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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 live at the twenty

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second annual Spine Orthopedic and Pain Management Conference.

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I'm currently joined by Zeeshan Tayeb, who is

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the medical director at Pain Specialists of Cincinnati.

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Thanks for being here. And let's start our

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conversation off by having you tell us a

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little bit more about yourself, your background, and

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your current role.

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Hello. Thank you, Grace, for having me over

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here and inviting me to be able to

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share a few ideas, with the group at

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large. So a little background about me.

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Dual board certified in physical med and rehab

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and pain management.

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I've been practicing,

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fourteen

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about fourteen years now. I've been private practice

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since about 02/2016,

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with my own practice, and I've been participating

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with Becker's on different levels since 02/2017.

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We started off with our original practice of

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a pain specialists of Cincinnati

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in the Lays and Regenerative Center.

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And, since then, we have actually grown and

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have expanded out our our practice model to

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be a little bit more holistic in nature.

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And so now we're doing

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or we've started something known as, like, our

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region life, and then we're also expanding that

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into a surgical center. So that's gonna be

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region life surgical center.

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And then we have also expanded out into,

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some research. So we've started an organization called

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IQRA,

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ICRA. We've also expanded into having a, nonprofit,

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with all the other things we have going

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on. And I could go on and on

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about that, but I will, digress over there.

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Wonderful. Well, thank you for taking the time

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to be here. Let's start with some trends

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and shifts you're seeing right now in the

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industry,

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things that you think are most important for

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industry leaders to pay attention to.

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Yes. So trends and shifts. Things are always

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trending and shifting, and we just have to

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be able to adapt. So I would say

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probably the biggest thing right now that has

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really been accentuated over the last, few years,

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especially since, COVID,

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are the fact that we continue to get

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hit with payers

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and, you know, just the different things that

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are involved with that. So not only, you

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know, do costs

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or reimbursements continue to get cut, we also

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deal with, you know, increased denials and a

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lot more work to do for prior authorizations.

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So now what does that all translate into?

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It's not just less money or more work.

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It actually translates into,

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maybe maybe an opportunity. Right? So things don't

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happen necessarily to us. That's a victim mindset.

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It happens for us. So where do we

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go from here? So I've been thinking about

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this on multiple levels. There are shifts where,

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you know, things are going from,

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you know, hospitals

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or what we would consider more on an

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inpatient basis over to ASCs and some things

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in the private practice. But the other thing

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is happening

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also. So

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there's things that are happening in private practice

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that need to shift over into

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surgical centers,

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possibly hospitals.

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A lot of the reason for that is

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because of

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there's sometimes a lack of accountability if you're

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just running your own practice. There's not as

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much oversight. And so some of these governing

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bodies are wanting to try to get

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more oversight over the different things that are

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coming about in in our practice of medicine.

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So what does this force us to do?

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It forces us to basically become more multidisciplinary.

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And what I mean by that or even

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interdisciplinary.

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So I mean,

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it's not just gonna be about filling a

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script or doing an injection. It's about working

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with

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people from different fields, not just our surgeons,

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but our doctors and all their different subspecialties.

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So in internal medicine and I'll probably come

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back around to, giving a couple examples about

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that. But also with some of our,

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other folks that are also involved in pain

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management. So behavioral health, exercise therapists, physical therapists,

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and so on.

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We were basically at one point, because of

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all the cuts,

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trying to make up for it by doing

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just more volume.

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And now

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it's not going to be enough just to

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do more volume because we're also being scrutinized

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for quality of care.

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So we're gonna have to the pendulum is

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gonna swing. We're gonna have to find that

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balance. And so there is a huge push

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now for for, value based care. And that's

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where AI then comes in. So AI

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is,

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is gonna be sweep it is sweeping us

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off of our feet. And if we don't

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get on board with that, we're gonna get

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left behind. So with that said,

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AI, it can be as simple as just

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doing things for intake,

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but it's also gonna help with clinical decision

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making, crossing t's, dotting i's, and helping to

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mitigate, hopefully, some costs with,

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you know, how much it takes to, you

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know, staff a place or to be able

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to run a place.

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But it's all gonna be about data,

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and AI is also being used for denials.

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So we talked about that just just moments

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ago.

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So on the flip side, we're gonna have

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to be able to use AI in a

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quote, unquote smart way so that we can,

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start getting, things to kinda swing back the

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other way.

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Absolutely.

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All great points.

