Dr. David Jacofsky on the top opportunities for outpatient orthopedics in 2020

David J. Jacofsky, MD, is chairman and CEO of HOPCo, a physician-led orthopedic management company and the CORE Institute, an orthopedic practice with locations in Michigan and Arizona Here, he shares his thoughts on outpatient orthopedics, private equity and more.

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

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

Dr. David Jacofsky: We will continue to see increased demand for total joint procedures for years to come, and that demand will encompass a wide variety of age groups. The number of inpatient procedures will still grow, but at a far slower pace than outpatient total joints. The opportunity to serve those patients in an outpatient setting is self-evident. The challenge is not only meeting that demand, but aligning the stakeholders, from the surgeons and facility administrators to insurance companies and patients, to create a win-win situation for all involved. Most importantly, we must strive to deliver the best possible outcomes at the best possible value for our treasured patients.

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

DJ: Patients are becoming more responsible and educated consumers and are getting a chance to see the advantages of outpatient orthopedics. Given the choice, patients, employers, and payers are all aligned to drive appropriate patients to lower-cost sites of care and are willing to financially reward providers for superior outcomes and the delivery of higher value care.

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

DJ: The ASC industry is a game changer when it comes to the medical marketplace and will continue to be so. But all of that opportunity is predicated on effective delivery of promised quality and value. That is why at HOPCo, the CORE Institute, and our other affiliated practices, have invested heavily in the development of integrated protocols, proprietary tools and data capabilities proven to provide such outcomes at lower costs. Growing acknowledgment of the advantages offered by high quality ASCs will not only attract more patients, but likely convince regulators to further expand the roles that ASCs can play in our healthcare system while further incentivizing employers and insurers to drive patients to such high value sites of care delivery.

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

DJ: We have been pioneers in developing and deploying new technology, from robotic devices to help guide surgeons, to new joint replacements that feel more natural and last far longer, to medical software that provides real-time feedback to surgeons following our protocols. We have a major commitment to continued research and are currently developing or co-developing systems and devices that we feel will have a profound impact on joint replacement surgery in the near future. One exciting area we are focused on internally are inexpensive, disposable, wearable sensors to help manage population health in the musculoskeletal space.

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

DJ: To quote a cliché, always start with the end in mind. In my opinion, the end in mind should be the delivery of a high value joint replacement with superior outcomes at lower costs. To understand how these outcomes are viewed by payers, I would suggest engaging in discussion with payers and experts to understand how they will define success, as this will ultimately impact your reimbursement rates and opportunity to excel in your market compared to peers. Further, understanding the target patient you expect to bring to the facility can have dramatic impact on the design of the center. Finally, local and state rules regarding permitted overnight stay, extended stay and similar compliance issues can force your hand in determining what surgeries and what patients may or may not be acceptable to plan to bring to a new facility.

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

DJ: Private equity has already had a major impact on the orthopedic specialty, and the early consolidation of the field bears witness to that. It can help practices develop or acquire the resources needed to manage data, track outcomes and build relationships with other organizations. For us, private equity was attracted by the proven quality of the evidence-based care we deliver and the value of the proprietary IT platforms we have developed, which, in turn, has allowed us to apply our methods to a growing number of partners and affiliates across the country. It is critical to define your goals prior to entering into such a transaction, as dollars alone will definitely not prepare a group for the future. Rather, most groups need a plan to acquire the operational infrastructure, claims analytics platforms, data warehouses, quality systems and business teams to endow them with a strategic advantage for what lies ahead. Money may be helpful, but money alone will not provide solutions to the complex challenges of tomorrow.

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