Hartford Business Journal

14 Hartford Business Journal • November 26, 2018 • www.HartfordBusiness.com By Sean Teehan steehan@hartfordbusiness.com W hen Dr. Andrew Caputo underwent reconstructive surgery on his ACL 25 years ago, it was done as an inpatient procedure. It was a hassle that required an overnight hospital stay to recover. That knee surgery today, thanks to new technology and the healthcare system's push to move more care to lower-cost facilities, would likely be performed as an outpatient procedure, said Caputo, himself an orthopedic surgeon. So are an increasing number of surgeries like total joint replace- ments and some spinal procedures. To accommodate that new real- ity, Caputo, along with the other 34 physicians who make up the indepen- dently owned Orthopedic Associates of Hartford, plan to open a new $30 million, 45,000-square-foot outpatient surgical center in Rocky Hill this Janu- ary that will boost capacity and offer myriad services, including shoulder, knee and hip replacements. And they aren't alone. Healthcare organizations across the state, rang- ing from large hospitals to indepen- dent practices, are investing tens of millions of dollars in new facilities for what is expected to be surging de- mand for outpatient orthopedics care. Other examples include St. Francis Hospital and Medical Center, which broke ground in September on a $26.2 million, 35,000-square-foot orthopedic and pain ambulatory surgery center in Hartford. Rendina Healthcare Real Estate is constructing a $25.3 million, 60,000-square-foot ambulatory care center in Bristol to be leased by Bristol Hospital for orthopedic and other ser- vices. Late last year, Stamford Hospital debuted a new orthopedic surgical unit it launched in partnership with New York's Hospital for Special Surgery. And Hartford HealthCare opened its $150 million, 130,000-square-foot Bone and Joint Institute in early 2017. "There's been a huge change in the types of procedures that are being done as an outpatient procedure ver- sus an inpatient procedure," Caputo said. "We have the capability of doing procedures that were previously inpa- tient … as outpatient." These big-ticket investments dovetail with increasing demand for orthopedic care, which experts expect to skyrocket over the next few decades as Connecticut's and the country's population ages and lives longer. More than 680,000 total knee replacements were performed in the United States in 2014, according to the latest data from the American Academy of Ortho- paedic Surgeons (AAOS), a 5 percent increase from three years earlier. Total knee replacements are project- ed to increase by 189 percent, to nearly 1.3 million, by 2030, and shoot up to about 2.6 million in 2060, according to AAOS projections. In the Hartford market, the volume of outpatient joint replacements is pro- jected to increase 227.1 percent over the next decade, while outpatient sports medicine and spine procedures are predicted to increase 43.9 percent and 27.5 percent, respectively, according to a recent analysis by Washington-D.C. consultancy Advisory Board. Hospitals and other healthcare orga- nizations are positioning themselves to get a healthy piece of that business. As people live longer and stay more active later in life, sports-related and typical wear-and-tear injuries — like Achilles tendon and ACL ruptures or a meniscus tear — are becoming more prevalent, said Dr. Mariam Hakim- Zargar, owner of New England Orthope- dic Center in Torrington and president of the Connecticut Orthopaedic Society. Meantime, many of those injuries are being repaired by minimally invasive surgery techniques and technology housed in outpatient facilities, he said. "That's not just a trend in Connecti- cut, that's (been happening) nationally, I'd say over the past 20 years," Hakim- Zargar said. Short visits The shift among orthopedic surgeons to send patients home as quickly and safely as possible makes sense, consider- ing the increasing number of surgery candidates, said Dr. Robert McAllister, St. Francis Hospital's director of operations for orthopedics and one of the principal investors in the hospital's new Orthope- dic and Spine Surgery Center, a collabo- ration with Lighthouse Surgeons and Woodland Anesthesiology Associates. Hospital bills grow exponentially with every day a patient spends recovering there, and with so many more people opting for orthopedic procedures, the cost of keeping them all hospitalized for as long as was once common would pose an unsustainable cost burden, McAllister said. For example, he said, people get- ting joint replacement surgery in 1981 might have an eight-hour surgery fol- lowed by two weeks in the hospital, and further recovery in a nursing facility. Today, a joint replacement surgery would take a few hours, and the pa- tient could leave the same day, he said. Like other new and under-construc- tion facilities, St. Francis' will be set up with the intent to get patients out fast, McAllister said. The center will house six orthopedic operating rooms, a procedure room and a 26-bay rehabilitation and physi- cian space serving patients suffering from sports-related injuries, spine injuries, while also offering pain-man- agement services. "There's not a growing pot of money to take care of people, so as physicians, we need to figure out how to care for patients at a lower cost," McAllister said. But cost isn't the only consideration. A 2011 study of patient outcomes at three hospitals in Syracuse, N.Y., demonstrated patients who have significantly longer hospital stays are more prone to complications — like attracting hospital-acquired infections — than those who left quicker. "We want the patient to stay the shortest amount of time possible … to decrease the likelihood of complica- tions," McAllister said. Ortho Boom As aging population boosts demand for orthopedic care, hospitals, others bet big on new outpatient facilities Orthopedic Associates' outpatient surgery center is still under construction. Dr. Andrew Caputo and the other 34 physicians who make up Orthopedic Associates of Hartford plan to open a 45,000-square-foot outpatient surgical center in Rocky Hill at an estimated $30 million cost. HBJ PHOTO | STEVE LASCHEVER HBJ PHOTO | STEVE LASCHEVER

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