1 00:00:00,080 --> 00:00:02,240 This is Carly Beam with the Becker Spine 2 00:00:02,240 --> 00:00:04,719 and Orthopedics podcast, and I'm thrilled to be 3 00:00:04,719 --> 00:00:06,899 joined today by doctor Susan Sadowsky, 4 00:00:07,919 --> 00:00:10,820 chief medical officer at Desert Sports and Spine. 5 00:00:11,039 --> 00:00:11,859 Doctor Sadowsky, 6 00:00:12,320 --> 00:00:14,500 thank you so much for being here today. 7 00:00:14,974 --> 00:00:17,054 Thank you for having me. So before we 8 00:00:17,054 --> 00:00:19,375 dive into our questions, can you introduce yourself 9 00:00:19,375 --> 00:00:20,975 and tell us a bit more about your 10 00:00:20,975 --> 00:00:21,475 background? 11 00:00:22,015 --> 00:00:22,515 Absolutely. 12 00:00:23,214 --> 00:00:26,255 I am a board certified physiatrist, which is 13 00:00:26,255 --> 00:00:29,475 a specialist in physical medicine and rehabilitation, 14 00:00:30,329 --> 00:00:33,609 with an additional focus in interventional spine and 15 00:00:33,609 --> 00:00:34,109 musculoskeletal 16 00:00:34,570 --> 00:00:35,070 medicine. 17 00:00:35,530 --> 00:00:38,090 And as you, so nicely introduced me, I 18 00:00:38,090 --> 00:00:40,809 am the CMO of our practice, Desert Spine 19 00:00:40,809 --> 00:00:43,994 and Sports Physicians, which I am cofounder with 20 00:00:43,994 --> 00:00:45,695 my husband, doctor Brad Saroski, 21 00:00:46,155 --> 00:00:47,054 here in Arizona. 22 00:00:47,594 --> 00:00:50,634 I also, am the fellowship director for an 23 00:00:50,634 --> 00:00:51,134 accredited 24 00:00:51,754 --> 00:00:54,810 fellowship that we have, by North American Spine 25 00:00:54,890 --> 00:00:56,109 Society and the interventional 26 00:00:56,490 --> 00:00:57,469 spine and musculoskeletal 27 00:00:58,010 --> 00:00:58,510 medicine. 28 00:00:59,370 --> 00:01:01,950 Great. And as chief medical officer and cofounder, 29 00:01:02,010 --> 00:01:03,929 can you talk about some of the biggest 30 00:01:03,929 --> 00:01:07,049 headwinds you're planning for in the next, twelve 31 00:01:07,049 --> 00:01:07,549 months? 32 00:01:08,204 --> 00:01:11,084 Sure. Sure. Yeah. The the headwinds, you know, 33 00:01:11,084 --> 00:01:13,244 it's it's always a it's a balancing act 34 00:01:13,244 --> 00:01:15,484 of of our business, our growing business, and 35 00:01:15,484 --> 00:01:16,144 our mission, 36 00:01:16,685 --> 00:01:19,644 to maintain excellent patient care while managing these 37 00:01:19,644 --> 00:01:21,504 headwinds, always our top priority. 38 00:01:22,204 --> 00:01:23,939 As always, you know, we've got the cost 39 00:01:24,020 --> 00:01:24,420 pressures, 40 00:01:24,900 --> 00:01:27,159 always rising for equipment and supplies 41 00:01:27,620 --> 00:01:28,439 and compensating 42 00:01:29,060 --> 00:01:30,760 staff, facility overhead. 43 00:01:31,380 --> 00:01:33,299 And for us, we're we're in the active 44 00:01:33,299 --> 00:01:36,260 state of growth. So we're always reaching for, 45 00:01:36,905 --> 00:01:39,224 excellent physicians, to meet the growing demands of 46 00:01:39,224 --> 00:01:40,524 our practice, which we 47 00:01:40,825 --> 00:01:41,325 can, 48 00:01:41,944 --> 00:01:44,185 excel through our fellowship in doing that. But 49 00:01:44,185 --> 00:01:45,864 we also need to meet the demands of 50 00:01:45,864 --> 00:01:49,144 our growth, with also advanced practice practitioners, like 51 00:01:49,144 --> 00:01:50,219 PAs and, of course, staff, 52 00:01:51,020 --> 00:01:54,159 all while trying to, protect, mission critical, 53 00:01:54,780 --> 00:01:56,319 culture in our practice. 