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This is Alan Condon with the Becker's Healthcare Podcast,
and I'm thrilled to be joined today by Dr. Philip Louie,
medical Director of Research and Academics at the Center for Neurosciences and
Spine at Virginia Mason Franciscan Health. Dr. Louis,
pleasure to connect with you again today and have have you on Becker's podcast
for your first time. I'd love turn the over to little bit your role,
your background before we dive into our conversation today.
Alan, thank you for this opportunity.
I've listened to many of these and enjoyed the conversation,
so I'm excited to be, uh, part of your journey. Um,
but thank you for that introduction. Yeah, so Phil Louie here.
I'm an orthopedic spine surgeon, um, out in Seattle, and, uh, I love Seattle.
It's near and dear to me as I grew up there.
I actually went to undergrad and med school at the University of Washington, uh,
before trekking out to Chicago to Rush University Medical Center for Orthopedic
Residency,
and then even further away from home to New York City Hospital for special
surgery for my spine fellowship and decided, you know,
home is where the heart is and, and brought my family back. Um, so yeah, so I,
a few years into practice now, my, my practice is, uh, predominantly, uh,
minimally invasive, um, degenerative, uh, practice. Um,
and sort of the purposes of, of sort of our topic today.
I had an opportunity about of six months, eight months into practice when,
you know,
we were in the height of the pandemic where we had to take surgeries out of, uh,
our main hospital. They, uh,
was provided an opportunity to start performing spine surgeries at a surgery
center, uh, about two years ago that had never, uh,
performed spine surgery up to this point.
So that's sort of where I've transitioned a lot of my practice as well. Yeah.
Thank you so much for the introduction, Dr. Lu. And, you know,
interesting background and of course you have your training here at Northwestern
Chicago. Spent some time out in the east coast of New York,
and they're obviously based out in Washington. Um,
and also have that background between moving more into ambulatory surgery space.
Um, to pick up on that, uh,
what are the kind of two or three trends that you're following closely,
just specifically when it comes to the ASC space today?
Yeah, I think one of the biggest theories that we look at in our group is,
you know, has always had a strong focus on, you know, this,
this concept of value-based care is, you know,
like how exactly is this growth of these ASCs that we're seeing, you know,
exploding everywhere, you know,
how does this fall into a value based care model, right? Eventually, right?
We know that there's been greater safety, um, that's been demonstrated.
There's an evidence of, you know,
quality metrics that are improved compared to main hospitals.
There's certainly lower costs from a patient perspective, right?
That tends to be easier to drive in and out of these surgery centers and,
and get to them rather than large hospitals and different parking settings. So,
you know,
where exactly does this growth of AFC fall into a value-based care model as sort
of this collide in near future?
Yeah. And you mentioned, uh, obviously you,
you started performing for the first time cases in the ambulatory surgery center
during Covid when we did see a lot of cases moving out of the hospital. Uh,
I'm curious when you, when you initially did start performing those, those,
those cases in an outpatient setting, what were, what were you surprised by,
if anything? And, uh, was there anything that was, uh,
presented a significant challenge in that, in that regard?
Yeah, I was actually really excited with the opportunity.
I think in residency and fellowship I had been able to train in,
in practices that had really done a fantastic job in
providing like absolutely wonderful patient care at these surgery centers.
And I think for me, taking these learnings into real life, you know,
definitely showed there are some obstacles that certainly existed compared to
sort of a well-oiled machine.
I think one of the biggest difficulties that were handed into was the surgery
center didn't have a spine microscope. You know,
we had an E N T microscope that had a very short focal length, uh,
but I never really enjoyed working through my loops down a, you know,
a small tube and, and we had to figure out, you know,
how are we going to transition our, our initial, um,
minimally invasive sort of tubular, uh, surgeries in the surgery center and,
and basically relied on some enabling technologies.
