Becker's ASC Review

34 ORTHOPEDICS competition in the [private equity] space for these groups will be fierce due to the smaller number of practicing orthopedic surgeons and neurosurgeons. Every day over 10,000 people turn 65 in this country. is creates a tremendous demand for orthopedic and spine surgeries in order for people to remain active later in life. e current environment is very ripe for disruption with operational losses accelerating in many provider health systems. ey will in turn try to cut costs, and this may include the reversing of hospital physician employment trends for the last 10 years. Exciting, innovative times with [private equity], which will benefit both patients and surgeons tremendously! Issada ongtrangan, MD. Spine Surgeon at Microspine (Scottsdale, Ariz.): e concerns I have as an independent spine surgeon on private equity acquisition are related to loss of business and clinical autonomy, income reduction and the uncertainty presented in future equity events with changes in ownership. e first goal of the investor is to make a profit. ey can't care less about the physicians, let alone patients' care. To deliver quality care, I have to spend time understanding each individual and their problems. I doubt that I will have time for each of my patients as we (an employee) have to make up the number for our "boss" (private equity). e only upside is that private equity has the power to negotiate the payer contract at a better rate and may be able to lower the practice's expenses without lowering our supply quality. e practice's surgeon and partners need to have a clear picture of their goals both individually and collectively before going through the checklist of the pros and cons of selling a portion of equity contained in their privately held practice. In my opinion, I am not certain that private equity is good for spine practice. n What makes or breaks outpatient orthopedics? By Carly Behm I t's not uncommon for some orthopedic surgeries to be done in the outpatient setting, but many factors go into creating a successful program. Editor's note: Responses were lightly edited for clarity and length. Question: What factors make or break an outpatient orthopedic surgery program? Philip Louie, MD. Virginia Mason Franciscan Health (Tacoma, Wash.): There are several factors that are critical for the success of outpatient orthopedic programs. Here are four important ones that I consider. 1. Medical comorbidity evaluation from a dedicated anesthesia team. Not all patients are candidates for outpatient procedures based on medical comorbidities. It may seem tempting to perform all "outpatient" surgeries at outpatient/ambulatory surgery centers — but patient selection is critical. Patient care must remain the cornerstone, and this all begins with ensuring that patients are properly indicated and reviewed by a dedicated anesthesia team that needs to manage the preoperative care day in and day out. 2. Effective Multimodal Analgesia (MMA) protocol with local injections (especially for fusions). I trained under Kern Singh, MD, several years ago and observed how he and his colleagues were meticulous in developing MMA protocols with multidisciplinary input. We have applied many of these same principles to our perioperative protocols — and this constantly is evolving with new literature. Local injections (erector spinae, rectus sheath and transverse abdominis plane) have allowed us to further improve our preoperative spine care to spine procedures traditionally performed in an inpatient setting. 3. Mapped out value stream pathways for ongoing evaluation of processes (pre-op, intra-op and post- op). "Without standards, there is no improvement." An initial mapping of all the processes and activities for each type of procedure with regular ongoing review of these processes ensures that there is ongoing focus on improving patient care and financial responsibility. 4. Multidisciplinary leadership with at least partial physician ownership. There are multiple roles that impact patient care in various ways. Surgery center leadership should be represented by multiple disciplines, and physicians must play a role in the ultimate decision making. James Abbott, MD. Best Surgery & Therapies (Cincinnati): My three items where I place focus: 1. Patient education and support pre- and post-op are critical to providing patients the necessary level of medical support and information to be successful, especially with more complex outpatient surgeries like joint replacement and spinal fusion. 2. Contracts with vendors and payers to ensure you are not overpaying for devices or being underpaid by insurers for performing complex surgery in a lower cost environment. 3. It really all comes down to the staff delivering the care. Well-trained and happy staff makes the environment better and safer for patients. When the staff buys into the advantage of ASC care for the patient, everybody wins. A great patient experience yields more referrals. n

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