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Gaze into the future of ASCs and learn
about the potential for growth and

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innovation at Becker's 29th Annual,
the business and operations of ASCs,

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meeting this October in Chicago with
200 plus ASC speakers and more than

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60 sessions.

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You'll leave the event with valuable
insight and relevant action items to leave

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your s c into the next 12 months.

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See if you qualify for complimentary
attendance as a reviewer by clicking the

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link in the description.

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This is Alan Condon with the
Becker's Healthcare Podcast,

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and I'm thrilled to be joined
today by Dr. Philip Louie,

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medical Director of Research and Academics
at the Center for Neurosciences and

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Spine at Virginia Mason
Franciscan Health. Dr. Louis,

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pleasure to connect with you again today
and have have you on Becker's podcast

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for your first time. I'd love turn
the over to little bit your role,

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your background before we dive
into our conversation today.

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Alan, thank you for this opportunity.

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I've listened to many of these
and enjoyed the conversation,

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so I'm excited to be, uh,
part of your journey. Um,

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but thank you for that introduction.
Yeah, so Phil Louie here.

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I'm an orthopedic spine surgeon, um,
out in Seattle, and, uh, I love Seattle.

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It's near and dear to
me as I grew up there.

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I actually went to undergrad
and med school at the
University of Washington, uh,

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before trekking out to Chicago to Rush
University Medical Center for Orthopedic

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Residency,

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and then even further away from home
to New York City Hospital for special

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surgery for my spine fellowship
and decided, you know,

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home is where the heart is and, and
brought my family back. Um, so yeah, so I,

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a few years into practice now, my, my
practice is, uh, predominantly, uh,

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minimally invasive, um,
degenerative, uh, practice. Um,

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and sort of the purposes of,
of sort of our topic today.

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I had an opportunity about of six
months, eight months into practice when,

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you know,

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we were in the height of the pandemic
where we had to take surgeries out of, uh,

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our main hospital. They, uh,

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was provided an opportunity to start
performing spine surgeries at a surgery

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center, uh, about two years
ago that had never, uh,

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performed spine surgery up to this point.

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So that's sort of where I've transitioned
a lot of my practice as well. Yeah.

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Thank you so much for the
introduction, Dr. Lu. And, you know,

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interesting background and of course you
have your training here at Northwestern

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Chicago. Spent some time out
in the east coast of New York,

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and they're obviously based
out in Washington. Um,

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and also have that background between
moving more into ambulatory surgery space.

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Um, to pick up on that, uh,

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what are the kind of two or three
trends that you're following closely,

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just specifically when it
comes to the ASC space today?

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Yeah, I think one of the biggest
theories that we look at in our group is,

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you know, has always had a
strong focus on, you know, this,

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this concept of value-based
care is, you know,

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like how exactly is this growth of
these ASCs that we're seeing, you know,

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exploding everywhere, you know,

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how does this fall into a value based
care model, right? Eventually, right?

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We know that there's been greater
safety, um, that's been demonstrated.

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There's an evidence of, you know,

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quality metrics that are improved
compared to main hospitals.

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There's certainly lower costs
from a patient perspective, right?

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That tends to be easier to drive in
and out of these surgery centers and,

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and get to them rather than
large hospitals and different
parking settings. So,

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you know,

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where exactly does this growth of AFC
fall into a value-based care model as sort

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of this collide in near future?

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Yeah. And you mentioned,
uh, obviously you,

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you started performing for the first time
cases in the ambulatory surgery center

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during Covid when we did see a lot of
cases moving out of the hospital. Uh,

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I'm curious when you, when you initially
did start performing those, those,

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those cases in an outpatient setting,
what were, what were you surprised by,

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if anything? And, uh, was
there anything that was, uh,

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presented a significant challenge
in that, in that regard?

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Yeah, I was actually really
excited with the opportunity.

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I think in residency and fellowship
I had been able to train in,

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in practices that had really
done a fantastic job in

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providing like absolutely wonderful
patient care at these surgery centers.

