1 00:00:00,240 --> 00:00:02,560 Hi, everyone. This is Brian Zimmerman with Becker's 2 00:00:02,560 --> 00:00:04,799 Healthcare. Thank you for tuning into the Becker's 3 00:00:04,799 --> 00:00:07,440 Healthcare podcast series. We are thrilled to be 4 00:00:07,440 --> 00:00:09,300 joined today by doctor Michael Swartz. 5 00:00:09,759 --> 00:00:11,919 Doctor Swartz is a leader in the trauma 6 00:00:11,919 --> 00:00:14,799 program for University of Michigan Health Sparrow, serving 7 00:00:14,799 --> 00:00:17,324 as director of orthopedic trauma since 2012. 8 00:00:18,105 --> 00:00:19,704 He is the chair in the department of 9 00:00:19,704 --> 00:00:20,684 orthopedic surgery 10 00:00:20,984 --> 00:00:23,704 at University of Michigan Health Sparrow. He's also 11 00:00:23,704 --> 00:00:26,664 in private practice at Michigan Orthopedic Center. Doctor 12 00:00:26,664 --> 00:00:28,265 Sors, thank you so much for joining the 13 00:00:28,265 --> 00:00:30,650 podcast today. Looking forward to diving in here 14 00:00:30,650 --> 00:00:32,490 with you in just a bit. Happy to 15 00:00:32,490 --> 00:00:33,149 be here. 16 00:00:33,609 --> 00:00:35,289 So to to get us started, can you 17 00:00:35,289 --> 00:00:37,210 sort of expand on your background? I know 18 00:00:37,210 --> 00:00:38,890 I give that that that brief little little 19 00:00:38,890 --> 00:00:41,370 blurb about your your background, your title. But 20 00:00:41,370 --> 00:00:42,729 can you share a bit more about your 21 00:00:42,729 --> 00:00:44,890 professional journey and the your current work in 22 00:00:44,890 --> 00:00:45,255 orthopedics? 23 00:00:46,695 --> 00:00:49,734 So I'm from Michigan originally. I did my 24 00:00:49,734 --> 00:00:52,475 medical school training at Michigan State and residency 25 00:00:52,615 --> 00:00:53,435 there as well. 26 00:00:54,534 --> 00:00:56,295 And during the course of residency, I had 27 00:00:56,295 --> 00:00:57,594 the opportunity to work at 28 00:00:57,960 --> 00:00:59,079 some really nice, 29 00:00:59,560 --> 00:01:01,579 trauma programs, OrthoIndy, 30 00:01:02,440 --> 00:01:05,180 Tampa General. And then when I finished my 31 00:01:05,719 --> 00:01:08,599 resident training, went out to Seattle to Harborview 32 00:01:08,599 --> 00:01:10,219 to do a foot and ankle fellowship 33 00:01:11,185 --> 00:01:13,344 with a heavy emphasis on traumatic and post 34 00:01:13,344 --> 00:01:13,844 traumatic 35 00:01:14,784 --> 00:01:17,025 injuries. And since that time, came back to 36 00:01:17,025 --> 00:01:19,284 Lansing in 2004 where I've been 37 00:01:19,825 --> 00:01:22,145 engaged in practice in in all aspects of 38 00:01:22,145 --> 00:01:24,545 foot and ankle care as well as a 39 00:01:24,545 --> 00:01:26,325 large volume of orthopedic trauma. 40 00:01:27,599 --> 00:01:30,079 Excellent. Well, I appreciate the the additional background 41 00:01:30,079 --> 00:01:32,319 about your journey there. I wanna get to 42 00:01:32,319 --> 00:01:34,239 sort of the the trend obviously that that 43 00:01:34,319 --> 00:01:36,239 that's on a lot of folks' minds is 44 00:01:36,239 --> 00:01:37,299 sort of more procedure 45 00:01:37,760 --> 00:01:39,760 shifting to outpatient settings. We've been talking about 46 00:01:39,760 --> 00:01:40,659 that for a bit, 47 00:01:40,965 --> 00:01:42,884 but wanna wanna 0 in here on an 48 00:01:42,965 --> 00:01:45,284 on ankle replacement with CMS approved for coverage 49 00:01:45,284 --> 00:01:46,984 in ASCs as of this year. 50 00:01:47,444 --> 00:01:49,364 How has this and other foot