Biggest challenges & opportunities in value-based orthopedics: Q&A with Dr. Craig McAllister

Craig McAllister, MD, an orthopedic surgeon with Proliance Surgeons in Kirkland, Wash., and Chief Medical Officer of The SwiftPath 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. There 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. This is a significant challenge.

In my opinion, there are two important opportunities that joint replacement surgeons need to lead. First, the movement toward bundled payments combined with outpatient joint replacement will naturally help us improve the patient experience and reduce costs. Second, information technology will combine evidence-based, state-of-the-art surgical protocols and the power of cloud-based patient engagement. This will help surgeons gain more control over the episode of care and reduce costs — all while reducing some of compliance burdens and inefficiencies 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-articular injections are contributing to an increasing shift 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. The ASC is a focused 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 SwiftPath Platform, 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: The 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. These 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. This system can be used with multiple implant and enables surgeons and institutions to make value-based choices.

The situation is more challenging for robotics. In a value-based environment, the robotic adds considerable cost, is linked to specific implants, and have yet to prove added benefit over the much more affordable navigated 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 surgeons next year?

CM: Value-based systems, outpatient joint replacement, and bundled payment models all represent exciting opportunities, but they also present significant challenges. Most thought leaders in hip and knee replacement 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 overwhelming. Regulatory and compliance issues, the cost of developing cloud platforms, 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. Traditional hospital-based joint camps will need to be reinvented as some patients will not follow traditional pathways. Patient selection algorithms will need to be incorporated so that hospitals’ intensive resources can be focused only on those who actually need them. Interactive online 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.

Learn more from Dr. Craig McAllister at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.

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