1 00:00:00,080 --> 00:00:02,240 This is Carly Beam with the Becker Spine 2 00:00:02,240 --> 00:00:03,620 and Orthopedics podcast. 3 00:00:04,080 --> 00:00:06,080 I'm thrilled to be joined today by doctor 4 00:00:06,080 --> 00:00:06,899 Morgan L'Oreal. 5 00:00:07,759 --> 00:00:10,000 Doctor L'Oreal, thank you so much for being 6 00:00:10,000 --> 00:00:10,740 here today. 7 00:00:11,279 --> 00:00:13,139 Thank you, Carly, for having me. 8 00:00:13,505 --> 00:00:15,985 So before we get into our discussion, could 9 00:00:15,985 --> 00:00:17,824 you introduce yourself and tell us a bit 10 00:00:17,824 --> 00:00:18,644 about your background? 11 00:00:19,265 --> 00:00:19,765 Sure. 12 00:00:20,304 --> 00:00:22,945 I'm Morgan L'Oreal. I'm an orthopedic spine and 13 00:00:22,945 --> 00:00:25,744 hand surgeon, and I've spent my career not 14 00:00:25,744 --> 00:00:26,885 just in the OR, 15 00:00:27,320 --> 00:00:30,119 but also advocating for policies that help both 16 00:00:30,119 --> 00:00:30,619 surgeons 17 00:00:30,920 --> 00:00:31,739 and patients. 18 00:00:32,439 --> 00:00:34,780 I currently serve as the president of ISAS, 19 00:00:35,239 --> 00:00:37,799 the International Society for the Advancement of Spine 20 00:00:37,799 --> 00:00:38,299 Surgery, 21 00:00:38,759 --> 00:00:40,059 which has been at the forefront 22 00:00:40,439 --> 00:00:41,579 of spine innovation 23 00:00:42,075 --> 00:00:43,854 for the past twenty five years. 24 00:00:44,875 --> 00:00:46,575 ISAS originally emerged 25 00:00:47,034 --> 00:00:48,335 from the Spine Arthroplasty 26 00:00:48,715 --> 00:00:49,215 Society, 27 00:00:49,835 --> 00:00:52,655 which was founded to advance motion preservation 28 00:00:53,435 --> 00:00:54,495 in spine surgery. 29 00:00:55,034 --> 00:00:55,534 Today, 30 00:00:56,240 --> 00:00:58,659 we continue to drive innovation in everything 31 00:00:59,359 --> 00:01:00,579 from disc regeneration 32 00:01:01,200 --> 00:01:02,899 to minimally invasive techniques, 33 00:01:04,159 --> 00:01:04,659 always 34 00:01:05,120 --> 00:01:07,620 with the goal of improving patient outcomes. 35 00:01:08,695 --> 00:01:10,375 Thank you. And doctor Loria, I know you've 36 00:01:10,375 --> 00:01:12,555 been a you've really been at the forefront 37 00:01:12,775 --> 00:01:14,475 of spine surgeon advocacy. 38 00:01:14,935 --> 00:01:16,534 Can you talk about some of your top 39 00:01:16,534 --> 00:01:19,255 priorities when it comes to physician advocacy this 40 00:01:19,255 --> 00:01:20,954 year? Yes. Absolutely. 41 00:01:22,049 --> 00:01:24,129 Well, as you said, Carly, physician advocacy is 42 00:01:24,129 --> 00:01:26,689 more critical than ever, especially in such a 43 00:01:26,689 --> 00:01:28,390 rapidly evolving field. 44 00:01:29,250 --> 00:01:31,670 My biggest priorities are probably the following, 45 00:01:32,289 --> 00:01:35,030 ensuring reimbursement keeps pace with innovation. 46 00:01:36,045 --> 00:01:37,105 We have the technology, 47 00:01:37,885 --> 00:01:38,704 motion preservation, 48 00:01:39,725 --> 00:01:41,505 biologics, and disc regeneration. 49 00:01:42,284 --> 00:01:44,625 But if insurers don't cover these advancements, 50 00:01:45,725 --> 00:01:47,265 patients don't benefit. 