and ankle 51 00:01:49,364 --> 00:01:52,265 procedure migrations affected your practice in the ASC? 52 00:01:52,564 --> 00:01:54,084 And what impact do you expect it will 53 00:01:54,084 --> 00:01:56,489 have on the overall market for outpatient foot 54 00:01:56,489 --> 00:01:58,730 and ankle procedures? So sort of a a 55 00:01:58,730 --> 00:02:00,730 personal direct question to how it'll affect your 56 00:02:00,730 --> 00:02:03,209 practice and then a bigger picture component of 57 00:02:03,209 --> 00:02:04,510 that question too for you. 58 00:02:05,450 --> 00:02:07,290 Yeah. I think it's a it's a really 59 00:02:07,290 --> 00:02:08,750 hot topic at the time, 60 00:02:09,530 --> 00:02:10,669 we're speaking because, 61 00:02:10,969 --> 00:02:13,074 you you know, 2 things have kinda happened 62 00:02:13,074 --> 00:02:13,574 simultaneously. 63 00:02:14,034 --> 00:02:14,854 There's been 64 00:02:15,474 --> 00:02:17,574 certainly some improvements in 65 00:02:18,354 --> 00:02:20,835 anesthesia techniques and regional blocks and those things, 66 00:02:20,835 --> 00:02:22,775 which will allow us to to do procedures 67 00:02:23,719 --> 00:02:25,479 and not have to worry so much about 68 00:02:25,479 --> 00:02:27,479 the management of postoperative pain. At the same 69 00:02:27,479 --> 00:02:30,520 time, there's been expansion of procedures that Medicare 70 00:02:30,520 --> 00:02:32,300 has allowed to to move in the ambulatory 71 00:02:32,439 --> 00:02:32,939 environment. 72 00:02:33,479 --> 00:02:35,319 And when you take those two things, I 73 00:02:35,319 --> 00:02:38,844 think the ambulatory setting becomes a very good 74 00:02:38,985 --> 00:02:39,485 place 75 00:02:40,185 --> 00:02:42,504 to do some of these procedures, particularly for 76 00:02:42,504 --> 00:02:44,844 patients that don't have the medical complexity 77 00:02:45,544 --> 00:02:46,284 that requires, 78 00:02:47,064 --> 00:02:49,644 you know, co management by other services, potentially 79 00:02:49,944 --> 00:02:50,444 postoperatively. 80 00:02:50,770 --> 00:02:52,449 So there's no question we are doing things 81 00:02:52,449 --> 00:02:53,030 in the 82 00:02:53,330 --> 00:02:54,550 surgery center now 83 00:02:54,930 --> 00:02:55,430 that 84 00:02:55,810 --> 00:02:57,650 probably 4 years ago, I would have never 85 00:02:57,650 --> 00:02:58,310 have considered, 86 00:02:58,930 --> 00:02:59,750 being possible. 87 00:03:01,090 --> 00:03:02,849 Yeah. That that that point about the those 88 00:03:02,849 --> 00:03:05,085 patients being fit for this setting, 89 00:03:05,545 --> 00:03:06,985 and it sort of speaks to some of 90 00:03:06,985 --> 00:03:10,105 the the the efficiency that's available for ASCs 91 00:03:10,105 --> 00:03:10,765 and efficiencies 92 00:03:11,545 --> 00:03:12,985 becoming even more, 93 00:03:13,465 --> 00:03:15,784 essential for ASCs as as sort of, you 94 00:03:15,784 --> 00:03:18,129 know, the the financial and stat pressures that 95 00:03:18,129 --> 00:03:20,069 that always come up in these conversations. 96 00:03:20,849 --> 00:03:23,189 What are some key considerations then for practices 97 00:03:23,250 --> 00:03:24,629 just starting to incorporate 98 00:03:25,169 --> 00:03:27,270 more of these these foot and ankle procedures? 