Imagine this. You're at the Hyatt Regency Chicago
surrounded by the top minds in the ambulatory
surgery center industry.
Welcome to the Becker's 30th annual meeting, the
business and operations of ASCs from October 30th
to November 2, 2024.
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from over a 1000 executive level attendees forging
priceless connections.
Feel the buzz of conversations
as you participate in more than 60 sessions
led by over
225 elite
ASC speakers.
Envision yourself gaining actionable insights on topics like
private equity strategies,
ASC business growth, and innovations in spine, orthopedics,
GI, ophthalmology, and cardiology.
Now imagine yourself listening to inspiring keynotes from
Hall of Fame boxing world champion, Lila Ali,
and professional basketball player, Caitlin Clark. Their stories
will motivate you to take your business to
new heights. You'll leave with a wealth of
knowledge and a network of connections to help
lead your ASC into the next year. Don't
miss out. Get registered today. Visit beckershospitalreview.com
and click on the events page to find
the conference website. That's the beckershospitalreview.com
events page. See you in Chicago.
This is Alan Condon with The Becker's Podcast.
I'm delighted to be joined today by doctor
Scott Hannam, president and medical director at Emerge
Orthos Brunswick
Ambulatory
Surgery Center.
Doctor. Hallum, a pleasure to have you back
on the podcast with us today. Before we
dive into some questions and pick your brains
a little bit, I'd like to turn the
floor over to you to hear a little
bit more about your role and your background.
Sure. Thanks for having me, Alan.
It's my 25th year, in private practice. I'm
a total joint surgeon by training in my
fellowship down to University of Florida in Shands,
and that was kind of the focus of
my practice and still is.
But in the last 5 years, I've taken
on the role of being the president and
medical director of our, orthopedic surgery center
where it's an independent
facility,
a 100% owned by the surgeons of, Emerge
Ortho. Emerge Ortho is
one of the large super groups in the
United States. I think at last count, we
were
the 7th largest group in the country. And,
that came to be about 7 years ago
when 5 large independent orthopedic groups in Wilmington,
Raleigh,
Greensboro,
Hickory,
and Asheville
all decided to merge together to to form
a Merge Orthopedics.
And, so I'm
a partner in that large group, but then
on a on a on a more microcosm
scale,
focused on running the surgery center, here locally
in Wilmington, North Carolina.
Fantastic. So again, pleasure to have you back
on and thanks so much for filling our
audience in with a little bit of that
breakdown in your background and what you're focusing
on now. I might love to kind of
pick your brains a little bit later on
orthopedic trends and the super grooves and whatnot,
but I'd love to kind of kick things
off first with what are what are 2
to 3 trends that you're following in the
health care or the ASC space today and
why?
Yeah. I think, obviously, there's a lot of
hot topics right now. I think,
you know, one big topic and
and it it will not be an easy
thing to overcome, but
a lot of us in this ASC space,
you know, the the trend in orthopedics especially
is for outpatient surgery. The the projected market
growth in ASCs
is exponential. Everybody understands that.
We are now able to safely and successfully
take care of
probably 75%, 80% of most orthopedic conditions, including
spine surgery and joint replacement
at an ASC facility.
But yet the, you know, CMS
and other payers
continue to reimburse
ASCs at a lower rate than outpatient
hospital centers.
And that disconnect is gonna be a problem.
It already is a problem as the margins
are thin.
And in the competitive landscape, we need to
really find a way to lobby CMS
to make that ASC
and HOPD
reimbursement
the same.
And, again, hospital lobbies are strong and and
important, and, you know, the hospital needs to
make money, and we understand that. But by
the same token, a lot of hospitals own
surgery centers as well. So
that is a huge
topic on
just in terms of the economics
of ASCs. And, obviously, it's a huge
hurdle to overcome
lobbying the federal government is
extraordinarily difficult.
Absolutely. So, obviously, the the trend and the
migration
to outpatient
surgery, it's been happening for for quite a
while. But maybe am I right in saying
accelerated when the pandemic came along? But when
you think about it, doctor Hanum, it wasn't
too long ago when
surgeries like spine surgeries, total hips, total knees
required a couple nights stay in a hospital.
Now we're seeing them being done, you know,
in an in an ASC like yours. Patients
open ambulate
ambulated out the door in a couple of
hours, reduced pain, limited opioid use. Robotics is
a big big buzzword, and it's certainly growing
in the total joint space as well. I'm
curious to see where do you see outpatient
surgery, specifically in orthopedics,
5 years down the road, what do you
think will be different? What will remain the
same?
Well, I think it's I think you're right.
I think it's gonna continue to exponentially accelerate.
You know, I think we,
you know,
as a clinician,
you know, first and foremost, we wanna take
great care of our patients. We don't wanna
put them in harm's way and we want
them to have excellent outcomes. And so
the push towards
rapid recovery and outpatient surgery,
we always thought that patients could recover quicker,
but you're right. The pandemic
really forced us
to accelerate that learning curve.
And once we proved that we could do
it safely and that patient satisfaction
was actually higher and complications rates were actually
lower than, you know,
the sky became the limit, and we just
really accelerated that. And that that trend is
gonna continue. I think spine is a big
area. We're we're starting to see trends right
now. There's
there's a lot of procedures that our spine
doctors
feel they can safely do in the ASC
space, but,
CMS and other payers have not approved a
lot of those codes to be done at
the ASC.
