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October 5, 2022
Publish Date: October 4, 2022   |  Tags:   Orthopedics


Four Advances That Could Transform Outpatient Total Knees

How Many Outpatient Spine Patients Visit EDs Postoperatively?

Building a Successful ASC Takes Partnerships and Critical Planning - Sponsored Content

AAOS Submits Objections to CMS' Proposed 2023 Payment Policy

Medical City Healthcare Opens Ortho & Spine Surgery Center in Dallas


Four Advances That Could Transform Outpatient Total Knees

Digital technology that improves surgeries and recoveries will continue to shrink in terms of cost and size.

Knee OT OrthoTennessee
JOINT SESSION Dr. Herman Botero expects that ongoing technological advances in knee replacements will further enhance outcomes while making the procedures more affordable for payers and patients.

Promising research and early use of high-tech devices are providing a glimpse into what could someday become the norm in the same-day joint-replacement space. Here is a breakdown of four developments that outpatient surgery centers should watch.

Smart implants. Approved for use by the FDA last year, think of these essentially as a Fitbit inside a patient's body. A smart implant features a small stem on its base that allows patients and their surgical teams to monitor how fast and far the patient is walking, as well as the new knee's functional range of motion. The stem contains an accelerometer and goniometer, as well as a sensor that collects data postoperatively. Using Wi-Fi, a base station placed in the patient's home transmits that data to a HIPAA-compliant cloud-based platform that the patient and care team can access.

Tyler Watters, MD, MBA, the first surgeon in North Carolina to use a smart implant in a knee replacement, says that monitoring gait speed, step cadence, stride length, range of motion and step counts not only benefits patients in the short-term, but in the long-term cumulative data collected from many patients could help surgeons and the orthopedic community in general learn more about what kind of movement to expect from patients after surgery.

Robotic assistance. Several major companies offer robotic systems to facilitate orthopedic procedures, but challenges remain for them to become standard operating equipment in outpatient settings. One is their capital expense as the systems can cost up to $1M, while the disposable tools used with the systems are pricey as well. Additionally, the platforms take up a lot of space. As the decade progresses, expect to see less expensive systems with smaller footprints.

Handheld navigation. This technology is a practical option for ASCs because it can be used on a case-by-case basis. Compared with the bulky towers that come with computer navigation systems, handheld devices help surgeons improve the accuracy of implant alignment at a more reasonable per-case cost with a much smaller investment. "Many handheld navigation systems are not cost-prohibitive and don't take up a lot of real estate, so they can be used very effectively in an ambulatory setting," says Dr. Watters. Herman Botero, DO, a fellowship-trained surgeon who practices at OrthoTennessee in Knoxville, says these devices can be good options when robotics systems aren't in a facility's budget.

Remote patient monitoring. Providers can use these platforms to deliver continuous information to patients who own smartwatches or smartphones, and patients can respond with direct feedback. This two-way communication can facilitate better overall care from pre-op until the patient's recovery is complete.

"The crux of the role providers play in orthopedics is about improving clinical outcomes at a lower cost," says Dr. Botero. "This technology is exciting and is going to continue to improve. Its use will become more widespread when payers and patients see high value in it and prices continue to decrease."

How Many Outpatient Spine Patients Visit EDs Postoperatively?

The worrisome answer is nearly one in 10, according to a large retrospective study.

Spine PLANNING IS PARAMOUNT Even as minimally invasive techniques enable more same-day spine procedures, surgeons must focus on planning postoperative care to ensure patients don't report serious complications.

A retrospective study that sought to determine the incidence and timing of emergency department (ED) visits after common outpatient spinal surgeries found room for improvement in postoperative care planning.

A group of researchers from the Department of Orthopaedic Surgery at Johns Hopkins University in Baltimore performed the study. "Outpatient spine surgery has markedly grown in popularity over the past decade, [but] the incidence of ED visits after outpatient spine surgery is not well established," they write in the study published in Spine.

To address the topic, the researchers analyzed a large commercial claims insurance database of more than 200,000 patients 65 years old and younger who underwent single-level anterior cervical discectomy and fusion, laminectomy and microdiscectomy in outpatient settings. Nearly 20% of the surgeries were performed at ambulatory surgery centers (ASCs), while the rest were performed at hospital outpatient departments (HOPDs). The researchers assessed the incidence, timing and diagnoses associated with ED visits within 90 days after the patients' surgeries.

Collectively, 22,198 ED visits occurred during the 90-day postoperative period, and approximately 9% of patients had at least one ED visit. "After adjusting for age, sex and comorbidity index, the odds of at least one ED visit were higher among patients who received surgery at HOPDs versus ASCs for all three procedures," the researchers write. More than half of the ED visits occurred during the first month postoperatively, with 30.8% occurring within the first week postoperatively and 10.7% occurring on the same day as the surgery. Postoperative pain was the most common reason for the visits.

"Our results indicate opportunities for improved postoperative care planning after outpatient spinal surgery," conclude the researchers. The results provide further evidence that while outpatient spine is an enticing service line for ASCs and HOPDs, increased attention needs to focus on ensuring patients' recoveries at home go smoothly.

Building a Successful ASC Takes Partnerships and Critical Planning
Sponsored Content

Ambulatory facilities upgrade, innovate and launch state-of-the-art surgery centers as outpatient procedures evolve.

Stryker Stryker

Every ambulatory surgery center (ASC) is unique from the start. Whether it is a renovated facility or a brand-new build, the work that goes into conceiving its purpose, planning for space requirements, streamlining its workflow, and managing day-to-day operations is a massive undertaking that requires teamwork and partnerships.