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And let's touch on staffing and workforce challenges

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as these continue to be concerns across health

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care as well. So how is your organization

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navigating these pressures, and what strategies have you

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seen work well?

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Great question. I think that's always been applied.

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It's just different time,

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relatively the same issues,

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but with a different a different hat or

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a different mask.

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So I think at this point,

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you know, we mentioned AI, and I'll circle

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back around to that. I think right now,

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we have to find people that have some

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heart and some soul. And so rather than

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just finding people that can quote unquote just

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do a job, we need to start actually,

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like, looking at people that actually share

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actually, that wanna actually invest in your business

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or invest in your practice or your philosophy,

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and then also kinda share the mission and

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the goals that you have as an organization

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or as a provider.

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So that's one thing that we've been looking

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for. So for some of our

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what I call, like, the quote unquote smaller

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jobs,

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those folks

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bring them in, share the philosophy, the vision,

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and they have their ninety days.

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On the flip side, if we're looking for

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people to try to direct programs, like, be,

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like, a director of a specific department that

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we have in place,

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those folks need to really kind of internalize

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that, take that in, and they're gonna be

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looked at in a different way. But a

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lot of it, in terms of trying to

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prevent turnover,

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providing a platform for people to be quote

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unquote happy, I think it's imperative for us

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to try to do the due diligence upfront

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as opposed to just bringing people in and

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then hoping that they make it. Other things,

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I think, some of the more practical things

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that I think we do as an organization,

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we're in a day and age where there's

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a lot of ADHD or ADD. A lot

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of people are bored.

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So it there was a lot of value

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back in the day just to be able

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to kind of focus on on a task

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at a time.

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I think most people are designed now or

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have basically gone into a way of being

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able to multitask to an extent. And a

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lot a lot of it has to do

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with the fact that, you know, we have,

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technology,

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electronics,

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AI, and things like that at our disclosure.

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And so if one used correctly,

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those kind of things can be optimized.

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So it helps with the role optimization,

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but it also then helps with,

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preventing burnout,

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for everybody pretty much involved. I think it

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also provides flexibility for people. So when people

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can do things outside of the office,

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it also gives them that opportunity to still

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be able to do the work. But, hey,

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I have a sick kid or I have

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something else popped up. My parent is sick.

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I can still get the job done and

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still provide the service, and still get paid

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without necessarily being reprimanded to the point where

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I may lose my job.

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And then we'll probably circle back around to

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this as well, I believe. But outsourcing is

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becoming a huge thing. There's always people out

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there that wanna continue or groups of people

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out there that wanna try to provide services

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for us. So I think working with groups

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that are specialized in specific areas, I think,

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is very beneficial.

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And, I've already used the buzz term AI

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at least twice, so I'll do it a

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third time now and just basically say that

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as,

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we continue to work together with AI, I

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think we're gonna actually continue to grow and

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prosper.

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A 100%.

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And as outpatient care continues to grow, how

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do you see the role of orthopedics and

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ASCs evolving within the broader healthcare ecosystem?

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So like I mentioned before, there's a shift

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for things that were

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more, on the inpatient end that were kinda

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shifting one direction, and then the things from

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the outpatient setting is shifting in the other

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direction. So, again, things happen for us, not,

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against us. And so it's about kinda going

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with the flow in some ways and trying

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to figure out, okay. Well, this is where

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I'm at, and this is what I need

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to do. So looking at it from that

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angle with everything,

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with a lot more shifting to outpatient, that

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just means that there's gonna be a lot

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more volume. So how are we gonna be

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able to basically take that volume in? So

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in some ways, it actually aligns with,

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CMS,

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Medicare guidelines,

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what insurance companies are looking for. So we're

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looking for cost efficiencies,

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you know, patient satisfaction, you know, aligning with,

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the payers and so on. You have to

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also understand that

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pain in orthopedics is one of the number

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one reasons why people actually even go and

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see a physician or provider or to see

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actually seek out help,

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period.

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So

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it gives us an opportunity in this specific

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field

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to actually become the quote unquote gatekeeper.

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Previously, primary care doctors were kinda looked at

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as the gatekeepers, but how often do they

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see their primary care doc?

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Maybe once every three months, six months, maybe

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once a year, depending on what's going on.

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But if you're working, if you're having an

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an orthopedic issue or a pain issue, you're

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gonna end up seeing those providers

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much more frequently. And so it gives us

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an opportunity not necessarily to do everything ourselves,

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but to be able to outsource

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to our behavioral health specialists, our exercise therapists,

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and so on.

