The Becker's team is excited to announce the
launch of our new CFO and Revenue Cycle
podcast.
Tune in for conversations with finance experts from
the top hospitals and health systems. We'll discuss
key trends and ideas to drive meaningful change
in the industry. Look for Becker's CFO and
Revenue Cycle podcast wherever you listen to episodes.
This is Carly Beam with the Becker Spine
and Orthopedics podcast.
I'm thrilled to be joined today by doctor
Jonathan Foray of Center for Orthopedics.
Jonathan, thank you so much for being here
today.
Yes. Thank you for having me. And before
we dive into questions, could you introduce yourself
and tell us a bit about your background?
Sure.
My name is doctor Jonathan Faure. I'm an
orthopedic surgeon at the Center for Orthopedics in
Lake Charles.
Did my medical school training at the Louisiana
State University School of Medicine in New Orleans.
Went from there to the University of South
Carolina School of Medicine,
orthopedic residency in Greenville, South Carolina.
Spent five years there doing orthopedic
surgery training, and then I returned back to
my hometown of Lake Charles, Louisiana.
I've been practicing
there
as a practicing orthopedist since
2012.
Like, they're really coming full circle with their
job.
Yeah.
Yeah. Can you talk about,
three top trends you're following in orthopedics?
Sure.
So one of the things we've been,
following and actively engaged in, number one, is
this outpatient shift in the total joint world,
including both total hips, total knees, and partial
knee replacements to an outpatient
setting.
We're also following and engaged in these rapid
recovery protocols for those patients. So, you know,
enhanced pain management techniques
that we can use, new
drugs that we can utilize to help these
patients feel better and recover faster.
And then one of the newer things that
I'm following
that's that's really very new is the artificial
intelligence and how is that gonna be, you
know, unfolding in our practices
in the coming years.
Thank you. And I wanted to pick your
brain, Morrie, about these rapid
recovery
protocols. Can you outline some of the
some of the protocols that you use in
your practice and how those are paying off?
Sure. So let's just take a total knee
replacement, for example.
You know, total knee replacement even a few
years ago may stay
in a hospital for a night or two
with, you know, pain control problems or things
like that that
have required them to stay in the hospital.
We've now transitioned our patients and from our
practice, about ninety five percent of my patients
are done at Joint Replacement Center in Louisiana,
which is a specialty
surgical center
where we can offer outpatient total joint replacement.
And the protocol involves both specialized anesthesia.
So most of these patients are done using
a spinal anesthetic
acting
anesthetics
that are that have a time release element
that helps to,
control these patients' pain.
And then these patients are able to mobilize
very quickly after surgery. Their spinal wears off
about
two hours after the time it's placed, so
they're only in the Recovery Room maybe
minutes.
And then they can be up walking around
on their knee immediately,
use a walker to be safe with their
balance, and they're typically being discharged about two
hours postoperatively
to their home.
That's really awesome turnaround time.
And then I was wondering, you know, we
think about,
the next generation of orthopedic robots and you
can all you know, including outpatient center.
How do you see
the future of those?
I think the future for the robot we're
on,
basically, you can think of the second generation
robot
that we're currently using.
Mhmm. And when I say that, I mean
that the robot is the same, but the
software has been updated, you know, one major
update to the software that had allowed some
some better features. So I think the one
thing we're definitely gonna see is we'll see
a newly designed robot at some point in
the next couple of years. That robot
will be much faster. Just like when you
get a new computer, it runs faster. It
works faster.
It's gonna have expanded capabilities, particularly
in the revision or redo setting of joint
replacement where we can plan people's
redo or revision surgery.
And then I think you're gonna see some
expanded indications for the robot. We know they're
gonna,
add a spinal application
for spine surgery and also a total shoulder
replacement application to the robot. And both of
those, the spine and the shoulder will likely
come in 2025
or possibly 2026.
That's a great quick timeline and lots to
look forward in that area. And how do
you see AI
weaving into all of this?
So I think AI will play a role.
I think it'll definitely play a role preoperatively.
I think we will start seeing our electric
medical records, though those softwares.
I think we will see a role for
AI in
utilizing protocols
to identify
patients who are either at risk for complications
or have a certain,
number of comorbidities
or take certain medicines that may cross react
and, you know, helping the surgeons identify those
patients preoperatively.
And then I think the second thing that
we may likely see is we're gonna start
seeing integrated activity
monitors for patients, meaning
our our electronic medical records and AI will
be able to tell the surgeon about the
patient's activity level based on their smartphone,
data and give the surgeons an idea of,
you know, how active is this patient before.