54 00:01:56,780 --> 00:01:59,200 And other headwinds would be Medicare 55 00:01:59,659 --> 00:02:00,159 always, 56 00:02:00,620 --> 00:02:03,579 and other regulatory and payer challenges. I don't 57 00:02:03,579 --> 00:02:05,420 know if you're aware, but Arizona is one 58 00:02:05,420 --> 00:02:07,625 of the six states that will be, 59 00:02:08,085 --> 00:02:09,784 involved in a Medicare preauthorization 60 00:02:10,324 --> 00:02:12,185 pilot in 2026. 61 00:02:12,245 --> 00:02:13,865 Mhmm. This will, for us, 62 00:02:14,805 --> 00:02:18,665 include certain interventional procedures, including epidural injections, 63 00:02:19,530 --> 00:02:20,269 nerve stimulators, 64 00:02:20,810 --> 00:02:23,469 and mild. So patients will be having 65 00:02:24,250 --> 00:02:26,590 probably a seven day period of preauthorization, 66 00:02:26,969 --> 00:02:29,549 which will put an enormous burden on our 67 00:02:29,609 --> 00:02:32,384 on our back office and and likely risk 68 00:02:32,384 --> 00:02:34,164 delay of care for certain procedures. 69 00:02:34,865 --> 00:02:36,384 So that that's always, 70 00:02:36,705 --> 00:02:38,705 that's on the horizon and and, of course, 71 00:02:38,705 --> 00:02:41,985 other kinds of reimbursement rules, documentation requirements that 72 00:02:41,985 --> 00:02:43,745 that always go on in in in the 73 00:02:43,745 --> 00:02:44,245 world. 74 00:02:44,870 --> 00:02:46,709 Yeah. And I wanna hone in on what 75 00:02:46,709 --> 00:02:48,329 you're saying just now about 76 00:02:48,629 --> 00:02:50,169 prior authorization. So 77 00:02:50,870 --> 00:02:53,109 what have you been doing right now to 78 00:02:53,109 --> 00:02:54,569 get ahead of 79 00:02:54,870 --> 00:02:57,829 this, whether it's communicating with patients, so what 80 00:02:57,829 --> 00:02:58,215 to 81 00:02:58,775 --> 00:02:59,275 expect, 82 00:02:59,574 --> 00:03:01,435 anything on the back end administrative 83 00:03:01,735 --> 00:03:02,235 wise? 84 00:03:03,014 --> 00:03:04,694 Yeah. I mean, we have a really strong 85 00:03:04,694 --> 00:03:05,194 authorization 86 00:03:05,495 --> 00:03:07,974 department within our practice, so I think that's 87 00:03:07,974 --> 00:03:09,995 a solid part of of our business. 88 00:03:10,375 --> 00:03:11,435 I'm doing a lot of 89 00:03:12,775 --> 00:03:13,080 discussion 90 00:03:14,120 --> 00:03:15,419 patients in terms 91 00:03:15,960 --> 00:03:17,000 of what they might be, experiencing in in 92 00:03:17,000 --> 00:03:18,300 the in the year ahead. 93 00:03:18,759 --> 00:03:19,659 I am a 94 00:03:19,960 --> 00:03:21,800 little bit cognizant of the fact that this 95 00:03:21,800 --> 00:03:24,199 might be fairly clunky when the year starts. 96 00:03:24,199 --> 00:03:25,479 So I I think just a lot of 97 00:03:25,479 --> 00:03:27,894 heads up for the patients, and, hopefully, this 98 00:03:27,894 --> 00:03:29,974 won't lead to delay of care in our 99 00:03:30,215 --> 00:03:31,914 our outpatient clinics have 100 00:03:32,215 --> 00:03:34,614 procedure rooms in office, so we're also able 101 00:03:34,614 --> 00:03:37,174 to offer procedures at very low cost to 102 00:03:37,174 --> 00:03:39,334 patients. So we actually are very proud of 103 00:03:39,334 --> 00:03:41,719 that on our website. We, have a transparency 104 00:03:41,939 --> 00:03:43,939 page and and issue all of our cash 105 00:03:43,939 --> 00:03:46,340 prices online. So which means that if a 106 00:03:46,340 --> 00:03:49,460 patient is in extreme pain, and cannot wait 107 00:03:49,460 --> 00:03:50,840 the seven days of preauthorization, 108 00:03:51,700 --> 00:03:54,020 they also, have a a fairly easy route 109 00:03:54,020 --> 00:03:55,159 to to have a procedure, 110 00:03:55,665 --> 00:03:57,344 cash pay if they decide to go that 111 00:03:57,344 --> 00:03:59,104 route. But, yeah, I think just a lot 112 00:03:59,104 --> 00:04:01,025 of education, just making sure our back office 113 00:04:01,025 --> 00:04:02,645 policies are are firm. 114 00:04:03,425 --> 00:04:04,784 So it sound it sounds like you're very 115 00:04:04,784 --> 00:04:05,284 proactive 116 00:04:05,585 --> 00:04:06,085 with 117 00:04:06,385 --> 00:04:07,205 all of this. 118 00:04:07,770 --> 00:04:09,310 Yes. Well, that's a bit 119 00:04:09,610 --> 00:04:10,810 a a a major part of our practice 120 00:04:10,810 --> 00:04:12,430 for a long time in terms of preauthorization. 