Leaders at orthopedic and spine ASCs share ambitions, concerns for 2023

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at the conference on June 15-17, 2023. The following are answers from our speakers.

To learn more about this event, click here.

If you would like to join as a speaker, contact Zoe McClain at zmcclain@beckershealthcare.com.

Question: What are you most excited about for 2023 and what makes you nervous?

Andrew H. Lovewell, MHA, MSHI, FACHE, CEO, Columbia Orthopaedic Group (Columbia, Mo.). What excites me about 2023 is the growing demand for healthcare data and the continued push to value based care. As an organization that has rooted itself in data analytics, patient reported outcomes, and being able to account for everything that touches a patient, we are excited to leverage our data intelligence and analytics to improve patient care.

The insurance companies have all of the data on our physicians and we need to as well. It is one, if not the only way we can combat the downward pressures of reimbursement. Being able to leverage the data to make better decisions and improve the care our patients receive is paramount now and in the future. Having said that, analyzing your own data and knowing what it says about your facility and physicians is essential. The data will tell you what value based programs to push towards and where you need to make improvements as well. In my opinion, investing in the time and resources to better understand your data is the key to running a high functioning facility.

There are a few things that make me nervous about 2023. Private equity, insurance contracts and government overreach. Entering 2023 we saw Medicare propose another physician pay cut of 4.5 percent, the pay cut has landed on 2 percent. With inflation and rising practice costs, the downward reimbursement trend is not sustainable for some practices. The rate cuts from Medicare aren't the only concern, though. Insurance companies continue to turn in record profits without providing rate increases to practices and facilities. On top of that, the consolidation of practices by private equity is a concern.

Tracy Hoeft-Hoffman, MBA, MSN, RN, CASC. Administrator, Heartland Surgery Center (Kearney, Neb.). What I am most excited about for 2023 is the completion of our 8,800 square foot addition. It will include two additional ORs, three recovery rooms, and four 23-hour stay rooms. This gives us the opportunity to grow, especially our total joint program, spine, ENT, and urology. What makes me most nervous is retaining the excellent team we have and recruiting additional team members.

Lauren E Matteini, MD, FACS, FAAOS. Orthopaedic Spine Surgeon, Fox Valley Orthopedics (Geneva, Ill.). 2023 is already on target to be a great year for me both professionally and personally! I am excited about the growth of my practice, expansion of Fox Valley Orthopedics and continuing to serve my community. The challenges we face continue to make me nervous as I see our fees reduced, and patient access to providers diminish. Insurance companies continue to dictate the way we practice evidence-based and safe medicine at the expense of the patients they claim to represent.

Philip Louie, MD. Orthopedic Spine Surgeon, Medical Director, Research and Academics, Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health (Seattle). It’s always nice to turn the page to another year. 2022, like the last couple of years before that, was certainly difficult on multiple fronts. I am looking forward to growing our practice, building our academic and research program, and seeing the rapid innovations of the enabling technologies in our field.

There is definitely a list of worries that make me a bit nervous — none of which are really in my control, so I try not to be too nervous about them. The ongoing pandemic and other illnesses that seem to be pervasive in the news, ongoing financial hardships faced by our hospitals and medical centers, a burnt out healthcare workforce that remains incredibly short staffed, and ongoing reimbursement cuts to name a few. But, we need to learn to make the best of whatever situation we are in, and find ways to grow, learn, and provide the best care possible to our patients.

John Polikandriotis. Chief Executive Officer, South Florida Orthopaedics & Sports Medicine (Stuart, Fla.). The thing I am the most excited about for 2023 happens to be the thing that I am also the most nervous about, and that is cultivating and nurturing organizational talent. It makes me nervous that many healthcare workers feel they are on a never-ending hamster wheel carrying physical, psychological and emotional weights in a very strained and competitive labor market. The new year is an opportunity to really move the needle towards authentic staff engagement, technology utilization to rethink and retool workflows, and staff empowerment to transition organizations to value creation activities versus continual issue resolution.

Joshua M. Rosenow, MD, FAANS, FACS. Director, Functional Neurosurgery and Professor of Neurosurgery, Neurology, Physical Medicine, Rehabilitation, Northwestern University Feinberg School of Medicine (Chicago). I am excited about all of the innovation in the neuromodulation space. We have an unprecedented number of new companies developing and/or launching neuromodulation technologies and the established companies are introducing new capabilities as well. Moreover, research into new indications for neuromodulation interventions continues to progress with numerous studies either being launched or coming to fruition in 2023. Those of us who specialize in neuromodulation have a bright year ahead of us as we demonstrate the far reaching possibilities of our field.

