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Orthopedic Systems Developed for the ASC: Insights Into DePuy Synthes Select's Innovative Business Model

DePuy Synthes has a well established reputation in the inpatient and hospital outpatient department setting. Now, the company is developing a new focus on freestanding ambulatory surgery centers: DePuy Synthes Select.

"With the launch of the Select organization, DePuy Synthes has acknowledged a need to innovate around the traditional orthopedic business model at the ASC site of care. Traditionally, orthopedic manufacturers have focused on a specific surgeon specialty and de-emphasized the importance of the other key stakeholders in these smaller/more agile facilities — whether that be the investment management groups, administrators, materials managers, or operating room professionals," says Steve Clareen, Business Unit Manager at DePuy Synthes Select. "The Select model is organized in a way that will allow our organization to bring that focus — from the office to the OR."

Here, Mr. Clareen discusses the DePuy Synthes Select business model and how the transition of orthopedic procedures into the outpatient setting is impacting ASCs.

Question: What are you seeing in technology development that allows surgeons to bring cases into the ASC?

Steve Clareen: The increase in higher acuity orthopedic cases in the outpatient setting is being driven by continued advancements in minimally invasive surgeries and pain management such as regional nerve blocks. These advancements are not only allowing procedures to be performed more safely but also allowing patients to recover from surgery quicker than ever before. In the non-acute trauma market, distal radius and other procedures of the extremities have always been common; however, we are starting to see more complex fractures and the technologies associated with treating them make their way to these facilities.

DePuy Synthes Select is positioned to address the movement of these non-acute trauma procedures in the near term and procedures such as spine fusions and joint replacements over the mid to long term. Our hope is that by aligning our organization around the movement of these procedures, DePuy Synthes can continue to maintain the highest standards of patient care and deliver more value to this site of care as a first line provider of their orthopedic needs.

Q: How is the Select program evolving to accommodate for the unique ASC setting?

SC: The ASC facility will no longer have to compete for the attention of other sales consultants and representatives within larger sites of care such as hospital facilities. Our Account Development Managers will be trained to understand the unique nature of ASC facilities including the impact that reimbursement has on the operation of facilities; and our Outpatient Product Specialists will be solely focused on the experience with our products in the operating room.  

This year alone we have made investments in the development and launch of three new compact systems that address the high volume non-acute or elective trauma procedures at these facilities. Additionally, we are making investments in logistics and software solutions that we hope will streamline, automate and innovate around some of the facilities interactions with our organization. The ultimate goal is to increase access to DePuy Synthes' high quality products and to deliver maximum value to the facility by driving efficiencies to all ASC stakeholders. DePuy Synthes Select intends to achieve this by maintaining our focus on support of the OR, increasing our interactions with the office and increasing the ASCs confidence in our delivery model.

Q: The Select instruments have some interesting developments for streamlining efficiency — how will that impact operating room time and room turnover for the ASC?

SC: The developments that you are seeing in DePuy Synthes Select's launch of three new compact systems is our organizations acknowledgement that one size does not always fit all and that the needs of ASC site of care are truly unique. When designing the sets our team really considered feedback from everyone who would handle the systems at the ASC facility. First and foremost, our team made certain that each new system would adequately address the majority of ankle fracture, forefoot reconstruction, and distal radius cases performed at the facility. Then, our team took the design one step further. We considered the ORP's supporting surgeons because their feedback suggested that the orthopedic systems being delivered to ASC facilities by the leading vendors were becoming increasingly too large and complex.

As a result, DePuy Synthes Select designed an intuitive system with order of use layouts and color coding of instrumentation and implants so as to avoid any confusion in the OR. Our goal was to make the OR experience more efficient but also to improve the ability to replenish the set after surgery. Our feeling was that at this site of care it is important to elevate everyone's acumen related to our systems not just the surgeons who may have trained on them during their residencies and fellowships. Our hope is that by taking these small steps the overall set up and turnover of ORs would be improved but even more importantly the comfort of everyone who handles our systems would also be enhanced.

Q: What have you learned about the ASC industry by focusing on its challenges exclusively?

SC: One of the key insights we have learned by talking to ASCs is that large orthopedic device manufacturers often transfer their organizational complexity on the facility. Across any large orthopedic vendor, you might have over 20 touch points within that organization. They identified this as grossly inefficient for their office staff. Our goal is to streamline these interactions with the DePuy Synthes organization and believe that this alongside more constructive conversations around individual facility challenges and needs will deliver greater value for our ASC customers.

