This is Alan Condon with the Becker's
ASC podcast,
and I'm thrilled to be joined today by
doctor Praveen Reddy, a fellowship trained neurosurgeon
surgeon who has performed
nearly 3,000
minimally invasive surgeries,
six hundred of which I believe are robotic
surgeries. Doctor Eddy is also the CEO of
the Center for Minimally Invasive Neurosurgery
in Conroe, Texas.
Doctor Eddy, I hope I got that right.
For those of our listeners who mightn't be
as familiar with you or your practice, do
you mind giving us a little bit more
insight into your role and your background?
Yeah. Basically, I'm a board certified neurosurgeon
and,
have done,
in my time in academics and have been
in practice for many years now.
And over the years, I kind of basically
have improved
the techniques of delivering
spine surgery through minimally invasive approaches,
smaller incisions,
very little blood loss, quicker recovery,
excellent outcomes.
And,
on patients where we made a determination
that the patients have exhausted
every other nonsurgical
option,
that is when we make we proceed with
these minimally invasive surgeries.
And they've they've excellent outcomes, and it's it's
kind of fun to help people with this
kind of surgery.
Yeah. Absolutely. And I'm kinda excited to kinda
dive a little bit deeper into that. So,
doctor Reddy, what what are kind of, the
two or three kind of key trends that
you're paying close attention to today? Whether it's
in the space of minimally invasive spine surgery,
in the SC space, what are you kinda
most paying attention to and why?
Well, I think I'm kinda paying more attention
to the surgical part is the easy part.
What I need, I think, paying attention to
is the,
the response by the payers
and the
response from both commercial payers, the government,
CMS,
and Medicaid on how
procedures are reimbursed. And
I have a master's in health care leadership
currently. I'm working on it through Brown University,
and I'm kind of very passionate about
value based care
or shared savings agreements, if you will.
I think a lot of these fine procedures
can be done in an ambulatory settings,
and
we can save substantial costs.
You know, I've done that for my
school masters, I actually had to do a
CCP project, a capstone project.
And I realized we can actually save,
for about
thousand surgeries,
about $16,000,000,
on an average in a year,
by just
relocating
point of care from,
a hospital acute care hospital setting to an
ambulatory
surgery center.
And
another space I'm kind of very keen on
looking at is about 30¢ on the dollar
is spent on post acute care.
And we gotta make a very concerted effort
as physicians to avoid readmissions,
infections, things like that, to kind of reduce
cost of care. Physicians have to be a
part of the solution
and reducing the total cost of care. At
this point, I think
one fifth our US economy, the the budgeted
dollars every year are spent on health care.
We cannot continue to do that. We gotta
make a change.
Absolutely. And kinda ties right back into, like,
value based care. I'm happy you brought it
up. It's kinda I'd love to kinda pry
a little bit deeper there. I think, you
know, value based care is such a broad
term. There's so much going on there we
could talk about. But when I think about
what are the key areas in spine surgery
where you see the biggest opportunities for growth?
Is direct to employer contract something you're you're
thinking about you're seeing? I'd be curious to
hear what are the key areas of value
based care that you see the biggest opportunities.
I think, you know, you gotta look at
it multiple fronts.
One is tackle it with accountable care organizations
and be responsible for a certain population.
And, basically, you are the,
I mean, you're the guard at the gate.
You make a determination whether this patient do
a six weeks of therapy.
Does it make sense to do an epidural
injection?
Is this a self resolving problem?
Or, you know, there's a lot of dollars
spent on unnecessary
care
and having a board certified neurosurgeon,
kind of, you know, watching what's happening with
the patients so that
we're not doing unnecessary
dollars spent at the same time or making
sure patient outcomes are well maintained.
So from an ACO standpoint
or with large commercial payers, you can have
a shared savings agreement.
Like in a market like Houston,
I take care of patients on the North
Side Of Houston and the Northeast Side Of
Houston.
And, you know, the rest of Houston can
be the control population,
and I am the, study population. And,
and if I'm able to save,
expenses, at the same time, maintain quality of
care,
the savings,
I think, should be say was shared with
the providers and the health systems involved.