To meet the unique needs of this emerging customer, Stryker launched an ASC-focused business in 2020. With thousands of unique and clinically proven products spanning more than 22 procedural specialties, a wide range of flexible financial options and teams who understand the ASC landscape, Stryker is committed to delivering tailored solutions and ongoing support for ASCs.

Building a successful ambulatory surgery center is complex. Every ASC balances a unique set of clinical, operational and financial circumstances. At Stryker, the dedicated ASC team starts by listening and learning about each ASC's unique challenges and goals to create a tailored solution that fully leverages goal-driven strategies, product solutions and flexible financial planning.

Stryker is one of the world's leading medical technology companies, offering innovative products and services in orthopaedics, medical and surgical devices, neurotechnology and spine to help make healthcare better for both patients and healthcare professionals. Procedural volumes, particularly total joints, have been migrating from the hospital outpatient department to ambulatory surgery centers. With the potential to provide over $55 billion annual healthcare cost savings, this shift in site of care is expected to continue beyond the post-pandemic environment. Vendor partners, such as Stryker, are poised to help make the total joint replacement migration more efficient.

The Stryker ASC business model offers a step-by-step approach that is customizable for individual ASCs, with options to expand capacity for higher acuity surgeries as well as partner for new builds that include innovative equipment and solutions. The process begins after property acquisition. Twenty months from opening, Phase 2, includes market research to determine the best project scope.

Planning for architect contracting gets underway, in Phase 3, at 18 months before opening, with Stryker's help in finding the partner that shares the vision and has the ASC design experience that will make the vision come to life. A custom equipment and budget plan in Phase 4 provides financial flexibility, which will help provide cash flow convenience by balancing initial investment with smart financing options.

With almost 30 years of equipping operating rooms, Stryker's broad product portfolio has the right equipment across the ASC to address Phase 5 and 6, room layout design and clinical specifications. At 6 months from opening, Phases 7 and 8 begin: construction and installation. After careful planning, Stryker can help ensure that the final steps in ASC installation go according to plan.

ASCs are going to continue to become popular as a care setting for a variety of surgeries. Trends indicate that we should expect outpatient facilities to provide surgery in a variety of subspecialties as these facilities upgrade, innovate and launch brand-new state-of-the-art centers across the country.

Note: For more information about Stryker's ASC business, please go to Ambulatory Surgery Center (ASC) | Stryker

AAOS Submits Objections to CMS' Proposed 2023 Payment Policy

Orthopedic surgeons are concerned about cuts to reimbursement and increased prior authorizations in HOPD settings.

In formal comments to the Centers for Medicare & Medicaid Services (CMS) on the agency's proposed payment policy changes for calendar year (CY) 2023, the American Association of Orthopaedic Surgeons (AAOS) urged the agency to address growing healthcare costs, expand access to care and ease physician burden amid financial and practice management challenges that have been exacerbated by the COVID-19 pandemic.

AAOS is particularly concerned about continuing cuts to physician reimbursement, including a nearly 4.5% conversion factor reduction, while expenses continue to rise. "With inflation soaring to 40-year highs this year, ongoing and scheduled statutory payment cuts and many physician practices still dealing with pandemic-related financial and staffing issues, the current proposal from CMS undermines the long-term sustainability of physician practices while threatening patient access to physicians participating in Medicare," wrote AAOS President Felix H. "Buddy" Savoie III, MD, FAAOS.

AAOS called for reform to CMS' current physician reimbursement system, urging the creation of value-based payment models that include incentives tailored to what it calls the "distinct needs" of specialty physicians. It also urged CMS to apply changes to the evaluation and management component of surgical global codes to maintain the relativity of the Physician Fee Schedule (PFS), as recommended by the RVS Update Committee. "The statutory prohibition on paying physicians differently for the same work applies regardless of code valuation method and the incremental increases should apply to all physicians," wrote Dr. Savoie.

AAOS also characterized CMS' proposal to increase prior authorization in the hospital outpatient setting as a "dangerous precedent" that will negatively impact patient care. Requesting that the proposal be formally removed from the final CY 2023 Outpatient Prospective Payment System (OPPS) rule, Dr. Savoie stated that requiring approval from a third party that is removed from clinical decision-making not only erodes the doctor-patient relationship, but also the ability for physicians to make decisions that are in patients' best interests.

Click to read AAOS' full comments to CMS regarding the PFS and OPPS.

Medical City Healthcare Opens Ortho & Spine Surgery Center in Dallas

The collaboration with over a dozen physician partners includes three overnight observation rooms.

Medical City Healthcare is in the midst of a five-year, $1.1 billion capital investment initiative to enhance its entire system by investing in expansion and improvements to existing hospitals, new services, upgraded technology and the purchase and construction of new facilities. One of the fruits of that effort is the newly opened Medical City Orthopedic & Spine Surgery Center in Dallas.

The center is operated in collaboration with 15 physician partners, including board-certified, fellowship-trained surgeons who specialize in adult and pediatric orthopedic and spine surgeries, hip and knee reconstruction, joint replacements, musculoskeletal oncology, neurology, orthopedic oncology, pain medicine, and shoulder and sports medicine procedures.

The health system calls the surgery center an "advanced facility" with an "environmentally conscious" design and "leading-edge" equipment that provides what it describes as a modern, safe and comfortable outpatient surgery experience for patients and their at-home caregivers.

The 25,000-square-foot space features four ORs customized for orthopedic and spine procedures, two procedure rooms for pain injections and nerve ablations, and three overnight observation rooms. The center, fully certified and licensed by the state of Texas and accredited by The Joint Commission, represents the latest addition to HCA Healthcare's network of 150 surgery centers nationwide, including 13 in North Texas.