8 trends in spine, orthopedics and ASCs over the next 5 years


Orthopedic and spine surgeons around the country are beginning to perform outpatient procedures, including total joints and spinal fusions, and many of these procedures can be performed in an ambulatory surgery center. This concept is new for many surgeons, but a few industry pioneers gathered last week in Chicago have decades of experience.

At the 15th Annual Becker's Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine event, a panel of experts spoke on "ASCs, Orthopedics and Spine: The Next Five Years." The panel included Founder of Mesa, Ariz.-based Desert Institute of Spine Care Anthony Yeung, MD; Founder of the Minimally Invasive Spine Institute at Rush in Chicago Frank Phillips, MD; Founder and President of Puyallup, Wash.-based NeoSpine Richard Wohns, MD; Founder and Chairman of Reno, Nev.-based SpineNevada James Lynch, MD; and Senior Vice President of Strategy and Payment Innovation of Surgical Care Affiliates Brian Mathis.


The panel discussed the following eight trends:


1. Surgical and pain management technique development makes outpatient orthopedic and spine surgery possible, but the economics hold some ASCs back. "It will take a combination of insurance companies, device manufacturers and supply chain vendors getting together to make these procedures possible," said Dr. Phillips.


2. Surgeons are taking older patients into the ASC setting. Medicare now has codes for some spine procedures in ASCs, and MedPAC is considering total joint replacements. "Just because someone is 65 doesn't mean they have to have their procedure done in a hospital," said Dr. Wohns. "If you take a spine practice that is 50 percent outpatient and 50 percent inpatient, consider increasing your goal in the outpatient arena by 5 to 10 percent annually."


3. Take control over the entire episode of care. ASCs are now partnering with physical therapists and rehabilitation specialists to ensure their patients receive the right care after surgery to optimize outcomes. Then surgeons can gather the data and develop bundled payments. "We had a multispecialty ASC in Reno for 11 years and built bundles working together and leveraging physical therapy," said Dr. Lynch. "We can bring down the cost of care and bring up quality."


Dr. Phillips also participates in bundled payments and found the ASC an ideal environment for controlling care. "Unpredictability and variability in cost — those are two things that make spine a mess," he said. "We are seeing more employers approach us about bundled arrangements."


4. Surgeons that provide high quality care will always have patients, regardless of regulations and insurance. "All I know is what I'm good at, and if I'm good at it, there are enough people who are concerned about their back pain that they will pay," said Dr. Yeung. "Patients have a choice in determining who to go to. I focus on the result…Focus on the patient, guarantee the result and everything else will work out."


5. There are advantages to both small independent groups and large chain affiliations, and both will find a niche going forward. "I think a smaller group has a better chance of surviving. They can do deals and go directly to the employers and self-insured groups," said Dr. Wohns. "Smaller groups could control their costs and be more cost-efficient than the larger group."


On the other hand, as healthcare becomes more integrated and data dependent, it could be more challenging for small groups to contract with payers and meet federal regulations. To avoid hospital employment, surgeons may decide to join a chain. "Payers can tap into networks of independent surgeons," said Mr. Mathis. "Bringing them to scale is something I'm excited about."


6. ASCs will need to distinguish themselves using data to prove their outcomes are better and adding ancillary services to improve leverage in payer contract negotiations. "If you have a novel imaging center and the hospital doesn't you can negotiate better contracts," said Dr. Lynch. Ancillaries are also a critical aspect of Dr. Wohns' business, including imaging, durable medical equipment, physical therapy and pain management. "If you are a single solo provider and think about the number of referrals you make outside the practice, you can support them within the practice," he said. "You don't have to add infrastructure for most of them."


7. Reputation management is becoming increasingly important as patients seek information online and travel for second and third opinions. "You need to be constantly changing and upgrading your services to the Nordstrum level of service," said Dr. Wohns. "You have to be there for your patient."


Patient education goes hand-in-hand with reputation management. Many patients come into the practice thinking they know what the best treatment is after searching the internet. "It's incumbent for you to choose what you know is right," said Dr. Lynch. "It's all about creating that environment in your office."


8. Primary care physicians want to make sure they're sending patients to a dependable surgeon, especially if they're assuming risk in value-based arrangements. "They want to know what happened when you were with the patient," said Mr. Mathis. "That can bring a ton of benefit to the patient and make sure they are cared for in a comprehensive way. It can be great for the surgeon to educate and screen patients and make sure you are seeing the people who need to see you."


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