51 00:01:48,439 --> 00:01:50,939 We have to protect physician autonomy. 52 00:01:51,879 --> 00:01:53,979 We must make sure that surgeons, 53 00:01:54,680 --> 00:01:55,420 not payers, 54 00:01:55,879 --> 00:01:57,500 are deciding the best treatments 55 00:01:58,119 --> 00:01:59,099 for their patients. 56 00:02:00,375 --> 00:02:03,575 Finally, bringing spine surgery coding into the minor 57 00:02:03,575 --> 00:02:04,075 era 58 00:02:04,694 --> 00:02:06,554 is a big need. 59 00:02:06,935 --> 00:02:09,014 Many of the procedures we perform today aren't 60 00:02:09,014 --> 00:02:11,194 reflected in current reimbursement models, 61 00:02:11,655 --> 00:02:13,435 and that needs to change. 62 00:02:14,460 --> 00:02:17,020 ISAS plays a big role in pushing for 63 00:02:17,020 --> 00:02:17,759 these reforms. 64 00:02:18,219 --> 00:02:20,540 And with our twenty fifth anniversary this year, 65 00:02:20,540 --> 00:02:23,180 we're more committed than ever to ensuring the 66 00:02:23,180 --> 00:02:24,080 spine surgeons 67 00:02:24,460 --> 00:02:24,960 worldwide 68 00:02:25,500 --> 00:02:26,400 have the tools 69 00:02:26,699 --> 00:02:29,259 and policies in place to deliver the best 70 00:02:29,259 --> 00:02:30,000 care possible. 71 00:02:31,094 --> 00:02:32,455 That's really cool. I I didn't know that 72 00:02:32,455 --> 00:02:34,854 ISS has come into, its twenty fifth year, 73 00:02:34,854 --> 00:02:36,314 so a huge milestone. 74 00:02:36,614 --> 00:02:38,474 I had a couple follow-up questions. 75 00:02:39,014 --> 00:02:41,735 One, you talked about, you know, bringing spine 76 00:02:41,735 --> 00:02:44,840 surgery coding into the modern era. Can you 77 00:02:44,840 --> 00:02:46,699 give me an example of a procedure 78 00:02:47,000 --> 00:02:49,020 that you would like to see 79 00:02:49,319 --> 00:02:50,460 have its codes 80 00:02:50,840 --> 00:02:51,340 modernized? 81 00:02:53,080 --> 00:02:55,260 I I think there's probably two 82 00:02:55,800 --> 00:02:57,419 areas that come to mind. 83 00:02:58,685 --> 00:02:59,905 One of them, for instance, 84 00:03:00,844 --> 00:03:01,564 was the, 85 00:03:02,844 --> 00:03:03,344 decompression 86 00:03:04,284 --> 00:03:06,465 with placement of inner spinous, 87 00:03:07,724 --> 00:03:08,224 spacer, 88 00:03:09,245 --> 00:03:11,724 known to by many as the Coflex because 89 00:03:11,724 --> 00:03:13,424 at the time, it was the only, 90 00:03:14,460 --> 00:03:15,439 device, yeah, 91 00:03:16,139 --> 00:03:18,719 in that realm, that that one code. 92 00:03:19,500 --> 00:03:21,840 It's now expanded to include other, 93 00:03:22,379 --> 00:03:24,639 devices that are seeking FDA approval, 94 00:03:25,099 --> 00:03:26,000 but it remains 95 00:03:26,564 --> 00:03:27,064 undervalued. 96 00:03:28,084 --> 00:03:29,384 And because it was undervalued, 97 00:03:29,685 --> 00:03:30,985 the Coflex device 98 00:03:31,284 --> 00:03:31,784 flatlined 99 00:03:32,485 --> 00:03:33,705 relative to sales. 100 00:03:34,644 --> 00:03:35,144 And 101 00:03:37,125 --> 00:03:38,405 because of its 102 00:03:39,370 --> 00:03:40,670 of it being bundled 103 00:03:41,450 --> 00:03:42,590 rightly or wrongly, 104 00:03:43,530 --> 00:03:45,230 it puts it at odds 105 00:03:45,689 --> 00:03:48,510 with codes that are called sacred cows that 106 00:03:49,050 --> 00:03:51,950 some entrenched societies don't want touched, 107 00:03:52,854 --> 00:03:55,574 potentially, in terms of reconsideration through the RUC 108 00:03:55,574 --> 00:03:56,074 process. 