I am sitting in the airport in Chicago after attending the Becker Review Meeting on the Future of Spine and Ambulatory Surgery Centers. Lots of exciting developments. In this post, I will go over the 5 things I see impacting spine and orthopedic care in the next few years 1. Data Collection and Utilization Data is at our fingertips everywhere we go, from googling the latest stats on your favorite San Antonio Spur to reading up on your favorite subject on wikipedia. Medicine and physicians have not been as aggressive about using this data to help us. There is an increasing focus on using data to decide what surgeries will help our patients (Is minimally invasive better? Should we operate from the front or the back?) as well as using the data to help educate patients as to their expected outcomes (How long will I be out of work? How much will my pain improve?). I have been collecting this data since I started practice and am working to collaborate with the Texas Orthopaedic Association to establish a database for all orthopedic (and spine) surgeons in Texas. 2. Increase in Outpatient Spine and Orthopedic Surgery As we expand our understanding of minimally invasive techniques, procedures that previously were done in hospitals with inpatient stays will continue to be pushed to outpatient surgery centers and outpatient units in hospitals. This week's topics included outpatient back fusions, outpatient neck fusions, outpatient total hips, and outpatient total knees. I would love to see 50% of my practice ultimately done in the outpatient setting. Insurance companies continue to see value in pushing these procedures to lower cost outpatient surgery centers. 3. Emerging Regenerative Technologies Many are focusing on the future with regards to arthritis and disc degeneration. Platelet-Rich Plasma has been in existence for some time now and involves taking a patient's blood and "spinning it down" with a special machine to concentrate the healing cells in one mix and the remaining volume in another mix. This "platelet-rich" first mix is then injected into the patient's knee, ankle, shoulder, hip, or tendon to presumably decrease inflammation. Stem cells are also being evaluated for their ability to restore disc height and improve cartilage in arthritis. There is insufficient evidence in our literature to know who is the appropriate candidate and what results to expect. Keep following as we will likely be involved in many of these cutting-edge studies down the road. 4. Bundled Payment Structures The payment for healthcare services continues to evolve. One trend emerging elsewhere in the country is direct pricing for an "episode" of care between the surgeon, anesthesiologist, surgery center, and insurance company. These have the potential for tremendous savings for the insurance company (and the patient if the insurance company structures it that way). In essence, the various providers put together a single price to an insurance company to take care of a total knee or a microdiscectomy. They take some risk in becoming responsible for repeat surgeries in a given period of time or simply show that their pricing structure is cheaper than the traditional in-hospital options. Time will tell if this will catch on or be a flash in the pan. 5. Continued Fights at the State Level over 'Scope of Practice' Physicians continue to be aggressive in protecting who can 'practice medicine' and what limitations should exist on their practice. In the world of Orthopedics, we are seeing challenges from chiropractors on being able to perform comprehensive physical exams (i.e. school physicals and employment physicals), from physical therapists to allow direct access without a physicians' referral, and from podiatrists on how far into the calf and leg they can operate and still be considered to be operating on the foot. Ophthalmologists are fighting with optometrists and anesthesiologists are fighting with nurse anesthetists. With increased cost pressures in health care, there is a focus on delivering care with less expensive providers. I will continue to support physicians far and wide in their efforts to protect their practices and ensure that patients receive the highest levels of care from those best trained to treat their ailments. The physician should remain the leader of a team of providers and have the ultimate responsibility for oversight of patient care.