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forward slash beckerspodcast.

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This is Gracelyn Keller with the Becker's Healthcare

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Podcast, and we are recording live at the

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twenty second annual Spine Orthopedic and Pain Management

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Conference.

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I'm joined today by Brett Shore, who is

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an orthopedic surgeon at Shore Orthopedics. So doctor

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Shore, thanks for joining me today. Let's start

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off by having you share a little bit

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more about yourself, your role, and your organization.

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Hi. Thanks for having me. Again, yeah, my

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name is Brett Shore. I am a fellowship

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trained sports medicine orthopedic surgeon with a particular

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interest in hips in kinda comprehensive hip care,

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from

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treating hip dysplasia and hip impingement,

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and hip replacements as well.

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So in terms of my role in the

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organization, so the other organization that I'm here

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kind of, I guess, representing or that I

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work with is DISC Sports and Spine. And

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within

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DISC Sports and Spine, I'm one of the,

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primary orthopedic

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surgeons.

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A lot of

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the a lot of the bandwidth within, Disc,

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Sports and Spine is in spine care,

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and they have recently expanded to bring on,

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extremity orthopedics. And I was one of the

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one of the early people that joined for

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that purpose.

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And then within Shore Orthopedics, I'm the it's

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my company. So I'm the president and CEO

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of that.

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Wonderful. Well, thank you for being here. And

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let's start off with

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some of the trends and shifts you're seeing

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right now in the industry that you think

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are the most important for industry leaders to

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be paying attention

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to? I think one of the things that

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that we see at DISC and that I

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think is a trend across,

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the industry is, the formation of partnerships between

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some of the surgery centers and,

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the payers, the insurance providers.

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In an effort to both minimize health care

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costs both for the patient and for the

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insurer and also as a way to try

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and maximize

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value for,

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the insurance company.

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Additionally, I think it's clear that more and

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more procedures are being moved to the ambulatory

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setting.

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I think back to some of the surgeries

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that

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were two to three night or more overnight

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stays when I was in my training,

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which was back I finished in 2011.

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And now a lot of those surgeries either

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done as twenty three hour obs or same

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day discharges.

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And let's touch on staffing and workforce challenges

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as these continue to be a concern across

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health care. So how is your organization navigating

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these pressures, and what strategies have you seen

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work well? Yeah. This is a this is

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definitely a challenging,

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environment

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for

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hiring and maintaining good staff.

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I think one of the areas where I've

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seen some of the greatest challenges, which is

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partially in relation to the fact that the

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medical director of my surgery center is my

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wife, who is an anesthesiologist,

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doctor Amy Shore,

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is

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the

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sort of onboarding and

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collaboration with,

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anesthesia providers, with anesthesiologists.

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And

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one of the challenges is that the landscape

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in

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anesthesia has changed dramatically over the last five

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to ten years in terms of both availability

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and reimbursement.

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And it can be hard to identify those

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changes as they're happening,

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and it can be easy for an organization

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to

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kind of get caught on the wrong foot

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with respect to those changes.

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And

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I think one of the keys

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in maintaining

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and running an efficient,

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safe, and profitable,

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surgery center

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is high quality anesthesia care.

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And it's an area where I'm not sure

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that

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it's always it hasn't always been a priority

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because the market didn't necessitate it.

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But at this point, the demand for high

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quality anesthesiologists

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is so high that it's an area where

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both DISC Sports and Spine and other,

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organizations,

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I think, are putting a greater emphasis on

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reimbursement

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and

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bringing on

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well trained qualified anesthesiologists.

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Absolutely.

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And as outpatient care continues to grow, how

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do you see the role of orthopedics evolving

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within the broader healthcare ecosystem?

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Well, I think orthopedics lends itself nicely to

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outpatient care in general because

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the majority of our surgeries,

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there are surgeries that are high risk that

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have high capacity for blood loss. One of

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them that I perform is the periacetabular

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osteotomy, PAO.

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That is an operation that

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technically could probably be done in a surgery

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center with a 23 obvs, but there's not

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gonna be a big push for that because

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most of those patients

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have a lot of pain and stay overnight.

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But for the majority of the procedures that

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we do,

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as minimally invasive surgery becomes more widespread

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and as

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we're able to use,

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products such as, tranexamic

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acid

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to reduce blood loss,

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Orthopedics is, in some ways, gonna be, a

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leader and a pioneer, I think, in bringing

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the majority of surgeries into the ambulatory setting,

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both as a way to improve

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patient outcomes, but also to reduce health care

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costs that are associated with inpatient stays.

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And then many organizations are also exploring new

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technologies, partnerships, and care models to improve efficiency

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and outcomes. So are there any innovations or

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initiatives that you found particularly promising?

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Yeah. It's a good question.

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And this is actually referring back a little

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bit to one of my previous answers in

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terms of the trends and shifts.

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This is one where I think partnerships between

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the surgery centers and the insurance providers,

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when done in a way that

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both checks a couple of boxes.

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One is providing safe and effective care.

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Two is providing it at a

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cost savings or value for both the surgery

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center

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and for the provider for the for the

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insurance company.

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And finally, that also improves physician reimbursement both

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on the surgical and and the anesthesia side.

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When you can check all those boxes, then

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it it ends up being, I think, a

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really promising development in the ambulatory surgery model.

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And as we wrap up, was there anything

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else you'd like to share that we didn't

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touch on today?

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I guess the one other thing that I

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would that I would, you know, mention in

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terms of some of the previous, topics that

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we've discussed is the unique challenge that Medicare

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brings

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to, the ambulatory surgery setting.

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As there are some procedures that are reimbursed

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reasonably well with through Medicare, but others which

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are not.

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And,

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understanding how to incorporate

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or choosing not to incorporate Medicare into the

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ambulatory model and what that means both in

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terms of physician and and and in terms

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of surgeon and anesthesiologist

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reimbursement, I think is gonna be critical for

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the success of surgery centers going forward

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as there doesn't seem to be a lot

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of appetite for increasing

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the reimbursement rates in Medicare in the federal

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government anytime soon.

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Wonderful. Well, doctor Brett Short, thanks so much

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for joining me today on the Becker's Healthcare

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podcast, and we are recording live at the

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twenty second annual Spine Orthopedic and Pain Management

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Conference.