On the other hand, I am tremendously nervous about the reimbursement headwinds. We are faced with a double-barreled CMS cut due to both pay-go and budget neutrality provisions. These cuts could have a chilling effect on seniors’ access to specialty care. Moreover, CMS has yet to remedy the lesser treatment of evaluation and management visits included in surgical global periods since the 2021 E&M code updates. This means that the same outpatient visit is treated differently when performed in the postoperative global period, which does not make sense.

Lastly, neuromodulation has been one of the main fields affected by prior authorization issues. While we hope to have a bill passed in Congress to dramatically reform this process for Medicare Advantage plans, prior authorization continues to cost physician practices excessive amounts of time and money while preventing patients from accessing the care they require.

Adeel A. Faruki, MD, MBA. Assistant Professor of Anesthesiology, Program Director, Advanced Perioperative Ultrasound and Clinical Training, University of Colorado Anschutz Medical Campus (Aurora, Colo). I am nervous to see how anesthesia groups at ambulatory surgical centers will adapt to the updated 2023 Medicare Physician Fee Schedule. I am excited to see how private equity groups who are already invested in ASCs will be adjusting their strategic plans after increased Medicare reimbursements from the final rule on Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment Systems for 2023.

Ramy Elias, MD. Orthopedic Surgeon, Center For Advanced Orthopedics & Sports Medicine (Auburn Hills, Mich). I’m excited by the continued trend of doing more cases in the ASC versus the hospital. I’m nervous about the significant increase in operational costs without an increase in payments.

Jeremy M. Steinberger, MD. Director, Minimally Invasive Spine Surgery, Department of Neurosurgery, Mount Sinai Health System; Assistant Professor, Neurosurgery and Orthopedics, Icahn School of Medicine, Mount Sinai (New York City). For 2023, I am most excited about the rapid evolution of technology in the world of spine surgery. To be honest, there is not much making me nervous at this time.

Harel Deutsch, MD. Co-Director, Rush Spine Center (Chicago). I am most excited about new technologies including navigation/robotics that will improve outcomes for patients. We were also involved in a new lumbar motion preservation device FDA trial which should become commercially available in 2023. I'm most nervous about ongoing trends in medicine such as increased government payers, decreased medicare reimbursements and decreased doctor autonomy. Despite the availability of technology, financial concerns may prevent us from employing the new technologies.

Vishal Mehta, MD. President and Managing Partner, Fox Valley Orthopedics (Geneva, Ill.). I am most excited about the continued growth of joints and spine cases in our ASC. I am most nervous about the continued pressure on our margins as supply and labor costs continue to rise rapidly.

Albert Wong, MD. Neurosurgeon, DOCS Health; Neurosurgeon, Cedars-Sinai Medical Center (Los Angeles). I am most excited about the robotic navigation landscape and virtual reality. Integration of these influential technological advances could potentially enable more successful complex spinal surgeries toward success for both inpatient and outpatient settings. However, I am concerned that these essential technological tools are not reimbursable by health insurance. This will limit the availability of these new technological advances to major hospital centers.

Mihir Patel, MD. Treasurer and Partner, OrthoIndy/OrthoIndy Hospital (Indianapolis). I am most excited about the growth of health technology companies, in short; 'HealthTech.' Four years ago, I was most excited about artificial intelligence reducing back office burdens for providers and those technologies are being deployed across the medical spectrum. From improving care models to continued improvements in devices and administrative procedures, HealthTech is only just beginning. On a day to day basis, labor and supply chain issues are at the forefront of making us nervous. Since healthcare can be unpredictable, both are kind of in the back of the mind as to whether we will have what we need when we need it.

Geoffrey Van Thiel, MD, MBA. Orthopedic Surgeon, OrthoIllinois; Associate Professor, Rush University Medical Center (Chicago). I am excited about the growth in ASC consolidation and the complexity of case mix. We are continuing to evolve with regard to both volume and case complexity in a safe and effective outpatient setting. Growth and consolidation in the ASC marketplace should allow better alignment with surgeons, ASCs and payers; resulting in rapid development of value based care creation.

What keeps me up at night is the regulatory environment. Restrictions on both ASCs, and the cases that can be done at ASCs, represents the biggest hurdle to continued progress. The data supports the ambulatory surgery center as a safe and effective setting for outpatient surgical care. However, many factors influence the regulations surrounding the ASC and the case mix allowed. If we follow the data, we will end up in a better place for providers, payers, healthcare economics and, most importantly, patients.