109 00:03:56,534 --> 00:03:59,514 And as such, when this code is analyzed, 110 00:04:00,375 --> 00:04:01,354 let's just say, 111 00:04:01,974 --> 00:04:02,715 it's not 112 00:04:03,735 --> 00:04:05,194 shown in the best light, 113 00:04:05,750 --> 00:04:07,289 and the work's not appreciated. 114 00:04:08,310 --> 00:04:08,810 The 115 00:04:09,750 --> 00:04:11,289 intensity is not appreciated. 116 00:04:11,830 --> 00:04:14,489 I think the newer products that are developing 117 00:04:14,709 --> 00:04:16,330 under this under this code 118 00:04:16,709 --> 00:04:17,209 descriptor, 119 00:04:18,334 --> 00:04:20,894 actually involve more time than the Coflex. And, 120 00:04:20,894 --> 00:04:21,394 hopefully, 121 00:04:22,254 --> 00:04:23,875 we can get that reassessed 122 00:04:24,574 --> 00:04:26,334 in the near future. That's a goal of 123 00:04:26,334 --> 00:04:26,834 mine. 124 00:04:27,214 --> 00:04:28,115 Mhmm. Another 125 00:04:28,894 --> 00:04:30,834 code out there would be the code for 126 00:04:31,189 --> 00:04:33,209 endoscopic lumbar spinal decompression, 127 00:04:33,990 --> 00:04:36,470 which was recognized to have an intensity that 128 00:04:36,470 --> 00:04:38,490 superseded almost everything in spine. 129 00:04:38,870 --> 00:04:39,689 And, frankly, 130 00:04:40,310 --> 00:04:43,350 the current review process was such that it 131 00:04:43,350 --> 00:04:45,050 couldn't adequately be assessed. 132 00:04:45,634 --> 00:04:45,954 And, 133 00:04:46,595 --> 00:04:48,294 CMS rightly made a decision 134 00:04:48,834 --> 00:04:50,055 that it was beyond, 135 00:04:50,995 --> 00:04:51,735 the AMA, 136 00:04:52,754 --> 00:04:54,675 and that each surgeon was going to have 137 00:04:54,675 --> 00:04:55,175 to 138 00:04:56,115 --> 00:04:56,615 negotiate 139 00:04:57,394 --> 00:04:58,854 a payment plan with 140 00:04:59,154 --> 00:04:59,975 each insurer. 141 00:05:01,120 --> 00:05:03,040 And that makes it kind of an untidy 142 00:05:03,040 --> 00:05:04,639 situation to manage, but it was at least 143 00:05:04,639 --> 00:05:05,139 better 144 00:05:05,600 --> 00:05:06,740 than what the alternative 145 00:05:07,040 --> 00:05:09,379 was. And I think we need to have 146 00:05:10,000 --> 00:05:11,379 a plan in place 147 00:05:12,000 --> 00:05:12,899 that pays 148 00:05:13,199 --> 00:05:13,699 parity, 149 00:05:14,745 --> 00:05:15,485 meaning that 150 00:05:16,024 --> 00:05:17,165 if a procedure 151 00:05:17,785 --> 00:05:19,245 achieves the same goal, 152 00:05:19,785 --> 00:05:21,004 improves outcome, 153 00:05:22,345 --> 00:05:23,404 lessens cost, 154 00:05:24,264 --> 00:05:26,205 why can't we reward the surgeon 155 00:05:26,904 --> 00:05:27,805 rather than 156 00:05:28,589 --> 00:05:29,089 torture 157 00:05:29,550 --> 00:05:32,370 him by literally paying him less 158 00:05:32,910 --> 00:05:35,089 and driving him away from providing, 159 00:05:35,949 --> 00:05:36,449 that 160 00:05:37,709 --> 00:05:38,850 treatment, that 161 00:05:39,310 --> 00:05:41,730 potentially wonderful outcome for his patient? 