Are are are they extremely sedentary? Are they
likely to run into problems with these types
of things? So I think that is those
tools for artificial intelligence,
I think we're likely to see coming in
the future.
It sounds like it'll be very helpful in
getting that extra layer of showing how a
patient
is
when they're, you know, outside of the doctor's
office or ORs kind of going about their
day.
Absolutely.
Yeah. And then the last topic I wanted
to pivot to is the role of orthobiologics
in orthopedics.
How do you see that evolving especially in
cartilage and knee care?
So orthobiologics
is obviously a a broad topic, but there
is a lot of interest. Specifically,
a lot of,
news and headlines around things that people call
stem cells.
And and within the orthopedic community, we are
still,
I think, working through
some of the logistics
of
it's just exactly,
you know, what what what are stem cells,
where are we getting them, what can we
call a stem cell treatment.
But I think it's safe to say that
the future
and the future of research in orthopedic orthobiologics
is
is to have
a treatment
which will be individualized for the patient based
on their specific cartilage problem
that would be some type of injectable
that could help regrow or reestablish
the cartilage surface of the knee that's being
damaged or worn
and either
help them avoid a joint replacement altogether or
significantly delay a replacement, especially in our younger
patients.
Absolutely. And I was wondering if you could
expand a little bit more on particular
types of studies, areas of research that
you wanna see
the field specialty do
in orthobiologics
or, you know, if you're involved in any
interesting studies, I'd love to hear more about
that as well.
Well, I think what we would like to
see,
as a as an orthopedic community would be
increased
funding and research toward,
what we would consider joint preservation.
Meaning, these treatments that can be given to
patients
to help
regrow or reestablish
the cartilage that has been damaged or worn
and
to
use these treatments in patients to help them
avoid,
these
these large operations.
And if that can be done, I think
we'll be successful in helping a lot of
patients,
avoid these types of surgeries. But that is
that's what the future holds, but it's it
is a there's a lot of work to
be done in that area for sure.
And, doctor Foray, the last question I have
for you is regarding outpatient orthopedics
and
the big migration,
especially in total joints. I'd love to hear
your
outlook on that and, you know, if you
might ever see a day where practically all
total joint replacements are done in the outpatient
center.
Yes. And we are seeing a large migration
currently. So,
you know, the joint replacement center in Louisiana
is a specialty center that myself and two
partners started to offer our patients
a specialized facility for outpatient joint replacement. And
that's a trend across the country that we're
seeing
is to do these patients in a specialized
center that has
specialized nursing care, specialized anesthesia care, and specialized
operative,
protocol
to allow these patients to be done,
as an outpatient. But, when you say outpatient
total joint, I think there's really two meanings
to that. And so the number one thing
people should understand is that the large, large
majority, meaning ninety plus percent of total joints,
whether they're done at a hospital or a
surgery center,
are identified
by the payers as
an outpatient
total joint. And so the the big thing
that we're following now in outpatient total joints
that I think will ultimately drive
the total joint volume
SC or the, ambulatory surgery center
is that if the payers go to a
site neutral payment,
then those
patients who were previously being done in a
hospital and and the hospital is being reimbursed,
up to 40% more than the ASC,
when no if those payments become equal,
then you'll see the remaining patients that were
being done in a hospital setting driven out
into the ambulatory
setting. And, yes, it will drive ninety plus
percent of total joints to the outpatient setting.
It's already
been proven to be safe and effective. I
do think it takes some additional investments
both preoperatively
with nurse navigator help and working with the
patients to understand what their joint replacement journey
is going to entail.
And then, obviously, enhance preoperative assessment and enhance
postoperative follow-up to help the patient successfully
go through their total joint replacement.
And you mentioned just kind of, like, those
investments to help with outpatient migration.
What kind of investments should ASC be thinking
about if they want to increase their total
joint volume?
Well,
specifically,
on the ASC side, you know, using,
nurse navigators,
using
physician assistants who can help,
both monitor the patients, but also a lot
of the patients
have,
become accustomed to to thinking that they need
the procedure done in a hospital.
And the role of the nurse navigator is
to walk the patient and especially their family
or care member
through the process so that they're comfortable, and
they understand
it's totally safe. They can have their joint
replacement. They can put their full weight on
it. They're going to be able to mobilize,
and that they can successfully have an outpatient
total joint replacement.
Thank you.
And, doctor Faure, thank you so much for
coming on a podcast today. I look forward
to connecting with you again.
Yes. Thank you for having me.