Procedures across all specialties are seeing increased volume and opportunities at ambulatory surgery and outpatient centers, and orthopedics and spine is no different.
As CMS removes more procedures from its Inpatient Only List, the demand for surgeries to be performed outside of the hospital settings is only likely to increase.
Completing orthopedic and spine procedures, such as total joint replacements and lumbar spine surgeries, in ASCs can lead to more efficient and better patient outcomes, according to Alexander Meininger, MD.
Dr. Meininger is an orthopedic surgeon and sports medicine specialist at Steamboat Springs, Colo.-based Steamboat Orthopaedic and Spine Institute, which has operated an ASC in Steamboat Springs since 2020. He recently connected with Becker’s to talk about the movement of orthopedic procedures to ASCs and the benefits provided to both surgeons and patients.
Note: Responses were lightly edited for clarity and length.
Question: What orthopedic trends are you seeing in terms of the shift to the outpatient space?
Dr. Alexander Meininger: The migration of orthopedic surgery to outpatient settings just continues to unfold. We opened our center in 2020 and we were eager to create a joint replacement pathway, so we’ve been performing outpatient, hip, knee and shoulder replacement surgeries in our ASC since 2020. That volume has only continued to grow, and the demand has grown. With us being in a rural environment, we want to have strict patient selection pathways. That means that certain patient conditions need to be closely monitored, and to some degree, change our ASC eligibility. So some patients just don’t qualify for those reasons. But otherwise, our hand, foot and ankle and sports medicine arthroscopic procedures are nearly 100% performed in the outpatient setting.
We’re lucky to be involved as surgeons, owners and operators in the center. We have a partnership with the hospital, and having some autonomy also gives us direction of the facility. ASCs, in contrast to the hospital setting, gives you ownership in the situation. You have ownership of the conversations around implants, human resources, personnel, which all help to streamline your efficiencies, make for a more affordable purchasing decision making and increase patient satisfaction. When we can advertise to our ACL or rotator cuff patients that we have an orthopedic-specific ASC, they’re excited and eager.
Q: Is the ASC now the preferred setting for orthopedic surgeons to perform procedures?
AM: The ASC is the preferred setting for surgeons of multiple specialties. From our position as orthopedic surgeons, it’s great because there are demanding procedures performed in ASCs and they require repeated efforts. It requires proficiency and motivation for our technologists and nurses to get familiar with the techniques. There’s 100 different steps in an ACL reconstruction, and if we have a different technologist every time we arrive, it just can make the surgery less fluid or less streamlined. If we can optimize those and get a team approach, where we have specific people who are dedicated to spine, total joints and sports medicine procedures, then those cases can be more predictable, more efficient and more satisfying.
Q: How does orthopedics continue to evolve in ASC settings?
AM: Initially, it was just knee replacement that came off of the inpatient only list, then hip replacement, then shoulder replacement. My partner, J. Alex Sielatycki, MD, orthopaedic spine surgeon at SOSI and the spine service line has only continued to grow and perform multilevel disc replacements such as multilevel cervical lumbar fusions. We’re one of the few sites in the U.S. that is hoping to get approval for the MOTUS total lumbar joint replacement device. Being able to perform outpatient lumbar surgery or treat some of these back patients in the ASC setting is one of our big horizons and opportunities for growth.
