Dr. Kenneth Pettine: Four Points on Performing Spine Surgery in ASCs

Written by Laura Miller | Becker's ASC Review | June 18, 2012

At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, Founder of The Spine Institute and Loveland (Colo.) Surgery Center Kenneth A. Pettine, MD, gave a presentation titled "Everything You Need to Know to Successfully Perform Spine Surgery in an ASC." In his presentation, Dr. Pettine touched on several factors that will make it easier to bring spine procedures into an ambulatory surgery center in the future. 

"My goal is to move 50 percent of inpatient hospital spine surgeries in the United States to an ASC," Dr. Pettine said. "I would encourage everyone to be involved in the Society for Ambulatory Spine Surgery. We need to change current Medicare ASC guidelines, which will allow us to perform more cases in the ASC. We've seen this trend with arthroscopies."

1. Negotiate down implant costs. It's important to negotiate down implant prices to retail prices, if they aren't already there. "It's not difficult to negotiate 40 to 60 percent discounts on implants," said Dr. Pettine. "Share that discount with spine surgeons."

Also consider implant cost when negotiating for payor contracts. "Don't leave implant money on the table," said Dr. Pettine. "Have appropriate contracts to perform spine surgery at the ASC."

2. Give surgeons the numbers. If surgeons in your community are dragging their feet about bringing cases into the surgery center, give them data to show them the impact it could make on their practice. "Surgeons are rather reticent to change their practice patterns," said Dr. Pettine. "They do the same procedures they did 10 to 20 years ago. One of the ways you can convince them to change is with data. With numbers is power."

The most important data to highlight includes:

•    Turnover times, which should be around 10 minutes in the ASC compared to 45 minutes in the hospital
•    Implant income with percentage over cost
•    Infection control data

3. Build a convalescence center. A convalescence center allows patients who need extra recovery time to stay 23-plus hours in the facility after outpatient spine surgery. If constructing a convalescence center isn't possible, consider partnering with other facilities for discharging patients who aren't quite ready to return home.

"You can accomplish the same thing as a convalescence center with a rehabilitation facility or nursing home," said Dr. Pettine. "There are ways to accomplish this same type of facility in states where surgery centers can't get a convalescence license." 

4. Procedures performed in a surgery center. Right now, typical procedures performed in the surgery center include anterior lumbar interbody fusions, posterior lumbar fusions, artificial disc replacements and sacroiliac joint fusions. "Currently, these are not controversial procedures to perform in an ASC because we have gathered effectiveness data," said Dr. Pettine. "We've done about 1,700 non-instrumented cases in the ASC and because of published data they aren't controversial."

Dr. Pettine also participates in clinical trials using biologics during spine surgery. "There are approximately 20 different types of adult stem cells in your body," said Dr. Pettine. "In orthopedics, we use mesenchymal stem cells. The goal is to harness the natural healing potential of stem cells. I am unaware of any adverse effects of using the patient's own stem cells."

After harvesting the stem cells, they are processed and then implanted back in the patient to promote fusion. The FDA considers the procedure the same as blood transfusion. "Results of the study are extremely promising," said Dr. Pettine. "The more you learn about this technology, the more optimistic you become."


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