Trends that will shape orthopedic surgery at ASCs in the next 5 years

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Improved marketing efforts, direct-to-employer contracting and the expansion of telemedicine are some of the trends expected to play a key role in the future of outpatient spine and orthopedic surgery.

During Becker's 18th Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, four experts discussed how orthopedic care delivery is changing and offered advice for surgery centers looking to thrive in the new normal.

Below is an excerpt from the conversation, slightly edited for clarity. To view the full session on-demand, click here

Note: Responses are lightly edited for style and clarity.

Question: How do you see orthopedic care delivery changing in the next five years? 

Jon Van Valkenburg. Executive Director, Upstate Orthopedics Ambulatory Surgery Center (Syracuse): There's been this trend of everything moving toward the outpatient setting, and it's been going on for quite some time now, but what we've seen in the last year is an acceleration. A big element of this, because of COVID-19, was just the surgeons being comfortable, particularly for things like total joints and especially for spine. Spine surgeons that are used to doing big cases, in the past have maybe referred away some of the things that could be treated more conservatively, and they've really focused on big fusions and cases like that. 

They started seeing this need for their practice to survive, where they would expand and start offering these things that in the past they were referring out, and had the opportunity to do those in the surgery center. Some of the spine surgeons in our group, they're owners in the surgery center, but had never set foot in here in 10 years. Some surgeons said they wouldn't feel comfortable doing a spine surgery without the 23-hour [stay]. But a lot of places were doing single-level discs on healthy patients and laminectomies, among other spine procedures, without the need for 23 hours. 

During the pandemic, some of the hospitals said, 'No elective inpatient procedures. If you want to do a spine surgery, you've got to do it outpatient.' So a lot of surgeons dipped their toes in the water and found that when they did, they had a great experience, the patient had a great experience and it really opened up to them the opportunity to do more cases in the surgery center. I think that's going to continue to accelerate this movement. 

Harel Deutsch, MD. Co-Director, Rush Spine Center (Chicago): There's going to be increasing migration of cases toward the surgery center. I think there's going to be more marketing to patients, and patients are going to be greater consumers and do more research. It's going to be less about referral and more about how you reach the patients, who are going to have more information available to them to make decisions about healthcare in the future. 

Meredith Warf. Administrator, The Surgery Center at Mississippi Sports Medicine (Flowood): They are our patients, but they're also consumers. So, we are just more and more aware that it's their choice as to where they seek orthopedic care, and continuing to focus on that total patient experience. That's going to be all inclusive of the quality items that we've been talking about. The set patient reported outcomes, basically their satisfaction with the entire process, is a huge component. In terms of marketing, it is going to be a continual surge to maintain position at the forefront of the community for all centers.

Then, as we migrate the cases, it's going to be patient awareness. There's a component of education of the population that has to go with all of this in the standard of care — the elective cases that we're talking about — to get patients back up and moving these total joint and spine cases to deal with their pain that's been plaguing these patients for a long time. That's part of our role as a provider: to educate them on what is offered and what the solutions are, and then provide the excellent experience as they choose.

Nader Samii. CEO, National Medical Billing Services: It'll be interesting to see the evolution of telemedicine as it relates to ortho and spine. Obviously, it's not going to replace surgery, but I think it will get utilized and in some capacity probably initially [with the] use of physician extenders, allowing surgeons to spend more time in the operating room and taking care of business from that perspective. Centers of excellence are evolving as they relate to bundled payment initiatives as well as this direct to employer movement. Those are the big themes that are going to be interesting to watch, and I think are a big part of where ortho and spine are going in the future. 

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