This is Alan Condon back on the Becker's
Healthcare podcast.
And today, I'm thrilled to be joined by
doctor Craig McMains, a fellowship trained spine surgeon
who specializes in minimally invasive
and complex spine surgery at OrthoIndy.
Doctor Maines, a pleasure to have you back
on the podcast with us today.
Before we dive into some questions that I'd
love to get to, I'd love to hand
the floor over to you just to tell
us a little bit more about your role
and your background at OrthoIndy.
Absolutely. Thanks for having me on, Alan. Appreciate
the time today.
As you've said, I'm, Craig McMains. I am
a orthopedic spine surgeon. I've been in practice,
close to a decade now. I'm currently
a partner at OrthoIndy,
specializing in minimally invasive and complex spinal procedures.
So,
OrthoIndy,
is a, Indiana's
first physician owned, like, orthopedic hospital. We founded
the hospital in, I think, I think it
was around 02/2005. The group's been together for
about fifty years.
And so that kind of,
innovative approach has been part of the DNA
of the group, and that's what attracted me
to joining the the group. And so,
for my individual practice,
kinda leveraging that, you know, physician ownership and
kinda top down control,
into my,
care for my spine patients and incorporating
kind of forward thinking technologies to get better
outcomes at a,
at a good value.
Alright. So we're excited to to dive in
and kinda learn a little bit more about
your practice, kinda where you're headed, what you're
planning for this year, doctor McMaes. I think,
certainly,
no secret to you, to me, to many
of our audience, the the big headwinds that
health care across the board is facing. But
I guess specific to your practice, specific to
spine surgery and orthoIndy,
what are the the big headwinds that you're
really planning for this year?
Yeah. So,
you know, that that's a great question, and
I think I'm gonna sound like a broken
record for everybody else, you know, in terms
of the
kinda group level headwinds. I'll I'll talk about
my individual practice first, though.
You know, I I'm we we started a
a little over a year, year and a
half ago, an endoscopic spine program at OrthoIndy,
And that's been something that's really kind
of caused me to see a paradigm shift
in how I view patients. Right? Historically,
you know, the foundations of spine surgery are
stabilized,
you know, decompress,
correct. And now,
you know, I don't have to approach that
with a kind of
anatomy altering approach anymore. Right? I don't have
to do a a spinal fusion to get
an adequate decompression
or,
to preserve,
you know, integrity. And so being able to
have these ultra minimally invasive approaches to the
spine where we can
decompress,
the neuroelements and kind of preserve anatomy has
been kind of a real boon in my
practice. Patients love it. They're they're getting back
to activity faster,
and, just really having good great recoveries.
The the analogy I I kinda
always bring up is,
you know, my orthopedic background is look at
the where shoulder,
arthroscopy went and and the treatment for rotator
cuffs. Right? We used to do these open
approaches historically.
They were highly disfiguring and highly,
you know,
morbid for patients to undergo.
Well, we got better. We we developed these
less invasive or you call minimally invasive techniques
of many open deltoid sparing you know, deltoid
splitting approach.
We got some good visualization with that. Some
people would advocate it was superior for a
long time even
after arthroscopy got introduced. Right? Because historically, arthroscopy
is really challenging, cumbersome, and expensive for shoulders.
But now if you look at the current
landscape, that's the gold standard. Nobody would tell
you that you should go backwards and have
these open approaches even in a less invasive
fashion. So I think spine's gonna go through
that paradigm shift as a field, and,
we're gonna do better of preserving,
normal anatomy while alleviating
pathology. So that's kind of
my big headwind is just, the kinda change
I see in my practice individually is, like,
how do I keep leveraging that? How do
I get that to go forward?
From a a group standpoint, you know, we're
we're facing these, you know, as always, kind
of
regulatory
and financial,
headwinds. Right?
We we have
trouble
with our payers, you know, giving,
surgeons and individual physicians
an appropriate compared to, say, like, a big
hospital system. Right? And there's all kinds of
data out there showing that the reimbursement for
facilities is going up or was physician rates
are flat, if not dropping.
And, you know, if you look at it
from, like, comparing it to, like, inflationary data,
you know,
physicians have not kept up from a pay
standpoint,
and a pay quality standpoint versus,
kind of what these large health care systems
do. So
just trying to make sure that we remain
patient focused. Right? We wanna get good outcomes
because,
you know, it's kinda like a field of
dreams thing. If you if you build it
if you build it, they will come. Like,
if we're doing good work, patients will come
see us.
But we have to we have to be
leaned. We have to make sure that we're
not,
you know, becoming bloated with,
you know,
excessive cost.
We try to be, you know, conscientious on
our implants that we're using, making sure that,
we're doing things that,
don't add significant
delays in care or cost to the system.
So,
I mean, that that's a complicated
answer, but that's kind of the thousand foot
view of our practice level.
