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Archive July 2016 XVII, No. 7

Capture Your Share of Same-Day Spine

What factors will influence where your surgeons will bring their cases?

Praveen Kadimcherla, MD


Dr. Kadimcherla PLACE AT THE TABLE As more surgeons are trained in outpatient spine, more spine cases will migrate to surgical centers, says Dr. Kadimcherla.

The spine surgeon's scalpel has come to a fork in the road. Which same-day ORs shall we bring our cases to — the hospital's or the freestanding surgical center's? Several factors will determine where we'll perform such same-day procedures as decompression, discectomy, vertebroplasty, and cervical and lumbar fusions. How skeptical your surgeons are. How hesitant your patients are. And how reluctant your payers are to reimburse spine cases done in ASCs.

  • Skeptical surgeons. Many surgeons are skittish about moving their spine cases into surgery centers. Most lumbar spine fusions, for example, are done on an outpatient basis, but I'd bet that 9 out of 10 of them are done in a hospital. New-surgeon training could lead to a wider acceptance of ASC-hosted spine.
  • Hesitant patients. A great many patients who may have been intimidated away from spine surgery by the perceived pain, length or intensity of recovery from open procedures can now be candidates, with the help of rigorous selection criteria that bring healthy, motivated patients with few comorbidities. Much credit is due to our colleagues in anesthesia, with their regional blocks and long-lasting agents before and after surgery.
  • Reluctant payers. The biggest challenge for same-day spine is going to be getting Medicare and commercial insurers to pay for the procedures. For that we'll need more clinical evidence that minimally invasive, outpatient spine stabilization works just as well or better than traditional methods.
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