Outpatient Spine Trends

Erik Sunset: [00:00:00] All right. We’re back. Hello and welcome to the DocBuddy journal. I’m your host, Erik sunsets. Here at DocBuddy, we deliver healthcare solutions to take the pain and costs out of broken workflows from the ASC to the clinic, to on-call at the hospital doc, but it helps providers access create a move data seamlessly all from the point of care, check out all of our solutions and set up a demo at docbuddy.com. And for those that we met in Biloxi, Mississippi this week at the Gulf states ASC conference. Uh, great to have seen you there. If you were there and didn’t get the chance to stop by the dock buddy booth, I hope you’ll reach out to us. Uh, DocBuddy.com.

So we can get you what you need. Get you look at our op note solution, which gives you the power of instantly generated operative reports. And I bet there is a subset of you who were at the gold state’s annual conference who will see us next week. At the Becker’s spine orthopedic and pain management driven ASC 21st annual conference [00:01:00] next week. Um, and for those who are not in that Venn diagram of having gone to the Gulf state show and going up to Becker’s next week, We’ll be there for you to Becker’s spine and poorest is June 19th through the 22nd. In Chicago at the Swiss hotel dock, buddy is booth number 1 0 2.

So we are really excited to once again, support. Uh, Becker’s and be a part of the spine ortho and pain management driven ASC conversation. And I think for the last time, at least for the foreseeable future at the Swissotel two. Certainly not the last time for DocBuddy to support. A Becker’s events, but I think this is going to be the last one. At least for the next little bit that is at the Swissotel they’re moving it to the Hyatt’s, uh, just down the streets for Becker’s ASC. Uh, regular ASC, the general Becker’s ASC show this fall.

So we’ll see you at both of those. And many other shows between now and then. And check out our prior episode to see exactly where we’ll be [00:02:00] over the course of the summer. And we’ll let you know where we’ll be through the fall. And with an eye towards next week’s Becker’s spine orthopedic and pain manager driven ASC annual conference. Let’s take a look at some fast facts around outpatient spine care, and that makes a ton of sense for us to do.

Obviously, DocBuddy has a ton of users. Of our oppnet solution in these, uh, spine and ortho. Ambulatory surgery centers. Our enterprise product also, uh, serves physicians at their clinics. So that’s our clinic based EHR integrated product, which is saving at least three minutes worth of patient documentation time per encounter for providers. So very much in focus for us to share from Becker spine, 10 insights, stats, and more, and this episode will obviously.

Excuse me.

This episode will obviously have the link to the article in the show notes.

Sorry [00:03:00] about that had to hit pause there. So I’m not coughing straight into your AirPods or to your computer speakers. So let’s take it from the top. Did you know that outpatient spine procedures grew among the Medicare patients between 2010 and 2021 with significant yearly growth at ASC? These findings in the March, 2024 issue of the north American spine society journal found that the total number of outpatient spine procedures rose about 193%. From 2010 to 2021.

So that’s a big jump. And for those. In the facilities. You’ll probably agree with that number. The compound annual growth rate for outpatient cases per year was 9.9% for hospital outpatient departments or HOPD and almost 16% for ASC. So that’s fantastic. are that triple aim of health care better for patients better. For providers and better for payers or the system, the economics of it, if you will. The article goes on [00:04:00] that, uh, while spine surgery is growing, the ASC setting, some factors are slowing its momentum.

One of those is pain management, according to Dr. Harold Deutsche of the rush spine center in Chicago. Quote, spine surgeries are painful and different patients have different responses to surgeries. Some patients having exaggerated pain responses requiring more immediate nursing care. Dr. Doris continues. Well, generally, most patients could have outpatient surgeries that can be difficult to predict which patient will need a longer stay.

Throw in my 2 cents into the, into the ring here, being that, you know, I’m the host of this show.

Nobody asks for these 2 cents, but you’re going to get it anyway. This seems like a fantastic opportunity for some patient outreach ahead of scheduling the procedure. You know, scale of one to 10, how well do you tolerate pain? And if that number is really low, I don’t tolerate pain while at all. Maybe it makes sense to have that surgery at the [00:05:00] HOPD the aforementioned HOPD.

Whereas those with a higher tolerance for pain or for a duress, I guess if you will, it may make more sense to have them in the ASC. Uh, consumerization of healthcare is coming questions like this in advance of the procedure or in advance of scheduling the procedure. Uh, probably well overdue. If you are a. Condition and trying to make that prediction on behalf of a patient.

Moving down the list of your number three, the most common spine procedures done at ASC is include back injections and spinal fusions.

And that’s according to the us news and world reports.

Another quick. Did you know. There are more than 200 ASC. That offer spine surgery in the U S. And here’s where it gets a little bit interesting where we look at the difference in Medicare coverage or CMS coverage for the costs. Uh, of these fusion of lower spine bones. Posterior or postero lateral approach, just code two to 6, 1 2 for my billers and coders [00:06:00] out there.

And this is comparing the charges at a hospital outpatient department versus the ASC. Um, so for these fusion of lower spine bones, posterior, or pasta, or a lateral approach code 2, 2, 6, 1, 2. At the ASC, the total cost is 10,270 bucks of which Medicare pays about 8,200 and the patient pays just about 2100. At the HOPD. The total cost is about $3,200 higher than the ASC at $13,560. Of which Medicare pays almost $12,000 and the patient’s responsibility comes to 1700 bucks. So a little bit of a interesting fact and finding there, we just talked about the growth of spine procedures at the ASC versus the HOPD. Spine procedures at the A’s ASC increased more than those at the HOPD. [00:07:00] According to the data, despite the fact that the total cost of the HOPD is higher. However, the patient responsibility is about $300 less.