Yeah. Absolutely. And it kinda ties kind of
into the the next question that I wanted
to to pick your brains on. I think
in terms of what we're seeing across the
board in spine and orthopedics, some of the
key trends that kinda play into that,
we're seeing a a sharp rise in, it
seems like, orthopedic,
MSOs,
management services organizations,
increased private equity investment coming into the field.
On the other hand, increased consolidation.
Also, a ton of excitement in terms of
what we see in spine technology, orthopedic technology,
some of the key trends across the board
here on on a broad level.
But with some of these in mind, how
do you see spine, orthopedics?
How do you see the field evolving over
the next two to three years? I'm curious
to kinda get your thoughts there as of
how you're looking at the future.
Yeah.
But the way I I, you know, in
my perspective is it's it's like this pendulum
swinging back and forth. Right? We used to
have all these private practices, and then,
basically,
you know, the Affordable Care Act came in
and,
changed the landscape. Physician ownership became much increasingly
rare from a hospital standpoint.
And
with insurances putting downward pressure on physician pay,
you know, the and the the regulatory burden
of, you know, documentation
and
everything else that was required kind of increasing,
it, you know, it became overwhelming for physicians
to manage all this. Right? We were trained
to do
patient care, to do medicine.
Our our experience in business is lacking in
that regard. And so you saw this pendulum
swing where physicians were becoming hospital employed, like,
we're joining large groups. Mhmm.
I think what we have seen now decade
plus into that kind of change
is that these large groups have realized they're
not great at managing subspecialists like spine surgeons.
Right? And so
I get the sense that we're kinda getting
and and the surgeons are getting really frustrated.
And and we have at the end of
the day,
we have the biggest
card to play in this at this table,
which is the power of the pen. Right?
Nothing goes through the health care system pretty
much without a physician order. And I think
physicians forget that kind of power they wield
in this
in these,
discussions, we'll call it.
And so physicians are starting to increasingly pull
away from these large health care, organizations.
And,
you know, right now, we're seeing this trend
towards, as an alternative, you know, private equity
involvement and maybe MSOs to try to diminish
cost,
with an economy of scale. At OrthoIndy, we're
we're expanding. We're trying to we we think
we have a good solution independently of those
two options, and we're trying to become a
larger brand around the state. But it's the
same thing. We're trying to everybody's trying to
increase economy of scale. So
I I think that you're gonna kinda continue
to see the pendulum swing in that direction.
I I don't foresee private equity.
I'd like to be wrong on this. I
don't see them being a long term solution.
I maybe I'm I'm gonna be proven wrong,
but,
you know, at the end of the day,
those groups are primarily focused with,
profitability.
And I think the historic,
perception of them is that they're gonna come
in, they're gonna
make an organization lean, and then the minute
it's hitting its profit margins, they're gonna try
to flip it and sell it. So,
that might, I guess, benefit a group if
they can buy it off the private equity
firm maybe. But, I think for physicians,
those are gonna be the trends we see
moving forward over the next, you know,
several years, five years plus.
And I think that in that regard,
if you can get and as a subspecialist,
if you can get in control
of your facility. Right? Because we we just
talked about it a second ago. The facility
reimbursements are doing well.
Spine surgery getting pushed in the way that
joints was before. It's it there we wanna
ratchet down implant cost. You know, we're gonna
push everybody to outpatient surgery. We wanna leverage
things like
minimally invasive endoscopy to get people
kind of up and back to life faster.
And so if you can get in on
an, you know, a a you know, a
an ASC,
that's gonna be huge because there's a
strong push from all sides, both physician, you
know, large organizations
to
move spine surgery in that direction. The days
of having a a surgery and staying a
week in the hospital are gonna become increasingly
rare outside of a really few special tertiary
facilities in my opinion.
Yeah. It's certainly interesting to see that trend
developed. To your point earlier when we talked
about the traditional spine surgery and how kind
of morbid it used to be, what also
wasn't that long ago when,
spine patients or even total knee, total hip
patients are staying two, three, four days in
the hospital. Now to your point with the
help of these minimally invasive surgical techniques, open
ambulated, out the door in an hour, two
hours. So currently, certainly interesting to see what
happens to the traditional inpatient environment as it
relates to spine surgery, orthopedic surgery, and some
of those territory environments like you had mentioned.
Doctor McBain, last question I have for you,
and you kind of alluded to it earlier.
Certainly interesting to see the the growth of
OrthoIndy over the years. Really fascinating, interesting, it
seems, maybe hub and spoke model there.
Where are OrthoIndy's
best opportunities
for growth? To your point, is it, acquiring
ASCs, building ASCs,
partnering with more referrals, kind of, really expanding
your footprint at that area, new physicians in
the group? Kinda love to get your kinda
the group's game plan and kinda how you're
thinking about growth there.
Sure.
So like you said, we we, you know,
individually, and I I would say to some
degree as a group, I I'm not speaking
for the group here, but,
you know, we we recognize the value of
ASCs and the expansion of ASCs, right, for
all of orthopedics, not just spine surgery.
