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Archive November 2017 XVIII, No. 11

9 Tips for Adding Outpatient Spine

Advice from the founder and the administrator of one of the country's first spine surgery centers.

Karen Reiter

Karen Reiter, RN, CNOR, RNFA


Robert Bray

Robert Bray


Spine surgery's soaring demand and seismic shift to the outpatient setting have combined to create an amazing growth opportunity for surgeons and ambulatory facilities alike. What's driving the demand for spine services? An aging, overweight and sedentary population suffering from back and neck pain, which causes more disability worldwide than any other disease or disorder.

A combination of factors has accelerated spine's recent conversion to outpatient surgery. Among them are advances in minimally invasive techniques that require much less muscle dissection or retraction, studies touting the safety and efficacy of outpatient spine surgery, high satisfaction rates among patients and, of course, lower costs that will be better suited for soon-to-arrive bundled payment models for spine, which will reward providers that deliver high-quality, low-cost episodes of care. Given all of this, it should come as no surprise that it's estimated that more than 50% of all spine surgeries can be safely performed outpatient.

You could say that we were ahead of the spine curve. Way ahead. We opened our first spine surgery center 11 years ago. We've since built a second spine ASC. We've performed more than 9,000 surgeries at both facilities — with a 99% patient-satisfaction rate and only 2 hospital transfers (for unrelated medical conditions). We've never had a death, never had a heart attack, never needed a transfusion and never had a surgical infection. If you're considering adding spine, we suggest you take advantage of all that we've learned.

1 Quality comes first
First, and most importantly, always emphasize quality over cost. Spine is expensive, but more than half of the money spent on it in the U.S. is spent dealing with problems — readmissions, infections, chronic pain, failed surgeries and so on. If you tackle quality first, and make sure you don't have those issues, cost will take care of itself.

In building our center, we used that philosophy for every component. We worked extensively with sterile processing and we went to great lengths to educate nurses and staff. We've tackled pain management, mobilization, bladder management, patient education and family education. We even built the facility with 100% HEPA filtration, 100% UV filtration and high-flow exhaust.

Quality is a never-ending pursuit. We typically have 4 or 5 quality studies going at any given time, and one result is that we consistently beat every national benchmark by a wide margin.

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