1 00:00:00,320 --> 00:00:02,659 This is Alan Condon with the Becker's 2 00:00:02,960 --> 00:00:04,179 ASC podcast, 3 00:00:04,559 --> 00:00:06,799 and I'm thrilled to be joined today by 4 00:00:06,799 --> 00:00:09,779 doctor Praveen Reddy, a fellowship trained neurosurgeon 5 00:00:10,320 --> 00:00:11,539 surgeon who has performed 6 00:00:11,839 --> 00:00:13,219 nearly 3,000 7 00:00:13,279 --> 00:00:15,059 minimally invasive surgeries, 8 00:00:15,675 --> 00:00:18,074 six hundred of which I believe are robotic 9 00:00:18,074 --> 00:00:20,795 surgeries. Doctor Eddy is also the CEO of 10 00:00:20,795 --> 00:00:23,214 the Center for Minimally Invasive Neurosurgery 11 00:00:23,835 --> 00:00:25,214 in Conroe, Texas. 12 00:00:25,595 --> 00:00:27,535 Doctor Eddy, I hope I got that right. 13 00:00:28,289 --> 00:00:30,689 For those of our listeners who mightn't be 14 00:00:30,689 --> 00:00:33,329 as familiar with you or your practice, do 15 00:00:33,329 --> 00:00:34,609 you mind giving us a little bit more 16 00:00:34,609 --> 00:00:36,149 insight into your role and your background? 17 00:00:36,929 --> 00:00:39,509 Yeah. Basically, I'm a board certified neurosurgeon 18 00:00:39,890 --> 00:00:40,390 and, 19 00:00:41,009 --> 00:00:41,729 have done, 20 00:00:42,289 --> 00:00:44,244 in my time in academics and have been 21 00:00:44,244 --> 00:00:46,344 in practice for many years now. 22 00:00:46,725 --> 00:00:49,145 And over the years, I kind of basically 23 00:00:49,445 --> 00:00:50,185 have improved 24 00:00:50,885 --> 00:00:52,505 the techniques of delivering 25 00:00:52,885 --> 00:00:55,545 spine surgery through minimally invasive approaches, 26 00:00:56,310 --> 00:00:57,130 smaller incisions, 27 00:00:57,750 --> 00:01:00,090 very little blood loss, quicker recovery, 28 00:01:00,789 --> 00:01:01,850 excellent outcomes. 29 00:01:02,549 --> 00:01:03,049 And, 30 00:01:04,549 --> 00:01:06,650 on patients where we made a determination 31 00:01:07,430 --> 00:01:09,209 that the patients have exhausted 32 00:01:10,215 --> 00:01:11,355 every other nonsurgical 33 00:01:11,814 --> 00:01:12,314 option, 34 00:01:12,935 --> 00:01:15,974 that is when we make we proceed with 35 00:01:15,974 --> 00:01:17,834 these minimally invasive surgeries. 36 00:01:18,215 --> 00:01:21,174 And they've they've excellent outcomes, and it's it's 37 00:01:21,174 --> 00:01:23,254 kind of fun to help people with this 38 00:01:23,254 --> 00:01:24,155 kind of surgery. 39 00:01:25,170 --> 00:01:27,170 Yeah. Absolutely. And I'm kinda excited to kinda 40 00:01:27,170 --> 00:01:29,349 dive a little bit deeper into that. So, 41 00:01:29,489 --> 00:01:31,650 doctor Reddy, what what are kind of, the 42 00:01:31,650 --> 00:01:33,730 two or three kind of key trends that 43 00:01:33,730 --> 00:01:35,810 you're paying close attention to today? Whether it's 44 00:01:35,810 --> 00:01:38,150 in the space of minimally invasive spine surgery, 45 00:01:38,284 --> 00:01:40,045 in the SC space, what are you kinda 46 00:01:40,045 --> 00:01:41,745 most paying attention to and why? 47 00:01:42,685 --> 00:01:45,005 Well, I think I'm kinda paying more attention 48 00:01:45,005 --> 00:01:47,185 to the surgical part is the easy part. 49 00:01:48,204 --> 00:01:50,525 What I need, I think, paying attention to 50 00:01:50,525 --> 00:01:51,325 is the, 51 00:01:51,980 --> 00:01:54,079 the response by the payers 52 00:01:55,020 --> 00:01:56,239 and the 53 00:01:56,540 --> 00:01:59,040 response from both commercial payers, the government, 54 00:01:59,500 --> 00:02:00,000 CMS, 55 00:02:00,299 --> 00:02:01,920 and Medicaid on how 56 00:02:03,500 --> 00:02:05,599 procedures are reimbursed. And 57 00:02:06,215 --> 00:02:08,314 I have a