Um, so. As a surgeon determining where to schedule your procedures, obviously money talks and you know what walks. Um, however, we’re not talking about huge differences in reimbursement here, although there is a difference and there’s something to be said for that. You know, We’ve talked about this on episodes prior.

Um, being a provider. And business means that you have to make money and remain profitable.

So there’s a fine balance there in, um, providing the best possible outcome for your patient while also managing your own revenue.

Coming down the line. Number six on average, CMS covers more for the costs of cervical disc replacement through the anterior approach, which is code 22, 8 [00:08:00] 56 at an HOPD hospital, outpatient department, compared to an ASC.

The total cost for said, procedure at the ASC is quite a bit lower. Uh, than at the hospital outpatient department. So at the ASC. The cervical disc replacement through anterior approach and total cost is 13,500. Call it. And we’re rounding here just for. Giving you a better listening experience versus the HOPD is $17,700.

Total cost. Uh, so about 4,000 bucks more expensive at the HOPD where Medicare is paying. Uh, 10,800 bucks at the ASC versus 15,000, actually call it 16,000 at the HOPD. So a $6,000 split there for what Medicare pays. And it’s about a thousand dollars split or the patient pays more at the ASC versus the hospital outpatient department. Um, so pretty interesting there, again, needing to weigh. The benefits, the risks, the [00:09:00] revenue of performing this procedure at the ASC versus the HOPD.

Obviously the devil’s in the details there.

Number seven. Spine and ortho robots can pose barriers. ASC is the ones who invest in the tech, but a strategic approach can turn the heavy upfront cost into a smart investment. We will quote here from Dr. Brian Fiani. VO. Uh, Mendelson, Kornblum, orthopedic and spine specialists in west Bloomfield, Michigan. Quote, 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. Uh, Dr.

Fiona and continues conducting a cost benefit analysis and consulting with surgeons and industry experts can help inform the decision making process. So wise words there, I don’t have a whole lot to add to that, you know, before you spend big money, you should be sure you both a really need to, and B really want to. So we’ll put there.

Dr. Fiani. [00:10:00]

Continuing down the line here with number eight spine surgeons or I in complex cases for the outpatient setting, but it will likely be a gradual process. Dr. Brian got Vercher. MD of the cranio spinal center of Los Angeles said. More ASSP we’ll need to get special exemptions to hold patients greater than 23 hours. Some AFCs 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. Paint positions, internal medicine, nursing and surgery staff decide. Uh, 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. So once again, wides words there. Um, [00:11:00] pushing the envelope and having that multidisciplinary approach. A prudent. Good thinking or good way to analyze your situation.

Coming down to number nine, our first to last point from the article. 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 BLS, that’s the bureau of labor statistics. Well, the mean annual wage for orthopedic surgeons.

Excluding pediatric surgeons is 378 grand. The mean wage at outpatient care centers reaches 429. Thousand dollars.

And finally, number 10 center of excellence, designations and direct to employer contracting could play a key role in ASC growth for spine surgery. Here’s a quote from Dr. Phillip Louis of Tacoma, Washington based Virginia Mason, Franciscan health. As the healthcare landscape is pushing toward an eventual value based care model [00:12:00] and potential smaller population-based models. Outpatient surgery centers need to better harness data and analytics. Dr.

Lewis continues, precision analytics and time-driven activity-based costing will be crucial for driving clinical and financial performance in these outpatient surgery programs.

Again, not a whole lot more to say there. I can offer my opinion on that point. Well, some of these, it depends scenarios. Um, so what we just heard from Dr. Louis, they’re using analytics to guide your decision-making. So time-driven, activity-based costing like that’s, that’s an analytic in my book. For the ASC. That are wanting to push the envelope from that doctor Brian got Vercher stats where you may want a higher complexity procedure and need clearance to hold a patient greater than 23 hours.

You, that multidisciplinary team. A little data wouldn’t hurt that process either. And then going [00:13:00] back in time, one more bullet point from Dr. Brian, Fiani about the investment. In surgical robotics. Um, you need data, you need data and we’re starting to see AFCs. Embrace that. Um, we’re hearing that there is a lot of data available, but maybe not all of that data is actionable or maybe a facility employees.

Aren’t totally sure what they should be doing with that data to provide a better patient experience, better patient outcome. Uh, to streamline their revenue cycle. So not only to get paid faster, like something that our op note product helps, uh, both the facility fee and professional fee. Do. But to be sure you’re not leaving any money on the table as you perform these procedures.

So that’s it for this week. Um, again, we will see all of you at the Becker’s spine event next week in Chicago. Doc, buddy is booth number 1 0 2. Stop by. We mentioned oppnet just a second ago. Stop by check out our oppnet solution. Check out our surgery workflows. Flow [00:14:00] solution. You’ll also be able to pick up a little bit of swag, a little dock, buddy swag from the booth to take home something that you can use over the course of the summer, or any time that you have a cold drink in your hand, do you want to stay cold? We’ve got some excellent slim can koozies that we, uh, that we give away figure you guys like that more. And the pens, then the notepads, then the stuff that, uh, maybe doesn’t make it out of the exhibit hall, it gets filed in one of those cylindrical containers. So with that, I’m half of the entire dock buddy team.

Thank you for listening. Be sure you’re subscribed on apple pods, Spotify, and YouTube. So you always get the newest episodes of the show. And until next time, I’m your host, Erik sunset and talk to you again soon.