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Service Lines: Tracking Subspecialties

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It is not enough to know that generally speaking, the orthopedic service line will see good growth in the foreseeable future. Knowing which subspecialty will head up or down can be a puzzle.

The American population will need more hips, knees, and shoulders as the baby boomers hit their senior years. John Cherf, MD, orthopedic surgeon at The Neurologic & Orthopedic Hospital of Chicago and a consultant with Illinois-based Sg2, says demographics are just part of the puzzle for future orthopedics. One trend pushing the growth of orthopedics is the increase in healthcare consumerism and marketing.

"There is probably a significant population with arthritic hips and knees that are undertreated," Cherf says. "We currently perform about 1 million knee and hip replacements annually in the United States. It is probable there are an additional 250,000 people who can be treated, but have not sought care for a variety of reasons." New technology has increased the number of orthopedic operations to more than 1,000 currently, with more coming. "And then there is economics. Our society is one of the wealthiest in the world. People have the resources and they are going to spend them."

Here's some of what may be seen in two subspecialties:

1. Total joints
The next 10 years could see whopping growth in both total joint replacement and revision joint surgery, Cherf says. Sg2 projections show that inpatient primary joint replacement could grow more than 50% in the next decade, with revision joint procedures growing more than 80%.

Greenville, SC-based Bon Secours St. Francis Health System is looking to expand its joint program, both beyond the limitations of its current 28-bed physical space and also in the market area it reaches by using the Joint Camp's outcomes to lure regional and national patients.

"The demographics are in our favor," says Stephen Ridgeway, MD, medical director of the program. "There is a projection of a 700% increase in the need for total joints in the next 20 years. So you have to do it efficiently; you have to do it well. The more satisfied patients you have, the more your business just grows."

2. Spine care
Spine care has driven much of the growth in orthopedics in the past decade and could again be a growth driver. Yet some of that growth may be misleading as payers debate the effectiveness of surgical intervention to treat spinal conditions.

"We are forecasting pretty good growth—double digit growth—for spine care," Cherf says. "But if the payers get very sophisticated, and if consumers are going to be responsible for more of the economic burden, they may be looking for better outcomes than are being delivered."

Jim Molpus

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