The future of outpatient orthopedics: 5 surgeon insights

Carly Behm -  

Outpatient surgery is an inevitable area for spine and orthopedic surgeons to explore. From the potential of innovation to the business outlook for hospitals, here's what five surgeons are saying about outpatient migration in 2022:

1. Outpatient centers as a tool for innovation: "Given the incredible momentum behind outpatient, ambulatory-based surgery, there will be increasing demand for ASC-based enabling technologies," said Jason Weisstein, MD, of Yavapai Regional Medical Center in Prescott, Ariz.. "That may mean a variety of technologies that find their wheelhouse in the ASC: single-use implants and instruments, active-intelligence platforms that crystallize the outpatient patient care pathway, or ASC-based navigation and robotic platforms."

2. Outpatient surgery will grow in orthopedics: "Outpatient surgery numbers will keep going up in the future," said Niranjan Kavadi, MD, an Oklahoma City-based orthopedic surgeon. "I will not be surprised to see an increase to an extent of 20 to 30 percent in five years. What is critical to perform surgery in an outpatient setting is precise perioperative planning. As more residents and a newer breed of surgeons get trained in ambulatory surgical settings, we will see an increase in the numbers. Primary knee replacements and uncomplicated spinal fusions are already being performed at a significantly higher volume in an outpatient setting than a few years ago."

3. Outpatient migration can advance spine surgery: "I think the movement of spine cases to outpatient settings will help drive [endoscopic spine adoption], because the surgery is significantly less disruptive," said Michael Gallizzi, MD, of The Steadman Clinic in Vail, Colo. "I think quite honestly, once people know it's available, consumers are going to start demanding it."

4. Hospital strategy can match outpatient efficiency: "One strategy that health systems have used with success to moderate the pace of migration is the creation of co-management arrangements with orthopedic providers," saidJohn Corsetti, MD, of New England Orthopedic Surgeons in Springfield, Mass.. "These agreements financially incentivize providers based upon quality and performance metrics, while allowing for heightened levels of service line control. A well conceived and executed co-management agreement typically results in improved satisfaction across every tier of the care team, in addition to enhanced patient satisfaction and even clinical outcomes. These agreements create a working partnership between the providers and the health system, aligning goals and incentivizing the attainment of mutually agreed upon measurable metrics. Many providers who have entered these arrangements have commonly seen inpatient care efficiencies improve to approximate those observed in the outpatient setting." 

5. Outpatient migration hasn't stifled hospital investments: "Progressive hospitals have already been planning for this by building ASCs or hospital outpatient departments," said Alok Sharan, MD, of NJ Spine and Wellness in East Brunswick. "They have created [enhanced recovery after surgery] or fast track programs to expedite care through an episode. Operating rooms are equipped with the proper equipment that enable spine surgeons to perform minimally invasive surgery with a faster recovery, either through the use of an endoscope or proper imaging tools … The future model of care will be outpatient focused factories that merge specialized centers of excellence with outpatient ASCs. The migration of cases to the outpatient space should encourage hospitals to rethink their business models and invest in capabilities which can achieve these goals."

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