Speaker 0: Hi, everyone. This is Lucas Voss with Becker's Healthcare. Thanks so much for tuning in to the Becker's Healthcare podcast series. It's great to have you, and I'm excited to welcome you to part one of our series on the evolution of soldier surgery and the increasing shift to ASC Environments. And joining me for today's discussion, fantastic to have him, is doctor Aaron Chamberlaine.

He's a board certified orthopedic surgeon with the Intermountain Orthopedic Specialty Group. His clinical interests include leading edge surgical management of shoulder and elbow problems, as well as innovative arthroscopic and open reconstructive surgical techniques. Doctor Chamberlain is passionate about advancing and innovating surgical care of the shoulder and elbow, which we'll hear about in a little bit. Doctor Chamberlain, it's great to have you. Thanks so much for being here today.

Speaker 1: Thank you, Lucas. It's good to be with you.

Speaker 0: Absolutely. We need to start at the beginning. How does one get into shoulder and elbow orthotics? I'd love to hear a little bit more about how you got into the space and then what interests you in the space.

Speaker 1: Yeah. I think it's, you know, as with many things, it's it's a long road and a series of decisions. Right? So from medical school, we we kind of have an an idea of what type of, you know, physician we wanna do and, you know, and types of things we wanna practice. And so a lot of us make a decision.

We wanna go surgical versus nonsurgical. And once we've made a decision to go surgical and orthopedics is a is a common area to consider, within orthopedic surgery residency, one of the subspecialties you can select is shoulder and elbow surgery. And and one of the things that drew me to shoulder and elbow surgery was the the the kind of vast, diversity of surgical techniques we use, you know, anything from an arthroscopic minimally invasive technique to more, large reconstructive open surgical techniques and being able to manage and and try to try to manage everything from all from simple to complex in the shoulder rather than just doing, you know, part of that spectrum of care that there's subspecialty of shoulder and elbow surgery. And that training lends itself well to that, kinda be the master of the joint, so to speak, and be the the subject matter expert. And then along with that interest, I I was, fortunate, to work alongside some fantastic mentors.

So in my residency, doctor Rick Mattson, who's, considered one of the father figures in shoulder shoulder surgery in The United States and north in the world, really, working alongside him in residency along with doctor Winston Warm. And then doing a a shoulder and elbow fellowship was kind of that next decision where, you know, trying to follow follow doctor Mattson's lead, and and his guidance and went into the shoulder and elbow fellowship at Washington University in Saint Louis and was able to work with, again, some fantastic mentors in doctor Ken Yamaguchi, doctor Lisa Gallitz, doctor Jay Keener, at WashU in Saint Louis and had a great, experience there, learned a ton about shoulder and elbow surgery, and was able to stay on there as faculty, for a little over a decade, as part of the shoulder and elbow, faculty, before joining Intermountain Health, a few years ago.

Speaker 0: Feel like your title should just be a master of joints. I love that. That's a fantastic title to have. And, again, speaking of titles, you certainly have a a unique role within Intermountain Health. I was wondering if you can talk a little bit about what your day to day looks like there, and how you really see health care evolving in your space, but also certainly beyond.

Speaker 1: Yeah. So my title within and my role within Intermountain Health is so I'm the senior medical director for the Musculoskeletal Clinical Program. So orthopedics essentially for our for our system. It's one of the larger health systems, in the country, and so we have a large large geography. But my role is to oversee and and guide, clinical best practice, and innovation care delivery of for orthopedics for our health system.

On a day to day basis, my my time is roughly split half and half between my administrative role as well as my clinical practice that I that I continue to work with. But my what really intrigued me about this role and this job with Intermountain is the opportunity to kinda work in an area that I'm passionate about, which is how do we innovate and solve the bigger picture problems we see within health care. How do we solve and work toward more affordable health care, better clinical outcomes, more efficiency? How do we innovate in a way that takes advantage of the, the technologies that we see evolving, and how can they best help us in health care and specifically within musculoskeletal care. So that's that's my my role and my area of focus, within my senior medical director role within Intermountain in addition to my clinical practice.

Speaker 0: And you spoke a little bit about how how health care is evolving and, obviously, some of the challenges that we're seeing that that are evolving with health care certainly here this year, into next year. And we've seen a lot of this impact, especially practices like yours in terms of shoulder cases really migrating rapidly to ASC settings primarily. What do you think has driven that specific shift, and what impact has it had on both patients, but then also certainly on providers?

Speaker 1: Yeah. The shift to ASCs has been one of the biggest, changes we've seen in musculoskeletal care over the last several years. I I think, in my opinion, we were shifted and pushed in that direction a little bit with COVID where being in the hospital became a problem and and bigger challenge for us. And so we collectively, in our profession, I think, learned how we can help patients get out of the hospital or have have the surgery done in a non inpatient way. So whereas many, many years ago, patients would stay multiple nights in a hospital, we quickly we had been moving in that direction, and I think COVID accelerated that learning process of how do we safely and effectively help patients get through a surgical episode and then and be out of the hospital.

