Transitioning ASC Experience into a Bundled Neurosurgery Product. Becker's Oct.2016

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1 Transitioning ASC Experience into a Bundled Neurosurgery Product.

2 ASC experience Neurological Institute ASC Founded Neurosurgeons. Spine and Pain 3795 general anesthesia cases spinal injections. Single and multilevel cervical and lumbar fusions Single and multilevel cervical and lumbar decompressions. Open and closed pain procedures. Endoscopic, microscopic, and MIS.

3 Cost standardization Surgeon willingness to change. Community resources and instruments. Transparency. Utilization and resource tracking. Establishing evidence based treatment plan protocols. Adherence to quality metrics.

4 Revenue cycle management Contemporaneous EMR completion. Correct coding with supporting documentation consistent with precert. Submit accurate charges within 24 hours.

5 ASC vs. hospital costs For single level minimally invasive instrumented posterior lumbar fusion: Total bill charges for inpatient: $75,663 Total bill charges for outpatient ASCs: $42,500 Average insurance payment for inpatient: $26,711 Average insurance payment for outpatient ASCs: $23,208 For single level minimally invasive TLIF: Total billed charges for inpatient: $160,606 Total billed charges for outpatient ASCs: $45,499 Average insurance payment for inpatient: $59,251 Average insurance payment for outpatient ASCs: $25,000 ASCs vs. Hospitals: How Spine Surgery Reimbursement Compares Written by Laura Dyrda Monday, 18 June :22

6 ASC vs. hospital costs 1. There were seven cost-based studies, which estimated average cost savings ranging from 17.6 percent to 57.6 percent associated with outpatient orthopedic procedures as compared to similar procedures performed in hospitals. 2. The difference in cost between the outpatient and inpatient surgery groups was $3,225 on average. 3. In one study, the mean total cost was $19,021 at the outpatient center versus $23,087 at the inpatient hospital. 4. Another study found for anterior cruciate ligament reconstruction procedures, average total cost was $3,905 at an outpatient center compared to $9,220 at the inpatient center. 5. Volar plating for closed distal radius fractures cost, on average, $5,220 at an ASC versus $7,640 at an inpatient hospital. 6. The review found patients who underwent outpatient surgery reported significantly less final cost than the inpatient group. Outpatient vs. inpatient orthopedic procedures: Where are the cost-savings? Written by Anuja Vaidya June 15, 2016

7 Opportunities

8 Partner Hospital Traits beds Rural/Critical Access

9 Bundled Payment Hybrids Non Surgeon Professional Services. Disposables. Implants. Capital Equipment. Coding assistance, revenue cycle management. Surgeon Services. Facility.

10 Benefits to Hospital Incremental Service line. New Revenue Stream Predictability in cost of episode of care. Patients remain in hospital system. Minimal Capital needed to start.

11 Hospital Benefits Hospital relieved of implant/disposable costs. True surgeon partner. Incentives aligned to exceed quality standards, reduce cost, and increase avaiblity to even the poorest patients.

12 Bundled NS Product Surgeon Fees Facility Fee One professional fee for a specific DRG. 60 day global period. Surgeon agrees to use requested EMR, PACS, and provide coding guidance including ICD 10 review and coordination Fee can include or exclude implants. DRG based. Anesthesia services excluded.

13 Bundled Price Options Surgery Center of Oklahoma Anterior Cervical Discectomy with Fusion, 1 level (includes hardware) i $ 18,960 * Anterior Cervical Discectomy with Fusion, 2 levels (includes hardware) i $ 25,360 * Lumbar Fusion, 1 level i $ 38,000 * Lumbar fusion, 2 levels i $ 49,625 * Lumbar Laminectomy i $ 9, * Microdiscectomy i $ 8, *

14 All Inclusive Pricing The Orthopedic Surgery Center of Orange County in Newport Beach, Calif., for example, practices price transparency by listing all-inclusive prices for 54 procedures, including six spine procedures. The charges include: Minimally invasive discectomy, laminectomy, laminotomy: $14,225 Two-level MIS discectomy, laminectomy, laminotomy: $16,200 Single-level MIS lumbar fusion with overnight stay: $30,000 Two-level MIS lumbar fusion with overnight stay: $38,000 MIS discectomy and/or fusion with overnight stay: $31,500 The growth of outpatient spine 9 Key Points Written by Scott Becker and Megan Wood Wednesday, 03 February :00