The top barrier to outpatient orthopedic surgery migration

Tyler Marshall, MD, an orthopedic sports medicine physician in Birmingham, Ala., outlines the big challenges and opportunities in outpatient orthopedics today.

Question: What are the top barriers to outpatient migration in orthopedic surgery? How can these barriers be overcome?

Dr. Tyler Marshall: The biggest barrier I see in my state is insurance companies restricting outpatient facilities from performing procedures. I think that overcoming these limitations will require time and discussions at the state legislature and medical board level.

In the meantime, physicians should talk with their patients about the benefits of having surgery in an ambulatory surgery center versus a hospital. During the pandemic, many people delayed undergoing elective procedures due to the uncertainties caused by COVID-19. However, moving forward with an elective procedure in an outpatient setting could be a safer alternative, with minimal risk of exposure. In many cases, joint preservation procedures can be performed in an outpatient surgery setting with no overnight stay required, compared to inpatient surgery when the patient could remain in the hospital for several days. As healthcare facilities are isolating specific areas for treatment of COVID-19 patients, the risk of viral transmission in other facilities like ASCs is significantly decreased.

Q: Are there any trends in orthopedic surgery that are concerning to you? If so, what are they?

TM: My biggest concern is insurance companies dictating patient care. This impacts healthcare in general, not just orthopaedics. Diagnostic testing and approval for surgery many times is delayed because of insurance company policies. I think patients can help combat this increasingly problematic process and take control of their healthcare by selecting plans that don't have restrictions on benefits. It is very important for patients to have conversations with the insurance company of their choice about deductibles, copays and benefits, so they are not caught off guard when the need for care arises.

Q: What do you see as the biggest opportunity in the field of orthopedic surgery this year?

TM: The biggest opportunity I see is that medical technology continues to evolve, allowing doctors to deliver enhanced patient care. With regard to shoulder surgery in particular, we have seen tremendous changes in philosophy and technology over the past decade. Surgeons are looking to move toward minimally invasive techniques that allow faster recovery times and improved patient outcomes.

In my practice, I have seen implants like the bone-preserving anatomic OVOMotion with Inlay Glenoid Shoulder Arthroplasty System provide excellent results. This system is a great solution for patients who want to resume normal everyday lives with lower activity as well as patients that work out, participate in sports and live highly active lifestyles. My patients have really seen a benefit with this system versus the traditional total shoulder arthroplasty that comes with a set of restrictions. Additionally, I am seeing a move toward more outpatient procedures in the world of joint preservation. With emerging minimally invasive techniques and enhanced pain control methods, we are able to safely perform procedures and get patients back home without an overnight stay.


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