This is Carly Beam with the Becker Spine
and Orthopedics podcast. And today, I'm thrilled to
be joined by doctor Brandon Hirsch at DISC
Sports and Spine Center. Doctor Hirsch, thank you
so much for being here today. Thank you,
Carly. Thank you for having me. I'm glad
to be here to chat with you.
Absolutely. And before we dive into our questions,
could you introduce yourself and tell us a
bit about your background?
Sure. So I'm an orthopedic spine surgeon, in
practice in Orange County in North San Diego,
and, I'm in my eighth year of practice.
Previously was in practice in Arizona,
trained on the on the East Coast, a
few different places before heading out West to
to begin my career.
Thank you. And to get started, I wanted
to pick your brain on telehealth
and spine surgery. Obviously, telehealth really exploded,
beginning the COVID pandemic. And now five years
on,
where have you seen it be the most
beneficial
to your work?
Yeah. So I think that
telehealth and telemedicine and spine care
happen to fit very well together,
and it was some something that I was
even interested in before the pandemic started. And
the pandemic, I think, just highlighted
how useful and effective,
you know, technology can be
in getting patients in front of,
spine care providers and spine surgeons who, you
know, have the expertise that they need.
So I view telemedicine as a very positive
development, and I think most patients do as
well. You know, I recently,
it's been held up a little bit by
the lack of a continuation
from Medicare
in,
coverage policy, but I think that that
I believe that's now been extended once again.
I'm not sure whether it's been permanently extended,
but that was sort of the main obstacle
to the continued growth that I think is
getting worked through now, which
is very welcome.
And what do you think will be some
of the next big game changers in this
area?
Well, I think just,
as
patients become more comfortable and it becomes more
commonplace and patients get more experience,
using telehealth,
I think that that
will improve both their comfort
with,
you know, using technology to have a discussion
with the doctor,
and it will also help doctors' offices
and practices
get better at sort of the the,
ins and outs of getting telehealth set up
set up in a reliable way. You know,
if you talk to people,
in practices that
weren't really familiar with telemedicine
and kinda just started
in the pandemic, you know, some practices had
technological,
you know, obstacles to overcome to get,
to get their telemedicine
platform
up and running the way they'd like it
to. But, you know, fortunately, with,
you know, technology like Zoom or any of
the other platforms,
it's now become a very easy to use,
highly reliable
way to see patients.
And,
I think it does
a number of things that are beneficial for
both sides.
For patients, you know, we live in an
era of convenience where convenience is
is at a premium.
Really, in in any part of our life,
there are probably people who will be listening
to this podcast
that no longer go to a grocery store
because they use a product like Instacart,
or,
you know, Uber Eats or or these things.
And so,
really, if you look at any other part
of our life, technology is constantly making things
more convenient and saving us time. So why
why would that not be, you know, helpful
in health care where
time
and, you know, resources are
scarce,
for both patients and and their physicians.
So
I think in that
regard, as
as the technology and and comfort
level gets better, I think the
the adoption and the the widespread use will
get,
better. Part of that, you know, I think
is the age of the population that's being
cared for. I think we're just,
you know, kind of at the edge of,
you know, the
the generation that's the oldest that are receiving
health care right now or kind of the
last
generation
that didn't grow up with,
the Internet and technology in their hands.
But I think once we go into, you
know, another fifteen years,
even the oldest,
people in our population will have had
extensive experience using, you know, the Internet, and
technology
in every part of their lives from from
the time they were a young age.
That's a really good point you make there.
And you mentioned earlier just some challenges
of telehealth in terms of government policy, etcetera.
I know we're recording this on December 9,
but
right now, how are you thinking about these
policy changes, and what do you wanna see,
in terms telehealth
access?
Right. So,
you know, during the pandemic, for those who
may not be familiar,
Medicare
passed a series of regulations
that,
enhanced or expanded coverage for telemedicine because,
you know, no they didn't want anybody seeing
people in person at that time.
And those had,
time limits on them, expiration dates.
And as as we got through that, and
and out of it, the
the expiration dates in a kind of a
classic, you know, Washington DC fashion got kicked
down the road six months or a year,
multiple times.
