Becker's ASC Review

21 THOUGHT LEADERSHIP Where orthopedics needs more innovation By Ariana Portalatin I mage interpretation within the orthopedic surgery field could use more innovation, according to David Kieras, MD. Dr. Kieras is an orthopedic surgeon at Virginia Mason Medical Center in Seattle. He recently spoke with Becker's about the areas in orthopedics that need more innovation. Editor's note: This response was lightly edited for clarity and length. Question: What areas of spine or orthopedic surgery need more innovation? Dr. David Kieras: Though slowly starting, definitive innovation in image interpretation and subsequent application to clinical care is needed. Examples: Knee MRI with initial interpretation of "meniscus tear" without further description of the nature of the tear (degenerative, flap, size, location, etc.), or a description of "arthrosis" without concise description of size, depth, location, cartilage quality, surface characteristics, local bony edema, etc. are not particularly helpful to the primary care provider, mid-level provider and patient. This "low quality" information along with information obtained online can be quite distracting. An initial visit with the orthopedist becomes an effort at debunking prior misconceptions on the results of imaging rather than an educational effort about findings and best treatment options. Similarly, with respect to shoulder MRI, rather than "tendinosis," "arthrosis, "labral lesion," "rotator cuff tear," etc., a more precise description [is needed], including degree of tendon, labral, cartilage or capsular damage or thickness, degeneration or signal quality distortion, precise area and depth of involvement, association with other findings such as narrowing of the subacromial space, deflection of the rotator cuff (assessed in three rather than two dimensions), estimated degree of atrophy, local edema, etc., is wanting. Along with precise imaging algorithms and data collection on outcomes, recommended care will eventually incorporate specific accepted clinical algorithmic recommendations, [such as] medical/ physical therapy, arthroscopy, arthroplasty, etc. Eventually, these advancements will result in streamlined care and should properly result in less questioning of clinical care by third parties, including insurance representatives. Initial evolution of this process will begin with improved MRI algorithms and subsequently be augmented via applied artificial intelligence. n The trends 3 ASC CEOs left in 2023 By Paige Haeffele B ecker's connected with the CEOs of three ASC to see what healthcare trends have outstayed their welcome and the trends they believe are gaining favor in the industry. Note: ese responses have been edited lightly for length and clarity. Question: What trends are losing steam in the ASC industry? What trends are picking up? Brian Bizub. CEO of Raleigh (N.C.) Orthopaedic Clinic. Overnight total joint patients have lost steam. Care pathways have been optimized to increase consistency, including less invasive techniques and faster-acting and more effective anesthetics, allowing patients to be safely discharged the same day rather than observing patients for 23 hours. Patients are demanding recovery in their homes rather than an overnight stay, which allows each patient to recover in the comfort of their home, return to activities quicker and research has proven to reduce complications of overnight stays continuing to reduce healthcare spend. Most patients prefer to complete their rehabilitation and physical therapy on an outpatient basis. Higher-acuity procedures are moving from the hospital outpatient department to ASC settings. Total shoulder replacements and minimally invasive spine procedures were moved from the inpatient-only list and have increased volumes in ASCs. ASCs continue to strategize on how to handle the substantial increase in procedural volume in the future as CMS continues to release procedures from the inpatient-only list to the ASC setting. ASCs have shown to be a patient's preference for their surgical procedure. ASCs focus on being patient- centric providing greater personal attention, convenience and navigation throughout the surgical process, substantially less expensive than HOPDs or hospitals, while ensuring high quality of care and patient safety. Surgery centers are highly regulated to ensure quality and safety, which has been the hallmark of the ASC model. John Brady. CEO of Fox Valley Orthopedics (Geneva, Ill.). e lack of surgical techs and the decreased enrollment in tech training programs. Many centers are now cross-training RNs to scrub into those roles as result of the surgical tech shortage. is places additional cost pressures on the operations side of the business as now we are using higher priced assets to perform these duties. Seeing this trend reverse would be very helpful to the industry. Kristopher Kitz. CEO of Wyatt Surgery Center, Tucson Ambulatory Anesthesia and Eye Associates of Tucson (Tucson, Ariz.): e trend of more aggressively moving cases from hospital ORs seems to be picking up. Payors have been pushing this through educating consumers on the differences in their out-of-pocket costs should they have a procedure in a hospital OR rather than a surgery center. is has been happening for some time, but during 2020-21 there was a break related to the pandemic and seems to be picking up. Likely a related trend is hospitals and health systems becoming more active in the ASC joint venture and management services space, likely to preserve revenue streams leaving inpatient ORs. I also see more hospitals and health systems allowing their employed physicians to invest in ASCs, which previously was uncommon. Previously, hospitals and health systems focused on HOPD surgery centers rather than joint ventures or revenue enhancement opportunities. While somewhat market-dependent, many organizations are shiing away from hospital outpatient department-focused strategies and to the joint venture model that engages surgeons and attracts consumers with price-sensitive health insurance. n

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