How orthopedics, spine will grow in ASCs from 4 surgeons

Orthopedics and spine are evolving specialties for the outpatient and ambulatory surgery center space.

Here, four surgeons discuss goals for their outpatient orthopedic and spine practices, and the role ASCs could play in the specialty going forward.

Question: What are your top one or two goals for your practice over the next three to five years? How do you see it growing and developing?

Thomas K. Miller, MD. Carilion Clinic (Roanoke, Va.): The challenge for any practice and healthcare system is associated with directing patients and services required to the most appropriate facility for the entire "package" of care. The concept of who really needs a traditional hospital environment continues to evolve.

Matching and appropriately allocating the limited resources of time/OR access, overhead, materials and staffing to the patient and procedure needs to be approached outside the longstanding models of care. This includes:

● Rigorous [preoperative] screening of comorbidities and assignment to a site of care based on anticipated perioperative needs (not just the procedure to be performed)
● Assessment and optimization of postoperative support services
● Patient (and family) education and training
● Supply of durable goods to enhance recovery
● Development of efficiencies based on large volumes and reliably reproducible protocols and continuous monitoring of outcomes and adjustment of care models based on objective evidence from this monitoring

As more complex procedures are shifted to nontraditional sites of care, we expect to see a narrower focus of service for sites of ambulatory care. Just as surgical specialties have become more subspecialized, we can expect ambulatory centers to become more specialized to improve efficiencies and quality of care. We expect to see not just specialty specific ASC sites but narrow focus procedure centric facilities.

Bobby Bhatti, MD. Atlanta Spine: Our growth continues to focus on changing the referral patterns in our city. It is imperative that referrers realize we offer all the latest technological advances to our spine patients, because we focus our practice solely on the spine. We are seeing a lot in sterile packaging for ASCs. This is a significant cost reduction and quality control measure that helps outpatient surgery significantly. I think robotics, albeit a great marketing gimmick, has a long way to go. Most of us spine surgeons know how to put in a pedicle screw; the real achievement will be operating through a remote station.

Hospitals as we know them are a thing of the past. ASCs provide boutique care that is more efficient [and] more cost effective with lower infection rates. We hope that reimbursement will reflect that as the insurance carriers see our results.

Kam Momi, MD. Coastal Spine (Mt. Laurel, N.J.): Our top goals are arranging for strategic partnerships with either a hospital or with other ASCs to form larger entities for potential buyout. Recruiting new physicians is our biggest challenge. We have been looking at nontraditional sources of surgical revenue, for example vascular surgery. [I would advise surgeons just entering the field to] join an ASC as soon as possible after you begin practice. The profitability is still there although it is a mature field.

Q: What role do you see outpatient surgery centers playing in the orthopedics and spine field in the future?

Neil Badlani, MD. The Orthopedic Sports Clinic (Houston): Outpatient spine surgery has grown dramatically over the last decade because of significant clinical and economic advantages to patients, physicians and the healthcare industry. Improving technology, increased patient and physician satisfaction as well as a desire to control healthcare costs are key drivers of this growth. Patients prefer outpatient procedures because of the increased convenience and quality of care.

Physicians benefit from the efficiencies of the outpatient setting and potential profit from ownership. The healthcare market continues to evolve because of ambulatory surgery centers providing a disruptive innovation to the existing industry structure. Shifting site of surgery to the outpatient setting leads to an overall decentralization of healthcare and significant cost savings opportunities. The trend toward moving spine surgery to the outpatient setting will continue as patients and physicians become more comfortable with the process and evidence continues to show excellent outcomes, low complications and economic efficiencies.

More articles on surgery centers:
4 essential marketing strategies for ASCs
Dartmouth-Hitchcock moves forward on $59M expansion with ASC: 3 details
How Surgery Partners plans to grow in the next year: 8 key points on strategy



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