Artificial intelligence, consolidation and ASCs: What the orthopedic industry will look like in 10 years


From artificial intelligence to increased consolidation, five surgeons told Becker's what they think the orthopedic industry will look like 10 years from now. While some surgeons are hopeful for the future of the specialty, others are not so sure. 

Question: What will the orthopedic industry look like in 10 years? 

Thomas Schuler, MD. Spine Surgeon, Founder and CEO at Virginia Spine Institute (Reston): Patients have a bright and hopeful future. In this biocentury, where genomics is vastly improving medical outcomes, technological advances in implants and surgical navigation are multipliers for even more exciting improvements in healthcare. The use of regenerative medicine will obviate the need for many procedures as we use the body's own healing potential to avoid or delay many traditional treatments. Innovative implants, especially in the spine, are already changing treatment paradigms. Artificial discs are rewriting the treatment algorithms for the wise and open-minded spine surgeons. This will continue to drastically improve patients' lives. Robotic surgery and augmented reality will further reduce surgical trauma, thus reducing iatrogenically induced disruption and accelerate recovery. All of these technologies will continue to improve and rapidly evolve over the next decade, thereby improving the lives of millions through improved outcomes and better quality of life. The future is exciting for our patients.  Industry will struggle with insurance and government commoditization of healthcare, but it will survive to provide essential life improving products to our patients.

Praveen Mummaneni, MD. Neurosurgeon at University of California San Francisco: On the spine side, there is already a push for degenerative diseases to be treated minimally invasively in outpatient settings. That push will continue due to finances. The inpatient side will be dominated by complex spine surgery for revision fusion, deformity and tumor as these types of surgery are not amenable to outpatient treatment. Neurosurgeons and orthopedic surgeons need to be familiar with minimally invasive approaches so they will be ready for the upcoming shift to outpatient settings for probably half their cases.

Lali Sekhon, MD, PhD. Neurosurgeon at Reno (Nev.) Orthopedic Center: 

The optimist in me says the following:

1. More outpatient surgery

2. Value-based care actually getting rewarded

3. Greater cost consciousness

4. Continued incremental advances in materials, technologies, robotics etc. with price sensitivity

5. Patient remote monitoring becomes more standard to assess recovery via GPS and motion tracking

6. Consolidation of industry (especially spine) where smaller companies offering generic products will find it harder to compete

7. Complete transparency on cost and outcomes at every level

The pragmatist/realist in me says the following:

1. Dwindling reimbursement

2. Hospitals push CMS to make some codes inpatient only to breathe life into their bottom line

3. More employed physicians

4. Private equity seen for what it is, but more ownership of practices by hospital systems

5. Two streams of practice: the sick or big surgeries done in hospitals and the healthy and well-insured in ASCs

6. Foggy transparency of costs and outcomes at every level

Issada Thongtrangan, MD. Orthopedic Surgeon at Microspine (Scottsdale, Ariz.): I predict that there will be more private equity-owned and -managed practices. Doctors will be just employees. There will be more utilization of "advanced" healthcare providers as it is more cost/effective and likely to make more profit for the “employer." We will see more movements from "big" companies such as Walmart, Amazon, etc. in the healthcare sector. Who knows if one day we may see hospitals and or ASCs run by these companies. We will see AI and ChatGPT involved in electronic health records and may be decision-making clinically. I am sure that all the commercial payers are looking at AI to beef up the authorization process for all kinds of necessary studies and surgeries. We will see more denials. More surgeries will be performed in the surgery center as it is cheaper than the hospital. 

Adam Bruggeman, MD. Orthopedic Surgeon at Texas Spine Care Center (San Antonio): I think the current trajectory suggests that the industry will be highly consolidated into vertically integrated systems where orthopedic surgeons are increasingly employed or controlled by insurance companies that also control the spectrum of care from primary care through hospitals.  The political environment has provided significant advantages to insurance companies while at the same time discouraging private practice. I don't think these chapters have been written and there is opportunity to redirect the trajectory, but it will take all aspects of medicine grouping together to fight the corporatization of healthcare.

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