And, actually, right before the most recent shutdown,
was the expiration of the most recent
extension. And so during the shutdown, there was
a period of time where Medicare was not
going to cover,
except for very narrow exceptions,
telemedicine.
And, naturally, the the commercial payers will always
follow suit
of what Medicare does. And so we experienced
very recently a a period of time where
there was no telehealth
access
through, you know, traditional insurance pathways.
And,
you know, that really
irritated patients and caused disruptions to their practice.
So
the
implementation
and the what I think needs to happen
is, number one, Medicare needs to
permanently,
outline
the coverage for telemedicine
that will then have the commercial payers follow
suit
and and,
provide coverage for it. You know, most likely,
no one can ever say exactly what the
commercial payers will do, but but they do
tend to follow Medicare policies and guidelines.
So I think that's, you know,
a must do, and I think that's on
the very near horizon and is,
is part of the
the health care related bills that are in,
Congress now.
So that's, you know, that's what I see
as the first next step. And then beyond
that,
you know, just the integration of telemedicine
into the rest of our
software ecosystem in health care, like EMRs, both
office based EMRs and hospital based EMRs.
Right now, a lot of the software platforms
do have
integrations for telemedicine,
but I've had limited experience with them. I
find they're not as reliable as a product
like Zoom is,
and maybe not as intuitive for,
patients to
use because people are just most familiar with
what they use in other parts of their
life, and that tends to be products like
Zoom at the at the moment.
So I think that's gonna be the next
phase is how how do we integrate the
telemedicine experience into
the rest of our health care software,
you know, ecosystem to make it a seamless
transition to get your care and to provide
the care
without making it clunky or or challenging. Just
trying to eliminate as many obstacles and friction
points as possible to make it,
natural and easy for for patients to get
care this way.
And what are some of the other
conversations
that you're following in terms of just, you
know, policy shifts and different discussions going on
in Washington, DC?
Sure. So I think it's,
it's a interesting time in health care and
in health care reform and in our overall
political environment.
But I view the
volume on the conversation around
health care and pay reform
to really be increasing in the last two,
three years.
I
enjoy being, you know, somewhat active in advocacy
discussions,
you know, online,
whether it's platforms like Twitter or LinkedIn.
There are a lot of people from different
parts of the country, different practice environments,
and even non physicians who are really
thoughtfully
engaged with
with each other on what's the best path
forward.
And I think they're really starting to make
make some waves in having people pay attention.
You know, actually,
you you may have seen this or may
not have, but,
people like Mark Cuban who have, you know,
tremendous business acumen, tremendous resources,
and a desire to
change the status quo
are getting seriously involved in health care. He's
done that already on the farm you know,
on the pharmacy side with his company that
provides generic drugs at, fair market prices.
And he's now engaging with, you know, people
that I know, individual physicians,
neurosurgeons,
people who've you've you've had, you know, feature
on the Becker's platform
are able because of technology, because of Twitter,
to have live discussions with people like Mark
Cuban
to engage, you know, his resources in
the
progress or the effort toward reform, which, you
know, is just
a a remarkable and inspiring thing for me
at a young stage in my career
to to see you know, maybe there is
the impetus and enough momentum to,
to change things,
because clearly,
you know, what's going on with health care
and and how payers work and how health
care is paid for is is clearly not
working for
the very vast majority of people in our
country.
And patients
are starting to get an understanding of this,
and it's starting to,
surface in the political discussions
as we approach,
you know, an election cycle.
So, you know, very,
very,
focused on that and
grateful to have people lending a hand who
may not be, you know, physicians themselves, but
are business people who are familiar with what's
going on in health care. Because,
unfortunately, to this point, when, you know, doctors
have been doing it kinda on their own,
just haven't haven't been able to organize well
enough or get the right audience
or
position things the right way at the right
time to get real change. And so,
you know, I think it's it's really time
for us to band together with with those
in the business world and the political world
to try to advance, you know, reform that's
clearly much needed and and obvious to everyone.
But often, the pathway to change in our
political
system is is not an obvious pathway.
Yeah. That's a really good point you make
about just getting,
collaborating with people within and also without
the medical world. And, you know, I was
wondering, doctor Hirsch, how are these different conversations,
how do you see them directly
affecting
spine care?