master's in health care leadership 58 00:02:08,375 --> 00:02:11,115 currently. I'm working on it through Brown University, 59 00:02:11,735 --> 00:02:14,074 and I'm kind of very passionate about 60 00:02:14,375 --> 00:02:15,754 value based care 61 00:02:16,135 --> 00:02:19,194 or shared savings agreements, if you will. 62 00:02:19,895 --> 00:02:22,189 I think a lot of these fine procedures 63 00:02:22,409 --> 00:02:24,669 can be done in an ambulatory settings, 64 00:02:25,450 --> 00:02:25,950 and 65 00:02:26,569 --> 00:02:28,750 we can save substantial costs. 66 00:02:29,210 --> 00:02:31,710 You know, I've done that for my 67 00:02:32,645 --> 00:02:35,044 school masters, I actually had to do a 68 00:02:35,044 --> 00:02:37,385 CCP project, a capstone project. 69 00:02:38,085 --> 00:02:40,344 And I realized we can actually save, 70 00:02:41,125 --> 00:02:42,025 for about 71 00:02:43,125 --> 00:02:44,185 thousand surgeries, 72 00:02:44,909 --> 00:02:46,849 about $16,000,000, 73 00:02:47,949 --> 00:02:49,409 on an average in a year, 74 00:02:50,750 --> 00:02:51,489 by just 75 00:02:52,189 --> 00:02:52,689 relocating 76 00:02:53,389 --> 00:02:54,930 point of care from, 77 00:02:57,064 --> 00:02:58,745 a hospital acute care hospital setting to an 78 00:02:58,745 --> 00:02:59,245 ambulatory 79 00:03:00,025 --> 00:03:00,925 surgery center. 80 00:03:01,625 --> 00:03:02,125 And 81 00:03:02,425 --> 00:03:04,745 another space I'm kind of very keen on 82 00:03:04,745 --> 00:03:07,305 looking at is about 30ยข on the dollar 83 00:03:07,305 --> 00:03:09,085 is spent on post acute care. 84 00:03:09,699 --> 00:03:12,500 And we gotta make a very concerted effort 85 00:03:12,500 --> 00:03:15,080 as physicians to avoid readmissions, 86 00:03:16,099 --> 00:03:18,580 infections, things like that, to kind of reduce 87 00:03:18,580 --> 00:03:20,819 cost of care. Physicians have to be a 88 00:03:20,819 --> 00:03:21,800 part of the solution 89 00:03:22,335 --> 00:03:24,574 and reducing the total cost of care. At 90 00:03:24,574 --> 00:03:25,794 this point, I think 91 00:03:26,175 --> 00:03:29,534 one fifth our US economy, the the budgeted 92 00:03:29,534 --> 00:03:31,955 dollars every year are spent on health care. 93 00:03:32,415 --> 00:03:34,895 We cannot continue to do that. We gotta 94 00:03:34,895 --> 00:03:35,715 make a change. 95 00:03:36,509 --> 00:03:39,310 Absolutely. And kinda ties right back into, like, 96 00:03:39,310 --> 00:03:40,909 value based care. I'm happy you brought it 97 00:03:40,909 --> 00:03:42,349 up. It's kinda I'd love to kinda pry 98 00:03:42,349 --> 00:03:44,509 a little bit deeper there. I think, you 99 00:03:44,509 --> 00:03:46,110 know, value based care is such a broad 100 00:03:46,110 --> 00:03:47,629 term. There's so much going on there we 101 00:03:47,629 --> 00:03:50,014 could talk about. But when I think about 102 00:03:50,074 --> 00:03:52,254 what are the key areas in spine surgery 103 00:03:52,314 --> 00:03:55,294 where you see the biggest opportunities for growth? 104 00:03:55,435 --> 00:03:57,834 Is direct to employer contract something you're you're 105 00:03:57,834 --> 00:03:59,675 thinking about you're seeing? I'd be curious to 106 00:03:59,675 --> 00:04:01,514 hear what are the key areas of value 107 00:04:01,514 --> 00:04:03,294 based care that you see the biggest opportunities. 108 00:04:04,080 --> 00:04:05,439 I think, you know, you gotta look at 109 00:04:05,439 --> 00:04:06,580 it multiple fronts. 110 00:04:07,199 --> 00:04:10,099 One is tackle it with accountable care organizations 111 00:04:10,560 --> 00:04:12,739 and be responsible for a certain population. 