The continued growth of digital platforms and specialty centers' increasing importance for orthopedic care delivery are just two predictions about the industry surgeons have shared with Becker's.
Four orthopedic surgeons shared with Becker's Spine Review the changes they expect will take hold by 2026.
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Note: Responses were edited for style.
Question: How do you see orthopedic care delivery evolving in the next five years?
Ammar Saymeh, DPM. NJ Spine and Wellness (Freehold): We are seeing more and more that bigger and complex orthopedic surgery procedures are being performed in the outpatient setting. This allows for a quicker and less costly turnaround for the health systems. The COVID-19 pandemic has forced us to pivot with the appropriate patient selection to ambulatory surgery centers. While being selective, we can ensure that patient outcomes remain outstanding regardless of the setting they are performed in. With the evolution of minimally invasive surgery in orthopedics, the landscape for the patient and surgeon alike continues to evolve. This will change postoperative protocols, reducing the necessity for patients to stay overnight for monitoring. Orthopedic care is going to continue to be geared toward getting patients better outcomes in a setting that allows for reduced costs for patients and health systems alike.
Jason Snibbe, MD. Snibbe Orthopedics (Los Angeles): I think orthopedic care will evolve into more digital platforms. These include patient portals where a patient can access the schedule, make appointments, review their notes and ask questions. There will be digital tracking to evaluate range of motion, steps per day and progression of physical therapy so outliers that are not progressing can get flagged and addressed.
I think physician assistants will continue to provide excellent care and work with orthopedic surgeons to help manage patients. Specialized care will be the answer to improving outcomes and patient experience. Hospitals and ASCs that just specialize in orthopedics and spine will be the leaders in care. The patients feel like it’s organized and centered on their specific needs.
Robert Peinert Jr., MD. Retired orthopedic surgeon in Harlingen, Texas: I think orthopedic care may revert to major regional centers of excellence and fiscally well-off metropolitan areas.
A lot of the higher tech advances now available, compared with a decade ago, will only be available in fiscally strong centers and to a population with the insurance clout to pay for the extra costs that these technologies generate. The rural, poorly endowed hospitals will not be able to sustain this. I foresee a regionalization of spine and joint replacement surgeries into regional centers where there is fiscal control, maximized physician excellence and fiscal reward and rapid turnover in cases.
The real issue will be in determining the cases that can be assigned to ASCs with those requiring hospitalization. If we regionalize, we may have patients who could have procedures in an ASC but live 100 miles or more from the center, in which case admission to a hospital overnight is a prudent consideration.
David Jacofsky, MD. The CORE Institute (Phoenix): The delivery of musculoskeletal care will evolve substantially over the next five years. In my view, there will be three areas where the most significant changes will be seen.
The first will be the ongoing site of service shift into the outpatient space. Although this shift has been peppered with fits and starts, the general trend will continue. Outpatient sites of service for appropriately selected patients have lower costs, better outcomes and improved patient experience and drive value in healthcare.
The second is the shift of risk to providers. Although defining the best model of risk-sharing with providers is an ongoing discussion, there remains little question that there is bipartisan support for this cultural shift to continue. Episodic bundled payments, condition-based bundles and population health are all showing good success in program performance in most settings. Although some of these programs will need to shift from "race to the bottom" models to more sustainable and longer-term population health models, that shift is now beginning.
Finally, we will see the rationalization of the plethora of IT tools out on the market today. Hundreds of companies promote telehealth, teletherapy, remote monitoring and purported artificial intelligence tools that have created a massive amount of confusion in the market, many having little more than buzzwords to drive their trials. As all these platforms promise to drive improved performance and outcomes — but very few have proven their value or differentiated themselves in the marketplace — a reckoning is due. Over time, the true champions that can really achieve the proverbial triple aim will become clearer, and adoption of these winning technologies will accelerate.
All three of these shifts in how we deliver musculoskeletal care should be viewed as opportunities for providers rather than roadblocks. Each, in its own way, can drive increased control over the healthcare dollar to prepared physicians. Now physicians need to begin to actively engage in understanding these shifts so as to best position themselves with a meaningful platform to help drive the sustained success of their practices in this evolving world.
Note: This article was updated 1:05 p.m. Oct. 21 to add a response.