December 6, 2023

Tech-driven operative suite makeovers enhance the work of spine surgeons.

DISC Sports & Spine Center
GROUP VIEW DISC spine surgeon Dr. Rojeh Melikian says the ability for everyone in the room to monitor surgeries together in real time is a welcome feature of integrated ORs.

Renovating a facility to accommodate the many spine procedures that can now be performed in outpatient settings often involves a digital makeover in the form of the integrated OR suite. At a minimum, this includes seamlessly interconnected technological platforms that provide surgeons and intraoperative staff centralized, customizable control over instrumentation and devices. The integrated OR allows providers to leverage a harmonized combination of video, clinical data, surgical lighting and medical records like never before.

At DISC Sports & Spine Center in Southern California, orthopedic spine surgeon Rojeh Melikian, MD, specializes in microscopic and reconstructive techniques that involve numerous advanced technologies. He believes integrated ORs are becoming a staple of modern surgery.

“We used to have 10 systems to control 10 things,” says Dr. Melikian. “Today, multiple things can run through just one system.” A big change an integrated OR offers to Dr. Melikian is his ability to instantly access surgery charts and video streaming, which allows everyone in the room to monitor the surgery in real time. That’s especially important for the microscopic surgery in which he specializes.

“Our anesthesiologist can watch the progress and adjust accordingly,” he says. “And outside the OR, recovery room nurses can also monitor and prepare. The best thing is that it keeps everyone on the same page. Everyone can see exactly what I am seeing.”

Karen Reiter, RN, CNOR, RNFA, CASC, vice president, operations and payor management at DISC parent company TriasMD, likens the integrated OR to a conductor-led orchestra. “From an administrator’s perspective, when a system ensures everyone is speaking the same language and there’s this visual communication of data between everyone in the OR, it’s really a beautiful thing,” she says.

Ms. Reiter lauds the added efficiencies that technology affords staff, particularly the real-time monitoring capabilities. “Instead of the surgeon having to stop and ask for an instrument, the scrub tech can anticipate what they need next,” she says. “When anesthesia is closely monitoring the progress of the surgery, they aren’t going to give extra sedation when they can see the surgeon is wrapping up a case.”

With ASC total shoulders now reimbursed by Medicare, surgery centers must carefully consider how they will grow profitably.

Ryan Shaver
POLE POSITION Performing research on your local market and carving out the ability to attract top surgeons to your facility is key to financial success when expanding your ortho line.

An expansion of the orthopedic procedures that are performed at ASCs provides facility leaders and owners with a potential pathway to long-term financial success. A recent addition to CMS’ reimbursement list for ASCs only makes that pathway more alluring.

The welcome news that CMS will cover outpatient total shoulder replacements at ASCs in 2024 is a milestone for the ambulatory surgery industry.

“As Medicare has added orthopedic procedures to its fee schedule, and we are experiencing an aging population, orthopedics will remain extremely viable in the near future,” says Gregory DeConciliis, PA-C, CASC, administrator of Boston Out-Patient Surgical Suites in Waltham, Mass.

David Uba, CEO of Excelsior Orthopedics in Buffalo, N.Y., agrees. He says ASC owners (and potential owners) love the orthopedics specialty for numerous reasons, with the most important factor being profitability. The cost to perform procedures like total joint replacements is much lower in the outpatient setting as opposed to in an inpatient hospital. That cost efficiency provides ASCs with significant negotiating power to secure profitable reimbursement from payors across the board, notes Mr. Uba.

However, says Mr. Uba, the potential for expansion-driven success hinges largely on the competitive landscape of your area. “Depending on how saturated your local market is with hospitals or larger ASC companies that own a vast majority of orthopedic surgeons, you could be facing an uphill battle to secure reimbursement rates good enough to make your leap profitable, not to mention dealing with too much competition to secure enough volume,” he says.

“On the flip side, if your local market has room and opportunity to secure orthopedic surgeons and the patients they can bring, then you could be sitting on a veritable goldmine if you launch an ortho service line,” adds Mr. Uba.

Before you decide whether to expand your orthopedics offerings and potentially add space to your facility, Mr. Uba and other ortho experts recommend performing market research to understand exactly your potential competition at hospitals and other ASCs. That should include speaking with surgeons in your area who don’t currently work at your facility. “Talk to these surgeons to understand what they are experiencing in terms of volume and reimbursement, as well as community need for ortho,” says Mr. DeConciliis.

Don’t be discouraged by eyebrow-raising capital costs, adds Mr. DeConciliis. “Orthopedic vendors are often willing to work with an ASC to place equipment in a creative arrangement that works for all,” he says.

A new spine center opens in a renovated office space bringing state-of-the-art technology and minimally invasive spinal care to the community.

Stryker and L37
Jared Broadway, MD, and his team at the Arrowhead Surgery Center in Duluth, Minn.

Procedures and services historically performed in an inpatient setting continue to shift to outpatient facilities prompting leaders in healthcare to explore a variety of options to satisfy the increase in demand for outpatient care options, including rebuilding and renovating existing spaces. Renovating and retrofitting an existing space can present unexpected challenges, but partnering with an experienced vendor can streamline and simplify the process.

Dr. Jared Broadway had a vision of providing minimally invasive spinal care using the latest technology in a patient-centric outpatient care setting. After evaluating a few different locations for the facility, Dr. Broadway and his team elected to move forward with renovating an existing office space into what is now Arrowhead Surgery Center located in Duluth, Minn. The surgery center is in the Arrowpointe Medical Center, which features a remodeled lobby, covered patient pick-up area and 1,100 convenient parking spaces ensuring easy access for patients.

Many vendors were considered at the onset of the project, and the Arrowhead team ultimately partnered with Stryker and its ASC Business to outfit and launch their new center this past summer.

“Patients want to be in an outpatient setting for their surgeries,” says Dr. Broadway. “Stryker really stood out as we were looking to build out Arrowhead Surgery Center. They have dialed in their ASC division to be able to help someone like me understand what technologies are needed for the buildout.”

Under the direction of Dr. Broadway, the 17,500-square-foot state-of-the-art surgery center includes two operating rooms, one of which houses Stryker's Airo TruCT. By utilizing fan beam CT technology, Stryker’s Airo TruCT is able to provide high-quality intra-operative imaging with the ability to capture a full meter scan of the spine in as little as 43 seconds.¹ This technology provides the OR team with cutting-edge image quality that is customizable to the specific needs of each patient.

“Arrowhead was built around the patient experience,” says Ben Fagerlie, the center’s administrator, who worked closely with the Stryker team to plan and equip the facility. The team also collaborated on co-marketing with Stryker to introduce the new facility and Stryker's partnership/capabilities/brand to the community.

For fellow surgeons, planning to open an ASC, Dr. Broadway has a key piece of advice given his positive experience working with Stryker – engage with a strategic partner. “If you’re standing on the sidelines and are interested in the ambulatory setting, explore the possibilities and find a partner that can offer guidance and support along the way,” he advises. The video of this new build tells the story of their journey.

References:
1. MI-19-0030 | Airo Design Verification Procedure

Note: for more information go to Ambulatory Surgery Center (ASC) | Stryker and Build your ASC | Stryker