112 00:04:13,680 --> 00:04:16,019 And, basically, you are the, 113 00:04:16,399 --> 00:04:18,004 I mean, you're the guard at the gate. 114 00:04:18,004 --> 00:04:20,485 You make a determination whether this patient do 115 00:04:20,485 --> 00:04:22,104 a six weeks of therapy. 116 00:04:22,485 --> 00:04:24,264 Does it make sense to do an epidural 117 00:04:24,324 --> 00:04:24,824 injection? 118 00:04:25,125 --> 00:04:27,224 Is this a self resolving problem? 119 00:04:27,685 --> 00:04:30,420 Or, you know, there's a lot of dollars 120 00:04:30,420 --> 00:04:31,639 spent on unnecessary 121 00:04:32,100 --> 00:04:32,600 care 122 00:04:32,900 --> 00:04:35,160 and having a board certified neurosurgeon, 123 00:04:36,259 --> 00:04:38,660 kind of, you know, watching what's happening with 124 00:04:38,660 --> 00:04:39,879 the patients so that 125 00:04:40,180 --> 00:04:41,560 we're not doing unnecessary 126 00:04:41,860 --> 00:04:44,115 dollars spent at the same time or making 127 00:04:44,115 --> 00:04:46,055 sure patient outcomes are well maintained. 128 00:04:46,514 --> 00:04:48,375 So from an ACO standpoint 129 00:04:48,915 --> 00:04:51,634 or with large commercial payers, you can have 130 00:04:51,634 --> 00:04:53,415 a shared savings agreement. 131 00:04:53,955 --> 00:04:55,574 Like in a market like Houston, 132 00:04:55,939 --> 00:04:57,699 I take care of patients on the North 133 00:04:57,699 --> 00:04:59,939 Side Of Houston and the Northeast Side Of 134 00:04:59,939 --> 00:05:00,439 Houston. 135 00:05:01,060 --> 00:05:04,099 And, you know, the rest of Houston can 136 00:05:04,099 --> 00:05:05,399 be the control population, 137 00:05:05,939 --> 00:05:08,919 and I am the, study population. And, 138 00:05:10,384 --> 00:05:12,805 and if I'm able to save, 139 00:05:14,225 --> 00:05:16,785 expenses, at the same time, maintain quality of 140 00:05:16,785 --> 00:05:17,285 care, 141 00:05:17,745 --> 00:05:18,485 the savings, 142 00:05:18,865 --> 00:05:21,025 I think, should be say was shared with 143 00:05:21,025 --> 00:05:23,444 the providers and the health systems involved. 144 00:05:24,310 --> 00:05:27,669 Mhmm. That's one modality. Another modality is have 145 00:05:27,669 --> 00:05:29,689 an upfront shared savings agreement, 146 00:05:31,589 --> 00:05:32,089 with 147 00:05:32,470 --> 00:05:33,529 with all payers. 148 00:05:34,149 --> 00:05:36,009 You're responsible for the quality. 149 00:05:36,709 --> 00:05:39,029 You can either look at upside downside risk 150 00:05:39,029 --> 00:05:39,615 or just, 151 00:05:40,735 --> 00:05:42,254 you know, I I think a two way 152 00:05:42,254 --> 00:05:45,694 risk model is probably the an option which 153 00:05:45,694 --> 00:05:46,175 you should, 154 00:05:46,654 --> 00:05:48,514 look at so that the even the payers 155 00:05:48,574 --> 00:05:49,074 have 156 00:05:49,535 --> 00:05:52,495 a clear appetite towards moving towards do that 157 00:05:52,495 --> 00:05:52,995 direction. 158 00:05:54,779 --> 00:05:56,160 Mhmm. Are you seeing more 159 00:05:56,620 --> 00:05:59,740 spine providers, more orthopedic providers, particularly on the 160 00:05:59,740 --> 00:06:01,899 independent side? And equally, maybe on the payer 161 00:06:01,899 --> 00:06:03,660 side, is there more of an appetite to 162 00:06:03,660 --> 00:06:05,420 get involved in some of these value based 163 00:06:05,420 --> 00:06:07,020 agreements now? Are you seeing any sort of 164 00:06:07,020 --> 00:06:09,555 a change over over recent years? Not really. 