99 00:03:27,969 --> 00:03:30,365 What what best practices or strategies do you 100 00:03:30,365 --> 00:03:30,865 recommend, 101 00:03:31,485 --> 00:03:34,444 so so so so these ASCs can can 102 00:03:34,444 --> 00:03:36,685 really thrive in this space? And and I 103 00:03:36,685 --> 00:03:38,525 guess would also be curious to hear your 104 00:03:38,525 --> 00:03:41,085 take on how strategic partnerships can be a 105 00:03:41,085 --> 00:03:41,985 supporter here. 106 00:03:42,560 --> 00:03:44,000 I think the the first thing you have 107 00:03:44,000 --> 00:03:45,780 to do is is look at the patient. 108 00:03:46,000 --> 00:03:48,000 Is it a suitable environment for the patient? 109 00:03:48,000 --> 00:03:49,919 What is their their home setup? Can they 110 00:03:49,919 --> 00:03:50,580 go home 111 00:03:50,879 --> 00:03:52,419 and be successful? So, 112 00:03:53,120 --> 00:03:53,620 incorporating 113 00:03:54,319 --> 00:03:54,819 presurgical 114 00:03:56,004 --> 00:03:58,245 therapy is necessary to to get the patient 115 00:03:58,245 --> 00:04:00,185 fit and ready for their postoper requirements, 116 00:04:00,805 --> 00:04:02,344 I think is really important. 117 00:04:03,365 --> 00:04:06,185 And so I think cooperation with therapy services, 118 00:04:06,485 --> 00:04:08,104 for think of it as prehab 119 00:04:08,564 --> 00:04:10,985 is important. And then as we start doing 120 00:04:11,980 --> 00:04:14,719 more complex procedures in the inventory surgery environment, 121 00:04:15,260 --> 00:04:17,500 you know, most surgery centers, yes, there are 122 00:04:17,500 --> 00:04:19,199 some that are very large and multiple 123 00:04:19,819 --> 00:04:21,819 room facilities, but most of them are smaller. 124 00:04:21,819 --> 00:04:24,300 They have a smaller central supply area. So 125 00:04:24,300 --> 00:04:25,839 you have to be able to 126 00:04:26,314 --> 00:04:27,774 plan your surgeries out 127 00:04:28,714 --> 00:04:31,115 and keep in mind the the shelf space 128 00:04:31,115 --> 00:04:33,675 and and autoclave availability. So you wanna really 129 00:04:33,675 --> 00:04:34,894 streamline your sets. 130 00:04:35,754 --> 00:04:36,254 And, 131 00:04:36,634 --> 00:04:38,314 if you if it's a large set, you 132 00:04:38,314 --> 00:04:40,639 really need to get those sets broken down 133 00:04:40,639 --> 00:04:41,539 into modules 134 00:04:41,839 --> 00:04:43,060 so you're not opening, 135 00:04:44,000 --> 00:04:46,479 items that you don't need. And so those 136 00:04:46,479 --> 00:04:49,680 things really require coordination between the surgeon, the 137 00:04:49,680 --> 00:04:50,180 facility, 138 00:04:50,719 --> 00:04:53,699 and and whichever industry vendor you're working with 139 00:04:54,774 --> 00:04:56,235 because you have to 140 00:04:56,935 --> 00:04:58,615 be able to streamline every step of the 141 00:04:58,615 --> 00:04:59,974 way because you're not gonna be able to 142 00:04:59,974 --> 00:05:02,875 get sets turned over in the same capacity, 143 00:05:03,095 --> 00:05:04,935 and there's certainly not the volume of sets 144 00:05:04,935 --> 00:05:06,794 you'd have in the hospital setting. 145 00:05:07,769 --> 00:05:09,449 And and, doctor Swartz, can you expand on 146 00:05:09,449 --> 00:05:11,129 sort of some of the the ins and 147 00:05:11,129 --> 00:05:13,610 outs of that coordination, especially thinking about, you 148 00:05:13,610 --> 00:05:16,410 you know, your supplier, your vendor, and and 149 00:05:16,410 --> 00:05:18,009 all the other sort of components and make 150 00:05:18,009 --> 00:05:18,829 sure that coordination 151 00:05:19,129 --> 00:05:21,290 is is, you know, up to par, up 152 00:05:21,290 --> 00:05:23,235 to what you what the standards that that 153 00:05:23,235 --> 00:05:25,394 you expect and need for those efficiencies. What 154 00:05:25,394 --> 00:05:26,935 what does that work kind of entail? 