"3 trends to watch in the business of orthopedics" - Becker's Spine Review

Published November 3, 2016

By Tamara Rosin

New technology, consumerism and federally imposed cost pressures have spurred rapid changes throughout the healthcare industry, particularly as organizations prepare to operate in a value-based care system. At the Becker's ASC 23rd Annual Meeting: The Business and Operations of ASCs in Chicago, a cadre of healthcare leaders discussed the evolution of healthcare as it pertains to the business of orthopedics, and noted trends to watch in the upcoming year.

Timothy Fry, JD, an associate at McGuireWoods, moderated a panel discussion with Allston Stubbs, MD, an associate professor of orthopedics at Wake Forest University and a board-certified orthopedic surgeon at Winston-Salem, N.C.-based Wake Forest Baptist Health; Dennis O'Donnell, president of popHealth Strategies and executive vice president of PinpointCare; and Larry Taylor, president and CEO of Practice Partners in Healthcare.

Here are three takeaways from the panel on trends to watch in orthopedics.

1. The migration to the outpatient setting will continue. New technology that allows procedures to be performed safely and efficiently in the outpatient setting, as well as patient preference, will continue to steer an increasing volume of orthopedic cases to ASCs. "Where some cases used to require two or three days in the hospital, with some of the changes in technology there are greater opportunities to have less than 24-hour stays," said Mr. O'Donnell. He also noted that patients prefer the ASC setting to the hospital because "it's more convenient, there are good outcomes and it feels more efficient."

However, Mr. O'Donnell said it is unclear whether CMS will remove total joint replacement surgeries from the inpatient only list. While the ability to partake in bundles like the Comprehensive Care for Joint Replacement Model or the Bundled Payments for Care Improvement initiative could be lucrative for many orthopedic surgery centers, Mr. O'Donnell said, "I don't see CMS taking it off the inpatient only list and moving [CJR] to the ASCs on the old payment model. They're probably wrestling with how to take it off the list and structure the payment model in the ASC setting."

2. Data will be king. Data collection, monitoring and analytics are already high priorities for most hospitals. The same is becoming true for ASCs, especially under value-based reimbursement models. "You really need to know your costs, even down to the individual physician level," said Mr. Taylor. "A minute of surgery time carries an extremely high cost." Determining metrics to evaluate surgeons' individual performance gives ASCs the opportunity to pinpoint which surgeons are more expensive in the OR than others, and which have the best quality outcomes. Physicians, who are evidence-driven thinkers by nature, will be more inclined to change their behavior and practices in the face of hard data.

3. Medical education is changing. "Anyone who is coming out of training today — the term 'ASC' is not foreign to them," said Mr. Taylor. Medical students and residents alike are expressing an interest in working in the ASC setting earlier on in their careers because they "see the throughout, subspecialty and efficiency that they want to be involved in," he added.

Dr. Stubbs said the continuing shift from inpatient to outpatient necessitates medical training programs to incorporate education on the ASC environment more broadly. Not doing so is a disservice to the emerging class of clinicians. "You can be an ostrich and put your head in the sand, or you can live above ground," he said.

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