Becker's ASC Review

50 ORTHOPEDICS 'The death knell for inpatient spine' & other forecasts for the setting in 5 years By Alan Condon T he spine surgical landscape is expected to change dramatically as outpatient migration accelerates and CMS elimi- nates its inpatient-only list by 2024. Five spine surgeons discuss how inpatient spine surgery will look like five years from now. Question: What will inpatient spine surgery look like five years from now? Michael Gordon, MD. Hoag Orthopedic Institute (Orange County, Calif.): In the next five years, spine surgery will look much different in the hospital setting. Most one- and two-level cervical surgery, and most one-level lumbar surgery will be outpatient. Inpatient surgery will be predominantly multilevel fusion and decompression surger- ies on an aging population with multiple comorbidities. Complex reconstructions and tumor surgery will be the most commonly performed inpatient procedures. I expect that improvements in imaging tech- nologies and minimally invasive techniques will push current procedures to the outpatient setting. is will be due to improvements in technology's ease of use, reliability and cost, particularly in current robotic platforms. Wearable goggle imaging devices, I hope, will mature to the level of current automobile moving map displays to improve surgeon 3D awareness. As always, the cost of new devel- opments must be met with improvements in patient cost of care and outcomes measures. Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Inpatient spine surgery will mostly be relegated to emergent cases, such as infections, pathological fractures and neoplasms as well as large complex deformity cases. By moving all of the inpatient-only codes outpatient, CMS has effectively sounded the death knell for inpatient spine. I am fairly certain this was unintentional, but as with most things in medicine, forethought ends up as hindsight. Surgery centers will contain the bulk of surgical cases, both in terms of minimally invasive surgery as well as two-level lateral and most multilevel arthroplasty cases. I sincerely hope surgeons will continue to use good judg- ment as to who should and should not have surgery on the inpatient side. ere will be more surgeries done as over- night stays (outpatient) in the hospital, but I would find it hard to not see surgery centers applying for and getting extended stay (under 36 hours) exemptions for cases. While this may sound attractive to CMS and Congress in terms of healthcare savings, it could be the ad- mission or urgent transfer of cases that are a 'bridge too far' to the hospital setting that will undoubtedly wipe out any long-term savings. Noam Stadlan, MD. NorthShore Neurologi- cal Institute and NorthShore Spine Center (Evanston and Skokie, Ill.): e number of inpatient surgery patients is decreasing due to an increased emphasis on outpatient surgery and shortening length of stay with enhanced recovery aer surgery protocols. e usual reasons for inpatient stays aer spine surgery involve the following concerns: neurological status, functional status, medical and pain. Over time, surgical pain will be reduced and treatment will be optimized, so inpatient stays for pain will go down significantly. Similarly, but perhaps not to the same extent, better and more active medical clearance and preha- bilitation will result in less inpatient stays for medical issues. erefore, inpatient stays aer spine surgery will be increasingly for those who have poor functional status and/or require monitoring for neurological status. Alok Sharan, MD. NJ Spine and Well- ness (East Brunswick, N.J.): As more spine surgery evolves towards the outpatient space, it is clear that we will see fewer surgeries being performed in the typical inpatient setting. Complex spine deformities, spinal oncology cases and traumatic injuries will be common- ly performed in the inpatient setting. Initially, as surgeons come out of training, they will be more inclined to do their cases in the hospital. As the systems to optimize a patient properly evolve, these surgeons will migrate their cases toward the outpatient setting. Nitin Khanna, MD. Spine Surgeon and Founder of Spine Care Specialists (Mun- ster, Ind.): Inpatient surgery will slowly be reserved for higher-acuity cases. ere is still a big role for inpatient spine surgery for adult and pediatric deformity, complex medical comorbidities, as well as tumor, trauma and infections. It is not sustainable for every outpatient spine surgical-eligible patient to have their surgery in a hospital. You would drive a car and not take a 747 airplane by yourself to work every day. I have published and presented on outpatient surgery at the International Journal of Spine Surgery and the Society for Minimally Inva- sive Spine Surgery. Safety, cost effectiveness and patient satisfaction have all been proven in the outpatient setting by many of my spine colleagues. e future looks bright for people suffering with spinal pain that now have so many minimally invasive outpatient options that can reliably relieve their suffering. n Orthopedic surgeon gets approval for Texas ASC, office building By Alan Condon A Texas orthopedic surgeon received approval June 10 to build an ASC and medical office building in Fredericksburg, according to Virtual Builders Exchange. The medical building will be 9,537 square feet, while the surgery center will span 10,025 square feet. The property is owned by Clint Beicker, MD, a total joint surgeon and sports medicine specialist, according to the report. Dr. Beicker is affiliated with Texas Hill Country Orthopaedics & Sports Medi- cine and practices with Hill Country Memorial, both in Fredericksburg. Dr. Beicker completed a residency at Texas Tech University Health Science Center in Lubbock and a sports medicine fellowship at Steadman-Hawkins Clinic of the Carolinas in Greenville, S.C., according to his website. n

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