June 30, 2022

The move highlights a changing landscape in the orthopedic and spine care world.

Healthcare Outcomes Performance (HOPCo), the largest orthopedic value-based care organization in the U.S. and a provider of musculoskeletal practice and clinical outcomes management solutions, added Pennsylvania's Premier Orthopaedics to a growing roster of what the organization called "unique and clinically integrated partnerships" with musculoskeletal practices, physicians, health systems and payors.

Premier Orthopaedics, comprised of more than 200 providers who treat the full spectrum of musculoskeletal disorders, has long been a significant presence in the Philadelphia metropolitan area with 28 practice locations, 17 physical therapy locations, four MRI facilities, urgent care centers and surgical facilities throughout the region. Premier says the partnership with HOPCo will further expand its reach while helping it meet the needs of a changing industry and more demanding payors.

"The landscape of orthopedic and spine care is shifting rapidly," says Jeffrey Malumed, MD, president of Premier Orthopaedics. "Both payors and patients have placed an increased emphasis on outcomes and proven value." Dr. Malumed points to HOPCo's decade-plus experience in driving the shift to value-based care and its proven model in multiple regions with multiple provider groups. "Their expertise and infrastructure will allow us to be the driving force for change in a very dynamic market," says Dr. Malumed.

Premier CEO Matthew O'Malley added that the partnership provides an opportunity for his system to grow further. "HOPCo's proven track record of optimizing operational performance and leveraging their robust and dedicated infrastructure, combined with unmatched practice analytics and improving alignment between physician practices, payors and health systems, was a natural fit for Premier Orthopaedics," he says.

HOPCo's expanding national musculoskeletal market transformation platform includes partnerships forged in the last year alone with organizations in Florida, Nevada, Michigan, Arizona and now Pennsylvania.

The specialty offers incredible growth potential but planning and execution must be thorough to ensure safety and profitability.

The provision of high-quality, accessible outpatient spine procedures requires careful planning, specialized equipment and instrumentation, a safety-first focus and a keen awareness of local healthcare needs.

Take, for instance, the 35,000-square-foot, multispecialty Surgery Center at Shrewsbury (Mass.), a collaboration among Shields Health Care, Reliant Medical Group and UMass Memorial Health that opened in 2018. In October 2021, the first outpatient spine procedure was performed there, a discectomy at the L3-L4 region, with a plan to gradually increase volume and procedural mix over the coming months and years.

When the facility opened, it performed numerous orthopedic and sports medicine surgeries and some plastic surgery procedures. "From day one, we focused on how to grow those service lines while also assessing the potential for growth into other specialties and services in the future, especially spine," says Prashanth Bala, MS, MHA, chief of ambulatory surgical services at Shields Health Care. "Building a spine service line demands careful and thoughtful planning, understanding local market conditions, and having substantive discussions with surgeons, anesthesia providers and staff that result in collective agreement on what procedures, equipment and protocols your center will offer, utilize and implement."

Mr. Bala points to several factors that have led to the successful, sustainable initiation of a spine line.

Physical space. At 520 square feet, each of the facility's nine ORs were built to be specialty-agnostic. Thirty total joints cases per month are performed in them, for example. "Adding spine, which to us represents the most exciting frontier for the musculoskeletal work we do, was always the logical next step after total joints," says Mr. Bala, who notes the specialty required no specific modifications to the facility's waiting rooms and pre-op or recovery spaces, and that shelf space was reserved for spine equipment three years before the line was added. "If you're designing a new facility, look forward five, 10 or 15 years into the future," he says. "Always design for growth if you plan to expand upon your service lines, especially if, like spine, they will require significant space."

Capital equipment. Get your spine surgeons on the same page and standardize as much equipment as possible to avoid overinvestment based on any one surgeon's preferences, says Mr. Bala. "We were able to control costs by focusing first on purchasing equipment and supplies for specific procedures all our surgeons would use, and then strategically adding to our fleet of attachments as needed," he says. "Start slow and grow from there once you have a foundational inventory."