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And so we're we have a huge opportunity

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here.

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Absolutely. And as we round out our conversation,

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you've touched on this, throughout the conversation so

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far, but many organizations are exploring new technologies

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and partnerships and care models to improve efficiency

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and outcomes. So are there any other innovations

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outside of the ones you've already touched on,

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or initiatives that you found particularly promising?

305
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Yeah. Absolutely. 100%.

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I think this is actually an opportunity for

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us to be able to see, like, how

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we can kinda look at things a little

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bit more holistically.

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So number one, one of the reasons we

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actually shifted our pain practice and our regenerative

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practice, which were actually two separate entities

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under one umbrella

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or, to try to have an umbrella organization

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for all of it was so that we

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could provide that holistic care. And so what

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I mean by that is

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I'm actually

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running lab tests and things like that on

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people

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to see where their kidney and liver is.

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I'm also looking to see, like, where some

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of their hormonal or nutritional,

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imbalances or deficiencies are. And so this gives

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us an opportunity now to actually send them

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back to their primary care doctor or to

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their rheumatologist or endocrinologist

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or a GI specialist or whatnot.

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The other thing that we also saw as

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an opportunity here was to actually then start

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up our own little,

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primary care clinic so that we can start

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that and be able to streamline that without

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necessarily taxing the current providers

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that are doing,

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the traditional pain management in orthopedics.

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So that's from that one angle. So, basically,

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in a nutshell there, we're looking at trying

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to get people more care and optimize their

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condition so that no matter what procedure, medication,

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or, innovations are being,

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recommended to them, they'll be in a good

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place to be able to receive receive it,

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not just, physically, but also on, multiple levels,

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be it spiritually, mentally, and so on.

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Now in terms of just, I'll I'll call

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the next part innovative interventions.

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So we have now not just opioids. When

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opioids first came out, it was like like

350
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a godsend.

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Now we're amidst a a pandemic or an

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epidemic of or people call it, like, the

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opioid crisis. And so now we're looking for

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other things to try to help,

355
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mitigate those issues. And so medications,

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that are sodium or specific sodium channel blockers,

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I e, gen generics,

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There's an opportunity to help, with something like

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that, and there's many other,

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examples

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just like that. And then, of course, the

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field is also continuing to blow up in

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the sense that we have all of the,

364
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the different, interventional procedures all the way from

365
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SI joint fusions, facet fusions, minimally invasive lumbar

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decompressions,

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basovertebral nerve ablations.

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We still have our traditional stem. We have

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our peripheral nerve stem. And then, I'll I

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saved, talking about pain pumps, for last because

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they have been around for a little while.

372
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But pain pumps have actually become a huge

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thing because it helps mitigate the opioid crisis.

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And we've actually,

375
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grown our practice significantly with that,

376
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technology, and we started doing microdosing.

377
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And this is a big thing now. Not

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only is the research supporting a lot of

379
00:13:18,950 --> 00:13:20,809
it, but we've also been able to,

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get that out onto, larger, forums, and we're

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able to present this, information at, other,

382
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big society meetings as well.

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Then the last thing I'm gonna mention is

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not just

385
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the clinical aspect, but you actually have a

386
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team that is

387
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has to be, I guess, optimized.

388
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And that means

389
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we talked about multitasking,

390
00:13:44,059 --> 00:13:46,059
but you can also overdo it. And peep

391
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and that can result in burnout and people

392
00:13:47,899 --> 00:13:50,059
getting stressed and wanting to leave their jobs

393
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and not having a work life balance and

394
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so on. And so this is where I'm

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gonna circle back around and just highlight

396
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the importance of,

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outsourcing. And so we have teams now outside,

398
00:14:02,404 --> 00:14:04,245
different places in The United States and even

399
00:14:04,245 --> 00:14:06,164
outside of The United States that actually, work

400
00:14:06,164 --> 00:14:07,684
with us to be able to do things

401
00:14:07,684 --> 00:14:11,605
like remote patient monitoring, therapeutic monitoring, chronic care

402
00:14:11,605 --> 00:14:12,105
management.

403
00:14:12,950 --> 00:14:15,190
We even have, like, another team dedicated to

404
00:14:15,190 --> 00:14:17,509
handling all of our durable medical equipment. And

405
00:14:17,509 --> 00:14:19,190
then we have people also helping with our

406
00:14:19,190 --> 00:14:20,570
revenue cycles, scribing,

407
00:14:20,950 --> 00:14:21,850
and prior authorizations.

