Becker's ASC Review

34 ORTHOPEDICS How orthopedics, spine will grow in ASCs from 4 surgeons By Laura Dyrda O rthopedics and spine are evolving specialties for the outpatient and ambulatory surgery center space. Here, four surgeons discuss goals for their outpatient orthopedic and spine practices, and the role ASCs could play in the spe- cialty going forward. Question: What are your top one or two goals for your practice over the next three to five years? How do you see it growing and developing? omas K. Miller, MD. Carilion Clinic (Roanoke, Va.): e challenge for any practice and healthcare system is associ- ated with directing patients and services required to the most appropriate facil- ity for the entire "package" of care. e concept of who really needs a traditional hospital environment continues to evolve. Matching and appropriately allocating the limited resources of time/OR access, over- head, materials and staffing to the patient and procedure needs to be approached outside the longstanding models of care. is includes: • Rigorous [preoperative] screening of comorbidities and assignment to a site of care based on anticipated perioperative needs (not just the procedure to be performed) • Assessment and optimization of post- operative support services • Patient (and family) education and training • Supply of durable goods to enhance recovery • Development of efficiencies based on large volumes and reliably reproduc- ible protocols and continuous moni- toring of outcomes and adjustment of care models based on objective evidence from this monitoring As more complex procedures are shied to nontraditional sites of care, we expect to see a narrower focus of service for sites of ambulatory care. Just as surgical special- ties have become more subspecialized, we can expect ambulatory centers to become more specialized to improve efficiencies and quality of care. We expect to see not just specialty specific ASC sites but narrow focus procedure centric facilities. Bobby Bhatti, MD. Atlanta Spine: Our growth continues to focus on changing the referral patterns in our city. It is imperative that referrers realize we offer all the latest technological advances to our spine pa- tients, because we focus our practice solely on the spine. We are seeing a lot in sterile packaging for ASCs. is is a significant cost reduction and quality control measure that helps outpatient surgery significantly. I think robotics, albeit a great marketing gimmick, has a long way to go. Most of us spine surgeons know how to put in a pedicle screw; the real achievement will be operating through a remote station. Hospitals as we know them are a thing of the past. ASCs provide boutique care that is more efficient [and] more cost effec- tive with lower infection rates. We hope that reimbursement will reflect that as the insurance carriers see our results. Kam Momi, MD. Coastal Spine (Mt. Laurel, N.J.): Our top goals are arrang- ing for strategic partnerships with either a hospital or with other ASCs to form larger entities for potential buyout. Recruiting new physicians is our biggest challenge. We have been looking at nontraditional sources of surgical revenue, for example vascular surgery. [I would advise surgeons just entering the field to] join an ASC as soon as possible aer you begin practice. e profitability is still there although it is a mature field. Q: What role do you see outpatient sur- gery centers playing in the orthopedics and spine field in the future? Neil Badlani, MD. e Orthopedic Sports Clinic (Houston): Outpatient spine surgery has grown dramatically over the last decade because of significant clini- cal and economic advantages to patients, physicians and the healthcare industry. Im- proving technology, increased patient and physician satisfaction as well as a desire to control healthcare costs are key drivers of this growth. Patients prefer outpatient procedures because of the increased conve- nience and quality of care. Physicians benefit from the efficiencies of the outpatient setting and potential profit from ownership. e healthcare market continues to evolve because of ambulatory surgery centers providing a disruptive in- novation to the existing industry structure. Shiing site of surgery to the outpatient setting leads to an overall decentralization of healthcare and significant cost savings opportunities. e trend toward moving spine surgery to the outpatient setting will continue as patients and physicians become more comfortable with the process and evidence continues to show excel- lent outcomes, low complications and economic efficiencies. n "The concept of who really needs a traditional hospital environment continues to evolve." - Dr. Thomas K. Miller, Carilion Clinic

• Cover