surgery center?" Identifying which cases present ideal opportunities
comes down to throughput. Procedures that don't take long and that
can be turned over quickly make for an efficient, service-oriented
schedule. That's not to say that patients are just products on an
assembly line. They like speedy surgeries and discharges as much as
physicians do. So choose for patient convenience and experience as
well.
Keep in mind, though, that you're bringing the procedures on board
as a new revenue stream, so it's important to assess the costs in light
of their reimbursement rates (see "Can We Profit From Outpatient
Spine?" on page 69). Just as you don't want to see physicians waiting
to start their cases, you don't want case costs to swamp your profits
before a procedure even begins.
Pain management procedures are a great place to start. Spinal injec-
tions and pain stimulator placements — for both trial and permanent
implants — are relatively simple operations and can build a base for
your service line. These cases are patient-satisfiers, not to mention
lucrative business.
Minimally invasive spine surgery is the next step up, and includes
kyphoplasty, microdiscectomy and laminotomy, which are easily per-
formed in outpatient settings and which pay pretty well. Anterior cervi-
cal discectomy and fusion also fall into this category, as do transforami-
nal and posterior lumbar interbody fusions. For the lumbar fusions,
however, your center must prepare for the possibility of overnight
stays. While some patients may be safely discharged, others may
require extended recoveries due to pain or airway issues. So you'll
need a plan, which first means consulting your state regulations on
whether 23-hour stays are allowable where you are.
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