Q: What innovations are you seeing in inventory management at ASCs? How can administrators and physician investors decide which ordering and inventory options are best for them?

SC: In orthopedics we are seeing a larger push for vendor managed inventory much like what the retail space has been utilizing for years. ASC customers in particular seem to be looking for a just in time inventory model with an even more limited touch (i.e. when a need for a product arises, we deliver if for use). As a result, DePuy Synthes and Select are making significant investments in facilities, technologies and software that will not only allow our organization to bring the right products even closer to the customer but also to transform the way the customer interacts with our organization.

For example, we are developing a state-of-the-art system which will allow our ASC customers to access and reserve our inventory when surgical cases are scheduled. This system will be used to enhance, not replace, the relationship they have with our sales consultants. When reservations are made the demand signal will be sent directly the DePuy Synthes Select personnel who will be able to view the request and act on it immediately.

DePuy Synthes Select wants ASCs to gain an even greater level of trust with our organization so they know that when they press a button they’ll have the inventory and OR support they need. Our mission is to organize ourselves in such a way as to be more responsive to the ASC's needs, to increase their confidence in our delivery of assets or support, and to help facilities move toward more efficient interactions with our organization so that there is shared value creation in an otherwise outdated model.

Q: Given the downward pressure on reimbursements, why is it important for device companies to work with administrators for cases in the outpatient setting?

SC: Healthcare is evolving and although no one can predict what the industry will look like in three, five or 10 years it is clear that there is one theme that has been consistent and will remain consistent through it all — procedures will move towards facilities where quality care can be delivered at a lower cost. ASCs are uniquely positioned to capitalize on this paradigm shift and DePuy Synthes believes that as an industry leader in orthopedics we also have a responsibility and unique opportunity to partner with this alternative site of care to not only improve but also lower the cost of patient care with innovative new models more finely focused on customer needs.

As mentioned earlier, DePuy Synthes Select is looking at every interaction with the ASC customer and making investments in people, product, and logistical solutions to position our organization as the preferred partner to the ASC facility. Our hope is to continue to build this future together.

Q: How do you see orthopedics evolving in the future?

SC: There are a number of headwinds and tailwinds facing the orthopedic industry that will result in its continued evolution. With this evolution there will be many challenges but more importantly there will be significant opportunities for organizations to redefine how they are going to operate. The procedural trend from inpatient to outpatient facilities will only continue. Orthopedic device manufacturers will need to continue to find ways to demonstrate value to the customer beyond product and price through a better understanding of their needs.

Life is in motion and a more active and rapidly growing baby boomers generation will continue to require advancements in technologies that return patients to full function in less time. It's an exciting time in the orthopedic industry and for organizations like DePuy Synthes who are willing to innovate around their entire approach to the customer with the launch of business models such as DePuy Synthes Select.

Q: What new opportunities do you see for orthopedic cases in the outpatient setting?

SC: There is an opportunity to help surgeons and their staff potentially decrease their OR time via our streamlined sets, and accelerate the learning curve around new orthopedic systems that are being launched into the ASC market. As mentioned earlier, higher acuity cases are moving into the ASC and surgeons are looking for products that work well in the outpatient site of care. DePuy Synthes Select is going to partner with the facility to go above and beyond the exceptional service and support our organizations have always provided in the operating room with flexible pricing options, new service models and innovative new technologies.

[The technology] advancements [mentioned earlier] will continue to accelerate the movement of spine and joint reconstruction procedures to the outpatient site of care. Already we are seeing significant spine procedural growth in ASCs as procedures such as cervical spine fusions move towards alternative sites of care. The trend for joint resurfacing and replacement will continue to accelerate towards the outpatient site of care with improvements in technology and changes in surgical approach.

Sports medicine surgeons are performing internal fixation procedures on the ankle and clavicle with increasing frequency as new products are being brought to market. Doctors of Podiatric Medicine are also performing more and more complex procedures in the foot and ankle and are treating disease states that were once treated non-surgically in a surgical fashion with orthopaedic implants. DePuy Synthes Select will continue to align around their clinical needs.

Moreover, DePuy Synthes Select will work with other stakeholders at their facilities to create greater alignment and increase access to the broadest orthopedic portfolio in the industry. Whereas, others are solely focused on surgical specialties, DePuy Synthes Select will look at the entire site of care and how we can build bridges and value to all the key stakeholders at the facility.

For more information or to learn more at the 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Business of Spine please contact Miriam Wehrli at

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