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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 currently joined by doctor Robert Bray, who

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is the founding director at DISC Sports and

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Spine Center. Doctor Bray, thanks for being here.

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Let's start off by having you introduce yourself

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and tell us a little bit more about

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your role and organization.

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Thank you for having me.

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I've been coming to Becker's for twenty plus

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years, so I think people know me quite

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well.

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I come via the United States Air Force

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on through on the way by to Cedars

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Sinai where I ran the inpatient program for

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years and the fellowship

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and then began outpatient surgery about twenty years

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ago forming DISC, which is now

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a a multi conglomerate.

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I'm a neurosurgeon.

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I do only spine and nothing besides spine,

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and that's been my focus for many years,

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minimally invasive in its development.

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Wonderful. Well, I'm excited to hear your insights,

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and I'd love to start our conversation off

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with what trends or shifts you're currently seeing

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right now in the industry that you think

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are most important for leaders to pay attention

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to.

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It's

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a big topic, and and trends have been

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coming for a long time.

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I was sort

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of misstated that I thought the trend when

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I introduced I was gonna go to outpatient

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spine twenty years ago that it would take

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five or ten years to go.

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It's taken twenty years. But the biggest trend

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we're seeing right now is that transition from

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a hospital based care to outpatient

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on a higher and higher acuity level. So

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things you would have never thought of being

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done as an outpatient, front and backs, multilevel

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arthroplasties,

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big cases, joint replacement. They're all done routinely

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now in outpatient centers. So that's just been

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the giant trend.

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The the second is the transition of the

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payer model.

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I was raised in a fee for service.

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You sent a bill and you got paid.

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That changed. And then,

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we we moved through the value care options

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from HMOs to to to value care organizations.

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And now we're seeing, especially in the ASC,

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a big migration to global payments.

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And what's happening is as the ASCs can

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deliver a better product

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at a cheaper

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price break point,

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we can really move the needle. So we're

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going to global payment systems within our disk

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model,

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and we're able to move that final product

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to the payer down a large number, sometimes

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30, sometimes up to 50% less on the

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dollar spent. So it's a it's a

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big a big trend to redo the entire

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model.

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The third is that people really need to

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start

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and and are becoming aware of the need

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to look at cost efficiency

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and quality outcomes

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and and link those two numb things together,

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not be one in a in absence of

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the other. And as we do that, the

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the centers,

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the payers, and the vendors are gonna all

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need to get together

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to look at, is it producing a quality

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outcome,

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data driven?

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Do we have a metric to demonstrate it

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actually works?

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And then everyone needs to get on board

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that that's where we're going, to a good

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outcome,

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patient centric

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at a good price price breakpoint.

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A 100%.

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And I'd love to also touch on staffing

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and workforce challenges as those continue to be

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a concern across health care. So how is

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your organization navigating these pressures, and what strategies

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have you seen work well?

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As everyone else with a great deal of

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difficulty,

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ASCs and structures, we don't have the necessarily

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the pockets of a Kaiser or the big

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hospital system, so we can't always be the

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highest pay competitor and just go by our

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our our nurses. I think we have to

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look at it, and we do try to

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look at it

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more as we're bringing in someone as a

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team member. And I came out of the

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military and a lot of special forces

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contacts.

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We try to build a team where where

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people feel like they're part of it. They're

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acknowledged. They're they're part of the growth.

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And,

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the the next big thing for us to

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look at that we're in process of there

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is to look at their workload capacity

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we're putting onto people and how we can

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make that more efficient. I think that's one

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of the places we'll see AI come in,

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not replacing people, but making their workflow easier.

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So I we we do it by trying

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to make sure that recognizes people.

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Absolutely.

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And segueing a little bit more into outpatient

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care, this is continuing to grow. So how

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do you see the role of orthopedics and

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spine evolving within the broader healthcare ecosystem?

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Probably the most difficult question you're you're asking

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of of where it fits because

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in short, I'll give you the answer, I

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don't know.

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It's not an easy answer.

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It's not a matter of if it's going

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to an ASC

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environment.

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It's a matter of how and when. And

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and we are on

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the the so called hockey stick or the

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logarithmic growth curve now, and it's it's just

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it's caught on. It's there. There's lots of

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people doing. It's an explosion.

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So now it's just where it fits and

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who. And there's going to be multiple players

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in the market.

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The hospital systems, obviously, with the rate the

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HOPDs and the systems will be developing their

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own system, and that's that's good.

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There's the corporate level of that, which is

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the HCA's of the world that are, you

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know, large

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delivery care vehicles and and do it very

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well.

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You can look to

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United and with through Optum buying SCA and

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and buy and hold. They I don't know

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how many hundreds and hundreds of surgery centers

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they have now, but that's a a verticalization

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of the health care system

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through the payer straight through the delivery vehicle.

