bladders function normally.
6
Safe at home
For some of our most complex cases, we also send a nurse to
the patient's home to help manage them for 8 to 24 hours. It's
more about reassurance than it is about true nursing, but patients
really appreciate it. It eases the fear that they're going to be sent home
with no one to adequately look after them. We do it at our own
expense, but it's a good investment, because it lets us do more com-
plex cases, and it improves patient satisfaction. Some facilities use
post-discharge recovery units or make arrangements with hotels. We
don't, but those are also worth considering.
7
Improving reimbursements
The reimbursement climate for spine has improved dramatical-
ly and continues to improve. Because we were pioneers at
doing complex cases in the outpatient environment, we were com-
pletely out of network when we started, and our surgeons had to do a
lot of peer-to-peer consultations to get cases approved. But payers are
increasingly seeing that we can efficiently achieve the triple aim of
being safer, better and cheaper, and more and more are coming to the
table. Happier patients, an amazing safety track record and efficiency
go a long way. We are now mostly in network for our spine cases.
In the last couple of years, Medicare has also stuck a toe in the door.
The margins are tight for spine, but there's hope that eventually we'll
see some sort of reward for the quality and cost savings we offer.
We're also looking at options with major groups that carry Medicare
Advantage. We may even consider risk-sharing or bundled payments
at some point.
5 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 7