162 00:05:42,404 --> 00:05:45,285 We try to provide patient centered care, and 163 00:05:45,285 --> 00:05:46,504 we're currently prohibited 164 00:05:47,205 --> 00:05:49,545 from doing so with the current payment model. 165 00:05:50,085 --> 00:05:50,585 Mhmm. 166 00:05:50,964 --> 00:05:53,045 And then you also were talking about the 167 00:05:53,045 --> 00:05:55,145 idea, you know, making sure that reimbursements 168 00:05:55,685 --> 00:05:58,160 keep on pace with innovation. I know, like, 169 00:05:58,160 --> 00:06:01,920 for technologies like disc replacement, it's taken some 170 00:06:01,920 --> 00:06:05,120 time for insurers to catch up with that 171 00:06:05,120 --> 00:06:05,620 technology. 172 00:06:06,240 --> 00:06:07,620 So I'm wondering, you know, 173 00:06:08,160 --> 00:06:10,819 of some of the newer spine surgery innovations 174 00:06:10,959 --> 00:06:11,699 out there, 175 00:06:12,455 --> 00:06:14,154 which do you think will see, 176 00:06:14,694 --> 00:06:15,675 you know, payers 177 00:06:16,935 --> 00:06:17,435 reimburse 178 00:06:18,375 --> 00:06:21,014 it sooner, and which ones might be more 179 00:06:21,014 --> 00:06:23,675 of a challenge to get coverage for? 180 00:06:24,870 --> 00:06:25,370 Well, 181 00:06:25,910 --> 00:06:28,229 that's a good question, Carly. I think that, 182 00:06:29,029 --> 00:06:29,930 these posterior, 183 00:06:32,310 --> 00:06:35,209 truly totally posterior spine procedures because, 184 00:06:35,990 --> 00:06:36,490 they 185 00:06:37,384 --> 00:06:37,884 circumnavigate 186 00:06:38,425 --> 00:06:38,925 or 187 00:06:40,105 --> 00:06:42,365 negate the potential for the need for a, 188 00:06:43,064 --> 00:06:44,365 cosurgeon will 189 00:06:44,824 --> 00:06:47,644 clearly identify all the work that's done, 190 00:06:48,345 --> 00:06:48,845 with 191 00:06:49,545 --> 00:06:52,285 these procedures. And I'm hoping as such 192 00:06:53,389 --> 00:06:53,889 that, 193 00:06:54,430 --> 00:06:57,970 the aura views generated will match the actual 194 00:06:58,750 --> 00:07:01,329 work form by performed by the surgeon 195 00:07:02,349 --> 00:07:03,089 with the 196 00:07:03,550 --> 00:07:04,050 anterior, 197 00:07:04,829 --> 00:07:08,050 disc replacements, at least lumbar. Many surgeons require 198 00:07:09,014 --> 00:07:10,154 an access surgeon, 199 00:07:10,535 --> 00:07:12,615 and I'm not so sure, frankly, that the 200 00:07:12,615 --> 00:07:13,115 RVUs, 201 00:07:14,535 --> 00:07:16,154 no matter how they're divvied up, 202 00:07:17,414 --> 00:07:17,914 or, 203 00:07:18,535 --> 00:07:19,894 adequately covering the, 204 00:07:20,615 --> 00:07:23,014 surgeons that is both of them involved in 205 00:07:23,014 --> 00:07:23,754 that process. 206 00:07:24,870 --> 00:07:26,410 So that that's one issue. 207 00:07:27,189 --> 00:07:29,689 I think you said what what might find, 208 00:07:30,949 --> 00:07:32,330 problems moving forward. 