They used a vizi on camera early on and, and been able to grow, you know,
certain enabling technologies just to be able to perform, uh,
spine surgery safely in the surgery center. And, uh,
using that as a tool to sort of teach the staff and, uh, sort of grow as a team.
Yeah, yeah. Really interesting to kinda see that growth in the ASC setting for,
for you and your practice center at Virginia Mason Health. I'm curious,
how is your,
how is your patient selection kind of vol evolved when you're performing more of
these cases in the asc? And is there any,
are you performing every spine surgery,
every spine procedure in the outpatient setting,
or is there certain procedures that you still like to perform in the hospital?
Yeah, that's a great question. I think first and foremost,
what's really important is we have this, um,
really close relationship with our anesthesia team and,
and the medical medical directors of, um, the surgery center.
So all of our patients,
even though I may think that they are healthy and safe performance surgery
center,
there's still our anesthesia team that overlooks every single decision that I
make. And,
and when there are some great areas we have a discussion together and they let
me know, hey, you know, maybe this, uh,
patient is better suited for the hospital.
And I've really enjoyed that collaboration and that relationship because I've
learned a lot from them in their standpoint. And, you know,
how can we provide safe care outside of the hospital setting?
But from a surgery standpoint, you know, I started with, um,
lumbar micro discectomies and, uh, laminectomy, uh, multi-level.
We've been performing one and two level cervical disc replacements and anterior
cervical fusions, you know, posterior cervical foram autotomies.
And we're actually starting, um,
single level lumbar fusions in the next couple weeks here. Uh,
but certainly anything greater than that, I've,
I've tended to feel more comfortable performing in the hospital at this point.
Alright, yeah, yeah, really interesting to get your 2 cents there. Uh, uh, Dr.
Li, I know just from speaking to you and from our previous discussions,
I know you're someone who pays very close attention to trends in spine surgery,
also the the new and innovative technologies. Um, with those two things in mind,
is there anything you're particularly excited about in terms of spinal trends or
technologies whatcha paying attention to right now?
Yeah, I mean, another trend that I, I I think that it's interesting if you,
if you look at healthcare in general, I think one of the big knocks on,
on us in health,
cuz we tend to be a little bit less nimble than other fields in this world.
And I think that we're finally starting to see a change, right? If,
if there's something the pandemic did, uh, and it's done a lot, it's,
it's forced us to sort of quickly alter the way in how we deliver
care. Um,
and so now we have this environment that I think is a ripe for innovation. And,
and that's what we're seeing, right?
We're we're seeing the expansion of procedures that can be done in a surgery
center, an ambulatory surgery center,
because I think that the innovations that are sort of driving the enabling
technologies are allowing us to do so safely, you know,
whether it's visualization, um, instrumentation really grouping together,
uh, the whole perioperative care from, um, planning for surgery,
getting everyone involved and,
and performing the surgery safely and then following them over a period of time.
And I think if there's one area and certainly a buzzword that people throw
around, it's this whole concept of big data, right? Mm-hmm.
We talked about augmented, um, sorry, artificial intelligence and,
and machine learning.
But I think the concept behind it is that we now have a really cool way and,
and actually really lots of ways to utilize large amounts of data and
apply them directly into patient care. And, you know,
the way I talk to my patients about this now too,
because I think there's so many technologies that have that as a backbone,
is that like every single patient now that comes in and is being treated is
essentially contributing to the care of future patients just like them in so
many different ways.
Mm-hmm. . Yeah. Really interesting. You, you brought that up.
I mean, it seems just the last couple of months in particular,
I know AI has been around in healthcare for, for quite a while,
but it seems just the last couple of months and the evolution of chat,
C P T and all this,
it's really kind of breaking into the mainstream and become such a hot topic.
Um, but specifically related to spine surgery on ai, um,
how do you kind of see that maybe potentially incorporating into diagnostics,
robotics? Is it the, the biggest opportunity for AI is related to spine surgery?
What do you think it is?
Yeah, and, and you're absolutely right, right?