155 00:05:28,115 --> 00:05:29,875 So in our in our setting, what we 156 00:05:29,875 --> 00:05:32,035 do is when we we plan out the 157 00:05:32,035 --> 00:05:32,535 surgeries, 158 00:05:33,235 --> 00:05:35,714 obviously, we indicate on our case reporting sheets 159 00:05:35,714 --> 00:05:36,214 what 160 00:05:36,639 --> 00:05:38,500 equipment we would need and implants. 161 00:05:39,040 --> 00:05:40,660 And then a couple days out, 162 00:05:41,839 --> 00:05:44,020 we we exchange an email that includes, 163 00:05:45,040 --> 00:05:47,600 the implant side of things as well as 164 00:05:47,600 --> 00:05:50,259 the facility in central supply and myself, 165 00:05:50,944 --> 00:05:51,845 and we list 166 00:05:52,305 --> 00:05:52,805 exactly 167 00:05:53,264 --> 00:05:55,584 what we need for the case. And if 168 00:05:55,584 --> 00:05:57,745 we need something, say, as backup or hold 169 00:05:57,745 --> 00:05:59,504 in case something comes up and we need 170 00:05:59,504 --> 00:06:01,664 it, that gets indicated that we need that 171 00:06:01,664 --> 00:06:03,125 available but not open. 172 00:06:03,470 --> 00:06:05,470 So that a couple days out, we're revisiting 173 00:06:05,470 --> 00:06:07,069 things and making sure that we're all on 174 00:06:07,069 --> 00:06:07,970 the same page 175 00:06:08,270 --> 00:06:09,870 so that when we get there to do 176 00:06:09,870 --> 00:06:10,610 these procedures, 177 00:06:11,230 --> 00:06:13,150 we have what we need. We don't have 178 00:06:13,150 --> 00:06:14,670 more than what we need, but we have 179 00:06:14,670 --> 00:06:17,150 what we need. And if plan b arises, 180 00:06:17,150 --> 00:06:17,889 that's available. 181 00:06:18,495 --> 00:06:20,415 And that I think, really, that's the part 182 00:06:20,415 --> 00:06:20,915 that 183 00:06:21,535 --> 00:06:22,514 is really important 184 00:06:22,975 --> 00:06:23,475 is 185 00:06:24,175 --> 00:06:25,074 making sure 186 00:06:25,694 --> 00:06:26,915 the surgical team, 187 00:06:27,615 --> 00:06:30,115 the support team in the ambulatory surgery environment, 188 00:06:30,740 --> 00:06:34,019 and then the implant or vendor side, that 189 00:06:34,019 --> 00:06:34,519 coordination 190 00:06:34,899 --> 00:06:35,800 needs to be, 191 00:06:36,259 --> 00:06:38,819 no question, a lot tighter because there isn't 192 00:06:38,819 --> 00:06:39,879 the backup resources. 193 00:06:40,660 --> 00:06:43,964 And you you have to plan it and 194 00:06:43,964 --> 00:06:46,365 then revisit a couple days before. And then 195 00:06:46,365 --> 00:06:48,125 the morning of confirm that you have what 196 00:06:48,125 --> 00:06:48,785 you need, 197 00:06:49,165 --> 00:06:50,925 before you start going. And I think that 198 00:06:50,925 --> 00:06:52,605 takes a little bit more work, but it 199 00:06:52,605 --> 00:06:55,165 does streamline and increase the efficiency of the 200 00:06:55,165 --> 00:06:55,665 day. 201 00:06:56,270 --> 00:06:58,110 Yeah. Doing that doing that work up front, 202 00:06:58,430 --> 00:06:59,710 it may take a little more work, but 203 00:06:59,710 --> 00:07:01,569 sounds like it pays off quite a lot. 204 00:07:01,790 --> 00:07:02,529 For sure. 205 00:07:03,069 --> 00:07:05,629 Yep. And and then looking ahead here, zooming 206 00:07:05,629 --> 00:07:07,949 out as well, what what what developments and 207 00:07:07,949 --> 00:07:09,550 opportunities do you see sort of in the 208 00:07:09,550 --> 00:07:11,569 future for foot and ankle in the ASCs? 209 00:07:11,974 --> 00:07:13,974 What really excites you here? What where where 210 00:07:13,974 --> 00:07:15,175 do you where do you see all this 211 00:07:15,175 --> 00:07:15,675 going? 