The addition of spine services requires many centers to add specially trained staff, obtain capital equipment and the purchase of instruments and implantable devices. Failing to recognize cost may cause financial performance to vary significantly from the business plan. Here a few considerations for four areas of costs when adding spine services.
Equipment. While a Jackson table and an operating microscope may be obvious needs, poll all spine surgeons planning to participate in the program to assure all necessary specialized equipment or instruments are included in the plan. 
Services. Intraoperative neuro-monitoring or bone marrow biopsy processing for use in graft augmentation can represent significant cost associated with spinal fusions.
Implants. Have physicians clearly specify their implant use, and potential changes in usage in either the near- or medium-term. Implant pricing can vary dramatically depending on the specific procedure performed, and from vendor to vendor. Cases paid in a manner that reimburses facility services and implants in a single payment can easily transition from a positive margin to negative based on a change in implant.
Managed care and business office. No matter how efficient the service, a positive margin is only achieved when reimbursement exceeds cost. Many ASC contracts are not set up for appropriate spine reimbursement. Consider the time and cost to renegotiate managed care contracts to allow favorable reimbursement for spine, as well as costs associated with either adding additional or training current staff to properly bill and collect for spine services.
Tom Flory is a seasoned healthcare professional and began his career in the industry in 1987. Mr. Flory is a manager who is a liaison to clients and coordinates payer negotiation and special projects, providing leadership and direction to Eveia teams. Mr. Flory has expertise in spine and has been a leader in this area for the EVEIA team. He is also the co-Manager of EVEIA’s Operations Compliance Services, and is an Eveia speaker at conferences. Prior to joining EVEIA, Mr. Flory was the Executive Director of a successful multi-disciplinary ASC with an emphasis on Spine & Pain Management in Washington State.