AI's been around for a really long time in residency. You know, I had this,
the joy of starting a company where we used a chat bot to,
to help with postoperative care in our patients. You know, that was, you know,
seven, eight years ago.
But now I think it's really interesting because we have all of these
technologies, um, that are being applied, whether it's, you know,
augmented reality, robotics and navigation, uh,
different types of imaging and visualization,
but they're all sort of separate entities right now. Mm. And I,
I think what we're heading towards and what we're hopefully heading towards is
being able to develop a all in one platform.
So you have information that you've gathered in the past from all of this data.
You have your current patients in front of you with their comorbidities,
their radiographic findings, their history, their exam findings, their concerns,
and you're able to sort of, uh,
take a segment of their care and put it into that sort of algorithm to start
developing these predictive analytics of what,
how they may recover from different procedures or what interventions might be
best. And then if it is surgery that's indicated within the same comprehensive
platform,
you're able to perform that surgery in sort of the safe disc and most efficient
manner in the operating room with, you know, whatever technology that is.
And then you take the preoperative analytics and you take the technology in the
or,
and the third part of that single comprehensive platform will be following them
up over time and seeing, you know, for example, with the lumbar fusion,
you know, what, how is that fusion occurring?
What's happening to the levels above and below the fusion? How has the patient,
uh, gone from compensating one way to living biomechanically in a different way?
And now that they've had the procedure,
but it's all within a single platform where it's easy to access and easy to,
to essentially utilize and for other people to, to use as well.
Yeah, yeah, really interesting point. So,
so sounds like almost integrating these AI mechanics into one platform,
similar in the way that I guess we're seeing a lot of health systems integrate
almost EHR platforms into this one system just to kinda streamline and things
that make it a lot more efficient.
I think so.
I think one of the biggest deterrents now is that there's so many options out
there, but none of them capture the full gambit of, you know,
what we're looking for. And I think if we look at the world around us,
consolidation is happening, you know, whether you like it or not. And,
and I think when it comes to, you know,
applying AI and machine learning to different enabling technologies,
I think we're gonna start seeing a con consolidation of efforts as well.
Yeah. Yeah, it's gonna be,
consolidation just seems like it's happening no matter where you are in the
world and what worst technology , um,
fascinating to kinda get your thoughts there.
I think AI is something that I'm specifically really interested in as well.
This would be really interesting to see how it evolves over the coming years,
especially when it relates to spine surgery for yourself. Um, Dr. Louis,
last question I have for you before I let you go, I mean,
we've touched on quite a bit already here, but when you think about yourself,
your own practice over the next 12 months or so, uh,
how are you thinking about growth?
Oh, that's a fun question. You know, I, I think at the end of the day,
like I'm still an, you know, academic, like a clinician scientist, right?
I'm still a spine nerd and nerd in, in many aspects, and, you know,
we have a, a large research team and I think that's one area where, you know,
I'm I in growth in the futures, you know,
how do we provide a greater level of evidence to the work that we're doing,
right?
So how can we better understand sort of the economics of the care that we're
providing, especially in a surgery center setting, you know, the,
the ergonomics of our care and self sustainability and protecting our bodies
over time.
So I'm no longer operating on my senior colleagues because of the toll that's
been taken on their body. You know,
how can we better demonstrate the safety and complication profiles of all these
new procedures that are coming out?
But really collaborating with other centers to do this in a large perspective
manner, because I think collaboration is key. Doing it prospectively is key.
And, and that's how we're going to grow spine care is really, you know,
working from the ground up and, and providing these,
these greater levels of evidence and,
and what we're doing and why we're doing it.
Fantastic. Yeah. Dr. Louis, a real,
real pleasure to have you on the podcast with us today. I always learn so,
so much from our conversations together and, uh,
look forward to having you on the podcast again sometime down the line,
and of course, bumping into you at a future Becker's event.
So thank you so much for your time today.
Awesome, Alan, thanks so much for your time as well.
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