From outpatient migration to an evolving healthcare cost landscape, spine and orthopedic surgeons have discussed the trends they’re watching on the “Becker’s Spine and Orthopedic Podcast.”
Editor’s note: Responses are lightly edited for length and clarity. Spine and orthopedic surgeons who wish to be featured on the Becker’s Spine and Orthopedic Podcast, please email Carly Behm at cbehm@beckershealthcare.com.
Chester Donnally, MD. Texas Spine Consultants (Addison): In training we didn’t use much navigation for placing pedicle screws and cages, and I felt very comfortable not using navigation. Then I just woke up one day and decided I didn’t like the extra radiation risk coming to myself and my team from not using navigation. Now I navigate about 90% of the pedicle screws I place. That’s all great, but there’s so much infrastructure needed for navigation these days. There’s so much cost. Most of these hospitals that have it already purchased it well before I came along. Even the intraoperative C-arm that makes the 3D navigation possible takes up a lot of space.
If there’s a way we continue to make the navigation technology smaller and cheaper, just like our cell phones or TVs, I think it’d be great to see. Some of our navigation technology and the augmented reality technology is a little bulky and a little cumbersome now, but if that can be something that’s even smaller, or can be placed onto the glasses you’re wearing. There’s just so many avenues from that standpoint. So navigation is one way.
My No. 2 point is just for fusions. It would be great if we can use navigation to help us with decompressions. We talk about robotic technology all the time, and right now for the most part, robots only help with fusion. It’d be great if robot navigation could help us with decompression, and there’s some out there that are being tested and being used to see how we know when we’ve decompressed enough of the spine or if there is a certain probe we can put on the nerve. From a navigation technology standpoint and from a nonfusion standpoint, I think that’s a great role.
Then No. 3 trend is looking at physician health. Are there certain things in terms of our structures, the loupes we wear, the microscopes we use, that help put less strain on our neck or on our back? It goes back to my first thing with navigation. The reason I switched to navigation was for less radiation, so hopefully better health benefits for me long term. Are there other things as a surgeon I could do in the office that helped my longevity?
Jonathan Foret, MD. Center for Orthopaedics (Lake Charles, La.): One of the things we’ve been following and actively engaged in is this outpatient shift in the total joint world. We’re also following and engaged in these rapid recovery protocols for those patients. Then one of the newer things that I’m following that’s really very new is artificial intelligence and how that is going to be unfolding in our practices in the coming years.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): One area that we’re looking at is patient reported outcomes. We track these all the time, and it’s interesting to see how different stakeholders are using them now whether they’re insurance companies or even our hospital leadership has identified important metrics.
Another trend I’m following is the most meaningful quality measures that are going to be captured so we’re not creating fatigue in these surveys and that stakeholders are getting the information that they need as well.
Artificial intelligence is another trend I’m watching. I don’t think that it will ever replace us fully, but I do think that surgeons and physicians who understand and can apply and utilize artificial intelligence will eventually replace those that cannot. It behooves us to really understand what is happening in the AI world and safely and responsibly try to adopt these various technologies and these practices. Then we just need to do a better job of communicating to our patients and understanding where they feel comfortable.
The last area is the financial healthcare landscape. Costs are rising, and we need to help more people, and we just need to do more. We have all these goals and targets, but we also have to remember that we have a responsibility to sort of train the next generation and continue to contribute to our body of knowledge as a field. As the financial landscape and healthcare changes, how do we attract people to continue to innovate, continue to provide the best quality of care to their patients, but also dedicate time to train that next generation?
Michael Meneghini, MD. Indiana Orthopedic Institute (Indianapolis): Orthopedic consolidation is definitely a trend. In Indiana there are large groups forming a conglomerate. So you’re seeing that occur to get scale, to be able to negotiate with the payers and try to drive down their cost internally by consolidating resources. That’s just the financial pressures that are occurring, and I think we’re going to continue to see more of that over time.
The other trend that we’re going to see is with outpatient hip and knee replacement for over a decade. We’ve published a lot about it. We’ve developed protocols, and I thought we would see more of the U.S. over the last decade transition more out of the hospitals into the ambulatory surgery centers. So I think that’s a trend that you’re finally going to start seeing a bit faster because that site of care is lower cost. The payers are going to push it. The government continues to encourage it, and then as these groups can have ownership stake in these ASCs. They can have control and help drive down the cost to perform value-based care in those facilities. I think we’re going to see that trend continue to pick up, depending on the state and their CON laws.
Alok Sharan, MD. Spine and Performance Institute (Edison, N.J.): There’s two main trends that I’m really curious about. One is that I’m seeing a greater move toward independent spine practitioners. I think that there was this pinnacle that we reached where spine doctors or spine surgeons were joining healthcare systems or large groups, and for a variety of different reasons, they perhaps are getting a little frustrated and they’re breaking away. The reason why I hear about it is because many people are beginning to call me, asking me about how to set up a practice and the challenges. So I’m curious to see if this is just a blip right now, or if it is truly a trend away from the pinnacle of these large groups and now towards the independent groups.
The other trend, which I think is gonna be really interesting is that President Trump nominated and confirmed the new Secretary of Health and Human Services, and there’s this huge effort to look for inefficiencies and payments. So many of the hospitals in this country depend upon government funding. If they truly start to pull back on that funding, it’s going to cause a really seismic shift in the way hospitals behave. I’m really curious to see how much of healthcare you can truly transform and change in funding.
