Becker's ASC Review

15 ORTHOPEDICS ASCs, spine tech fuel mutual growth By Carly Behm e growth of spine technology and outpatient spine migration are two things that can benefit from each other. e outpatient spine landscape, which is already strong, will "greatly expand" from what's happening now, according to Don Park, MD, of UCI Health in Orange, Calif. "With the increased adoption and utilization of endoscopic spine surgery in the U.S., more surgeries can be performed in the ASCs using these ultra-minimally invasive techniques," Dr. Park, said. "In addition, awake spine surgery techniques with epidural, spinal and fascial blocks can allow more patients to undergo spine surgery without the need for general anesthesia. is will allow older patients with more medical comorbidities to have endoscopic spine surgery performed in the outpatient setting." Endoscopic spine surgery, while slower to grow in the U.S., has seen success abroad. In 2023 the technique was gaining traction with surgeons and medtech companies. Endoscopic spine surgery may also be a better fit for ASCs — a study published in the January edition of the Journal of Neurosurgery: Spine, found the minimally invasive technique cost more than open spine procedures at hospitals. Awake surgery has also seen growing interest in recent years. In December Portland-based Oregon Health & Science University completed its first awake spine surgery, led by Josiah Orina, MD. e benefits of ASCs and allowing at-home recovery make the outpatient setting increasingly attractive, and can push spine technology toward the trend. "Embrace the transition of surgical procedures migrating to the outpatient setting," Steven Barnett, MD, chief medical officer at Hoag Orthopedic Institute in Irvine, Calif., said. "Evolution of surgical technique including the use of technology as well as anesthetic protocols allows us to perform many more procedures safely with day-of-surgery discharge. Patients benefit in that they can oen receive treatment in a local ASC while recovering at home, reducing the risk of infection in these historically inpatient surgeries." Frank Phillips, MD, of Chicago-based Midwest Orthopaedics at Rush, said although enabling technologies have been costly for ASCs, continued growth could even help bring some complex cases outpatient. "Evolution of these platforms with an eye on the ASC will undoubtedly allow for migration of more complex cases to ASCs," Dr. Phillips said. "Implant manufacturers have been reluctant to embrace ASCs for fear of cannibalizing their hospital margins on products. By using procedural bundled payments, we have made this a win-win at our ASCs. As less-invasive fusion techniques advance, these will facilitate further ASC migration." n Why noncompetes are 'worthless' to Dr. Nicholas Grosso By Carly Behm I n his time at Bethesda, Md.-based Centers for Advanced Orthopaedics, Nicholas Grosso, MD, has found physician exits to be rare. Dr. Grosso, president of the orthopedic group, said the practice doesn't demand noncompete clauses in their physician contracts. For other physicians, noncompetes have caused rifts, and many have advocated for an outright ban on them. Dr. Grosso spoke with Becker's about why he dislikes noncompetes. Note: This conversation was lightly edited for clarity. Question: The FTC is set to make a decision on the proposed ban on noncompetes. What would a noncompete mean for independent orthopedic groups like yours? What would be the upsides and downsides? Dr. Nicholas Grosso: Personally, I don't like non-competes. I've been with my practice for the last 22 years, and we've had two or three guys leave. We've never enforced a noncompete. We're not going to make a guy move out of state. I think noncompetes are worthless, to be quite honest with you. The reason why noncompetes exist is because what practices don't want to see happen is they hire someone out of training. They put a lot of money into building a practice, and then the physician goes across the street and sets up a practice. We're smart guys. Our lawyers are smart. They'll come up with some other way, whether it's a clawback provision in their bonuses or something to make it fair. There would have to be some new contract clause that says if you leave within a certain amount of time, you've got to pay us back a certain amount of what we paid you up front. I wish they would outlaw noncompetes, because we run into noncompete problems. We have a lot of physicians who are hospital employees or PE group employees who are exceedingly unhappy and want to come join CAO, and we can't take them because they're being held back by their noncompete clauses. n

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