209 00:07:33,230 --> 00:07:33,730 It 210 00:07:34,069 --> 00:07:35,770 there is a ever 211 00:07:37,030 --> 00:07:37,530 enlarging 212 00:07:39,514 --> 00:07:40,014 overlap 213 00:07:41,435 --> 00:07:42,334 of orthoneurospine 214 00:07:43,514 --> 00:07:44,495 with pain, 215 00:07:44,954 --> 00:07:46,175 and there are technologies 216 00:07:46,714 --> 00:07:47,615 that are developing, 217 00:07:48,794 --> 00:07:50,574 that are used by both. 218 00:07:51,754 --> 00:07:52,254 And 219 00:07:53,920 --> 00:07:54,420 that 220 00:07:55,360 --> 00:07:57,040 in the past was dealt with in a 221 00:07:57,040 --> 00:07:59,040 more collaborative fashion, but it has become more 222 00:07:59,040 --> 00:07:59,939 of a turf 223 00:08:00,240 --> 00:08:02,580 war, but it is inevitable that there, 224 00:08:03,279 --> 00:08:04,339 will be folks 225 00:08:04,879 --> 00:08:06,240 from multiple fields, 226 00:08:07,254 --> 00:08:08,795 performing some of these procedures. 227 00:08:09,814 --> 00:08:11,194 And if they're done, 228 00:08:12,295 --> 00:08:12,795 percutaneously, 229 00:08:14,375 --> 00:08:15,275 I would suggest 230 00:08:16,055 --> 00:08:19,095 that if they achieve the same goal with 231 00:08:19,095 --> 00:08:19,754 the same 232 00:08:20,259 --> 00:08:23,560 outcome, with the same benefit, and they actually 233 00:08:23,620 --> 00:08:24,839 decrease cost, 234 00:08:25,539 --> 00:08:27,779 well, my god, they ought to be paid 235 00:08:27,779 --> 00:08:28,599 with parity, 236 00:08:30,099 --> 00:08:30,599 rather, 237 00:08:31,300 --> 00:08:32,120 than again, 238 00:08:34,524 --> 00:08:36,625 pay, that poor surgeon 239 00:08:37,245 --> 00:08:38,304 or proceduralist 240 00:08:38,764 --> 00:08:39,264 less, 241 00:08:40,125 --> 00:08:41,504 to achieve that end. 242 00:08:43,404 --> 00:08:45,325 Well, thank you for breaking that down. And 243 00:08:45,325 --> 00:08:47,665 I had a couple other questions for you. 244 00:08:47,980 --> 00:08:49,419 You know, kind of bouncing off what we're 245 00:08:49,419 --> 00:08:51,340 talking about just now. Can you talk about 246 00:08:51,340 --> 00:08:53,820 some of the spine innovations in general that 247 00:08:53,820 --> 00:08:55,120 are exciting you? 248 00:08:55,500 --> 00:08:56,000 Yes. 249 00:08:56,940 --> 00:08:57,840 Spine surgery, 250 00:08:58,460 --> 00:09:01,475 is an exciting phase of transformation currently. Disc 251 00:09:05,534 --> 00:09:06,034 regeneration, 252 00:09:07,375 --> 00:09:10,495 but also disc repair. We're closer than ever 253 00:09:10,495 --> 00:09:13,615 to restoring function instead of just stabilizing the 254 00:09:13,615 --> 00:09:14,115 spine, 255 00:09:14,660 --> 00:09:17,080 and that is a paradigm shift. 256 00:09:17,620 --> 00:09:20,019 Another example is three d printing for custom 257 00:09:20,019 --> 00:09:20,519 implants. 258 00:09:21,220 --> 00:09:23,480 These personalized three d printed 259 00:09:24,100 --> 00:09:26,759 implants match a patient's unique anatomy 260 00:09:27,139 --> 00:09:28,679 and are improving outcomes 261 00:09:29,595 --> 00:09:30,975 and reducing complications. 262 00:09:33,674 --> 00:09:36,074 Another thing that stands out is AI and 263 00:09:36,074 --> 00:09:37,294 its predictive analytics. 264 00:09:37,754 --> 00:09:41,274 Everybody's talking about it. Artificial intelligence is helping 265 00:09:41,274 --> 00:09:42,414 us to plan surgeries, 266 00:09:43,320 --> 00:09:43,820 assess 267 00:09:44,360 --> 00:09:47,820 risk, and personalized treatments like never before. 