The future of orthopedic care delivery from 3 surgeons


From evolving population health initiatives to increased risk-sharing and the shift toward outpatient care, three orthopedic leaders discuss how care delivery is changing:

Note: Responses are lightly edited for style and clarity.

Martin Roche, MD. Hospital for Special Surgery Florida (West Palm Beach): Patients are concerned about being in the hospital with COVID, and insurance companies are realizing outpatient care is cheaper care for them. There's a lot of momentum that will continue to drive this if patients are selected right, and if we can continue to show that the outcomes are just as good. 

Secondly, I think surgeons, now being driven by patients, are requesting the best technology for the best outcomes. That includes everything from sensor-assisted surgery to robotics. DePuy just announced that their robot will be coming soon, so each of the big four device companies all have a robotic application for knee surgery. It's going to be exciting over the next couple of years integrating robots, not only into hospitals, but into ASCs. 

Thirdly, remote patient monitoring with wearable sensors and other communication links are the future. As patients are going home the same day, it's still our role to ensure their recovery goes as seamlessly and as safe as possible. I think you're going to see the use of wearables and different telehealth integration to keep an eye on patients to make sure they're not having any complications along the way. 

Nicholas Grosso, MD. President of The Centers for Advanced Orthopaedics (Bethesda, Md.): We're not going anywhere. With the baby boomers getting older, the need for orthopedics is going to increase, especially on the joint replacement side. Looking at some of the trends of total knees and total hips expected to be done in the U.S. in the coming years, it's almost a vertical line up. We're already starting to see that volume.

I think we'll see an acceleration of these surgeries being moved outpatient. The pandemic hastened that process because a lot of people just don't want to go to the hospitals. Surgery centers that have the capacity are doing more procedures to try and take up some of that volume. We'll see an acceleration of the transition of site of service out of the hospitals to outpatient surgery centers. This has been very good for orthopedics because most of us are owners in our surgery centers. That may help keep the market going and maybe offset some of the CMS cuts.

Wael Barsoum, MD. President and Chief Transformation Officer of HOPCo (Phoenix): My belief is that changes in [Bundled Payments for Care Improvement Advanced] and other programs being considered by the federal government clearly signal a broader shift toward population health, which will be the catalyst to orthopedic care being increasingly delivered in vertically integrated systems that align physicians, hospitals and payers. The main driver of this will be reducing variability and cost while improving patient outcomes.

As physicians and health systems take on more financial risk, the ability to manage the entire continuum of care is imperative. Care will shift to lower-cost sites of service, such as surgery centers, and health systems must have a coordinated strategy to maintain volumes and margins in the hospital setting through more integrated value-based care programs and more intensive and effective inpatient care redesign.

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