6 keys to orthopedic success in the next 2 years


The pandemic has shifted the orthopedic industry tremendously. Six orthopedic leaders spoke with Becker's Spine Review on their solutions to ensure orthopedic success in the coming years:

1. Shift to ASCs 

"​A private practice will have a hard time maintaining autonomy without an ASC, as increased regulatory burden and decreased reimbursement have led to high overhead models for most groups," said Nitin Khanna, MD, spine surgeon and founder of Munster, Ind.-based Spine Care Specialists.

Dr. Khanna added that ASCs give surgeons more control of the work environment — making them more efficient and increasing job satisfaction. 

"With case migration to the outpatient setting, a well-run ASC should be profitable for the foreseeable future," said Ed Hellman, MD, president of Indianapolis-based OrthoIndy.

Orthopedic surgeon Nicholas Frisch, MD, president of operations for Birmingham, Mich.-based Smithfield Surgical Partners, added that this migration is specifically important for surgeons performing joint replacements because of CMS adding total joint procedures to its outpatient list.  

2. Implement virtual tools 

Implementing virtual patient management tools and telehealth platforms can help orthopedic practices stay ahead of industry changes. 

"These can affect not only workflow of the practice operations, but the culture of the organization and how you interact with your patients," Dr. Frisch said. "Implementing the infrastructure needed to manage patients more remotely is critical."

This inclusion will also help patients locate and choose these practices. 

"Most patients research orthopedic practices and providers online — most of the time on their phone. Making sure your practice has an up-to-date web presence can decide whether or not you are even in the running to be their surgeon," Jeffrey Hodrick, MD, orthopedic surgeon at Nashville, Tenn.-based Southern Joint Replacement Institute, told Becker's Spine Review.

3. Focus on industry shifts

Understanding the industry is critical for orthopedic practices to stay ahead of market shifts. 

Michael Ast, MD, an assistant professor of orthopedic surgery at Weill Cornell Medical College and surgeon at Hospital for Special Surgery, both in New York City, said an industry understanding is critical for success.

"It is important for practices to understand the landscape around them and position themselves to be nimble if major market shifts occur locally," he told Becker's Spine Review. "Failure to recognize the landscape as a whole would be a major risk to an orthopedic practice."

4. Diversify revenue

Andrew Bush, MD, is an independent orthopedic surgeon at his solo practice, Central Carolina Orthopaedics Associates in Pittsboro, N.C. He told Becker's Spine Review that he has had to revamp his practice by gaining a pharmacy dispensing license and starting a regenerative medicine program.

"It seems that the diversification of revenue-generating activities is the only way a small practice like mine will hopefully survive the current trends in medicine," he said.

"I think the key to maintaining a positive cash flow is a diversified ancillary income stream." Dr. Hellman said. "Advanced imaging, therapy and [durable medical equipment] should all figure into the ancillary stream."

4. Use robotic assistance

Some surgeons say robotic assistance in the operating room, especially in joint replacement, will continue to grow in the coming years.

"Although we must be good servants and measure our results of this technology, it is my opinion that we will be able to provide a better, more standardized surgical product by using a robot," Dr. Hodrick said. "As our experience deepens and results are published, patients will seek the best care and latest technology."

4. Consolidate with larger companies 

Four orthopedic supergroups of 100-plus physicians have formed since the onset of the pandemic. Some orthopedic surgeons predict consolidation will continue as payers see opportunity for ownership in surgery centers. 

Hussein Elkousy, MD, an orthopedic surgeon at Houston-based Fondren Orthopedic Group, told Becker's Spine Review that consolidating into large group practices will "improve quality and improve efficiency and focus on ancillary revenue stream."

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