Columns

A Peek at the Future of Orthopedics

By Michael Barbella, Managing Editor | November 22, 2016

Looking back is much easier than looking forward. Winston Churchill, despite his talent as a futurist (he foretold of compact engines, wireless telephones, synthetic biology, and material 30 times stronger than steel), was not very fond of prognostication, having once said, “I always avoid prophesying beforehand because it is much better to prophesy after the event has already taken place.”

That’s quite the sage advice, though the whole point of prediction is to portend events/trends/technology/life before it occurs.

While the experts below certainly could have followed Churchill’s lead and “forecast” the medtech industry’s top issues for 2016 (or, better yet, 2015), Orthopedic Design & Technology thought it might be more interesting to elicit true prophecies of the future from professionals untrained in the art of prediction.

The brave souls who stepped up to the challenge included:
  • John Babitt, EY Americas medtech leader and Arda Ural, EY partner in life sciences.
  • Jeffrey Wang, M.D., treasurer of the North American Spine Society.
  • Gerald R. Williams Jr., M.D., president of the American Academy of Orthopaedic Surgeons.
Michael Barbella: What will capture headlines in the orthopedic industry in 2017?
John Babitt and Arda Ural: We see several likely developments taking place in the medtech sector during 2017 that will capture headlines. The portfolio optimization taking place by many major players in the sector is likely to continue as companies divest assets where they don’t have the economies of scale to succeed. We expect the lion’s share of deals to be “bolt-on” transactions versus transformational mega-deals over $5 billion. 

We expect another positive year with respect to [U.S.] FDA [Food and Drug Administration] approvals, including both 510(k) clearances and PMAs [pre-market approvals], which will continue to help fuel innovation in the sector. Likely increases in capital flows from Asia-Pacific provide exciting opportunities. The rise in precision diagnostics brings new prominence to the sector being at the forefront of healthcare innovation and cost-effective delivery models.

The maturation of recent digital business model experiments by companies focused on achieving new capabilities in data analytics, computational power, and sensors to enable the development of future products and services and improve patient care. We expect to see companies rapidly scale up these experiments but also look to “fail fast” in collaborations that are not working out.

The future of the medical device tax, originally part of the Affordable Care Act but suspended until at least 2017, will continue to be closely watched by the industry. The tax could potentially be implemented, revised, eliminated entirely, or potentially bundled with a larger tax reform designed to repatriate ex-U.S. cash. Any of these scenarios would of course have significant implications for the sector.

Dr. Jeffrey Wang: Although it is difficult to anticipate the future, I foresee a move towards bundled payments for surgical procedures and services, and hospitals and groups looking to become more efficient to handle these new reimbursement models. The benefit of this is that surgeons are going to have to work with the hospitals to become more efficient, deliver more efficient care, with less complications and readmissions. This may have an overall result in better patient outcomes and more efficient use of the healthcare dollars. What effect this will have on new technology and products, that are typically more expensive and would drive up the costs, will have to be seen. However, this will have some impact on the costs of new technologies, and perhaps lead newer technologies to be more cost-effective. New technology will no longer be required to be easier for the surgeons, but will also need to be more cost-effective than the older technologies in order to justify their costs. However, if a new technology has higher upfront costs, but does in fact reduce costs in other areas, it may be overall more cost-effective. We will no longer just look at the immediate costs of the implants or technology, but whether it could be a savings in some other area in the future. Perhaps it has less complications, less re-admissions, or leads to a lower infection or re-operation rate. This could justify the use of newer technologies.

Dr. Gerald R. Williams Jr.: In 2017, we will continue to see the creation of new tools, implants, and techniques derived from 3D printing, as well as the ongoing integration of computers and robotic systems into surgical practice. I also expect to see new research and discoveries using biologics—most notably, stem cells—to regenerate or repair damaged bone and cartilage. While there is much we still have to learn about the regenerative powers of biologics, they have tremendous potential to improve patient outcomes and function, and to delay or avoid surgery. Finally, there will be continued discourse regarding the challenges associated with regulating rapidly developing products and integrating patient-specific risk-benefit assessments into both regulation and treatment plans. 

[Editor’s note: See the “Year in Review” feature for an assessment of the past year’s headline-grabbing issues.]