Outpatient spine surgery is growing in popularity, but payer response has varied. Question: How do you approach payer negotiations — particularly with commercial plans that may be resistant to the shift from inpatient to outpatient for spine? Prairie Spine & Pain Institute (Peoria, Ill.): Our approach has been to work with commercial plans that are self-funded and self-insured. We save tens of thousands of dollars on average per spine surgery as compared to our regional hospitals. Sinkov Spine.