And with that, alongside that, I should say, there was the the the ASC strategy that came came to bear and became a little more accelerated around that same time point where it became clear that, you know, with, with some of the early experience, we could provide a better patient experience, better outcomes in in most cases, and have it, cost less to the patient and cost less to the system to have it done in AAC. And so with the clinical learnings we have shifting from an inpatient to more outpatient total joint replacement surgery, Along with that, the economics of the ASC, I think those there's been two pretty powerful drivers to get more cases to the ASCs. And now we see that that, you know, health plans, are are also kind of accelerating that. They've they've we've seen a lot of partnerships with health plans where they're trying to provide incentives to providers to drive cases toward ASC where the claims expense savings is substantial on the health plan side. We also see patients, now more and more requesting for their cases to be done to ASC.

They experience everything from something as simple as just finding parking and getting into the building, you know, having efficient, you know, an an efficient time efficient experience in the in the for their surgery day, and then having a more kind of a a a personal touch, to their to their surgical experience we can provide at the ASC. So I think, you know, moving forward, we're gonna continue to see that drive, from the patient standpoint, in their experience as well as the health health plan or health insurance standpoint as well. And then I should say for the providers, it's my favorite place to work is in a is in our surgical center. I mean, we have great efficiencies. We got a great team.

People care, you know, put the patient first, and we're able to make decisions in a more nimble way around how do we think this is gonna positively affect the the care of patients we see, and we can we can enact those changes quickly.

Speaker 0: I I was going to say or or ask rather, what's for you? What's the you've mentioned a couple of them, but what's sort of the number one biggest advantage of performing these cases in that ambulatory setting for you as a surgeon versus actually being in a hospital?

Speaker 1: Yeah. So for me as a surgeon where my primary concern is how is my patient my the patient gonna feel and and what's their experience gonna be like. I feel most confident as a provider that I can create and and provide that experience for my patient, number one. Number two, you know, I can I can be I I'm passionate? I think a lot of my colleagues are passionate around how do we help health care be more affordable.

I I know, and I I as part of my job, I can see the the the expense the the difference in expense to the health plan and the patient in many cases around doing the surgery at the ASC versus in a hospital setting. So we're clinically appropriate. I feel feel pretty strong that I'm able to save the patient money in their pocket, and that's one of the things that I feel strongly about in general is how do we help our patients feel like health care is more affordable, and, you know, and accessible in that way. And so for me and then thirdly, it's obviously more efficient for me. I I have the same team that I work with every every time I operate.

I can, you know, affect change, and we can make decisions that are, that help the process be more safe, more higher quality, and more efficient. So for a provider that that having that ability to affect change like that like that, I think, is is a big deal.

Speaker 0: Speaking of efficiencies, I think we'd be remiss if we didn't talk about technology and a little bit about the innovation that's been happening in this space. Again, not just this year, but probably over the last five years and certainly heading into 2026. And, certainly, patient expectations are are changing as well. They they continue to shape the outpatient orthopedic space. How do you see this technology, this innovation that's happening so rapidly on a regular basis impacting the space?

And, certainly, if you could talk about the patient expectations too that are rising on a consistent basis, as well.

Speaker 1: Yeah. So our again, starting with the patient, our patients are expecting, and I think rightly so, high precision, you know, experience when it comes to a surgical intervention, they're expecting precision. They want to know that we are doing everything we can to minimize complications while maximizing their opportunity for a good outcome. And so we need, as a profession, to continue to identify and then leverage any technology that helps meet those expectations in the patient. And so to do that, you know, as far as identifying how do we, you know, minimize complications, I think any technology that helps us, be more precise to avoid outliers as far as surgical technique or implant positioning, things like that that may affect, patient outcomes.

I think it's our job and our responsibility to to find those opportunities to minimize those kind of complications. We wanna utilize everything anything that helps us technically to perform the procedure better in a more precise way to understanding data. You know, how do we identify what are we doing that's helping patients? You know? Data is is gold nowadays with with health care among other industries.

But within health care, we need to do a better job and and leverage the technology we have available to understand outcomes. When we make decisions as providers, are we measuring and how are we measuring to understand the effect that it has on the patient outcome? Does it make a difference? Yes or no? To what extent is it making a difference?

How much should we be paying for such a technology because of the difference it's making? So that's where utilizing that data and understanding the effects of our decisions, I think, goes a long way as well.

Speaker 0: Doctor Chamberlain, the master of joints. I'm establishing this happening. Thank you so much for your time and insights today. It's fantastic to have you.

Speaker 1: Thank you. Thanks for letting me join you.

Speaker 0: Absolutely. We also want to thank our podcast sponsor, the Pew's and Theys. Make sure to come back for part two of our series tomorrow and tune in to more podcasts from Becker's Healthcare Care by visiting our podcast page at beckershospitalreview.com.