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Build slowly
If you have an existing center or hospital outpatient depart-
ment, and you're thinking of adding spine, it makes sense to
start with the simpler stuff — microdiscectomies and microdecom-
pressions, for example. Just make sure you understand your environ-
ment, your doctors, where cases will come from and the payer mix.
If, on the other hand, you're thinking about opening a center that
does everything we do, know that it's a big undertaking with a lot of
moving pieces. It's doable, but in addition to needing a surgeon cham-
pion to run it, you'll need a tenacious administrator, some very signifi-
cant capital and someone with a lot of expertise in negotiating con-
tracts. In fact, partnering with an experienced management company
is probably your best bet.
Current ambulatory spine procedures include spine injections, lum-
bar decompression surgery, posterior cervical decompression, anteri-
or cervical decompression and fusion vs. artificial disc, and lumbar
fusions. We started with relatively minor procedures and developed
incrementally. Now we have 9 spine surgeons and we've progressed
from microdiscs to anterior cervical discectomies, to complex lumbar
fusions, to super-complex front and back interventions, to removing
intradural tumors. The only procedure we don't do is multi-level scol-
iosis, primarily because these patients require a longer hospital stay
for pain management.
For more complex cases, you need to have access to spinal cord
monitoring capability and all the experience and skills needed to run
a complex environment. We have every piece of spine-related equip-
ment hospitals have, and then some. The nice part about being in
charge is you don't have to jump through all the budget-related hoops
you face at most hospitals.
We operate in California, which is a 23-hour, 59-minute outpatient
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