Issue link: https://beckershealthcare.uberflip.com/i/1471343
22 ORTHOPEDICS medicine have remained rather stagnant over time, fundamentally doing the same thing today that surgeons did 20 years ago. Spine, however, has been a hotbed of innovation. e progression of minimally invasive surgery aided by novel less-invasive approaches, enabling technology, hardware solutions and biologic advances continues to push spine surgery forward. Even today, how I solve spine problems is dramatically different from where I was six years ago. Advances in this regard have fueled the transition to outpatient spine care in the ASC and continue to drive better patient outcomes while reducing the morbidity of traditional spine surgery. Not only is this trend saving orthopedic spine, it's resulting in better patient care, tearing down the stigma of spine surgery's mixed outcomes with advances in minimally invasive surgery and technology. I believe we will see this trend continue as enabling technology advances and big data analytics permeate into the world of spine surgery. Enabling technology will likely continue to drive MIS allowing faster, less invasive approaches and transition toward aiding surgeons with the decompression as well as the hardware placement. Big data analytics will push forward with the goal of reducing the variability of diagnosis and treatment algorithms. Today, five spine surgeons approach the same problem in five different ways. In the future we may be able to use historic data to drive decision making and reduce the variability of treatment and variability of outcomes. Lastly, innovations in post operative pain management with the increasing usage of multimodal anesthesia and enhanced recovery aer surgery protocols has further facilitated outpatient and less invasive care with a lower reliance on opioids. Further innovations in this space will continue to offer spine surgery to patients with a safer and more predictable postoperative course. ere are a number of interesting innovations in the space of neural stimulation currently being worked on, which may further benefit our patients. I'm excited to see what the next 10 years of practice looks like as we continue this evolution that is currently saving spine surgery and essential to its future. Kern Singh, MD. Co-Director of the Minimally Invasive Spine Institute of Midwest Orthopedics at Rush (Chicago): e movement of spine cases to the ambulatory setting will continue to play an important role in the evolution of spine surgery. By utilizing ASCs to match surgical settings with patient and procedural risk, surgeons are able to achieve considerable cost savings while maintaining greater autonomy over patient care and practice. From a financial perspective, the ASC delivers the clear benefit of avoiding the expenses associated with inpatient admission to the hospital, affording insurance companies and providers considerable savings. In addition, the ASC increases the financial interests of physician owners, providing a clear incentive to save on operative costs via process standardization, which may in turn facilitate a favorable reduction in the price of surgical implants. Along that concept of physician interest, the ASC may promote increased surgeon autonomy in their practice. As large hospital systems continue to expand through acquisition of private groups, the autonomy of the surgeon in the hospital faces increasing resistance. Surgeon ownership of outpatient surgical centers provides an avenue for enterprising physicians to take ownership of their patient care and collections with less administrative resistance. Michael Wood, MD. Orthopedic Surgeon at Mayo Clinic (Rochester, Minn.): ere are at least four trends that will have a positive impact on the specialty of orthopedics over the next decade: 1. e age-related demographic trend in the U.S. as well as worldwide. is has been a relentless trend over the last century but is expected to continue unabated. In 2019, there were 54.1 million Americans over the age of 65, and by 2040 this number is projected to be 80.8 million. In general, people over the age of 65 consume four-fold more healthcare per capita than the population under the age of 65, and this can be expected to apply to orthopedic care as well. 2. Orthopedic residency applicants are increasingly more accomplished in terms of academics (DePasse, et.al., JBBS, 2016). is is reflected in the higher USMLE scores as well as the greater number of publications, abstracts and presentations from applicants over the last 10 years. 3. e breadth and depth of what is considered orthopedic surgery is expanding as a result of advances in biology and engineering. is includes the discovery of tissue substitutes, materials advances and implant designs. 4. Virtual care has recently become a practical reality as a result of the COVID-19 pandemic challenges to in-person care. Although it is uncertain if the regulatory obstacles to virtual care that have been relaxed as a result of temporary COVID-19 policies will be continued as permanent, virtual care has the potential to expand access to a greater population for orthopedic care. Earl Kilbride, MD. Orthopedic surgeon at Austin (Texas) Orthopedic Institute: In general, our aging population is much more active than ever before. Couple an aging population with one trying to remain active and orthopedics is actually primed for a curve where the patients outnumber the providers. is is a good problem to have as a provider. From a business point of view, two things are contributing to a business model favorable for orthopedic surgeons. First and foremost, the aging patient population is staying active. is leads to an overall increase in the number of surgical candidates. Many, if not most, elective orthopedic procedures can be done as outpatient. e inpatient facilities have now come onboard and are extremely interested in this shi in care. New partnerships will help the orthopedic physician collect on the facility as well. Essentially, combining a bigger denominator of patients with ability to own shares in a facility can help offset the declining reimbursements. Andrew Wickline, MD. Orthopedic surgeon at Mohawk Valley Health System (Utica, N.Y.): 1. Shi to outpatient and physician ownership of ASCs. 2. Interest from employers for carve-outs for specific procedures, which help reduce the cost that the commercial payers extract from the employer (direct-to- employer model). 3. Dr. Ira Kirschenbaum's open access digital orthopedics journal, [The Journal of Orthopaedic Experience and Innovation]. This is a major disruptor of a billion dollar industry that quite frankly stifles innovation. 4. Marty Nichols' team that is working on developing an orthopedic bank. 5. Surgeons with the guts to drop Medicare and commercial payers. 6. Transparent pricing models. 7. Small- to medium-size orthopedic companies that are still nimble enough to react quickly to market demands and meet deadlines on time or ahead of time. 8. e social media surgeons who spend