Advancements in minimally invasive surgical technologies have now made it possible to perform complex spinal surgeries in an outpatient setting. Clinical innovations such as improved anesthetic techniques and enhanced postoperative protocols, paired with the willingness of payers to reimburse for a growing number of procedures, have led to an increase in the number of procedures performed in ambulatory surgery centers (ASCs).
Currently, thousands of ASCs across the United States offer minimally invasive spine surgery. Procedures such as anterior cervical discectomy and fusion (ACDF), artificial disc replacement, and lumbar discectomy and laminectomy are now frequently performed in ASCs. This shift can not only enhance patient convenience and outcomes, but can also significantly reduce healthcare costs, presenting a compelling case for the continued growth and adoption of outpatient spine surgery.
Data from 2018-2023 indicates that nearly 800,000 outpatient spinal procedures were performed in ASCs in the United States. For this study, we examined six common spinal procedures using the procedure groupings defined by the American Academy of Professional Coder (AAPC). These procedures include:
The shift toward performing more outpatient procedures in general, and spinal procedures specifically, was catalyzed by the Covid-19 pandemic. The pandemic jolted the healthcare industry in many ways, perhaps most significantly in sharply reducing access to care and facilities. Elective cases were delayed if not canceled outright with only the most acute surgical procedures still performed in a hospital setting.
In 2020, ASCs were cleared to resume non-urgent and elective procedures before hospitals were, and the shift in setting was dramatic. Similar to a rise in telehealth visits and treatments, the growth trend didn’t abate as Covid did. Both providers and patients showed a preference for the change forced by necessity, and procedure growth rates in ASCs continued to outpace those in hospital settings in 2021, 2022, and 2023.
More spinal procedures are still performed in hospitals overall, but the gap between ASC and hospital settings continues to shrink, with Anterior or Anterolateral Approach for Extradural Exploration/Decompression Procedures on the Spine and Spinal Cord specifically experiencing a rapid shift to the ASC setting. Simply put, thousands and thousands of procedures are shifting their setting each year with no signs of slowing down.
However, the analysis of our proprietary model derived from 100% of Centers for Medicare and Medicaid Services (CMS) data and >300m patients across open- and closed-claim sources shows that different states are adopting ASC practices at different rates. The clinical and financial benefits of outpatient spinal surgery are not being evenly experienced by patients and providers across the United States. Growth rates by state fall into one of four quadrants:
From the top left, clockwise:
States with comparable ASC adoption or growth rates in any of the four quadrants do not appear to have obvious similarities or differences. Multiple factors may influence the state-by-state disparities in ASC adoption rates, including local policies and regulations, regional demographics, social determinants of health, provider preferences, and reimbursements. Curiously, state-by-state differences in Covid-19 infection rates or public restriction policies also don’t seem to be a common factor, despite Covid-19 restrictions being the impetus for recent increasing ASC procedure trends.
More data and analyses are required to determine which variables are most influential in driving ASC adoption of spinal procedures so the transition process can be standardized and streamlined and the benefits of this shift can be realized in lagging regions.
The shift towards performing spine surgeries in ASCs marks a significant advancement in healthcare delivery, offering numerous benefits including reduced costs, enhanced patient outcomes, and increased procedural efficiency. While the trend is robust and growing, it is essential to address the challenges and regional disparities to fully realize the potential of this model. Continued innovation, supportive policies, and targeted education will be crucial in sustaining and expanding the adoption of outpatient spine surgeries in the coming years.
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