Yeah. So anything that impacts access to care
and health care is gonna have a direct
impact on spine care. You know, Lobaqin is
the most common reason that people seek medical
care, and so it represents a large proportion
of our overall health care economy as far
as diagnoses are concerned.
And so any,
reforms or changes that can make it,
number one, easier for patients to afford their
care,
and number two,
easier for physicians
to provide the care be because of the
economics or a reform of prior authorization
is going to positively
impact
spine care.
And that means, you know, things like,
more reasonable contracted, you know, rates,
things like we were just discussing,
impacting regulation or or legislation around,
telemedicine care to make sure that that's not
something that has to get revisited every year
to extend, you know, temporary
coverage, but that it becomes a normal
recognized way for for people to receive and
people to provide health care.
So, you know, those are both things. I
I think that
the
tremendous growth of of premiums
disproportionate to the amount of actual coverage,
is something that probably is gonna need need
to be regulated.
Other areas that I think maybe are further
away are things like,
you know, repealing certificate of need laws and
addressing
the ban on physician ownership of hospitals.
Those are those are two large priorities
subjects
that would
really directly impact spine care.
Much of, you know, spine care can be,
you know, provide on an outpatient basis.
Some some does require hospital,
but the,
kind of perverse economic incentive of the much
higher facility fees,
driving a lot of care
to a hospital environment when it doesn't really
need to be in that environment. You know,
having
a reform like site neutrality for payments
would
really allow true competition and allow us to
reduce the cost of care because
we're not just kinda shuffling
the cards around, you know, as a health
care provider to where are we gonna maximize
reimbursement, but where is it the most efficient
and cost effective
location and and environment for care?
Very well said, and I appreciate that overview
of everything.
And then doctor Hirsch, I was wondering, how
are you thinking about growth in your own
practice next year?
Yeah. So I'm in a, you know, somewhat
unique practice environment of of independent,
private practice in a market in Southern California
that has,
a lot of spine surgeons, also has a
lot of patients, but but is fairly saturated.
And,
so I'm always thinking about growth in patient
volume,
and growth in
digital footprint.
And so,
you know, that will be a big part
of what I focus on in in early
twenty twenty six is growing,
you know, my footprint online, you know, just
like we were discussing,
the growth of telemedicine.
Along with that comes growth in how patients
find physicians.
And,
these days, if if you're not visible,
you know, online, it's almost as if your
practice doesn't exist in real life, because that's
just the reality of how,
how people are searching for health care.
So that, you know, that'll be a priority,
you know, growing
aspects of my practice that are somewhat
specialty like spinal endoscopy,
disc replacement,
you know, are always gonna be,
growth goals.
And, you know, probably in 2026, I'll have
more of an involvement in advocacy discussions,
both at the society level and
at
the kind of more grassroots, just physician organization
level
because the election cycle toward the end of
the year is probably
gonna be pushing
a lot of these
potential reform items up to the front of
the conversation. I I hope as long as,
you know, some other scandal or topic doesn't
distract public's attention from, you know, the important
topics at hand.
Got it. And and then my last question
for you is, what do you think will
be the biggest disruptor to spine surgery next
year?
Yeah. So I I I think disruption in
spine surgery
is tough to predict, number one, and usually
takes
a little more than a year. But I
know that,
the adoption
of endoscopy and the ways that,
surgeons are using it is rapidly
progressing,
and there's even more and more ability for
surgeons to
discuss cases
with other surgeons in their local market. And
because there are more people
utilizing that technique
in any given market, that allows for even
more conversation,
amongst surgeons. And so I have, you know,
several surgeons just in my own market
where I'll plan to
go to observe their cases, and and they
may or may not come to observe my
cases. And that,
I think is how we drive real progress
and innovation and improvement in the
surgical techniques that we offer.
So that'll be a a major focus. And
then, you know, on the
digital media, you know, side of things,
you know, at least for my practice,
putting resources into that to really
transform
your
your online presence.
You know, I think that that I I
anticipate that's going to bring
significant,
change in the practice volume and types of
patients that are coming to see me.
Well,
doctor Hirsch, thank you so much for joining
our podcast today. It was a pleasure to
speak with you, and I look forward to
connecting again down the line.
Absolutely. Thank you very much, Carly, for having
me. It was a pleasure.