Hi, everyone. This is Brian Zimmerman with Becker's
Healthcare. Thank you for tuning into the Becker's
Healthcare podcast series. We are thrilled to be
joined today by doctor Michael Swartz.
Doctor Swartz is a leader in the trauma
program for University of Michigan Health Sparrow, serving
as director of orthopedic trauma since 2012.
He is the chair in the department of
orthopedic surgery
at University of Michigan Health Sparrow. He's also
in private practice at Michigan Orthopedic Center. Doctor
Sors, thank you so much for joining the
podcast today. Looking forward to diving in here
with you in just a bit. Happy to
be here.
So to to get us started, can you
sort of expand on your background? I know
I give that that that brief little little
blurb about your your background, your title. But
can you share a bit more about your
professional journey and the your current work in
orthopedics?
So I'm from Michigan originally. I did my
medical school training at Michigan State and residency
there as well.
And during the course of residency, I had
the opportunity to work at
some really nice,
trauma programs, OrthoIndy,
Tampa General. And then when I finished my
resident training, went out to Seattle to Harborview
to do a foot and ankle fellowship
with a heavy emphasis on traumatic and post
traumatic
injuries. And since that time, came back to
Lansing in 2004 where I've been
engaged in practice in in all aspects of
foot and ankle care as well as a
large volume of orthopedic trauma.
Excellent. Well, I appreciate the the additional background
about your journey there. I wanna get to
sort of the the trend obviously that that
that's on a lot of folks' minds is
sort of more procedure
shifting to outpatient settings. We've been talking about
that for a bit,
but wanna wanna 0 in here on an
on ankle replacement with CMS approved for coverage
in ASCs as of this year.
How has this and other foot and ankle
procedure migrations affected your practice in the ASC?
And what impact do you expect it will
have on the overall market for outpatient foot
and ankle procedures? So sort of a a
personal direct question to how it'll affect your
practice and then a bigger picture component of
that question too for you.
Yeah. I think it's a it's a really
hot topic at the time,
we're speaking because,
you you know, 2 things have kinda happened
simultaneously.
There's been
certainly some improvements in
anesthesia techniques and regional blocks and those things,
which will allow us to to do procedures
and not have to worry so much about
the management of postoperative pain. At the same
time, there's been expansion of procedures that Medicare
has allowed to to move in the ambulatory
environment.
And when you take those two things, I
think the ambulatory setting becomes a very good
place
to do some of these procedures, particularly for
patients that don't have the medical complexity
that requires,
you know, co management by other services, potentially
postoperatively.
So there's no question we are doing things
in the
surgery center now
that
probably 4 years ago, I would have never
have considered,
being possible.
Yeah. That that that point about the those
patients being fit for this setting,
and it sort of speaks to some of
the the the efficiency that's available for ASCs
and efficiencies
becoming even more,
essential for ASCs as as sort of, you
know, the the financial and stat pressures that
that always come up in these conversations.
What are some key considerations then for practices
just starting to incorporate
more of these these foot and ankle procedures?
What what best practices or strategies do you
recommend,
so so so so these ASCs can can
really thrive in this space? And and I
guess would also be curious to hear your
take on how strategic partnerships can be a
supporter here.
I think the the first thing you have
to do is is look at the patient.
Is it a suitable environment for the patient?
What is their their home setup? Can they
go home
and be successful? So,
incorporating
presurgical
therapy is necessary to to get the patient
fit and ready for their postoper requirements,
I think is really important.
And so I think cooperation with therapy services,
for think of it as prehab
is important. And then as we start doing
more complex procedures in the inventory surgery environment,
you know, most surgery centers, yes, there are
some that are very large and multiple
room facilities, but most of them are smaller.
They have a smaller central supply area. So
you have to be able to
plan your surgeries out
and keep in mind the the shelf space
and and autoclave availability. So you wanna really
streamline your sets.
And,
if you if it's a large set, you
really need to get those sets broken down
into modules
so you're not opening,
items that you don't need. And so those
things really require coordination between the surgeon, the
facility,
and and whichever industry vendor you're working with
because you have to
be able to streamline every step of the
way because you're not gonna be able to
get sets turned over in the same capacity,
and there's certainly not the volume of sets
you'd have in the hospital setting.
And and, doctor Swartz, can you expand on
sort of some of the the ins and
outs of that coordination, especially thinking about, you
you know, your supplier, your vendor, and and
all the other sort of components and make
sure that coordination
is is, you know, up to par, up
to what you what the standards that that
you expect and need for those efficiencies. What
what does that work kind of entail?
So in our in our setting, what we
do is when we we plan out the
surgeries,
obviously, we indicate on our case reporting sheets
what
equipment we would need and implants.
And then a couple days out,
we we exchange an email that includes,
the implant side of things as well as
the facility in central supply and myself,
and we list
exactly
what we need for the case. And if
we need something, say, as backup or hold
in case something comes up and we need
it, that gets indicated that we need that
available but not open.
So that a couple days out, we're revisiting
things and making sure that we're all on
the same page
so that when we get there to do
these procedures,
we have what we need. We don't have
more than what we need, but we have
what we need. And if plan b arises,
that's available.
And that I think, really, that's the part
that
is really important
is
making sure
the surgical team,
the support team in the ambulatory surgery environment,
and then the implant or vendor side, that
coordination
needs to be,
no question, a lot tighter because there isn't
the backup resources.
And you you have to plan it and
then revisit a couple days before. And then
the morning of confirm that you have what
you need,
before you start going. And I think that
takes a little bit more work, but it
does streamline and increase the efficiency of the
day.
Yeah. Doing that doing that work up front,
it may take a little more work, but
sounds like it pays off quite a lot.
For sure.
Yep. And and then looking ahead here, zooming
out as well, what what what developments and
opportunities do you see sort of in the
future for foot and ankle in the ASCs?
What really excites you here? What where where
do you where do you see all this
going?
I mean, I I think
other than patients that
have medical comorbidities, the the overwhelming majority of
the cases are suitable
for the ambulatory environment.
You know, obviously, there's been a huge expansion
and
and improvement
in implants and and and technologies in the
foot and ankle space.
And, you know, cost consideration is certainly something
that has to be mindful.
But I think that everyone is recognizing
that foot and ankle procedures in the ambulatory
environment
fit together,
really well.
Yeah. It it it more to come there.
And I imagine
you you're highlighting there the benefits that are
gonna come to a lot of patients, right,
in terms of convenience here?
For sure.
Yep. Yep. And is there anything we didn't
get to offer today or you didn't get
a chance to say or something you wanna
reemphasize for our listeners before I let you
go, doctor Schwartz?
Well, I I just think it's important if
you're gonna start moving some larger cases to
the ambulatory surgery center that you need to
evaluate
what your plan is, how you're gonna do
it, and then, you know, make a list
of what your perceived roadblocks would be and
and how you're gonna overcome those. And I
think that with appropriate planning
and alignment of resources that that the overall
majority of cases can be done in the
ambulatory environment.
Doctor Swartz, it was a pleasure speaking to
you. Thank you so much for joining on
me on the podcast today. Thank you very
much.
I'd also like to thank our podcast sponsor,
the Pecosynthys, the orthopedic company of Johnson and
Johnson.
You can tune in to more podcasts for
Becker's Healthcare by visiting our podcast page at
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