Lorraine Hutzler, MPA. Associate Program Director, The Center for Quality and Patient Safety, Department of Orthopedic Surgery, NYU Langone; Adjunct Assistant Professor of Health Policy and Management, NYU Wagner (New York City). It is now the end of the public health emergency. What happens next for orthopedics and specifically quality? Hospital-acquired conditions and readmission penalties were put on hold during COVID; where does this leave hospitals in the next fiscal year? Moving forward, we are looking at strategies to streamline care and reach institutional goals as well as creating systemness with the continued growth of mergers and acquisitions.

Daryl Steven Henshaw, MD, MBA. Associate Professor, Department of Anesthesiology, Wake Forest School of Medicine (Winston-Salem, N.C.). In early 2022, my current employer, Atrium Health, announced a merger with Advocate Aurora Health. This merger, which will grow the healthcare system to 67 hospitals across six states, will certainly have profound impacts on both our providers, including myself and our patients. In terms of growth, in 2023 our organization will continue construction on a new state-of-the-art tower that will house critical care, emergency room and operating room services at Atrium Wake Forest Baptist Hospital. In addition, we will begin construction on at least two ambulatory surgical centers in neighboring communities, which will further expand the volume and reach of our surgical services. Certainly, big changes are on the horizon for 2023 and I am extremely excited about the future.

The rising costs of providing care is what makes me the most nervous for the coming year. As the COVID-19 pandemic has demonstrated, supply chain limitations can be unpredictable, frequently happen swiftly, and often result in higher product costs. These resultant additional expenses, combined with ongoing inflation and rising staffing costs, not to mention staffing shortages, will likely test the financial stability of many hospitals across the country. While I am optimistic that inflation, supply chain constraints and the job market will all stabilize soon, not knowing if or when this might occur certainly contributes to my current anxiety level.

John V. Prunskis, MD, FIPP. Medical Director/Principal, DxTx Pain and Spine; Chief Executive Officer, Illinois Pain and Spine Institute (Barrington, Ill.). For 2023, what I am most excited about clinically is the advancements in technologies and devices that can help treat our patients after a precise diagnosis has been made. Specifically, I am referring to minimally invasive procedures such as: both epidural and peripheral neuromodulation, sacroiliac joint stabilization, those treating spinal stenosis with neural claudication, degenerated disc pain as well as pain related to Modic changes in the vertebral body.

There’s also exciting research ongoing regarding many painful conditions therapies for contained herniated discs. From a patient care and operational perspective, I am most excited about the growth of our consortium DxTx Pain and Spine, for which I am Medical Director/Principal. We have now grown to almost 50 locations in six states and have 550 employees. Three years ago we had six locations in one state with 70 employees. We are continually looking to affiliate with high-quality interventional pain physicians that have their own ASC. I am also happy to see that several state governors are now looking at increasing Medicaid reimbursement for interventional pain procedures which will allow Medicaid patients access to procedures that will help fix the painful problem and therefore reduce opioid usage.

There are many things that are of concern to me. The fall in physician compensation by CMS is absolutely irrational especially taking into account the inflation pressures that medical practices are now under, the complexity of insurance pre-certification and payment systems as well as increasing insurance audits is alarming. Medicare setting practice reimbursement rules on limited clinical data is troubling, related to this is physicians potentially practicing in a matter of what reimburses versus what is needed by the patient. Continued activity of some state DEA agencies to prosecute physicians practicing appropriate pain management is a concern, the disparity between reimbursement in an ambulatory surgery center setting and hospital outpatient setting makes no sense.

Hospital employment of physicians which compel a physician to refer to a doctor that may not be the best for the patient, but is employed by the same hospital system. Electronic health records which have added unnecessary layers of frequently meaningless complexity to the physician patient interaction are bothersome.

Carmen Quatman, MD, PhD. Orthopedic Surgeon, The Ohio State University Wexner Medical Center (Columbus). I am most excited about the healthcare innovations and technology that 2023 will bring for patient care! I am most nervous about the growing barriers of payers and insurance for patient care — the growing denials for critical needs for patient care impacts the entire healthcare ecosystem. Longer lengths of stay, unnecessary burdens on healthcare teams and patients, potential dangerous 'misses' due to denials of necessary imaging and families needing to 'hoop jump' to get patients the necessary care.

Betsy Grunch, MD, FAANS. Neurosurgeon, Longstreet Clinic (Gainesville, Ga.). I am very excited for the future of spine surgery in 2023 and increasing spine ambulatory surgical care. It's very rewarding to be able to provide the ability for patients to go home the same day or next day with less pain and increased activities. In the post-COVID era, this is extremely important to patients. What makes me nervous is the increasing stipulations of insurance companies to prior authorize needed procedures for my patients.

