December 6, 2023



The Power of OR Integration

Outpatient Orthopedics Options Expand

The ASC Market Continues to Grow With the Help of Experienced Partners - Sponsored Content

A New Joint in the Suburbs

Considerations Before Major Capital Equipment Purchases


The Power of OR Integration

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

IntegrationDISC 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.”

Outpatient Orthopedics Options Expand

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

OrthoRyan 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.


The ASC Market Continues to Grow With the Help of Experienced Partners
Sponsored Content

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

GroupStryker 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.

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

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


A New Joint in the Suburbs

New England Baptist Hospital’s soon-to-open ASC will bring ortho procedures closer to patients living south of Boston’s core.

In many urban areas, major hospitals that perform all manner of surgeries are located downtown, which has long proven inconvenient for the growing population in distant city neighborhoods and the surrounding suburbs. The growth of ASCs that serve those inner and outer ring communities has understandably proven popular with patients who don’t want to travel downtown and deal with the traffic congestion and expensive parking that comes with the trip.

Accordingly, many downtown hospitals have noted the trend and are looking to extend their surgical services to outlying areas. Take Boston, for example, where New England Baptist Hospital (NEBH) partnered this summer with ASC management and development firm Constitution Surgery Alliance (CSA) and 15 local surgeons to convert an existing hospital outpatient surgery department in Dedham, Mass., to an ASC. The facility was previously known as the New England Baptist Outpatient Care Center.

The result is New England Baptist Surgery Center, which will focus on all outpatient orthopedic surgical subspecialties, including total joint replacement and sports medicine as well as hand, wrist, elbow and foot surgeries. The partners say the new ASC will be more convenient and cost-efficient for patients who live south and west of Boston’s core.

NEBH will operate the ASC in partnership with CSA, which will manage the facility. NEBH is part of the Beth Israel Lahey Health system, which operates academic medical centers and community and specialty hospitals, and employs more than 4,800 physicians.

“Conversion of the existing hospital-based facility to a new ambulatory surgery center is one way that we are able to help our hospital partners meet the needs of their communities,” says CSA President and CEO Kris Mineau. “This innovative project demonstrates a value-based approach, where a health system, in partnership with its medical staff, expands community access to high-quality surgical care while lowering costs to patients.”

”We made the decision to convert our existing space in Dedham due to increased patient demand,” says NEBH President David Passafaro. “With advancements in anesthesia and less invasive surgical procedures, ASCs are a good option for most orthopedic procedures. Patients are increasingly able to go home the same day. They will get the same high-quality, gold-standard care they expect from the Baptist, without having to drive into Boston.”

The partners characterize New England Baptist Surgery Center as “one of the largest musculoskeletal surgical facilities in New England” and say it “is expected to ensure appropriate capacity to meet growing demand as the population ages and seeks more total joint replacement surgeries.” The 35,000-square-foot center, which features eight ORs and two procedure rooms, is expected to perform over 5,000 surgeries, including 2,000 total joint replacements, in its first year of operation.


Considerations Before Major Capital Equipment Purchases

Ensure you’ll be able to get the most out of big upgrades, both financially and operationally.

Capital purchases are major expenditures for items that are intended for long and productive lifespans, so it’s important to get them right. Michael Young, MHA, FACHE, president and CEO of Temple University Health System in Philadelphia, possesses a long and successful history in making these crucial and expensive decisions.

Mr. Young, who sits atop a large academic nonprofit healthcare network that operates six hospitals, says any major medical device you are looking to purchase should be extensively vetted by providers to ensure the equipment is easy to use.

That may sound obvious, but other aspects of these purchases require additional finesse. For example, the number of surgeons and employees who will be using the equipment and how often the equipment will be used, are also primary considerations. Do the numbers truly add up to make such a large outlay financially feasible and profitable?

Mr. Young advises to account for training that will be required to safely and effectively use any new major equipment. He says leaders should also investigate just how reliable any vendor upgrades to equipment you already have in-house really are. In some cases, bringing in the “latest model” isn’t always the best idea. “If you have a C-arm that’s going down all the time, it’s costing you money every single minute that it’s not operational,” he says.

Mr. Young suggests pushing manufacturers for a two-year warranty, even when you’re told the standard warranty length is one year. He says bundling purchases for multiple ORs at the same time is a money-saver, as is considering buying used or refurbished items that may have been used at defunct facilities. “Surgery centers come and go,” says Mr. Young. “If you’re looking at used items, you might be able to get something faster, and you’ll definitely be able to get it cheaper.” He says the quality of used and refurbished items is generally extremely solid and dependable.

A final note from Mr. Young: Don’t forget to get your anesthesia providers’ opinions, especially when considering equipment like C-arms and picture archiving and communication systems. OSM

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