Spine and orthopedic experts in February shared insights on topics from value-based care to consolidation.
"In 2024, there will be an unprecedented emphasis on surgical navigation and robotics. Competition between various platforms will center around how easily these capabilities can be incorporated into operative workflows and, more importantly, how they augment surgical abilities. Foremost, safety must be ensured. With respect to surgical navigation, accuracy and faithfulness to planned hardware placement is paramount. With regard to robotics, seamless incorporation of imaging guidance into effector placement is key. Thus, in this exciting time, competition will be driven by innovation. In the fields of spine and orthopedic surgery, technology is increasingly being utilized not only to develop new hardware, but also to devise tools which can more safely and efficiently guide a surgeon intraoperatively. Surgical navigation, robotics and smart tools represent the forefront of this evolving arena with surgeons and the industry working together to realize their potential." — Alex Vaccaro, MD, PhD, on evolving spine competition in 2024.
"I think a lot of physicians think of value-based care as a different way to interact with payers and be rewarded for quality and patient satisfaction. One of the problems we've run into is everybody agrees that lowering costs and improving quality and improving the patient experience are all important. It just seems like people have struggled to figure out how to do that. So how do you do that? What does it mean to have a value-based care program? I think we've kind of hit a stumbling block in that a lot of hospital systems and big incumbent players embrace this concept, but I don't really see it being practiced so much on a daily level as a physician. I think the state of value-based care is in a little bit of limbo right now. I think we're still trying to figure it out because of the bottom line." — Michael Havig, MD, on value-based care in orthopedics.
"Consolidation is a double-edged sword, as it can have both positive and negative effects. There are multiple things to consider with consolidation, including the cost of healthcare, the physicians themselves and patient care. Most consolidations happen from healthcare groups or when private equity takes over a private practice. Many of these purchases aim to reduce costs, but this can come at an expense. Reducing costs and increasing revenue can happen by decreasing staff or increasing the number of patients seen per provider. Consequently, this can result in more stress on physicians, longer wait times and less individualized patient care." — Matthew Harb, MD, on orthopedic consolidation.
"More complex surgeries done in ASC settings must be done gradually. More ASCs will need to get special exemptions to hold patients greater than 23 hours. Some ASCs should stick to the simple, safer, and better margin surgeries. For those wanting to push the envelope, I recommend doing a careful safety analysis with a multidisciplinary team of anesthesiologists, pain physicians, internal medicine, nursing, and surgery staff to decide what is safe and feasible. Just because you can do a surgery in an ASC setting does not mean you should. Any transformation into a higher-acuity center should take place gradually, with very careful consideration of each patient case and its appropriateness for the ASC setting." — Brian Gantwerker, MD, on shifting complex spine surgery to the ASC.
"Robotic-assisted spine surgery allows the minimally invasive instrumented spine procedures to be done with more precision and efficiency while minimizing radiation exposure. Such technology would be a great addition to an ASC to provide high-quality care. The current robotic systems, however, are quite expensive. Such significant purchases can be profitable in a high-volume ASC with several spine surgeons involved in robotic surgery. There are also opportunities to 'rent' the robot for lower-volume ASCs." — Vladimir Sinkov, MD, on ASCs and spine robots.