121 00:04:13,209 --> 00:04:15,050 Unfortunately, a lot of the patients, feel a 122 00:04:15,050 --> 00:04:17,610 little bit blindsided in terms of, what's ahead 123 00:04:17,610 --> 00:04:20,269 of them, as they many of them chose 124 00:04:20,329 --> 00:04:23,754 Medicare over Medicare replacement plans due to the 125 00:04:23,754 --> 00:04:24,894 lack of preauthorization. 126 00:04:25,355 --> 00:04:25,855 So, 127 00:04:26,235 --> 00:04:27,834 this is this is going to be a 128 00:04:27,834 --> 00:04:30,394 a difficult road ahead, I think. So we'll 129 00:04:30,394 --> 00:04:31,774 see how that rolls out. 130 00:04:32,235 --> 00:04:35,055 Yeah. And then you also mentioned, your fellowship. 131 00:04:35,115 --> 00:04:37,829 Can you talk more about that, how, that's 132 00:04:38,229 --> 00:04:40,649 led to growth within the the practice? 133 00:04:41,029 --> 00:04:41,769 Yeah. Sure. 134 00:04:42,310 --> 00:04:44,470 My husband, Brad Svaroski, and I started our, 135 00:04:44,789 --> 00:04:47,430 fellowship in actually, in 2011, a few years 136 00:04:47,430 --> 00:04:48,729 after we started our practice. 137 00:04:49,349 --> 00:04:51,634 And then it became accredited by the North 138 00:04:51,634 --> 00:04:54,055 American Spine Society in 2018, 139 00:04:54,435 --> 00:04:55,795 which is a cohort of about, 140 00:04:56,275 --> 00:04:58,595 25 or so programs around The United States 141 00:04:58,595 --> 00:05:01,475 that meet rigid, criteria to be a part 142 00:05:01,475 --> 00:05:04,535 of. We have a formal match process, etcetera. 143 00:05:04,595 --> 00:05:07,269 And so we train about two to four 144 00:05:07,269 --> 00:05:08,490 fellows in interventional, 145 00:05:09,110 --> 00:05:10,089 spine and musculoskeletal 146 00:05:10,470 --> 00:05:12,410 medicine each year, and we're actually 147 00:05:12,790 --> 00:05:15,189 very happy to say that we've trained 22 148 00:05:15,189 --> 00:05:17,290 fellows that are out in the world practicing 149 00:05:17,509 --> 00:05:20,154 in academic and private practice spaces. 150 00:05:20,855 --> 00:05:23,175 With that fellowship, we have used our fellows, 151 00:05:23,415 --> 00:05:25,435 for growth. Right? It's a year long interview 152 00:05:25,495 --> 00:05:27,435 practice. We all end up practicing 153 00:05:27,735 --> 00:05:29,415 the same flavor of medicine at end of 154 00:05:29,415 --> 00:05:31,254 the day with Nuances, of course. So we're 155 00:05:31,254 --> 00:05:33,975 able to to offer to our patients a 156 00:05:33,975 --> 00:05:35,194 consistent and excellent, 157 00:05:35,850 --> 00:05:36,829 way of management. 158 00:05:37,370 --> 00:05:39,370 And then in our fellowship, we we really 159 00:05:39,370 --> 00:05:41,370 work hard to standardize, you know, what are 160 00:05:41,370 --> 00:05:44,009 the advanced skills that that physicians need in 161 00:05:44,009 --> 00:05:45,149 this, nonsurgical 162 00:05:45,529 --> 00:05:46,509 spine and musculoskeletal 163 00:05:46,970 --> 00:05:47,949 medicine space, 164 00:05:48,524 --> 00:05:51,485 whether that's, you know, image guided procedures under 165 00:05:51,485 --> 00:05:53,024 a fluoroscopy or ultrasound, 166 00:05:53,805 --> 