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COVER STORY


rates reported for traditional open back surgeries.” Schlesinger’s ASC sets up a regis-


try and tracks parameters that include expected blood loss, expected need for IV and narcotics for postop pain, the risk of morbidity/mortality, postop complications and operating room (OR) time. “You want to make sure that it is a case that will be done in an acceptable range of time, which is 3–4 hours for lumbar and 2–3 hours for cervical, and that can be discharged within the acceptable timeframe” he says. “While the Centers for Medicare & Medicaid Services (CMS) guideline is 23 hours, our ASC has the ability to do overnight stay, but we have never needed to keep a patient overnight or longer than 4–6 hours.”


Asher and his team track short- and long-term patient outcomes— including complications


such as


wound infection and readmissions— along with patient-reported out- comes, particularly pain scores, dis- ability assessments and quality of life scores. “We look at a variety of out- comes and place significant emphasis on the patient perspective on care,” he says. “Over time, we have come to the conclusion that in most domains, the ASC setting is better for patients than the hospital setting, particularly for more common spine procedures such as lumbar decompressions and 1- and 2-level ACDF procedures. Wait times are shorter and adminis- trative procedures are often stream- lined in ASC settings. ASCs may also provide greater operational effi- ciency versus the hospital setting.” Asher collects most of the data as


an extension of his ASC’s participation in a national spine registry. “We partic- ipate in and help lead the Quality and Outcomes Database sponsored by the American Association of Neurological Surgeons,” he says. “Orthopedic and neurological surgeons participate in the data collection. The registry allows


My main two arguments for including spine surgery in the ASC setting in the bundled care model would be lower infection rates and cheaper costs.”


—Scott Schlesinger, MD, Legacy Spine & Neurological Specialists


for evaluations of site-specific perfor- mance as benchmarked against risk- adjusted, national measures of quality.”


Spine Surgery in ASCs under the Bundled Care Model “My main two arguments for includ- ing spine surgery in the ASC setting in the bundled care model would be lower infection rates and cheaper costs,” Schlesinger says. “If we track the met- rics we just discussed and do a com- parative data analysis between ASC patients and hospital patients to see how they stack up, my guess is that the infection rate would be significantly lower in ASCs and the cost would be much cheaper as well.” On average, outpatient surgery cen-


ter facility fees are roughly 70 percent of the fees for the in-hospital setting, Asher says. “Savings will vary greatly market remain


to market, and costs proprietary.


often Nevertheless,


ASCs have yet to prove costlier for any surgical disease state.”


10 ASC FOCUS NOVEMBER/DECEMBER 2016


In addition, Asher says that it is eas- ier to control quality in an ASC than in a hospital and the care is more efficient in an ASC setting. “Quality processes are facilitated in ASCs due to their rela- tive size, focus and homogenous patient population, along with their orientation toward greater physician involvement in efficiencies and general operations,” he says. “We can create win-win situations because payers receive greater eco- nomic value with clinical outcomes that are generally comparable to or, in some instances, better than those achievable in a hospital setting. “ASCs represent an inherently more controllable operational envi- ronment than hospitals,” he con- cludes. “As the assessment and man- agement of clinical and economic risk is essential to the intelligent construction of sustainable bundles, ASCs may be a better setting to explore early bundled care models than in the far more heterogeneous hospital environment.”


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