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And I think for me, taking these
learnings into real life, you know,

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definitely showed there are some obstacles
that certainly existed compared to

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sort of a well-oiled machine.

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I think one of the biggest difficulties
that were handed into was the surgery

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center didn't have a spine
microscope. You know,

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we had an E N T microscope that
had a very short focal length, uh,

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but I never really enjoyed working
through my loops down a, you know,

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a small tube and, and we
had to figure out, you know,

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how are we going to transition
our, our initial, um,

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minimally invasive sort of tubular, uh,
surgeries in the surgery center and,

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and basically relied on
some enabling technologies.

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They used a vizi on camera early on
and, and been able to grow, you know,

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certain enabling technologies
just to be able to perform, uh,

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spine surgery safely in the
surgery center. And, uh,

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using that as a tool to sort of teach the
staff and, uh, sort of grow as a team.

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Yeah, yeah. Really interesting to kinda
see that growth in the ASC setting for,

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for you and your practice center at
Virginia Mason Health. I'm curious,

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how is your,

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how is your patient selection kind of vol
evolved when you're performing more of

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these cases in the asc? And is there any,

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are you performing every spine surgery,

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every spine procedure in
the outpatient setting,

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or is there certain procedures that you
still like to perform in the hospital?

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Yeah, that's a great question.
I think first and foremost,

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what's really important
is we have this, um,

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really close relationship
with our anesthesia team and,

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and the medical medical directors
of, um, the surgery center.

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So all of our patients,

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even though I may think that they are
healthy and safe performance surgery

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center,

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there's still our anesthesia team that
overlooks every single decision that I

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make. And,

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and when there are some great areas we
have a discussion together and they let

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me know, hey, you know, maybe this, uh,

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patient is better suited for the hospital.

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And I've really enjoyed that collaboration
and that relationship because I've

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learned a lot from them in
their standpoint. And, you know,

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how can we provide safe care
outside of the hospital setting?

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But from a surgery standpoint,
you know, I started with, um,

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lumbar micro discectomies and,
uh, laminectomy, uh, multi-level.

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We've been performing one and two level
cervical disc replacements and anterior

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cervical fusions, you know,
posterior cervical foram autotomies.

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And we're actually starting, um,

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single level lumbar fusions in
the next couple weeks here. Uh,

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but certainly anything
greater than that, I've,

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I've tended to feel more comfortable
performing in the hospital at this point.

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Alright, yeah, yeah, really interesting
to get your 2 cents there. Uh, uh, Dr.

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Li, I know just from speaking to you
and from our previous discussions,

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I know you're someone who pays very close
attention to trends in spine surgery,

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also the the new and innovative
technologies. Um, with
those two things in mind,

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is there anything you're particularly
excited about in terms of spinal trends or

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technologies whatcha paying
attention to right now?

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Yeah, I mean, another trend that I, I
I think that it's interesting if you,

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if you look at healthcare in general,
I think one of the big knocks on,

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on us in health,

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cuz we tend to be a little bit less
nimble than other fields in this world.

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And I think that we're finally
starting to see a change, right? If,

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if there's something the pandemic
did, uh, and it's done a lot, it's,

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it's forced us to sort of quickly
alter the way in how we deliver

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care. Um,

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and so now we have this environment that
I think is a ripe for innovation. And,

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and that's what we're seeing, right?

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We're we're seeing the expansion of
procedures that can be done in a surgery

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center, an ambulatory surgery center,

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because I think that the innovations
that are sort of driving the enabling

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technologies are allowing us
to do so safely, you know,

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whether it's visualization, um,
instrumentation really grouping together,

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uh, the whole perioperative care
from, um, planning for surgery,

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getting everyone involved and,

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and performing the surgery safely and
then following them over a period of time.

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And I think if there's one area and
certainly a buzzword that people throw

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around, it's this whole concept
of big data, right? Mm-hmm.

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We talked about augmented, um,
sorry, artificial intelligence and,

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and machine learning.