That's gonna change in the next few years.
There's there's no question about it. So I
truly believe we're gonna be doing, you know,
75%
of orthopedic care
in an outpatient center. It's it's unfortunately the
only the very, very sick patients, the trauma
patients, the complex revision
surgeries that have to be done. Those are
the only things that are going to be
done in a hospital setting.
Yeah. So like you said, that other 25%
portion of patients is either going to be
highly complex orthopedic care. I'm presuming
patients with a lot of comorbidities,
maybe fractures. And like you said, for the
lion's share, the rest of those surgeries are
gonna be able to be done safely in
the outpatient setting going forward.
No question. No question about it.
And, doctor Hanna, I wanna revisit something you
said at the top of the conversation just
about the orthopedic landscape more broadly when we
think about the United States. Like you said,
Emerge Ortho, the result of a
merger and acquisition many years ago, now the
7th largest orthopedic group in the country as
you said.
How do you see this trend
of consolidation
among orthopedic practices?
The growing nature of these orthopedic
management services organizations
seems to be a hot topic, a big
trend in recent years. Do you expect more
of the same in the future as more
of these groups of independent providers band together?
I do. I think we've
seen an influx of private equity. We've seen
I don't know if that's going to increase
or I don't know if that's maybe even
on the downturn because
not all of the private equity experiments have
turned out well. There was
initial enthusiasm for that in some markets, but
then
the second go around or the third go
around,
when you have somebody who's mostly focused on
their investors and their return on their investment,
it's not really the same
focus as the medical practice group. So, you
know, we've taken a different tactic in trying
to grow large
regionally.
And then, you know, as you just said,
the whole philosophy of MSOs
on a broad scale,
We've already started to partner with other large
orthopedic groups on the West Coast, in Texas,
in Indiana
to try to come to,
you know, some commonality
to
help other large groups become successful
and how do we do that on a
national scale and at the same time enable
other smaller orthopedic groups to piggyback off of
our successes.
So, you know, we kind of think of
ourselves as the private equity and independent orthopedic
groups except we don't wanna own your group.
We just wanna help you
grow your success.
Yeah. It's really interesting to keep an eye
on that trend in terms of, I like
you said, moving away from ownership will be
will be more of an affiliation, more of
a partner, and looking to grow, it sounds
like, from more of a regional group to
a lot of these larger national orthopedic group
in the future.
Doctor Hanam, last thing I wanted to ask
before we let you go, what are you
excited about? When you think about the future
of orthopedics,
the future of ASCs, what are you excited
about when you think about the next 5
years or so?
The experience that I have in the last
5 years, I am
really
excited about
the care that we're giving patients and being
able to take care of them in an
outpatient facility.
Their patient satisfactions
are through the roof.
People are really recovering
quicker and easier,
and we're going to continue that. We're taking
advantage of new technologies. You mentioned robotics,
You know, AI and health care is a
huge hot topic. We've incorporated that on a
small scale
in terms of documentation.
Basically, that's the easiest thing to do in
AI right now is is to have the
AI, listen to conversations and help with transcription
and those things, but it's gonna play a
role in our analytics. It's gonna play a
role in just taking better care of,
developing care pathways and clinical pathways for patients.
So, you know, that combination of technology
and rapid recovery and outpatient surgery to basically
get people back healthy and upright and recovered
from whatever their condition is
is pretty exciting. So
Yeah. Yeah. And last, but I promise this
is the last, last question. But tacking on
to what you've mentioned there in terms of
really excited about being able to deliver that
top quality, top tier patient care in the
outpatient setting, no doubt minimally invasive surgery, robotics
plays into that quite some bit, but will
likely play an even larger role in the
future. I know this is an area of
particular expertise for you as well. But I
I guess,
when you think about the total knee, total
hip robots now, what do you think the
next iteration or the next version of these
robots will be? Is there something that you're
hoping that the next version of these robots
can do that they currently can?
For sure. I think, you know, the learning
that the whether it's an AI learning or
it's just embedded in the
software is just gonna continue to
improve. You know?
You know, right now, the robot in a
knee replacement
can help with
mediolateral,
anterior posterior
balancing,
and range of motion.
Well, there's multiple degrees of freedom in a
knee,
and
having a robot that can simulate in real
time
the kinematics of any given patient
to essentially
perfectly reproduce that as it builds the custom
knee replacement,
you know, that's the holy grail. Well, that's
really complicated. We're not there yet. But there's
no reason to expect that that can't be
achieved,
especially with AI modeling that can then be
built into a system. You know, again, it
takes a while for manufacturers
to be able to do that and, you
know, FDA clearance and things like that for
medical
devices takes a long time, but
it will not stop. It will only get
better.
Yeah. Doctor Hanlon, a real pleasure to to
pick your brains. I hear your insights on
outpatient surgery, trends in orthopedics. I'm super interested
to kinda hear about your thoughts on robotics
for the future as well. Real pleasure to
have you back on the podcast with us,
and I look forward to catching up with
you again down the line.
Oh, I would love to do it again,
Alan. I appreciate it.