After his physician group closed its hospital, Daniel Lieberman, MD, was looking for his next career move. He found it in an ASC.
Dr. Lieberman opened Phoenix Spine & Joint, a minimally invasive-focused spine and pain management practice with ASCs in Scottsdale, Ariz., and Goodyear, Ariz. Here, he discusses his thought process behind opening the ASCs and elaborates on current and emerging trends.
Note: Responses were edited for style and clarity.
Question: What was the thought process behind establishing and building an ASC?
Dr. Daniel Lieberman: My idea of medicine has always revolved around providing a world-class patient experience. To achieve that requires empowering the people at the point of care to manage the patient experience. In 2015, the group I led sold our physician-owned hospital. As I evaluated my next career move, I knew that my options were limited if I wanted to maintain the same level of patient experience that I valued in a community hospital. The best way to ensure my patients remained just as satisfied was to open my own ASC for musculoskeletal surgery.
Q: What are your thoughts on CMS migration of joint replacement procedures to the outpatient setting?
DL: The migration of joint replacement surgery to the ASC is going to save a lot of money and lives. Most of the complications of joint replacement surgery, like [deep vein thrombosis], loose hardware/dislocation and pneumonia, etc., are due, at least in part, to poor early mobilization.
That's not a problem in an ASC, as patients have to be up and walking right out of surgery. ASCs typically have a lower rate of infection than hospitals, which is crucial in joint replacement, as every infected joint is a catastrophe for the patient. Selecting patients who are medically fit for surgery in an ASC is also likely to lead surgeons to make better selections about which patients are fit for surgery in general.
Q: What do you view as an emerging opportunity in the spine field in the next three years?
DL: On the business side, we need to view back pain as a chronic disease, and engage patients in a lifelong relationship. About 17 percent of patients who had a fusion this year had a [past fusion] within the last four years. There are five discs, 10 facet joints, five interspinous ligaments, two SI joints and 10 nerve roots in every patient's lumbar spine. No matter how good of a job you do on one pain generator, there are a couple dozen more in line behind it.
On the procedure side, we are seeing the emergence of new treatment paradigms for surgeons that will change the game. Depending on the age of the population you're treating, nearly 80 percent of patients with back pain have pain of facet or discogenic etiology. We haven't had good treatments for these groups. The rise of endoscopic rhizotomy for the treatment of facet-mediated pain is a game-changer for patients with spinal arthritis. In my practice, this treatment reduced the need for fusion by 40 percent. Similarly, our early experiences with amnion and bone marrow-derived stem cells for discogenic pain are really encouraging. Hopefully, these two procedures will give us much better options for people with back pain in the near future.
Q: What is one successful thing your ASC is doing that you'd like to share with other ASC leaders?
DL: We've been able to institute teleconferences for patients during the early stages of their process with us. For patients who have been told by other surgeons that they need surgery, we always encourage them to come to us for a free second opinion by teleconference. We’re able to video chat and discuss their case to see if we agree that surgery is necessary, and if it is, how one of our procedures may be easier on them or more effective than what’s already been recommended. And with the video chat, it means the patient doesn't have to spend the time or expense of visiting our facility. They can take this meeting from the comforts of their own home.
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