And, you know, there's a there's a strong
current out there, like I said, of these
smaller practices
feeling pressure, not being happy, or able to
maybe manage the
modern pressures of management. And we think that
we've kind of developed a pretty good model
in in Indianapolis here. And so the the
idea is that maybe we're an alternative
to
all three of those previous options, right, to
big health care organizations like, you know, the
big, you you know, hospital chains that were
were an alternative to MSOs or an alternative
to PE. We can we can provide those
services, but allow surgeons to maintain control and
to guide the patient experience
on a on a on a individual kinda
hands on practice level.
But we can also kinda, by pulling our
resources, generate that economy of scale that lets
us then,
you know,
manage these in rising costs and and,
you know, manage these,
overhead issues that we're all having. Because that's,
like, the biggest
barrier to growth. So, like, you know, you
can try to expand, but, you know, we
we don't want people to we don't want
patients to go out there and have more
problems to some degree. Right? Like, we don't
want we don't want there to be more
business. Instead, the the way that we can
get growth is by diminishing our overhead and
our cost.
I I think that the way that
OrthoIndy
and other practices should look at this the
most is the best opportunity for
growth
is data monetization. Right? So, like, we're all
generating this
impressive data. And
with
some of these AI tools that are available,
we finally have a way of processing
big data, right,
which we never had, you know, ten plus
years ago.
And so if if you as a if
we can, as a practice, figure out, okay,
what's the most efficient pathway through our system
that generates the best outcome for a patient?
And,
you know, with the implants that we're using
and our utilization, you know, what what's the
optimal
construct or, you know, what's the optimal surgery
to get the best outcome? Like, those are
those data monetization questions that if we can
start to
capture that and act on it, that's gonna
lead to the biggest growth changes. And I
and I think, you know, we're doing that.
We're we're we're we're working with, you know,
an AI driven, basically, call center that kinda
manages all of our scheduling now, and that's
that's gonna make a boom. And we're starting
to do that with some of our
PRO data, like our outcomes data. We we
have our own research foundation.
We're gonna we're gonna turn this, you know,
lens to implants here.
And so I think that, as we figure
out how we can
diminish our costs going forward,
that's how we can drive more volume towards
us because patients will and the patients, payers,
employers, right, direct employers, a whole another discussion
we can go in a rabbit hole with.
They'll all start to realize that, hey. OrthoIndy's,
you know, approaching this from a patient
centric, patient versus standpoint, and
they're also forward thinking enough that they're trying
to get ahead of these challenges. And,
I I think we're we're that perfect size
of mass, but nimbleness that we can make
these changes rapidly, and, we're not burdened by
bureaucracy.
Yeah. No. And I and I guess I
told a lie because you did bring up
such an interesting point there as it relates
to potential
direct to employer contracting and whatnot.
In my recent conversations with orthopedic groups across
the country, it seems like, particularly around the
size and scope of ortho window OrthoIndy,
it seems like more independent orthopedic groups like
yours are taking a harder look at potentially
some of these,
direct employer contracts. Is that something that's top
of mind for Orthoindo,
as you consider
or tackle some of these headwinds? I'd love
to kinda get your perspective there before I
wrap up.
Yeah.
Dan, once again, this is like an individual
perspective.
I I don't speak for the group in
this regard, but, you know, I I think
it's it's one of those scenarios where, you
know, if you're a large enough group that
you can handle a large influx of volume
and you have a geographic footprint that, you
know, an employer with, you know, a bit
of a geographic spread needs you know, has
maybe, employees all over the place.
And, you know,
insurance companies are becoming you know, they're they're
combative. They're they're they're challenging to,
work with from as an individual physician standpoint.
Right? They they cave to these big groups
because of that old economy of scale discussion.
Well, if you can offer a superior outcome
and a, you know,
a a superior patient experience,
why can't you go to that employer and
and, you know, maybe pass along some kind
of savings to them, by offering that kind
of direct employer
negotiation
for their for their employees.
I mean, everybody wins then. Right? They're the
the employer is saving money. The patients get
a better experience.
And, you know, the the reason why we're
pushing that is because, hey, we don't have
the
the the the mass of of, negotiators to
chase after, you know, a big,
you know, national insurance company with. So,
I I think that's something that, like, you
know, is gonna become
it's not something maybe as a solution for
every group to pull off. But if you
have a group that is of a certain
size,
you know, it's something that we can it
definitely would be it's definitely on our radar,
and I think it's becoming something that we're
hearing this discussion
occur around the country more and more frequently.
Yeah. No. Fascinating to get your perspectives there.
And I know indeed speaking from for yourself,
a member member of the group, but not
for the group, I really appreciate your perspectives.
Perspectives.
Doctor McMains, so great to have you back
on the podcast.
Really, really enjoyed this conversation, and I look
forward to speaking with you again down the
line.
Really appreciate it. Thank you so much.