165 00:06:09,555 --> 00:06:11,794 I think, me, because of my background and 166 00:06:11,794 --> 00:06:13,334 master's in health care leadership, 167 00:06:14,194 --> 00:06:17,574 I'm kind of very, very keen on establishing 168 00:06:17,954 --> 00:06:21,095 certain patterns of at least creating an ecosystem 169 00:06:21,314 --> 00:06:24,274 for value based care. We gotta create centers 170 00:06:24,274 --> 00:06:26,490 of for excellence for spine surgery, 171 00:06:27,029 --> 00:06:29,670 where we act as accountable people and o 172 00:06:29,830 --> 00:06:30,889 accountable organizations. 173 00:06:31,430 --> 00:06:33,750 We're responsible for controlling cost of care, and 174 00:06:33,750 --> 00:06:36,490 at the same time maintaining quality of care. 175 00:06:37,125 --> 00:06:37,604 And, 176 00:06:38,084 --> 00:06:40,985 we just get reimbursed for being accountable. 177 00:06:41,764 --> 00:06:42,264 Mhmm. 178 00:06:42,564 --> 00:06:44,964 Doctor Eddie, I'd be curious to hear that's 179 00:06:44,964 --> 00:06:47,125 obviously one key area of growth, one area 180 00:06:47,125 --> 00:06:49,384 of focus for a lot of spine providers. 181 00:06:49,845 --> 00:06:51,930 Well, many like yourself really on the forefront 182 00:06:51,930 --> 00:06:52,750 of that area. 183 00:06:53,290 --> 00:06:56,089 What are you most excited about at the 184 00:06:56,089 --> 00:06:58,330 moment? Whether you're coming at this question from 185 00:06:58,330 --> 00:07:00,889 a technology standpoint, from your practice, kind of 186 00:07:00,889 --> 00:07:02,569 there's so much we could tackle here, but 187 00:07:02,569 --> 00:07:04,189 curious to hear your thoughts on this. 188 00:07:04,904 --> 00:07:05,785 I think, you know, 189 00:07:06,585 --> 00:07:09,145 the the one of the things which we 190 00:07:09,145 --> 00:07:12,205 are in America, we're kinda lacking is adopting 191 00:07:12,345 --> 00:07:14,045 endoscopic spine surgery. 192 00:07:14,504 --> 00:07:16,665 Our counterparts in Europe and Asia have been 193 00:07:16,665 --> 00:07:17,805 doing this for years. 194 00:07:18,105 --> 00:07:21,259 It's not rocket science. Most neurosurgeons know how 195 00:07:21,259 --> 00:07:22,240 to use an endoscope. 196 00:07:22,779 --> 00:07:24,879 The only reason is there's, 197 00:07:25,660 --> 00:07:28,139 for making the payers make a change to 198 00:07:28,139 --> 00:07:29,839 Rheembers endoscopic surgery. 199 00:07:30,300 --> 00:07:32,560 If you're not getting Rheembers, there's no motivation 200 00:07:32,620 --> 00:07:33,919 for anyone to learn. 201 00:07:34,394 --> 00:07:37,855 And endoscopic surgery, middle main laser surgery, robotic 202 00:07:37,915 --> 00:07:39,995 surgery, I mean, these are things which we 203 00:07:39,995 --> 00:07:40,814 have to adopt 204 00:07:41,194 --> 00:07:43,774 to make spine surgery safer, efficient, 205 00:07:45,274 --> 00:07:46,154 and less 206 00:07:46,794 --> 00:07:49,055 have as few complications as possible. 207 00:07:50,210 --> 00:07:52,610 Yeah. I mean, so, the things that we 208 00:07:52,610 --> 00:07:54,949 often hear from spine surgeons is 209 00:07:55,410 --> 00:07:59,009 the the shackles with reimbursement around endoscopic spine 210 00:07:59,009 --> 00:08:01,350 surgery, potential lack of training 211 00:08:01,730 --> 00:08:04,095 forms, and and I have heard about a 212 00:08:04,334 --> 00:08:07,295 somewhat steep learning curve initially. But to your 213 00:08:07,295 --> 00:08:07,795 point, 214 00:08:08,814 --> 00:08:10,194 nothing that's from a neurosurgeon 215 00:08:10,975 --> 00:08:13,475 standpoint. But when you think about lower complication 216 00:08:13,615 --> 00:08:16,349 rates, lowering the ultimate cost of care, it 217 00:08:16,349 --> 00:08:18,269 seems like a no brainer. What what do 218 00:08:18,269 --> 00:08:19,629 you think is the real hold up here? 219 00:08:19,629 --> 00:08:21,389 Is it just the short answer down to 220 00:08:21,389 --> 00:08:22,289 the payers ultimately? 