Becker's ASC Review

19 ORTHOPEDICS The future of spine surgery & ASCs: 5 leaders' thoughts By Patsy Newitt A s spine surgeries increasingly become approved for the outpatient setting, ASC leaders are eyeing new procedure lines and growth opportunities. Here are five leaders' thoughts on the future of spine surgery and ASCs. Sigurd Berven, MD. Professor in Residence and Chief of Spine Service at UCSF Health (San Francisco): The rise of outpatient surgery is both encouraging and concerning. Ambulatory surgical centers have demonstrated significant ability to deliver cost-effective and efficient care for our patients. The development of techniques and technologies for minimally invasive care, including endoscopic surgery, is revolutionizing how we manage common spinal disorders. However, it is imperative that surgeons and healthcare policy leaders direct patients to appropriate care, and that when more extensive reconstructive surgery and higher risk and higher cost surgery is appropriate, that we support those interventions with appropriate reimbursement and risk stratification. Philip Louie, MD. Spine Surgeon and Medical Director of Research and Academics at Virginia Mason Franciscan Health's Center for Neurosciences and Spine (Seattle): The past decade has shown us that orthopedic and spine surgery (in the properly indicated patient) can be performed in a safer, more efficient and cost-saving manner compared to the traditional large hospital setting. This migration of surgeries to the ambulatory surgery centers and other outpatient centers have been fueled by the innovation of several enabling technologies. With ongoing financial stressors of large hospital systems and patients' concerns with hospitals, the ability to expand technologies to aid safe surgeries in outpatient settings will be paramount. Understanding how this all plays out in a landscape trying to become more value-based will be interesting to be a part of. Ali Mesiwala, MD. DISC Sports & Spine Center (Newport Beach, Calif.): As instrumentation in spine surgery becomes routine and outpatient operations involving instrumentation have increased in frequency and availability, the definition of complex spine surgery will need to change. Single-position and single anesthesia anterior-posterior operations are being performed in ASCs across the U.S., and navigation and robots are more common in outpatient settings. Those operations that involve deformity correction, substantial reconstruction or multiple stages through unique approaches will define complex spine surgery. Higher risk operations, such as intramedullary tumor resections, may also be considered complex, especially when done in ASCs. Michael Venezia, DO. Orthopedic Specialties of Tampa Bay (Clearwater, Fla.): I am most excited about us catching up with other areas such as total joints in moving care to a more ambulatory setting, safely and with all our technology that we have started utilizing. I think it is exciting to see the advances we have made in spine surgery using more ultra- minimally invasive techniques such as endoscopy to help advance this movement, and I think it is only going to grow over the next year. Peter Whang, MD. Professor in the Department of Orthopedics and Rehabilitation at Yale University School of Medicine (New Haven, Conn.): I expect that 2024 will continue to be a difficult environment for surgeons as well as orthopedic and spinal implant companies. Considering the looming cuts in Medicare reimbursement for our services in the setting of increasing expenses, we are facing significant headwinds that make the practice of medicine almost untenable for surgeons and our industry partners alike. In response to these challenges, I believe that we will see an even greater shift of orthopedic and spinal procedures to the outpatient setting in an attempt by surgeons to establish more diverse income streams while providing more cost-effective care. Likewise, I anticipate that there will be further consolidation in our industry as more companies grapple with the stark economic realities of our healthcare system. Despite these myriad issues, I remain optimistic about the future of orthopedic and spinal surgery. which I am confident will continue to advance in terms of the development of novel technologies and the ability to improve the clinical outcomes of our patients. n option for many surgical procedures … Reimbursement rates for ASCs have been improving over the years, making it financially viable for physicians to establish and operate independent ASCs." 2. Overhead for private practices can be tighter. For physicians who start their own practices, they have to manage or oversee business operations along with clinical duties. Dwindling Medicare fees may put additional strain on surgeons working independently from a hospital. "Inflation, rising costs (rent, staff, supplies), and declining reimbursements will continue to create difficulties for practice management for all private practice physicians," Arjun Saxena, MD, told Becker's. "Unfortunately, I do not see any of these trends reversing. In order to maintain their small businesses and their autonomy, something will have to change. Orthopedic surgeons will need to expand ancillary capabilities and seek partnerships they may not have discussed in the past." 3. Consolidation or taking private equity investments have increased among orthopedic practices looking to scale. However it can be a double-edged sword. Some orthopedic surgeons say practices can benefit from the resources and tools gained from these partnerships, but others are wary about its long-term viability, especially for younger surgeons. n

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