408
00:14:22,470 --> 00:14:24,149
Now with all of that said, that's still

409
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a lot of man manpower in a sense

410
00:14:26,549 --> 00:14:27,049
or

411
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people power.

412
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This is also as AI is involved with

413
00:14:31,695 --> 00:14:34,034
this process, hopefully, we'll be able to,

414
00:14:34,975 --> 00:14:35,475
mitigate

415
00:14:35,934 --> 00:14:37,475
some of the issues of

416
00:14:38,095 --> 00:14:40,514
cost in that regard and also help streamline

417
00:14:40,575 --> 00:14:41,075
processes

418
00:14:41,455 --> 00:14:42,914
that are already, you

419
00:14:43,429 --> 00:14:45,589
know, pretty much, simple. They just need to

420
00:14:45,589 --> 00:14:46,089
have

421
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some form of,

422
00:14:48,870 --> 00:14:49,370
organization.

423
00:14:49,909 --> 00:14:50,809
And if it's

424
00:14:51,350 --> 00:14:53,909
where it doesn't involve, say, as much thought

425
00:14:53,909 --> 00:14:56,009
and it's something that just needs to be

426
00:14:56,069 --> 00:14:58,329
done in terms of, from an

427
00:14:59,174 --> 00:14:59,674
algorithmic,

428
00:15:00,455 --> 00:15:03,414
standpoint. That's where, AI can actually really come

429
00:15:03,414 --> 00:15:05,174
in and fit in until it, quote unquote,

430
00:15:05,174 --> 00:15:05,914
gets smarter.

431
00:15:07,014 --> 00:15:09,495
Absolutely. Well, Zeeshan, thank you so much for

432
00:15:09,495 --> 00:15:11,654
joining me today. Is there anything else you'd

433
00:15:11,654 --> 00:15:13,335
like to touch on that we didn't get

434
00:15:13,335 --> 00:15:13,835
to?

435
00:15:15,100 --> 00:15:16,379
Just a shout out to all of our

436
00:15:16,379 --> 00:15:18,459
organizations that have been working with us and

437
00:15:18,459 --> 00:15:20,860
all of the societies that continue to, support

438
00:15:20,860 --> 00:15:21,360
us

439
00:15:22,539 --> 00:15:25,419
in our, endeavors to try to further,

440
00:15:26,375 --> 00:15:28,454
basically everything that we do in our patient

441
00:15:28,454 --> 00:15:29,754
care. That includes,

442
00:15:30,375 --> 00:15:31,595
Ipsos, ASAP,

443
00:15:32,214 --> 00:15:32,714
NASS,

444
00:15:33,174 --> 00:15:35,355
and I could go on and on, AAPM,

445
00:15:35,654 --> 00:15:36,154
ABPM,

446
00:15:37,414 --> 00:15:39,790
all all of our different boards. And then,

447
00:15:40,350 --> 00:15:41,790
one other thing I would like to just

448
00:15:41,790 --> 00:15:43,250
have a little, personal,

449
00:15:43,629 --> 00:15:45,309
if you have enjoyed any of this, you

450
00:15:45,309 --> 00:15:47,389
can just, you know, reach out, and find

451
00:15:47,389 --> 00:15:49,629
out from us on how we have been

452
00:15:49,629 --> 00:15:51,389
trying to utilize all of these services because

453
00:15:51,389 --> 00:15:52,830
a lot has changed in the last, like,

454
00:15:52,830 --> 00:15:55,095
year or year and a half. And, things

455
00:15:55,095 --> 00:15:56,634
are going at a very fast pace.

456
00:15:57,175 --> 00:15:59,175
And, also, I am actually a new author

457
00:15:59,175 --> 00:16:00,455
of a book. And so if you'd like

458
00:16:00,455 --> 00:16:02,315
to check that out, it's called Reversing Osteoarthritis,

459
00:16:02,934 --> 00:16:04,394
and it can be found on Amazon.

460
00:16:05,292 --> 00:16:07,212
Wonderful. Well, thanks for being here. Again, we

461
00:16:07,212 --> 00:16:09,372
are recording live at the twenty second annual

462
00:16:09,372 --> 00:16:11,632
Spine Orthopedic and Pain Management Conference.