The two most important spine-specific types of equipment are positioning frames for different procedures and a surgical microscope, says Mr. Bala. "Specialty patient positioning devices are expensive and take up valuable space," he says. "To save both money and square footage, only buy the frames you absolutely need." Microscopes are important to some but not all spine surgeons, he adds. "Some surgeons prefer to use them because they can stand up and see vascular conditions in and around the different components of the spine without needing to hover over the surgical field," he says.

Implants and trays. Spine procedures typically involve five to seven trays, says Mr. Bala. "A key for us was narrowing down exactly how much instrumentation our surgeons would need for a given case," he says. "We've engaged our vendors to focus our supply purchasing process and, as a result, we've reduced it down to three to five trays. We call them our ‘spine sets,' and all our surgeons have agreed on what they should include. We've avoided overloading sterile processing while also saving storage space."

Staff. You won't necessarily need specialized staff, but same-day spine surgeries require careful attention to preoperative preparation and postoperative recovery. "The surgery might be the same as what's done in a hospital, but the recovery phase is different because patients aren't wheeled to the floor postoperatively where someone can monitor them overnight," says Mr. Bala. "Instead, you need to prepare your patients to go home the day of surgery and recover appropriately." A staff nurse designated as the facility's full-time "complex care coordinator" works with surgeons to ensure expectations are set with patients, secure the patient's information from the surgeon's office and consult with the surgeon on areas of concern about the patient.

Payments. With commercial payers growing more bullish on outpatient spine in safe, proven environments, potential patient volume is growing. "We have a responsibility to ensure patients know that it is no longer required to get this type of care at a hospital, and that they'll receive the highest quality of care at our outpatient facility," says Mr. Bala. "To attract top physicians, we have tailored an efficient, safe, standardized program that will make them feel comfortable and confident working here, and ensure every patient receives the same high quality of care," he says.

"Everything we've done with our spine line has been a ‘crawl before we walk, walk before we run' approach," says Mr. Bala. "Our growth in spine is designed to be thoughtful and purposeful, so that when we expand, we're not just growing for the sake of growth."

Planning for a new build takes key partnerships to take advantage of the growing orthopedic market as surgeries migrate to the outpatient setting.

Today, orthopedic surgeries are a focus of much of the news circulating in the outpatient surgery community. More patients and their physicians are opting to have complex surgeries performed in the outpatient setting, including total joint replacement surgery and spine procedures.

The pandemic has driven some of this expansion as the medical community was forced to make these moves for some patients. Hospitals also grappled with the uncertainty of scheduling surgeries in their locations while COVID-19 cases surged. While not all patients are candidates for outpatient total joint surgery, surgeons worked to select patients for that location and process while setting expectations and protocols for same-day surgery and at-home post-op care.

Today, performing total joints and other procedures has become an option for ASCs as many surgery center teams offer orthopedic and spine procedures on a regular basis. Not surprisingly, facilities also have begun choosing to renovate or build new centers to accommodate the patient flow and anticipated future growth.

Key to the success of these orthopedic and spine cases is the ASC itself, which needs to be well equipped with a modern footprint. In some cases, ASC owners have opted to commit to new builds instead of renovations to successfully introduce the procedures now migrating to the ASC. There is also a need to plan for the appropriate workflow, equipment and protocols in a new, updated public space and ORs.

Partnerships with industry partners specializing in the ASC space have contributed to the state-of-the-art facilities opening across the country. The dedicated BD ASC team has helped establish more than 200 new ASCs across the market with a comprehensive portfolio of high-quality, market-leading surgical instruments especially suited for the ASC environment.

Driving this market is the increased demand for reducing healthcare costs, patient preference for less hospital time, and the demonstrated success rate of outpatient procedures including the more complex orthopedic cases. Technology advances and developments in surgical devices and instrumentation, along with customized training and partnership support, all contribute to the continued evolution of the ambulatory surgery center.

Note: For more information please go to BD Ambulatory Surgery Centers — Products & Solutions and BD Quality Solutions Brochure 2020.pdf