Issue link: https://beckershealthcare.uberflip.com/i/1471343
21 ORTHOPEDICS ASCs, technology, consolidation & more: The trends that are saving orthopedics By Ariana Portalatin T he migration of outpatient procedures, consolidation under orthopedic supergroups and innovative technologies were among the top trends surgeons credited with saving the specialty. Insight from 13 surgeons: Editor's note: Responses were lightly edited for clarity and length. Nicholas Grosso, MD. President and Orthopedic Surgeon for the Centers for Advanced Orthopaedics (Bethesda, Md.): e question of what is "saving" orthopedics depends on your point of view. As a private practice orthopedic surgeon, I feel that orthopedics is being saved by the consolidation of independent private practice groups into large "supergroups." By joining together, these groups can remain viable through the savings realized by the economies of scale, and they can stay competitive by having the resources to build the infrastructure necessary to navigate the rapidly changing healthcare landscape, including transitioning to more value- based payment models. By not allowing themselves to be purchased by a hospital system, or taking private equity investments, they retain the independence necessary to continue to practice the way they see fit without having to answer to outside investors. I also feel supergroups will be able to provide the most cost-efficient care in the market, making them attractive to large, self-insured employers and payers willing to enter into capitated arrangements for their musculoskeletal care. is was the motivation behind the development of the Centers for Advanced Orthopaedics nearly a decade ago. Niranjan Kavadi, MD. Spine Surgeon in Oklahoma City: e most important trend at this time in healthcare saving orthopedics is the transition to outpatient surgical care whenever feasible. Traditionally, open musculoskeletal procedures have been associated with postoperative pain interfering with rehabilitation. Minimally invasive techniques to achieve excellent outcomes are evolving rapidly with an advantage of less surgical morbidity and quicker rehabilitation. Specifically for the spine, endoscopic techniques are appealing. Obviously careful selection of patients who are suitable for outpatient care is essential. Outpatient surgery not only can potentially save the hospital setting resources for sicker patients but also has a positive psychological impact on the patients facilitating rehab and return to daily activities. Stephen Barr, MD. Orthopedic Surgeon at Spectrum Orthopaedics (Portland, Maine): e rapidity of change, the increasingly complex world of insurance, medical regulation, loss of physician independence, all combine in a flanking attempt to drive a wedge between the doctor-patient relationship. is, I feel, will be the key saving trend in orthopedics. I try my best to get in tight with the doctor- patient relationship, a place I feel most comfortable and gain the most satisfaction from on any given day in my practice as an orthopedic surgeon. In the words of one of my orthopedic professors, Bill MacAusland, MD, past president of the American Academy of Orthopedic Surgeons, "When the physician bears the patient's pain then will medicine its fainting hope sustain!" Davis Hurley, MD. CEO of Orthopedic Centers of Colorado (Denver): For many, the pandemic has been a wake-up call for an improved quality of life and being in your best shape for the future. Young and old patients look to orthopedic surgeons for fitness and injury recovery optimization in the here and now. Orthopedics can use a long-term perspective and a back-to-action- now mentality to facilitate musculoskeletal health for today and a more active future. Orthopedic surgeons are well-positioned to create patient, community and business benefits with their ability to bend the cost curve. Site of service savings and a willingness to advance value-based care initiatives are ideally suited to the orthopedic surgeons' choices for patient care. One cannot lose sight of the professionalism required of being a physician and surgeon. Patients count on surgeons, and we must have a seat at the table to advocate for our patients and the future of our specialty. Unfortunately, many influences and competing interests undermine our status as a knowledgeable and skilled profession. Focusing on quality patient outcomes, a value-based perspective and technological advancements based on a bedrock of patient safety will save our specialty. Matthew Barber, MD. Orthopedic Surgeon at Springhill Medical Center (Mobile, Ala.): 1. Transition to care in ASCs for more cases, particularly total joints and spine. is has helped to streamline care, produce better patient experiences, reduce costs and facilitate alternative payment models. 2. Alternative payment models. is one is early and will take some time to mature. However, as this market develops it will help to realign things to more patient-centered care and will help to preserve surgeon autonomy. is is a space that is evolving due to oppressive insurance costs and bureaucratic red tape. It includes direct care (cash pay), medishares, bundled payments, employer contracting, and population management for musculoskeletal care. It is unlikely that any of these models will completely dominate, but they will create an ecosystem of options that gives patients more choices and allows participating providers to remain independent. As these options open up, it may reverse some of the recent flow of private practice surgeons into employed roles. 3. e internet. at sounds stupid to say, but the democratization of information will help to save orthopedics. - Patients can learn about surgeons and procedures. - Patients can shop for options that fit their needs clinically, financially and logistically. - Social media allows healthcare consumers to vet their providers almost instantly. - Surgeons can cross talk with an international community of their peers in real time. - Open access journals like e Journal of Orthopaedic Experience and Innovation help to rapidly spread concepts that are significant to surgeons that insider networks at traditional journals stifled. Deepak Reddy, MD. Orthopedic Surgeon at South Bend (Ind.) Orthopaedic Associates: As an orthopedic spine surgeon I'm constantly amazed at our evolution over the past 30 years. Certain subsets of