Adam J. Bruggeman, MD. CEO, Texas Spine Care Center (San Antonio). On a personal note, we are opening a new ASC this year. The focus will be on orthopedic joints and spine procedures. We intend to do some direct to consumer marketing after we open, which will be interesting to track over time.

I have significant concerns about the combination of significant inflation and significant physician fee payment reductions. I respectfully disagree with the Medicare Payment Advisory Commission who stated that continued cuts will not be disruptive to access or care. I hear from an increasing number of physicians who are looking to go out of network and/or reduce or eliminate Medicare patients from their practice. When hospitals have significant concerns about their 4 percent increase, how can we expect that a 4.5 percent cut to physicians won’t have an impact?

Unfortunately, this trend has no perceivable end and we appear to be heading towards something similar to the annual SGR fight to prevent significant cuts every December. Physicians should not have to beg Congress every year to maintain their current pay, which doesn’t even account for increases related to inflation.

Daniel Mulconrey, MD. Orthopedic Surgeon, Midwest Orthopaedic Center (Peoria, Ill.). I am excited to expand and improve upon the patient experience in 2023. Patient satisfaction will be critical for independent practices in the next few years. Improving patient satisfaction, optimizing patient outcomes, and maintaining access to care should be an exciting focus in 2023. One concern for 2023 is the inability to achieve these goals. Current struggles with supply chain demand create havoc on our ability to provide care. Maintaining adequate staff and developing a positive culture in the workplace is challenging during these difficult times in healthcare.

Thomas Scully, MD. Neurosurgeon, Northwest NeuroSpecialists (Tucson, Ariz.). I think neurosurgeons, as a rule, are basically pessimistic, and we see the downside to most change. The Becker’s meetings remind me that there are opportunities with every change. Thus, 2023 is going to be one of the most exciting, yet daunting years in my almost 30 years of practice. I have been in private practice since I finished my residency in 1994. As times change in healthcare, it has become more and more difficult to survive as a small group practice. Many forces align against us. These include insurers, of which there are only a few big players and thus they wield extreme power in reimbursement. We have very little leverage to negotiate.

Medicare cuts are looming. And, we face these continuing reimbursement cuts in the face of marked inflation and increased costs of doing business. Add in a very tight healthcare labor market, and the ability to provide the services we are accustomed to providing is challenged. As such, we are becoming employees on or about April 1, 2023. After many years in private practice as an owner and a boss, I will become an employee. Associated with this is a change in our home hospital. The hospital we have supported for all these years has seen many changes, not all good. We are therefore moving our practice to a new hospital system. It is a community not-for-profit hospital.

So, I have some angst, fear, anxiety. Yet, I look forward to a new endeavor and all that accompanies it. I view it as a positive, and a challenge that will also allow me to continue to practice, and do so without many of the worries and difficulties of being a boss and owner. In addition, I can finish my career helping the local community hospital. My wife is a sole proprietor of a home goods and gift store. I am a big proponent of shopping local. In that regard, I need to practice what I preach!

Emily Putney, DO, MS. Orthopedic Spine Surgeon, Coastal Orthopaedics and Sports Medicine Center (Port St. Lucie, Fla.). As far as what I'm most excited about for 2023, I would say continuous innovation in spine surgery that allows less invasive surgery, but doesn't skimp on correction or decompression goals. This is possible since the pandemic has subsided, and research opportunities and in-person education conferencing is back on track. For a while, there was a sense of stagnation due to necessary restrictions, but now there is a palpable 'joie de vivre' among myself and peers with renewed interest in discovery. I don't think that will be contained again for quite some time.

I'm concerned about the political climate that affects insurance decisions regarding patient care. Access to care including imaging, procedures, consults and surgery can be unnecessarily delayed or denied currently, and there doesn't seem to be much improvement anticipated despite efforts. I'm also concerned about perpetually reduced reimbursement rates for common spine surgical procedures, as this affects my private practice's bottom line. Meanwhile, there is no end in sight to increased IT costs including compliance, software and hardware updates for the imaging units and EMR, malware attack prevention, etcetera.

Justin Paul, MD, PhD. Spine Surgeon, OrthoConnecticut (Danbury, Conn.). I’m excited to see increases in insurance authorization for basivertebral nerve ablation procedures as it becomes an alternative to fusion procedures. I’m increasingly concerned with the ever increasing unfunded mandates requiring doctors to spend time on paperwork and 'peer to peer' phone conversations. This is usually uncompensated and takes time away from patient care.

Personally, I've been anxious about the rise in COVID cases overseas, but nevertheless I'm eager to get out and travel with my family more this year if it's safe enough to do so!

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