268 00:09:48,600 --> 00:09:49,100 Mhmm. 269 00:09:49,720 --> 00:09:53,899 And endoscopic and minimally invasive techniques are becoming 270 00:09:53,960 --> 00:09:54,460 adopted 271 00:09:54,840 --> 00:09:56,940 at a faster rate here in The US. 272 00:09:57,554 --> 00:09:59,654 The trends towards smaller incisions, 273 00:10:00,434 --> 00:10:03,554 faster recovery, and precision based procedures is only 274 00:10:03,554 --> 00:10:05,174 going to accelerate further. 275 00:10:06,195 --> 00:10:08,035 One of the most exciting shifts we're seeing 276 00:10:08,035 --> 00:10:10,350 in spine surgery is something I mentioned earlier 277 00:10:10,350 --> 00:10:13,410 is the rise of posterior motion preserving solutions 278 00:10:14,029 --> 00:10:15,410 like the TOPS system 279 00:10:15,790 --> 00:10:17,730 and three Spine's MODIS device. 280 00:10:18,590 --> 00:10:20,690 What makes these technologies so compelling 281 00:10:21,070 --> 00:10:22,670 is they allow us to work in a 282 00:10:22,670 --> 00:10:23,170 familiar, 283 00:10:23,745 --> 00:10:25,365 recumbent prone position, 284 00:10:26,065 --> 00:10:27,764 total posterior spine, 285 00:10:29,024 --> 00:10:31,044 optimizing direct open decompression 286 00:10:31,664 --> 00:10:34,245 while also unloading the posterior facets, 287 00:10:34,865 --> 00:10:36,085 effectively addressing 288 00:10:36,544 --> 00:10:39,044 what is truly a three column problem. 289 00:10:39,879 --> 00:10:41,339 Rather than rigid fixation, 290 00:10:41,959 --> 00:10:44,379 these implants restore controlled motion, 291 00:10:45,320 --> 00:10:47,899 offering patients an alternative to fusion 292 00:10:48,360 --> 00:10:49,740 while maintaining stability 293 00:10:50,199 --> 00:10:50,940 and function. 294 00:10:51,735 --> 00:10:54,794 It's a natural evolution in how we think 295 00:10:55,095 --> 00:10:56,315 about spinal reconstruction. 296 00:10:57,335 --> 00:11:01,115 This challenge now the challenge now is integrating 297 00:11:01,174 --> 00:11:01,914 these advancements 298 00:11:02,294 --> 00:11:03,754 into mainstream practice 299 00:11:04,214 --> 00:11:07,115 and ensuring payers recognize the value. 300 00:11:08,429 --> 00:11:11,470 Those are all very exciting trends you're talking 301 00:11:11,470 --> 00:11:13,309 about here, especially when it comes to things 302 00:11:13,309 --> 00:11:16,669 like personalized medicine and, you know, using AI 303 00:11:16,669 --> 00:11:17,169 to 304 00:11:17,549 --> 00:11:19,009 support, you know, just 305 00:11:19,309 --> 00:11:21,970 better outcomes for patients. And 306 00:11:22,445 --> 00:11:24,465 my last question, doctor L'Oreal, 307 00:11:25,004 --> 00:11:27,664 when you think about the payer physician relationship, 308 00:11:28,125 --> 00:11:30,284 how do you think it will change? How 309 00:11:30,284 --> 00:11:31,965 do you want it to change? And are 310 00:11:31,965 --> 00:11:33,345 you optimistic or 311 00:11:33,804 --> 00:11:35,664 nervous about it? 312 00:11:37,379 --> 00:11:40,659 There are some things, frankly, that, have, popped 313 00:11:40,659 --> 00:11:42,899 up very recently that I can't speak out 314 00:11:42,899 --> 00:11:43,620 to, but, 315 00:11:44,419 --> 00:11:45,159 the insurers 316 00:11:46,179 --> 00:11:46,679 now 317 00:11:47,139 --> 00:11:47,639 realize 318 00:11:48,914 --> 00:11:50,615 that their customers 319 00:11:52,034 --> 00:11:54,054 know what's been going on. 320 00:11:54,754 --> 00:11:56,534 Mhmm. And that's come, 321 00:11:57,075 --> 00:11:58,855 to their realization recently. 