Outpatient Surgery Magazine

Snuffing Out Surgical Smoke - December 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 90 of 156

epidural space in the spinal column and sends the patient home for a week to see if they get relief from the intervention, says Dr. Shaparin. When the week is over, the implant comes out regardless of the out- come. The trial period is key because the patient can adjust the stimu- lation in real time. "Let's say the patient is home, and the SCS is not stimulating the exact right area enough," says Dr. Shaparin. "A lot of times, the device rep can change the stimulation over the phone or over the internet." If there's adequate relief, a permanent SCS is implanted in the epidural space, and the battery goes around the buttocks area, below the beltline, with a remote control for the patient to adjust as needed. As you can imagine, between the trial and the implantable device, this intervention is costly. The stimulator implant alone costs upwards of $25,000. Plus, from a staffing standpoint, at a minimum you're talking about needing a physician, at least 2 OR techs, and an X-ray tech or at least someone who's well-versed in fluoroscopy. The good news is CMS just began reimbursing for this procedure in 2018, and commercial insurers tend to pay around the Medicare rate for SCSs. But the reimbursement process itself is more involved for SCSs. "Implantable devices require the use of a psychologist, because this intervention can lead to significant long-term implications," says Dr. Kramskiy. Due to those implications, insurers' response is to require some degree of additional screening, besides just relying on the physi- cian's recommendation, before approving this treatment, he adds. Still, there's some compelling reasons to consider this option. For one, it can be very effective. "There's quite a bit of evidence for the value of spinal cord stimulation in patients who have back pain and shooting leg pain after surgery," says Paul Christo, MD, the director of the multidisciplinary pain fellowship program at Johns Hopkins Medicine in Baltimore, Md. Plus, the upfront costs can be misleading. D E C E M B E R 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 9 1

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