and you don’t want to cut corners in this area. If you are already doing orthopedics and pain, you may have some of the basic equipment necessary. If you are not doing any like procedures you can count on needing a microscope, a C-Arm, a pneumatic drill system, your instrument sets and potentially a lumbar table. It can be costly, but your cost benefit could easily justify it.

Training your team is paramount - Optimally, you would have staff that have spine experience and/or have worked with your surgeons, but if not, it is important to get some training – whether it’s through a saw bones lab or another opportunity. Having adequate resources who understand the needs of these patients preoperatively and postoperatively will make a significant difference in your ability to have a successful program out of the gate.

Patient Preparation - The final piece is ensuring patients' expectations are managed. You are not only making efforts to change the mindset of the physicians, the payors, and the staff; you now have to focus on the patients. This process should start in the physician’s office and, like all patients, they need to understand what to expect postoperatively and to be prepared to go home. Helping them to understand that they can go home with good pain control will ease their anxiety and allow for a successful discharge transition.

Adding spine can make a big difference to your center's profitability and reputation. If your center is ready to take this step, it's important to have a comprehensive plan that includes the right physicians, staff, and patients to ensure success.