221 00:08:23,310 --> 00:08:25,870 Yeah. I mean, their change is very slow 222 00:08:25,870 --> 00:08:27,169 in America, and, 223 00:08:28,430 --> 00:08:29,409 there's bureaucratic 224 00:08:29,709 --> 00:08:31,009 impediments are, 225 00:08:32,134 --> 00:08:34,615 as long as the bureaucracy and the impediments 226 00:08:34,615 --> 00:08:37,174 are designed to keep people safe, it's okay. 227 00:08:37,174 --> 00:08:38,794 But when it delays, 228 00:08:40,054 --> 00:08:41,595 technology and improvements 229 00:08:42,455 --> 00:08:43,195 and innovation, 230 00:08:43,575 --> 00:08:45,495 then we gotta look at other ways to 231 00:08:45,495 --> 00:08:48,450 kinda circumvent it. There's really no, 232 00:08:49,170 --> 00:08:51,570 try reaching CMS. I mean, there's no way 233 00:08:51,570 --> 00:08:52,389 to reach CMS. 234 00:08:53,250 --> 00:08:55,269 Yeah. Yeah. Hopefully, we'll see. 235 00:08:55,730 --> 00:08:57,730 Maybe maybe some change coming down the pipeline. 236 00:08:57,730 --> 00:08:59,970 But like you said, it's been widely used 237 00:08:59,970 --> 00:09:01,725 in the likes of Korea and Europe for 238 00:09:01,725 --> 00:09:02,865 so for so long. 239 00:09:03,565 --> 00:09:05,245 US, which is usually on the forefront of 240 00:09:05,245 --> 00:09:07,725 a lot of these surgical innovations, somewhat behind 241 00:09:07,725 --> 00:09:09,725 when it comes to endoscopic spine surgery, it 242 00:09:09,725 --> 00:09:10,225 seems. 243 00:09:10,684 --> 00:09:11,184 Yeah. 244 00:09:11,644 --> 00:09:13,485 Doctor Reddy, a last question for you while 245 00:09:13,485 --> 00:09:15,165 I let you go. I'd love to hear 246 00:09:15,165 --> 00:09:17,379 a little bit more about your practice. Kind 247 00:09:17,379 --> 00:09:19,139 of how are you thinking about growth over 248 00:09:19,139 --> 00:09:20,659 the next twelve to twenty four months or 249 00:09:20,659 --> 00:09:21,159 so? 250 00:09:21,620 --> 00:09:23,960 Yeah. I think I'm, I'm working on collaborating 251 00:09:24,100 --> 00:09:27,159 with the large local ACOs, accountable care organizations, 252 00:09:27,379 --> 00:09:29,264 to see if we can kinda come up 253 00:09:29,264 --> 00:09:31,524 with a shared savings agreement. And, 254 00:09:32,544 --> 00:09:35,424 with my capstone project, I'm hoping I have 255 00:09:35,424 --> 00:09:37,684 the numbers through open care data 256 00:09:38,225 --> 00:09:41,365 on what these commercial payers are spending 257 00:09:41,889 --> 00:09:44,529 and, for providing care for these patients. I 258 00:09:44,529 --> 00:09:47,009 think we have a an excellent product where 259 00:09:47,009 --> 00:09:49,509 we can provide high quality care, 260 00:09:50,529 --> 00:09:51,750 same or better outcomes 261 00:09:52,450 --> 00:09:52,950 with, 262 00:09:54,049 --> 00:09:55,509 reduced cost of care. 263 00:09:56,084 --> 00:09:58,884 So, hopefully, I'll be able to negotiate these 264 00:09:58,884 --> 00:10:00,424 contracts in the coming 265 00:10:01,044 --> 00:10:02,345 six to twelve months. 266 00:10:03,204 --> 00:10:04,985 Got it. Fantastic. Well, certainly, 267 00:10:05,365 --> 00:10:07,125 fascinating to kinda have you in the podcast, 268 00:10:07,125 --> 00:10:08,440 be able to pick your reins a little 269 00:10:08,440 --> 00:10:10,360 bit, some of those key area of focus 270 00:10:10,360 --> 00:10:11,740 for you, your practice. 271 00:10:12,519 --> 00:10:14,519 Doctor Reddy, it's been an absolute pleasure. Thank 272 00:10:14,519 --> 00:10:15,959 you so much for joining us today, and 273 00:10:15,959 --> 00:10:17,399 I look forward to connect with you again 274 00:10:17,399 --> 00:10:19,639 down the line. Sounds great. Good talking to 275 00:10:19,639 --> 00:10:21,019 you. Have a wonderful day.