Here's what three orthopedic leaders said about outpatient spine in the last month.
Editor's note: This response was edited lightly for brevity and clarity.
Basil Besh, MD. Surgeon at FORM Hand, Wrist & Elbow Institute (Fremont, Calif.): The healthcare cost curve is unsustainable and payers are more receptive than ever to strategies that deliver high quality at a lower cost. There are several factors which make orthopedics and spine uniquely well-positioned in the current healthcare environment. Those specialties comprise two of the three most expensive inpatient service lines (total joint replacement, spine surgery and cardiology). Both are well suited to shifting to the outpatient realm with the percentage of total joints and spine surgeries being done safely and effectively in the outpatient setting increasing year after year with no signs of slowing down. Finally, both service lines include a large percentage of elective cases, which make them well-suited to bundled payment and shared savings models. It will require continued education of legislators, regulators and payers, but the wind is certainly at the back of these specialties.
Kevin Bozic, MD. President of American Academy of Orthopedic Surgeons: The shift from inpatient to outpatient makes orthopedic surgeons less relevant to hospitals. Historically, we relied on hospitals for medical directorship, co-management agreements and other types of support. We will have to replace those with other things, as we transition out of hospitals and into ASC settings. Another big challenge with that is adapting to the new way healthcare will be organized and paid for. We are seeing more consolidation in the industry under health systems and private equity.
Alejandro Fernandez. CEO at Synergy Orthopedic Specialists (San Diego, Calif.): Value-based care in orthopedics should be about a patient-centered vision to provide quality medical care, at the lowest costs, with the best patient-reported outcomes. But in actuality, the few value-based care initiatives continue to be about payment models that incentivize physicians to provide care for the lowest costs, e.g., ASC versus hospital outpatient departments, less expensive implants, etc. Few organizations record and report patient-reported outcomes, and even fewer insurance payers or employers provide additional financial incentives to physicians and ASCs to improve patient experience and outcomes.