"out of control" healthcare costs. And he believes that focus is only
going to intensify.
"The drive to save money is there," he says. "You're starting to see
Medicare for outpatient spine. A lot of the taboos have lifted. The
wave of the future is now reality."
Dr. Gantwerker believes it's the "fear factor" — liability concerns, in
other words — that's keeping some surgical facilities out of the outpa-
tient spine business. But he says the right equipment and a properly
selected patient can mitigate the safety risk.
"The upside for reimbursements is really nice," he says. "For a
spinal cord stimulator, you're talking $20,000 to $30,000, so you
could make a nice profit."
To get a program off the ground, a surgical facility would need "basic
spine instruments" — tools such as retractors, curettes and a neuro
microscope, for starters. Intraoperative fluoroscopy would be a necessi-
ty, as well, so the facility would need to factor approximately $150,000
for the capital cost of a C-arm into the budget.
His parting words to outpatient facilities considering adding spine to
their service lines: Manage patient expectations, develop protocols for
pain control, and don't take on any procedure that makes you or your
facility uncomfortable.
"Start slowly, maybe with microdiscectomy," he says. "And be aware
of the hidden cost involved with things like neuro-monitoring, which
is an important safety feature but can have an effect on your case
costs." — Bill Donahue
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