The increasing movement of procedures to ASCs settings, biologics and new technologies are three trends that orthopedic surgeons are keeping up with.
These seven orthopedic and spine surgeons recently connected with Becker's to share the big trends in orthopedics and healthcare that they are currently keeping an eye on.
Note: Responses were lightly edited for clarity and length.
Question: What orthopedic and/or broader healthcare trends are you currently following?
Michael Gross, MD. Michael L. Gross, MD, FAAOS (Hackensack, N.J.): First, the continued shift in surgical procedures to an ambulatory setting, and the beginning of the shift from ASCs to office-based procedures. Second, the blurring of scope of practice lines between orthopedic surgeons and other practitioners such as pain management specialists and "non-operative" orthopedists. In an unrelated area, the ever increasing competitive nature of orthopedic residency applications. Finally, the shift away from private practice, and the reality of what practice in a corporate setting really means to many long-time independent individuals.
Jack Jensen, MD. Athletics Orthopedics & Knee Center (Houston): I feel the most exciting area is biologics. This is more than a trend. It's here to stay. This includes platelet-rich plasma, exosomes and stem cells. Patients are asking for this, and as physicians we need to be well-versed in the appropriate applications
Niranjan Kavadi, MD. VA Hospital and Clinics (Oklahoma City): There is an ongoing shift of increasing volumes of orthopedic and spine cases towards outpatient surgical centers from traditional hospital based care. It is certainly useful for the surgeons to improve efficiency as well as more convenient for the patients. I am closely following this trend of how procedures with increasing complexity like spinal fusions are being transitioned to the ASCs with diligent planning and support for perioperative care. It's also important to keep a track of the changes in reimbursements for these procedures in this outpatient setting and how that evolves over time. I am also excited about the increasing use of endoscopic spine surgery procedures, which are quite suitable for these scenarios. The indications as well as acceptance of these procedures by payers are expanding, which is beneficial for offering quality care options for the patients.
Earl Kilbride, MD. Austin (Texas) Orthopedic Institute: The first is consolidation of practitioners. Physicians seem to have a myriad of options when it comes to models of employment. Each year, the number of single-specialty independent private practitioners is dwindling. Private equity models, hospital employment models, multispecialty groups are all options that entice providers. The issue is with each model the number of stakeholders increases. The only way to sustain this is to increase complexity of the model and thus cost to provide care. Furthermore, in many of these models, the physician is simply a cog in the wheel, not a key stakeholder. Second is the ASC involvement of more acute cases. Healthcare is switching to a more ambulatory-based model. As evidenced by the recent approval of more orthopedic procedures to the ASC (total shoulders), the payers are beginning to realize the significant cost savings compared to a traditional inpatient facility. Furthermore, some payers are even incentivizing providers to take particular procedures to the ASC. The traditional hospital is having to take notice and pivot their traditional model of care. Will this continue?
Pete McCunniff, MD. The Pain Center of Arizona (Glendale): I think one of the interesting things in spine is the development of enabling software that has been growing alongside many of the new enabling technologies. Just like navigation and robotics have become more widely available and utilized, I think we will see a similar surge in availability of software for data collection. Previously, collection of patient-reported outcomes measures and access to surgical planning software was only found in the large academic centers that were able to pay the costs of implementing and maintaining these services. Private practice and hospital-employed surgeons find it very difficult to successfully lobby for these because there is no direct financial benefit to justify their cost to administration. However, we know this data is incredibly important to justifying the reimbursement for the services that we provide. Hopefully this can provide another tool that surgeons can use to our advantage and to make it possible for smaller practices to maintain their autonomy and independence.
Timothy Mologne, MD. Orthopedic & Sports Institute of the Fox Valley (Appleton, Wis.): I am interested in outpatient joint arthroplasty, including the new in 2024 CMS approved shoulder arthroplasties, robotics in orthopedic surgery (knee and shoulder), and new technologies in joint preservation and articular cartilage restoration.
James Wylie, MD. The Orthopedic Specialty Hospital (Murray, Utah): The healthcare trends that I am currently following are mostly related to the transition from a more fee-for-service-based care/payment plan to more value-based care. The value equation that defines value as the outcome/cost provides us with a framework to understand how to evaluate our patient care. In regards to cost specifically, following the transition from hospital-based surgical care to ambulatory surgery center-based surgical care and transition of advanced imaging out of the hospital outpatient departments and into ambulatory settings at lower cost. In addition, we need good metrics to fully understand the cost of the care that we provide to patients. Similarly, as orthopedic surgeons we need to understand that with newer technologies there is not always a correlated improved outcome. Therefore, we need to be careful in the adoption of new/expensive technology and make sure that it actually provides improved outcomes to make sense in the value equation. This will take significant research and understanding of whether the newest/flashiest technique/implant actually provides value to our patients with improved outcomes that make the increased cost worthwhile. Otherwise, traditional techniques that get the same outcome at a lower cost make more sense for our patients.