What we heard in 2023

Featured Insights

Spine and orthopedic experts this year spoke with Becker's Spine Review about topics from Ozempic to outpatient migration.

Here are 10 insights to know:

1. "As payers continue to signal a shift from fee-for-service to value-based care models, independent practices will need significant resources and infrastructure to facilitate this successfully. Independent practices may encounter substantial challenges in building these capabilities, given limited resources and experience. Practices can, however, consider aligning or partnering with organizations that have a comprehensive and proven infrastructure and platform for [musculoskeletal] value-based care success." — Wael Barsoum, MD, president and chief transformation officer at Phoenix-based Healthcare Outcomes Performance Company on his outlook for independent orthopedic practices.

2. "Any good spine surgeon does their homework. The night before a case, I review the images for surgery and go over the plan I prepared to address the issue. I review my notes. In my mind's eye, I imagine each step of the procedure I'm going to do and any potential difficulties I might encounter during surgery. Most importantly, I get a good night's sleep!" — Jeremy Smith, MD, of Hoag Orthopedic Institute in Newport Beach, Calif., on how he prepares for a busy day.

3. "The SI joint fusion groundswell has leveled off quite a bit in the past four to five years. While we cannot replace this joint, I think more interesting companies will come to the fore with simpler techniques and likely integrated with image guidance out of the box. This would be dually good and not so good for patients. While it would help make us better at the operation, it opens the door for unqualified people to do them on likely thin or nonexistent indications. The democratization of spine surgery should not mean everyone should do it, quite simply because they lack the training, insight and ability to manage these patients in the long term," Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, on his outlook for sacroiliac joint fusion.

4. "We are just scratching the surface of the potential possibilities of mixed reality currently. This technology may be very useful for orthopedic trauma as well. I would expect its use to grow as more features are incorporated into the technology, such as the ability to reliably use it for instrument navigation. Instrument navigation, without mixed reality, has been used in shoulder surgery and is an emerging technology that holds immense promise. Along with instrument navigation comes robotic surgery, which is currently in use for hip, knee and spine surgery, to name a few. This technology is gradually making its way into the shoulder replacement space and has the potential to improve accuracy and reliability." — Dave Shukla, MD, on the growth of mixed reality in orthopedics at New York City-based Mount Sinai. 

5. "The migration of total joint arthroplasty and spine surgery to an outpatient/short-stay setting is well underway, but in my opinion is still in the early innings. On the other end of this spectrum, some surgical cases are migrating to an in-office site of service, particularly in pain procedures, as well as hand and foot cases. ASCs must adapt to this transition in important ways which will require increasing investment in facility infrastructure and staff training. The same is true of in office procedure capabilities. This is a top-of-mind issue as our practice looks to the future of healthcare and the future of our surgical practice. This migration has legs as it is a strong value proposition for our patients and for third-party payers." — Paul Perry, MD, on how Tri-State Orthopedic Surgeons in Evansville, Ind., is seeing a shift to orthopedic ASCs. 

6. "Overall, orthobiologics are not overhyped. This type of treatment has been established as being safe and effective in the well-selected patient. The proper use of leukocyte-rich or leukocyte-poor PRP formulations, minimally manipulated adipose, or bone marrow concentrate has shown benefit in many common orthopedic injuries. On the other hand, "regenerative medicine" is not a proper description of these treatments. Advertisements that suggest cartilage, tendon or spinal discs can "regrow" are extremely misleading and medically false. Patients should consult with their doctors to ensure they pursue the treatment best for them rather than the treatment receiving the most hype," — Gurtej Singh, MD, on the state of orthobiologics.

7. "The best advice I could give the next generation of orthopedic surgeons is to be constantly looking for opportunities to innovate. We have made great strides in orthopedic care in recent decades, both through surgical techniques and in the philosophy of how we approach and treat different medical problems. Although we always want to build upon the techniques and practices that have come before, I am constantly challenging the next generation to come up with newer and better ways to help patients recover and regain mobility as quickly as possible," Frank Liporace, MD, on the best advice for early-career surgeons.

8. "Future medtech company mergers have the opportunity to either disappoint or improve healthcare. The outcome is solely based on the heart of the companies. If the coalescence of these companies leads to the prevention of attainable healthcare and devices as well as commodifying patients, then it will be at the detriment to the medtech consumers first and ultimately the mergers long term. However, if the mergers improve the accessibility and quality of patient care, these plans could be exciting." — James Chappuis, MD, of Spine Center Atlanta on spine medtech company mergers.

9. "The more healthcare becomes transactional, the less patients will have the warm and fuzzy feelings about their treating provider. The less power MDs will have in the system, the human touch will be replaced by episodic algorithmic care. The outliers, contraindications and reliable transfer of information will take a back seat to overarching standards. I worry that the ability to innovate will be stifled by the one-size-fits-all mentality based on older data because its proven, and newer treatments will not be approved. The constant scrutiny of the pre-approval process will cross the line for deciding treatments or indirectly, and de facto, become practicing medicine without a license." — Alan Reznik, MD, Connecticut Orthopaedics (Hamden), on healthcare disruptors.

10. "I am seeing increased usage of GLP drugs. Initially, the effect of these drugs will have little impact on spine and orthopedics; however, in a few years time, it will have a bearish effect as thinner people will have fewer spine and orthopedic problems. After a few more years business will pick up again since people will be living longer. I believe usage of this class of drugs will increase." — John Prunskis, MD, of Illinois Pain & Spine Institute in Elgin, on the effect Ozempic could have on the spine industry.

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