Mhmm. That's one modality. Another modality is have
an upfront shared savings agreement,
with
with all payers.
You're responsible for the quality.
You can either look at upside downside risk
or just,
you know, I I think a two way
risk model is probably the an option which
you should,
look at so that the even the payers
have
a clear appetite towards moving towards do that
direction.
Mhmm. Are you seeing more
spine providers, more orthopedic providers, particularly on the
independent side? And equally, maybe on the payer
side, is there more of an appetite to
get involved in some of these value based
agreements now? Are you seeing any sort of
a change over over recent years? Not really.
I think, me, because of my background and
master's in health care leadership,
I'm kind of very, very keen on establishing
certain patterns of at least creating an ecosystem
for value based care. We gotta create centers
of for excellence for spine surgery,
where we act as accountable people and o
accountable organizations.
We're responsible for controlling cost of care, and
at the same time maintaining quality of care.
And,
we just get reimbursed for being accountable.
Mhmm.
Doctor Eddie, I'd be curious to hear that's
obviously one key area of growth, one area
of focus for a lot of spine providers.
Well, many like yourself really on the forefront
of that area.
What are you most excited about at the
moment? Whether you're coming at this question from
a technology standpoint, from your practice, kind of
there's so much we could tackle here, but
curious to hear your thoughts on this.
I think, you know,
the the one of the things which we
are in America, we're kinda lacking is adopting
endoscopic spine surgery.
Our counterparts in Europe and Asia have been
doing this for years.
It's not rocket science. Most neurosurgeons know how
to use an endoscope.
The only reason is there's,
for making the payers make a change to
Rheembers endoscopic surgery.
If you're not getting Rheembers, there's no motivation
for anyone to learn.
And endoscopic surgery, middle main laser surgery, robotic
surgery, I mean, these are things which we
have to adopt
to make spine surgery safer, efficient,
and less
have as few complications as possible.
Yeah. I mean, so, the things that we
often hear from spine surgeons is
the the shackles with reimbursement around endoscopic spine
surgery, potential lack of training
forms, and and I have heard about a
somewhat steep learning curve initially. But to your
point,
nothing that's from a neurosurgeon
standpoint. But when you think about lower complication
rates, lowering the ultimate cost of care, it
seems like a no brainer. What what do
you think is the real hold up here?
Is it just the short answer down to
the payers ultimately?
Yeah. I mean, their change is very slow
in America, and,
there's bureaucratic
impediments are,
as long as the bureaucracy and the impediments
are designed to keep people safe, it's okay.
But when it delays,
technology and improvements
and innovation,
then we gotta look at other ways to
kinda circumvent it. There's really no,
try reaching CMS. I mean, there's no way
to reach CMS.
Yeah. Yeah. Hopefully, we'll see.
Maybe maybe some change coming down the pipeline.
But like you said, it's been widely used
in the likes of Korea and Europe for
so for so long.
US, which is usually on the forefront of
a lot of these surgical innovations, somewhat behind
when it comes to endoscopic spine surgery, it
seems.
Yeah.
Doctor Reddy, a last question for you while
I let you go. I'd love to hear
a little bit more about your practice. Kind
of how are you thinking about growth over
the next twelve to twenty four months or
so?
Yeah. I think I'm, I'm working on collaborating
with the large local ACOs, accountable care organizations,
to see if we can kinda come up
with a shared savings agreement. And,
with my capstone project, I'm hoping I have
the numbers through open care data
on what these commercial payers are spending
and, for providing care for these patients. I
think we have a an excellent product where
we can provide high quality care,
same or better outcomes
with,
reduced cost of care.
So, hopefully, I'll be able to negotiate these
contracts in the coming
six to twelve months.
Got it. Fantastic. Well, certainly,
fascinating to kinda have you in the podcast,
be able to pick your reins a little
bit, some of those key area of focus
for you, your practice.
Doctor Reddy, it's been an absolute pleasure. Thank
you so much for joining us today, and
I look forward to connect with you again
down the line. Sounds great. Good talking to
you. Have a wonderful day.