00:05:55,725 regenerative medicine, which is a big part of 167 00:05:55,725 --> 00:05:58,464 our practice, with PRP and and bone MAC, 168 00:05:58,845 --> 00:05:59,345 electrodiagnostics, 169 00:06:00,524 --> 00:06:01,024 rehabilitation, 170 00:06:01,324 --> 00:06:03,480 and and health and wellness. So really looking 171 00:06:03,480 --> 00:06:06,199 to standardize all these skills, and and helping 172 00:06:06,199 --> 00:06:09,579 to produce really the next generation of, interventional 173 00:06:09,800 --> 00:06:10,779 spine and musculoskeletal 174 00:06:11,319 --> 00:06:11,819 physicians. 175 00:06:12,680 --> 00:06:15,000 That's great. And you're thinking about just the 176 00:06:15,000 --> 00:06:16,220 future of spine. 177 00:06:16,680 --> 00:06:19,694 How do you see, the spine orthopedic field 178 00:06:19,754 --> 00:06:20,254 evolving 179 00:06:20,634 --> 00:06:22,335 in the next two to three years? 180 00:06:23,275 --> 00:06:24,955 Yeah. It's it's an exciting time, I think, 181 00:06:24,955 --> 00:06:26,875 in terms of of the shift that we 182 00:06:26,875 --> 00:06:28,634 have in terms of the tools in our 183 00:06:28,634 --> 00:06:30,714 tool bag. You know, when we started this 184 00:06:30,714 --> 00:06:31,170 practice, 185 00:06:31,730 --> 00:06:33,910 I would say we were more, reactive 186 00:06:34,290 --> 00:06:37,569 applying Band Aids to injuries or or pain 187 00:06:37,569 --> 00:06:38,790 in the spine and musculoskeletal 188 00:06:39,090 --> 00:06:41,009 system. And and over time, there's been a 189 00:06:41,009 --> 00:06:44,625 huge expansion in regenerative medicine, especially, within our 190 00:06:44,704 --> 00:06:46,165 practice, and and that would include, 191 00:06:46,545 --> 00:06:48,245 PRP, platelet rich plasma, 192 00:06:48,785 --> 00:06:51,425 and and bone marrow aspirate concentrate, which is 193 00:06:51,425 --> 00:06:53,425 AKA stem cells. You know? And as this 194 00:06:53,425 --> 00:06:56,545 is the biologics are gaining stronger evidence and 195 00:06:56,545 --> 00:06:59,045 broader acceptance. You know, the shift is really 196 00:06:59,480 --> 00:07:02,279 towards not a Band Aid, but true, tissue 197 00:07:02,279 --> 00:07:04,920 restoration and healing. And and this is probably 198 00:07:04,920 --> 00:07:07,160 the most exciting part of, what we're offering 199 00:07:07,160 --> 00:07:08,379 to patients now. 200 00:07:08,839 --> 00:07:11,180 Mhmm. And I'd love to hear your perspective 201 00:07:11,240 --> 00:07:14,014 on just kind of the most interesting innovations 202 00:07:14,154 --> 00:07:17,115 that you think will start taking front and 203 00:07:17,115 --> 00:07:18,095 center stage. 204 00:07:18,634 --> 00:07:20,314 Yeah. I mean, again, I think that really 205 00:07:20,314 --> 00:07:23,435 revolves around the regenerative therapies. So and and 206 00:07:23,435 --> 00:07:26,410 expanding into into more biologics. So, again, sort 207 00:07:26,410 --> 00:07:28,350 of now we have our our main workhorses 208 00:07:28,410 --> 00:07:29,230 of the PRP, 209 00:07:29,930 --> 00:07:31,149 and and BMAC. 210 00:07:31,449 --> 00:07:34,410 But for example, we're doing, a research project 211 00:07:34,410 --> 00:07:37,335 on on meso blast, which is, a combination 212 00:07:37,335 --> 00:07:40,875 of regenerative cells and hyaluronic acid for degenerative 213 00:07:40,935 --> 00:07:43,335 disc disease. So just as an example of 214 00:07:43,335 --> 00:07:46,395 of the field evolving into other biologic therapies 215 00:07:46,615 --> 00:07:48,314 and working on that evidence, 216 00:07:48,855 --> 00:07:50,875 and to strengthen results. 