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40 JUNE 2017 CONFERENCE PREVIEW Biggest Challenges & Opportunities in Value-Based Orthopedics: Q&A With Dr. Craig McAllister By Laura Dyrda C raig McAllister, MD, an orthopedic surgeon with Proliance Surgeons in Kirkland, Wash., and chief medical officer of e SwiPath Program, LLC discusses value-based care and how orthopedic practices are evolving to meet their patients' needs. Q: What is the best opportunity for orthopedics surgeons to grow their practices in the future? Dr. Craig McAllister: Everyone in the orthopedic industry is anticipating a substantial increase in the future need for joint replacement. ere is a projected 670 percent increase through 2025. During that same time, there is a projected decrease in the number of specialty trained joint replacement surgeons. Still, surgeons and caregivers are being called upon to find ways to make the joint replacement patient experience better and, at the same time, reduce costs. is is a significant challenge. In my opinion, there are two important opportunities that joint replace- ment surgeons need to lead. First, the movement toward bundled pay- ments combined with outpatient joint replacement will naturally help us improve the patient experience and reduce costs. Second, informa- tion technology will combine evidence-based, state-of-the-art surgical protocols and the power of cloud-based patient engagement. is will help surgeons gain more control over the episode of care and reduce costs — all while reducing some of compliance burdens and inefficien- cies of modern patient care. It will enhance the surgeon's experience and make the transition a positive and sustainable one. Minimally invasive techniques, modern pain management, and peri-artic- ular injections are contributing to an increasing shi of joint replacements into the outpatient arena. Today, over 80 percent of my total hips and knees are done as outpatients, and many are done in our ASC. e ASC is a fo- cused Joint Replacement Center of Excellence that has helped my patients get better faster while solving problems of surprise medical billing. As more patients go to the ambulatory space and are followed on the SwiPath Plat- form, my workload decreases. As we rely more on non-narcotic solutions for pain, we contribute to solutions for narcotic diversion. Q: How is robotic technology changing orthopedic surgery? CM: e technology used in a majority of hip and knee replacements today, rudimentary cutting blocks, extra-medullary and intra- medullary rods, and instruments haven't changed since the 1980s. ese basic instruments have been successful but have limitations in consistency, need for exposure, and blood loss. Computer navigation has proved successful, accurate and reproducible. Computer navigation is affordable and is particularly cost effective when coupled with universal instruments. In my ASC, we use the Operativ iKnee System. is system can be used with multiple implants and enables surgeons and institutions to make value-based choices. e situation is more challenging for robotics. In a value-based envi- ronment, the robot adds considerable cost, is linked to specific implants and have yet to prove added benefit over the much more affordable nav- igated systems. Even computer navigation has met resistance. I think robotics will face some of those same challenges. Q: What is the biggest challenge facing orthopedic sur- geons next year? CM: Value-based systems, outpatient joint replacement and bundled payment models all represent exciting opportunities, but they also pres- ent significant challenges. Most thought leaders in hip and knee replace- ment are to some extent developing better patient education, outcomes measures and non-narcotic pain management platforms. But realistically, trying to do this as individual surgeons and departments is overwhelm- ing. Regulatory and compliance issues, the cost of developing cloud plat- forms, and the rapidly changing landscape simply make these grass roots efforts difficult to finish and even harder to sustain. Another challenge is to take the patient education to the next level. Tra- ditional hospital-based joint camps will need to be reinvented as some patients will not follow traditional pathways. Patient selection algo- rithms will need to be incorporated so that hospitals' intensive resourc- es can be focused only on those who actually need them. Interactive on- line educational platforms that hold patients accountable for education, communication and management of their care will empower patients like never before. Surgeons will need to adopt new learning behaviors as well. We are going to need to find ways to stay on top of trends that are moving much faster. n Dr. Craig McAllister will be speaking on "Emerging Protocols and Technology to Aid the Shift of Total Joint Procedures to an Outpatient Setting" at the conference Thursday, June 22 at 2:00 a.m. Fix It, Don't Mask It — Illinois Pain Institute's Dr. John V. Prunskis on What Makes Interventional Pain Physicians Successful By Mary Rechtoris J ohn V. Prunskis, MD, sheds insight into the evolving pain management field and how interventional pain physicians can succeed in light of these changes. Question: What spurred you to launch the Illinois Pain Institute? Dr. John V. Prunskis: I founded Illinois Pain Institute with my wife, Dr. Terri Dallas Prunskis, who was the chairman of the