322 00:11:59,715 --> 00:12:01,235 And I don't really wanna go into details 323 00:12:01,235 --> 00:12:03,154 further. I think everybody knows what I'm talking 324 00:12:03,154 --> 00:12:03,654 about. 325 00:12:04,299 --> 00:12:06,559 But, the CEOs from 326 00:12:07,019 --> 00:12:09,199 the five major payers are aware, 327 00:12:10,139 --> 00:12:12,480 that they're gonna need to deliver something, 328 00:12:13,740 --> 00:12:14,240 to, 329 00:12:14,940 --> 00:12:16,319 their customer patients 330 00:12:16,904 --> 00:12:19,565 if this current insurance game is to continue. 331 00:12:20,664 --> 00:12:22,204 So I'm cautiously optimistic, 332 00:12:22,745 --> 00:12:24,184 but I know we still have work to 333 00:12:24,184 --> 00:12:27,164 do. Right now, the pair of physician relationship 334 00:12:27,865 --> 00:12:29,404 feels like an uphill battle, 335 00:12:30,190 --> 00:12:32,029 especially when it comes to newer treatments like 336 00:12:32,029 --> 00:12:33,090 total disc replacement 337 00:12:33,550 --> 00:12:34,290 or regenerative 338 00:12:34,750 --> 00:12:35,250 therapies. 339 00:12:36,190 --> 00:12:37,730 That said, we're seeing progress. 340 00:12:38,430 --> 00:12:40,370 The data is becoming undeniable. 341 00:12:41,070 --> 00:12:43,009 Motion preservation and biologics 342 00:12:43,310 --> 00:12:45,250 aren't just experimental anymore. 343 00:12:45,554 --> 00:12:46,855 They're frankly essential. 344 00:12:47,475 --> 00:12:49,875 We need insurers to take a long term 345 00:12:49,875 --> 00:12:50,375 view 346 00:12:50,835 --> 00:12:53,014 instead of just looking at upfront cost. 347 00:12:53,554 --> 00:12:55,335 A well placed disc replacement 348 00:12:55,794 --> 00:12:59,414 or regenerative procedure can now prevent bigger, costlier 349 00:12:59,554 --> 00:13:00,054 interventions 350 00:13:00,679 --> 00:13:01,579 down the line. 351 00:13:02,440 --> 00:13:04,539 ICS continues to push for these changes, 352 00:13:04,919 --> 00:13:06,779 advocating not just for new technology, 353 00:13:07,240 --> 00:13:09,399 but for the reimbursement of policies that will 354 00:13:09,399 --> 00:13:11,579 allow patients to access them. 355 00:13:11,959 --> 00:13:13,339 It's a long game, 356 00:13:13,879 --> 00:13:15,480 but I believe we're moving in the right 357 00:13:15,480 --> 00:13:15,980 direction. 358 00:13:16,894 --> 00:13:19,554 Well, I'm glad to hear that you're sounding 359 00:13:19,774 --> 00:13:22,274 overall optimistic about things despite 360 00:13:22,654 --> 00:13:23,795 any challenges. 361 00:13:24,575 --> 00:13:26,575 And I wanna thank you for joining us 362 00:13:26,575 --> 00:13:28,892 today on the podcast, doctor L'Oreal. It's been 363 00:13:28,892 --> 00:13:30,832 a pleasure to speak with you as always, 364 00:13:30,892 --> 00:13:32,892 and I hope we can connect again down 365 00:13:32,892 --> 00:13:35,472 the line. Thank you, Crowley, for having me.