Minimally invasive techniques and technologically advanced equipment helps neurosurgery patients at the NeoSpine Microsurgical Spine Center to experience shorter recovery times and lower cost surgery than neurosurgery patients who undergo more traditional procedures for the same disorders. This article will discuss some of the surgical techniques, technology, and operating protocols that allow patients to receive spinal surgery and interventional pain procedures safely and economically in this ambulatory surgical center setting.
Everything at the center is directed toward providing the best possible patient care, and those working at the facility are committed to new ideas, tools and techniques. Both neurosurgery and pain management care are offered at the center. While not all pain management patients eventually undergo neurosurgery and not all neurosurgery patients undergo pain management procedures, offering the two services in one place alleviates many concerns for the patients and makes it easier for the staff to coordinate care.
Minimally invasive techniques help patients recover quickly, leading to cost savings that are critical to the overall success of the center. For example, the insertion of percutaneous lumbar pedicle screws and three-level anterior cervical fusions are procedures that have been performed at the center. These procedures can be performed appropriately as outpatient procedures due to the comparatively small incisions and the use of tubular dilators. Use of the dilating tubes enables the neurosurgeons to avoid cutting muscle and nerve tissue that surround the actual site of surgery.
High-Tech Equipment
High-tech equipment at the center includes specialized nerve monitoring equipment that helps to pinpoint precisely the source of a patient’s pain. Also, teleradiology technology during surgery allows neurosurgeons to consult with radiologists outside the OR while simultaneously viewing the same image.
A commitment to new technology made in the center’s earliest days was the decision to use an electronic medical records system as much as possible. The EMR documents all phases of the surgery, expedites coding and billing functions, and assists staff in coordinating preoperative and postoperative care when the patient is in the clinic.
Low-Tech Systems That Work
Many of the systems and practices that staff find invaluable as they go about their daily routines are decidedly low-tech. One example is the drug storage system. Developed by staff nurse Angie Parrish, the system effectively tracks drug inventory, usage and control.
To keep the infection rate well under 1.0 percent, the center uses another low-tech technique: vigilance. As at many surgical facilities, an autoclave is used to sterilize all of the instruments, but unlike many such facilities, a biological check, or biocheck, is run on every load. All of the center’s instruments also are run through a decontaminator that cleans them using a special enzyme before moving them into the autoclave, and a Bowie-Dick test is conducted each day on the autoclave to ensure that it is working properly.
Overnight Recovery Care
Two recovery care rooms are available for patients, who may remain at the center up to the 23 hours and 59 minutes allowed in Washington state. The rooms are comfortably appointed with wood cabinetry, floor lamps, LCD screens, CD players, books and a Murphy bed that a friend or family member can use to spend the night.
Patients who stay overnight typically remain at the facility when they have undergone a procedure new to the center. The physician who performs the procedure asks the patient to remain overnight just to be certain that any unforeseen complications could be addressed immediately by an experienced healthcare professional. So far, no patient asked to remain at the center for this reason has ever experienced an adverse outcome.
Many other patients who remain at the center overnight stay simply because they have traveled a long way. Out-of-town patients who choose to stay overnight in a hotel rather than at the center are given the beeper number of a physician assistant and told to use it as needed through the night. Within 24 hours, just like every patient at the center, they receive a postoperative follow-up call from one of the nurses on staff.
Billing and Reimbursement
Approximately 98 percent of the center’s patients are covered either by workers’ compensation or by private pay agreements. This is because most of the procedures performed at the center treat conditions caused by work-related injuries, repetitive use injuries or congenital disorders. Moreover, most of the procedures performed at ambulatory surgery centers are not reimbursed by Medicare.
Getting insurance providers to pay for procedures performed at the center sometimes has been a struggle. To prove that the procedures could be performed safely and cost-effectively in the ambulatory setting, a few cases were performed without contracts, and the outcomes of those cases along with hundreds of the same type of cases performed in a hospital-based outpatient center were sent to the insurance providers in the region. When insurance providers saw the center’s positive patient outcomes and reduced costs, most of them agreed to negotiate contracts. Getting insurance authorizations has gotten easier over time, but even today a staff member occasionally calls an insurance provider to obtain authorization, especially when a procedure is new to the center.
To help demonstrate the center’s quality of care to insurance providers, a variety of data are useful. All patients and physicians are asked to provide a wide range of information about their experiences at center, and the data is compiled using a long-term clinical data collection and management tool available from a company in Albuquerque, N.M. Data collection begins when the patient first contacts the center and extends up to two years after the patient’s procedure. Benchmarking data also is useful during negotiations with insurance providers. The center benchmarked against national data provided by multispecialty ambulatory surgery centers until its recent merger with NeoSpine and now expects to include specialty-specific indicators that will be even more useful when negotiating with insurance providers and that will help the center better address its own specialized needs.
Neurosurgery is one of the last surgical specialties to move into the ambulatory surgery center setting. Our experience suggests that for many patents, this setting is an excellent option.
Hiroshi Nakano, MBA, is CEO of South Sound Neurosurgery PLLC, in Puyallap, Wash. Dawn Bisceglia, RN, is manager of the Microsurgical Spine Center, a joint venture partnership of NeoSpine, LLC, and South Sound Neurosurgery. Richard N.W. Wohns, MD, MBA, is founder and president of South Sound Neurosurgery and chairman of the board of NeoSpine.