6 questions on the future of outpatient orthopedics with Dr. Randall Schultz

W. Randall Schultz, MD, is an orthopedic surgeon at Texas Orthopedics in Austin. Here, he shares his thoughts on outpatient orthopedics.

Note: Responses have been lightly edited for style and clarity.

Q: What changes or opportunities are you expecting to see for outpatient total joints in the coming years?

Dr. Randall Schultz: I expect we will see increasing volume in outpatient centers as competition on cost and quality increases with value-based payment programs and employer-based insurance programs. Additionally, our ability to optimize patients preoperative will improve and increase volume through the centers. “Don’t cherry pick — Make more cherries!"

Q: Are there any kind of overarching trends that you're seeing right now in outpatient orthopedics?

RS: There is an interesting divergence in the world of joint replacement with a move to more expensive, computer and robotic-based procedures while we are simultaneously seeing market pressures to reduce costs and improve quality.

Q: How do you hope the ASC industry will change in the coming years?

RS: I think it will be increasingly recognized as a viable competitor to the hospital experience. Often physicians have a greater role in ownership and administration of these facilities, and this often leads to quality improvements and better patient experience. It is important that ASCs maintain the same regulatory standards and not put profits in front of safety.

Q: Is there any new technology you're looking forward to on the horizon?

RS: I think we have just seen the tip of the iceberg in the world of preoperative optimization. The ability to identify modifiable risk factors and correct them preoperatively will lead to increasing volume of patients who are healthy and fit enough to have their procedures performed in a lower cost, ambulatory setting.

Q: Do you have any tips or things to know before starting a total joint program?

RS: Variation is the enemy of any program. Creating consistency and developing clinical pathways with engaged provides are the fundamentals to creating a successful program.

Q: Do you think private equity will have an impact on the orthopedic specialty? Why or why not?

RS: I think we will see it become more prevalent (and are seeing) it in the marketplace due to declining reimbursement and increasing overhead costs. Unfortunately, I think the shift from physician ownership of practices will ultimately decrease satisfaction for both the providers and the patients.

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