Becker's Spine Review

12 THOUGHT LEADERSHIP What the orthopedic surgery landscape will look like in 10 years By Riz Hatton The orthopedic surgery landscape of today may not look the same tomorrow. Four orthopedic surgeons connected with Becker's to discuss what the orthopedic surgery landscape will look like in 10 years. Note: Responses have been lightly edited for length and clarity. Steven Barnett, MD. Chief Medical Officer at Hoag Orthopedic Institute (Irvine, Calif.): Robotic technology is here to stay. Despite present day shortcomings in current systems, research and development in these technologies will hopefully lead to a gradual evolution resulting in future platforms that have smaller footprints, increased disposability, greater efficiency and lower cost. If that's the case, then surgical execution of total joint arthroplasty will improve based on analytics from data obtained both intraoperatively as well as from smart sensor technology incorporated within implants. This will result in improved functional outcomes as well as greater patient satisfaction and return to high-level activities. Vishal Khatri, MD. Alliance Orthopedics (Bloomfield, Freehold, Fair Lawn, East Brunswick, Old Bridge and Randolph, N.J.): We will continue to see insurance companies adjusting reimbursements towards outcome- based care. As healthcare costs continue to rise, we cannot continue practicing as usual as there is not an endless supply of healthcare dollars. Insurance companies will begin dropping surgical coverage of procedures that do not have strong evidence in terms of research driven outcomes. In addition to this, insurance companies will continue bundling reimbursement for disease-specific conditions. We have already seen this change in adult reconstruction and arthroplasty. This will begin to make its way into the sports medicine and spine surgery world as well. So for surgeons to become more cost conscientious when treating certain pathologies. There is going to be a larger push for surgical centers of excellence. Insurance providers will adjust the payment models to incentivize patients to use the centers of excellence when undergoing surgical procedures. This will all be data driven based on surgical case volume, outcomes, length of stay and other associated factors. Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Tacoma, Wash.): If the past 10 years are any indication of the next 10 years, I think we are in for an exciting upcoming decade, and probably a bit of a rollercoaster! 1. Safety and value with growing outpatient procedures. The current healthcare landscape and ongoing consolidation is forcing us to completely change how we practice medicine. Orthopedic surgery has been a thought leader and primary mover on this front. We will continue to see improvements and growth in surgical techniques and perioperative management in partnership with our anesthesia colleagues to transition more care to ambulatory and outpatient surgery centers. 2. Increased synergies and collaborations across specialties. Although sub-specialization has traditionally siloed many of our work and efforts, we are starting to witness the influence of knowledge, surgical techniques, and principles from other subspecialties into our own. Take spine, for example. I am now using my sports and general surgeon's arthroscopic and laparoscopic equipment and principles for spine procedures (as many are around the world). We are working with our trauma surgeons to develop better minimally invasive techniques for spinopelvic injuries. We have applied perioperative local pain control protocols from our transplant colleagues. There are so many potential cross-specialty synergies that we will see soon — all in the name of improving patient care, safety and value. 3. Motion preservation. As the spine field seems to be lagging behind some of our orthopedic colleagues, I think that we will continue to see significant ongoing efforts to preserve motion and stability of joints, in which fusion has often been considered. This may be in the form of injection therapy (there is an incredible focus on regenerative efforts in basic science labs) or novel surgical techniques. Arun Rajaram, MD. Orthopedic Sports Medicine Specialist and Arthroscopic Surgeon at Alliance Orthopedics (Bloomfield, Freehold, Fair Lawn, East Brunswick, Old Bridge and Randolph, N.J.): I anticipate that 10 years from now, the world of orthopedic surgery will continue to grow and advance minimally invasive techniques to help patients get better faster. The growth and development of surgical techniques, instruments and orthobiologics continue to evolve and improve over time. Additionally, we will continue to grow with multispecialty collaboration to help provide comprehensive care to patients. This will include surgeons and physical and occupational therapists working closely together on preoperative and postoperative protocols to help optimize patients' outcomes. We will continue to focus on each individual patient and tailor their treatment plan to enable them to return to all the activities that they love. n

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