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So they're gonna exist. There's the independents who

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hold out, and they're doctor owned completely.

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And that's good, and they they like their

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autonomy,

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but they're capital limited. So they they within

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their niche, they can do well, but they're

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very capital limited to expand. So

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and then the new the new

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wave in the market, which I think is

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still

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wait to see where it goes is a

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private equity world. We chose to go there

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about three years ago and took in private

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equity money, CPF here in Chicago,

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Chicago Pacific founders with,

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brought into our models. We have our own

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management structure called Trius that that manages it.

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I've gotta tell you, so far, they're good

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people. They're they're they're putting in immense amount

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of capital in. They brought a lot of

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resources to the table

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for contacts. We we have made tremendous

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progress with the payers

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that, you know, frankly, I just didn't have

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the ability to get to. I'd be negotiating

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at the local contract level, and they came

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in and they can sit down at the

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corporate suite. So

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I I think the answer is they will

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all do well

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as long as they have a plan of

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where they go.

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They are different models. There'll be different applications

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in different areas of the country based on

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where, you know, intermount west if you're in

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the Mid Con

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there are a lot of different models.

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They all will fit into the system.

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I think the physicians need to look within

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their how do they maintain

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their happy spot, their autonomy enough that they

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are not trotting down on the way by,

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and how do they survive? So physicians will

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need to look

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of each individual product and where they fit.

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And and I think we'll see an entire

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system evolve,

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but it's not a question of if that's

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gonna be an ASC model anymore.

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That question got answered. We're there.

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Wonderful. And then as we kinda wrap up

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our conversation, I'd love to know what,

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partnerships,

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care models, technologies,

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that are increasing efficiency and outcomes that you

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are currently,

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exploring or working with? I know you mentioned

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AI earlier in our conversation. Is there anything

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else specifically that you are seeing,

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particularly promising?

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I I divide

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technology as a much is a big statement

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into, four different categories,

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and we're looking independently within each category

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what type of AI we're gonna do.

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Surgical, the operating room is one, obviously,

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and, you know, robots or endoscope

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navigation systems or or augmented reality. We're looking

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at all of them. And the problem is

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that today,

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all the young surgeons coming through are trained

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with these things coming out of their fellowship

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to good places. We're on a panel with

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the guys from Russian. They're training them to

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use all these. They come out. They want

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them. Okay. Are they cost efficient? Do they

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fit the model? That's one. So we're we're

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looking at all of them, and we have

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most of them in our centers, but we

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need to adapt to the new surgeons. The

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second area is the patient facing interface,

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and the patient facing interface

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is marketing to lead generation and lead generation

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to a consult in the office.

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And that's a whole application for AI. You

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know, it used to be a phone tree

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and then a call center, and and now

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that's gonna be a a big AI push.

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And there's multiple companies here looking at that

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opportunity. We we are looking and testing different

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things right now.

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The third is

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back office functions.

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Huge place for

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maximizing the flow. The payers are using AI

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to deny us.

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We need to be using AI to deny

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their denial and and go back to them.

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And, you know, an immense amount of time

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is spent by my

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staffing. That's where I mentioned it before, the

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AI. Immense amount of time stuck in the

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phone trying to get things authorized denials.

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We need an agent,

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an AI agent that that does most of

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that work, and I will have happier employees

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that are not tied up with

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the time consuming hassle that they have to

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have. So back office is a big and

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the fourth and the final is just which

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is not tapped on really much at all

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here is analytics.

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We just put in an Ospitec system into

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our RORs for data.

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We have to start looking at data for

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efficiency, data for flow

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analysis,

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and then

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we're looking at systems right now to integrate

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patient outcome into that structure. So you need

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data analytics. And if you don't have data

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going forward, you're you're sunk.

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Absolutely. Well, doctor Bray, thank you for joining

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me. Is there anything else that we, didn't

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touch on that you'd like to cover or

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share?

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I I have my advice to Becker's, which

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is you need an entire conference on where

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does the young surgeon fit and where do

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they go and where their future will be.

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Because what we really need to do is

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not just look to the right now and

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who's trying to put the money in their

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pocket, whether it's a vendor or AI or

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it's a hospital or it's a system. We

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need to look where the new surgeons survive

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in the long term, where their careers live,

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how they build,

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where they grow, and how they integrate into

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this. Because as we're building a system, it

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it needs to be about them.

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Absolutely. Well, thank you so much for taking

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the time to be here on the Becker's

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Healthcare Podcast. Again, we are recording live at

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the twenty second annual Spine Orthopedic and Pain

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Management Conference.

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Thank you for having me.