Becker's ASC Review

25 Executive Briefing value and operational efficiency of the technology we selected." There is also a learning curve to implementing most new technology that surgeons and their teams must overcome. Using an entirely new type of system for orthopedic surgeries, like robotic technology, takes time to train and then integrate into the normal workflows. In the beginning, using this type of technology could add time to the procedure and might not have a significantly better outcome. "Surgeons want to avoid disruptive technologies that will add time in the OR and change their normal processes," said Dr. Durbhakula. "They want to offer technology for their patients that improve outcomes but doesn't disrupt the flow of cases or require a huge cash outlay. They need to be able to pay for the technology on a case-by-case basis." Long-term changes The pandemic had a swift and immediate impact on orthopedic practices, and it will continue to frame how the field evolves for years to come. Dr. Ast said the entire preoperative workflow has changed in his practice; now all patients undergo antibody and viral testing, including a test within one week of surgery as well as a nasal swab upon entering the ASC or hospital. Patients also undergo a temperature check and are sent home if they exhibit any concerning symptoms. "In the first week of implementation, we had four asymptomatic patients test positive for COVID-19 on the morning of surgery, and their procedures were canceled," said Dr. Ast. "Now we are trying to figure out what the next step will be. That is changing our workflows and preoperative screening methods." Hospital for Special Surgery surgeons also anticipate making telehealth a permanent part of their practice and conducting virtual physical therapy and rehabilitation sessions with some patients postoperatively. The pandemic has also highlighted the clear advantages of specialty hospitals and ASCs to delivering surgical care. "Long term, the pandemic will reinforce some of the negative views of general hospitals, and I think in the future it will drive patients to seek care at surgery centers and specialty hospitals," he said. "Patients view HSS as a potentially safer place to be than others because we focus on orthopedics." Dr. Durbhakula also predicts that the fears about hospitals could bleed into any healthcare setting. Some patients may decide to delay medical treatment in any setting due to fears and prefer telehealth as a convenient way to receive care. Patients will also turn more to online education about their conditions and treatments. "They may decide to do online consults and research on their own about joint replacements before seeing the doctor," said Dr. Durbhakula. "This will make medicine more technologically advanced and we will be able to use more resources for patient education." ASCs in the next five years While total joint replacements were already trending to the outpatient setting, the pandemic has sped up the transition. Dr. Ast and his team at Hospital for Special Surgery have spent the past five years adopting the protocol and patient selection policies for joint replacement in the outpatient setting and are now prepared to take on additional patients during the pandemic. "We are prepared for the sudden onset of more joint replacements in the outpatient setting from a capacity and safety standpoint," he said. "That's why the ramp up will be so dramatic. CMS and private payers have been predicting the shift of outpatient total joints and I think there will be a big opportunity in the next five years for that trend to accelerate." In the near term, budget restrictions will slow the purchase and implementation of expensive technology, especially without a clear path for improved patient care. "With leaner budgets and not as much reimbursement as the hospital, technology has to be cost-effective," said Dr. Durbhakula. "There are also many ASCs with multiple owners who will not use the technology, some of which aren't even orthopedic surgeons. Not everyone wants full robotic technology, and the technology they do implement has to be mobile so rooms can be transitioned for other procedures quickly." Dr. Durbhakula sees computer-assisted surgeries and navigation technology as becoming a large part of orthopedic practices moving forward, especially as the percentage of total joints performed in the outpatient setting grows. He projects that up to 40 to 50 percent of total joint arthroplasties could be outpatient in the next five years. He also sees insurance companies incentivizing members to have cases done in the less costly ASCs when it's safe. In conclusion ASCs have a long road ahead to recover from the COVID-19 pandemic, but there is clear opportunity in adopting efficient and effective total joint arthroplasty procedures. The high-acuity cases can be performed safely in the ASC for the appropriate patients, and technology can help ease the operational and clinical transition. n OrthAlign is the leader in smart-tech powered joint surgery. The Company's handheld devices (analogous to a smart-phone) are loaded with applications for total knee, partial knee, and total hip replacement arthroplasties. Micro-electromechanical sensors deliver accurate and precise live-navigation in a single-use disposable form factor, without any equipment outside the sterile field. OrthAlign's technology has powered more than 150,000 surgeries to date.

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