217 00:07:51,399 --> 00:07:53,800 And doctor Swarovski, can you talk about how 218 00:07:53,800 --> 00:07:54,300 you're 219 00:07:55,160 --> 00:07:55,660 collaborating 220 00:07:56,120 --> 00:07:57,639 with surgeons as, 221 00:07:58,519 --> 00:07:59,500 pain medicine, 222 00:07:59,959 --> 00:08:00,459 experts? 223 00:08:01,079 --> 00:08:03,419 Yeah. We've also we've always had a very 224 00:08:03,654 --> 00:08:06,854 healthy dynamic relationship with our surgical colleagues. I 225 00:08:06,854 --> 00:08:09,014 I think that that's gonna be the way 226 00:08:09,014 --> 00:08:11,014 we need to move forward, especially in this 227 00:08:11,014 --> 00:08:12,555 space, you know, is how to 228 00:08:12,935 --> 00:08:14,074 produce these integrated 229 00:08:14,535 --> 00:08:16,959 care models partnering with, you know, not only, 230 00:08:17,120 --> 00:08:19,759 obviously, physical therapists in the nonsurgical space, but, 231 00:08:20,000 --> 00:08:20,500 orthopedics, 232 00:08:20,879 --> 00:08:23,060 spine surgeons, and orthopedics and neurosurgery, 233 00:08:23,519 --> 00:08:24,879 you know, in order to not just be 234 00:08:24,879 --> 00:08:25,939 these isolated 235 00:08:26,399 --> 00:08:28,800 silos of patient care, but, you know, to 236 00:08:28,800 --> 00:08:29,300 produce 237 00:08:29,725 --> 00:08:30,225 paradigms, 238 00:08:30,605 --> 00:08:31,904 where we have more seamless, 239 00:08:32,445 --> 00:08:34,544 management of patients and and collaboration, 240 00:08:35,164 --> 00:08:38,625 perhaps even, sharing data and functional outcomes, 241 00:08:39,325 --> 00:08:41,485 all to, you know, achieve a better outcome 242 00:08:41,485 --> 00:08:43,345 and and a more seamless experience. 243 00:08:44,629 --> 00:08:46,730 Right. And, you know, my last question, 244 00:08:47,590 --> 00:08:50,169 what were some other big health care trends 245 00:08:50,309 --> 00:08:52,490 that you're following right now? 246 00:08:53,029 --> 00:08:55,110 Yeah. I mean, I think the trend, at 247 00:08:55,110 --> 00:08:56,889 least as we see it as as nonsurgical, 248 00:08:57,669 --> 00:09:00,254 specialists is, you know, just this really growing 249 00:09:00,254 --> 00:09:02,975 role for nonsurgical therapies. You know, how to 250 00:09:02,975 --> 00:09:06,514 delay, how to avoid surgery where appropriate. Right? 251 00:09:06,654 --> 00:09:08,575 You know? And and hopefully getting more insurance 252 00:09:08,575 --> 00:09:11,075 coverage for these things, including regenerative therapies, 253 00:09:11,615 --> 00:09:13,534 you know, as as the patient demand is 254 00:09:13,534 --> 00:09:15,700 is growing for that. And and that's also, 255 00:09:15,700 --> 00:09:17,879 you know, flipping the script a little bit, 256 00:09:18,100 --> 00:09:20,740 focusing, on the prevention, right, and finding things 257 00:09:20,740 --> 00:09:22,120 before they become an issue, 258 00:09:22,420 --> 00:09:23,960 preventing rather than treating. 259 00:09:24,340 --> 00:09:26,740 You know, obviously working on the fundamentals, movement, 260 00:09:26,740 --> 00:09:27,794 exercise, diet, 261 00:09:28,115 --> 00:09:31,075 but, how to identify early degenerative changes and 262 00:09:31,075 --> 00:09:33,235 perhaps even with biologics so, you know, we 263 00:09:33,235 --> 00:09:36,514 can prevent things, from deteriorating and and getting 264 00:09:36,514 --> 00:09:37,254 so advanced. 265 00:09:38,115 --> 00:09:38,615 Absolutely. 266 00:09:39,154 --> 00:09:41,634 Well, doctor Sadowsky, thank you for joining us 267 00:09:41,634 --> 00:09:43,689 today. It's been a pleasure speaking with you, 268 00:09:43,689 --> 00:09:45,449 and I look forward to connecting again down 269 00:09:45,449 --> 00:09:47,689 the line. You're so welcome. Have a wonderful 270 00:09:47,689 --> 00:09:48,189 day.