212 00:07:16,535 --> 00:07:17,754 I mean, I I think 213 00:07:18,615 --> 00:07:20,074 other than patients that 214 00:07:20,375 --> 00:07:23,654 have medical comorbidities, the the overwhelming majority of 215 00:07:23,654 --> 00:07:24,875 the cases are suitable 216 00:07:25,709 --> 00:07:27,490 for the ambulatory environment. 217 00:07:27,870 --> 00:07:30,209 You know, obviously, there's been a huge expansion 218 00:07:30,269 --> 00:07:30,769 and 219 00:07:31,149 --> 00:07:31,889 and improvement 220 00:07:32,269 --> 00:07:34,990 in implants and and and technologies in the 221 00:07:34,990 --> 00:07:36,129 foot and ankle space. 222 00:07:36,509 --> 00:07:39,149 And, you know, cost consideration is certainly something 223 00:07:39,149 --> 00:07:40,290 that has to be mindful. 224 00:07:40,845 --> 00:07:42,944 But I think that everyone is recognizing 225 00:07:43,485 --> 00:07:45,644 that foot and ankle procedures in the ambulatory 226 00:07:45,644 --> 00:07:46,144 environment 227 00:07:46,764 --> 00:07:47,584 fit together, 228 00:07:48,365 --> 00:07:49,105 really well. 229 00:07:50,764 --> 00:07:52,444 Yeah. It it it more to come there. 230 00:07:52,444 --> 00:07:53,105 And I imagine 231 00:07:54,045 --> 00:07:56,550 you you're highlighting there the benefits that are 232 00:07:56,550 --> 00:07:57,909 gonna come to a lot of patients, right, 233 00:07:57,909 --> 00:07:59,449 in terms of convenience here? 234 00:07:59,750 --> 00:08:00,490 For sure. 235 00:08:00,949 --> 00:08:02,870 Yep. Yep. And is there anything we didn't 236 00:08:02,870 --> 00:08:04,949 get to offer today or you didn't get 237 00:08:04,949 --> 00:08:06,389 a chance to say or something you wanna 238 00:08:06,389 --> 00:08:08,310 reemphasize for our listeners before I let you 239 00:08:08,310 --> 00:08:09,289 go, doctor Schwartz? 240 00:08:09,964 --> 00:08:11,564 Well, I I just think it's important if 241 00:08:11,564 --> 00:08:14,605 you're gonna start moving some larger cases to 242 00:08:14,605 --> 00:08:17,345 the ambulatory surgery center that you need to 243 00:08:17,805 --> 00:08:18,305 evaluate 244 00:08:18,685 --> 00:08:20,525 what your plan is, how you're gonna do 245 00:08:20,525 --> 00:08:22,444 it, and then, you know, make a list 246 00:08:22,444 --> 00:08:25,004 of what your perceived roadblocks would be and 247 00:08:25,004 --> 00:08:27,120 and how you're gonna overcome those. And I 248 00:08:27,120 --> 00:08:29,379 think that with appropriate planning 249 00:08:29,920 --> 00:08:32,559 and alignment of resources that that the overall 250 00:08:32,559 --> 00:08:34,000 majority of cases can be done in the 251 00:08:34,000 --> 00:08:35,059 ambulatory environment. 252 00:08:36,240 --> 00:08:38,000 Doctor Swartz, it was a pleasure speaking to 253 00:08:38,000 --> 00:08:39,279 you. Thank you so much for joining on 254 00:08:39,360 --> 00:08:41,355 me on the podcast today. Thank you very 255 00:08:41,355 --> 00:08:41,855 much. 256 00:08:42,154 --> 00:08:44,475 I'd also like to thank our podcast sponsor, 257 00:08:44,475 --> 00:08:47,195 the Pecosynthys, the orthopedic company of Johnson and 258 00:08:47,195 --> 00:08:47,695 Johnson. 259 00:08:48,075 --> 00:08:49,595 You can tune in to more podcasts for 260 00:08:49,595 --> 00:08:52,154 Becker's Healthcare by visiting our podcast page at 261 00:08:52,154 --> 00:08:52,654 beckerspodcast.com.