1. Allen Flex Frame Operating Table.
Dr. Lynch, a boardcertified neurological surgeon and fellowship-trained spine surgeon who chairs the board for the Surgery Center of Reno, says he recommends an Allen operating table, which folds up — an advantage in space-challenged ASCs — and costs $100,000 less than some commonly used hospital operating tables. Dr. Lynch says the typical hospital OR table is too large and doesn’t swing easily between the smaller spaces occupied by ASCs. “Hospitals have space for storage, but most ASCs have little extra room and rent space for their ASCs. Storage costs money. This works well for us.”
2. Leica Operating M520 F40 Surgical Microscope.
Dr. Lynch says the Leica scopes can also save ASCs money and deliver great quality and value. They cost $80,000-$90,000. But he says high end microscopes with image guidance abilities can cost up to $250,000.
Beth Ann Johnson, RN, vice president of clinical systems for Blue Chip Surgical Center Partners, says her company tries to purchase refurbished microscopes. “There’s a company called Prescott’s, Inc., that reconditions surgical microscopes for between $60,000-$70,000. Neurosurgeons will give you the names of $200,000 microscopes when you actually can get a top model refurbished. Prescott’s doesn’t just dust them off, but takes them apart, reconstructs them and produces and sells great microscopes for a good price.”
3. Anspach Pneumatic Surgical Drills.
These devices cost around $15,000-$28,000 apiece. “You will need two for each operating room,” Dr. Lynch advises. “You’ll need one for backup in case the first one breaks down or is sent out for repair. You don’t want to be dependent on just one and have it go out on you.”
Ms. Johnson says her firm negotiates loaner drills and a limited number of drill bits needed. “We agree to minimum numbers to purchase to drive down the cost of the bits.”
4. Intraoperative fluoroscopy unit (C-arm).
The imaging units are manufactured by General Electric, Siemens and others and cost $140,000-$150,000. Dr. Lynch recommends investing in a new or refurbished high-end model to provide intraoperative imaging for lumbar and cervical visualization. “The older versions often provide poor visualization and require extensive repair. And surgeons will go nuts if they see that you’re using equipment that breaks down. Some will say the equipment is not on par with the hospital and will refuse to do surgery there,” Dr. Lynch says. “If you’re going to do it, do it right.”
5. Bipolar Medical Coagulation and Cauterizing Instrument.
Anne Roberts, administrator for the Surgery Center of Reno and a former hospital ER nurse and executive, says the COAG machine, which costs about $12,500, is essential to ASC spine procedure. It is used to stop bleeding.
6. Retractors and instrument trays.
Ms. Roberts says ASCs offering spine surgical services need lumbar ($21,500) and cervical ($16,730) instrument trays and Shadowline ($14,500) and McCulloch ($16,650) retractors. “This is surgeon-specific,” she says. “You need physician buy-in. They need to be a part of the decision-making process. Typically we identify what procedures will be performed and then get a list of what our neurosurgeons want. Then you discuss it with them to try to standardize the products.”
Ms. Johnson says Blue Chip often uses TeDan Surgical Innovations for spinal retractors. “They produce them for $9,000-$15,000 instead of $20,000-$25,000 for the same quality,” she says. “It’s important when adding a specialty to an ASC to keep capital equipment costs to a minimum.”
7. Spinal implants.
“We’ve had great success in working with DePuy, BioMet and Medtronic’s Sofamor Danek Division on price and standardization for plates and screws,” says Ms. Johnson. “It’s important that the ASC ask the manufacturer to loan the instrumentation needed to install the plates and screws. Each set of implants requires instruments, and you don’t want to have to buy that. You also want them to agree to have an inventory of plates and screws on consignment, so you’re not holding thousands of dollars in inventory you’ll seldom use. Depending on the volume you do with them and the relationship you share, they’re usually agreeable.”
Implants typically cost $5,240-$13,000.
“Be cautious about the dollar amount spent on disposables or implants used,” she advises. “Unless those items are carved out of a global reimbursement methodology, many health plans and payors will not pay for them,” Ms. Johnson says. “Hence, your high expenses can significantly affect your profit margins.”
She says it’s important to standardize purchases so the ASC doesn’t staff a different set for each surgeon. “That’s not a wise use of inventory. ASCs need to get around the table with their physicians and decide on one manufacturer. Once you have agreed to do that, you have much more negotiating power with the company as well,” Ms. Johnson says.
8. One Headlit Surgical Head Lamp.
Plano, Tex.-based medical equipment producer, L.I.T. Surgical makes these surgical lights, which sell for around $6,000. Neurosurgeon Ken Pettine, MD, a spine surgeon from Loveland, Colo., says they represent the latest in LED technology and never decrease in brightness. Dr. Pettine says he prefers them to some of the top brands because after 200 hours many of the top brand lights begin to lose up to 40 percent of their brightness. Many other brands are connected to boxes, which are attached by cables, and may cost up to $12,000. “I don’t have to wear lead with the One Headlit, which weighs 8-10 pounds and starts to fatigue you after 5-6 hours. And there are no cables attached either.”
9. Haemonetics Cell Saver 5 Blood Processing System.
Dr. Pettine says several companies produce cell savers, which are autologous blood filtering, storage and recovery machines that allow surgeons to filter patients’ blood and return half of what they lose intraoperatively. “You need it if you’re doing big time spine surgery,” he says. He says his Loveland Surgery Center bought a refurbished cell saver for $4,000, but said new models can cost around $12,000.
Contact Mark Taylor at mark@beckersasc.com.