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But I think the concept behind it is
that we now have a really cool way and,

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and actually really lots of ways to
utilize large amounts of data and

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apply them directly into
patient care. And, you know,

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the way I talk to my
patients about this now too,

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because I think there's so many
technologies that have that as a backbone,

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is that like every single patient now
that comes in and is being treated is

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essentially contributing to the care
of future patients just like them in so

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many different ways.

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Mm-hmm. <affirmative>. Yeah. Really
interesting. You, you brought that up.

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I mean, it seems just the last
couple of months in particular,

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I know AI has been around in
healthcare for, for quite a while,

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but it seems just the last couple
of months and the evolution of chat,

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C P T and all this,

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it's really kind of breaking into the
mainstream and become such a hot topic.

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Um, but specifically related
to spine surgery on ai, um,

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how do you kind of see
that maybe potentially
incorporating into diagnostics,

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robotics? Is it the, the
biggest opportunity for AI
is related to spine surgery?

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What do you think it is?

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Yeah, and, and you're
absolutely right, right?

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AI's been around for a really long time
in residency. You know, I had this,

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the joy of starting a company
where we used a chat bot to,

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to help with postoperative care in our
patients. You know, that was, you know,

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seven, eight years ago.

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But now I think it's really interesting
because we have all of these

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technologies, um, that are being
applied, whether it's, you know,

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augmented reality, robotics
and navigation, uh,

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different types of
imaging and visualization,

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but they're all sort of separate
entities right now. Mm. And I,

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I think what we're heading towards and
what we're hopefully heading towards is

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being able to develop
a all in one platform.

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So you have information
that you've gathered in the
past from all of this data.

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You have your current patients in
front of you with their comorbidities,

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their radiographic findings,
their history, their exam
findings, their concerns,

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and you're able to sort of, uh,

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take a segment of their care and put
it into that sort of algorithm to start

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developing these predictive
analytics of what,

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how they may recover from different
procedures or what interventions might be

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best. And then if it is surgery that's
indicated within the same comprehensive

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platform,

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you're able to perform that surgery in
sort of the safe disc and most efficient

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manner in the operating room with,
you know, whatever technology that is.

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And then you take the
preoperative analytics and you
take the technology in the

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or,

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and the third part of that
single comprehensive platform
will be following them

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up over time and seeing, you know,
for example, with the lumbar fusion,

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you know, what, how is
that fusion occurring?

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What's happening to the levels above and
below the fusion? How has the patient,

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uh, gone from compensating one way to
living biomechanically in a different way?

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And now that they've had the procedure,

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but it's all within a single platform
where it's easy to access and easy to,

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to essentially utilize and for
other people to, to use as well.

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Yeah, yeah, really interesting point. So,

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so sounds like almost integrating
these AI mechanics into one platform,

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similar in the way that I guess we're
seeing a lot of health systems integrate

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almost EHR platforms into this one system
just to kinda streamline and things

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that make it a lot more efficient.

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I think so.

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I think one of the biggest deterrents
now is that there's so many options out

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there, but none of them capture
the full gambit of, you know,

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what we're looking for. And I think
if we look at the world around us,

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consolidation is happening, you know,
whether you like it or not. And,

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and I think when it comes to, you know,

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applying AI and machine learning
to different enabling technologies,

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I think we're gonna start seeing a
con consolidation of efforts as well.

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Yeah. Yeah, it's gonna be,

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consolidation just seems like it's
happening no matter where you are in the

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world and what worst
technology <laugh>, um,

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fascinating to kinda
get your thoughts there.

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I think AI is something that I'm
specifically really interested in as well.

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This would be really interesting to see
how it evolves over the coming years,

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especially when it relates to spine
surgery for yourself. Um, Dr. Louis,

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last question I have for you
before I let you go, I mean,

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we've touched on quite a bit already
here, but when you think about yourself,

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your own practice over the
next 12 months or so, uh,

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how are you thinking about growth?

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Oh, that's a fun question. You know,
I, I think at the end of the day,

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like I'm still an, you know, academic,
like a clinician scientist, right?

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I'm still a spine nerd and nerd in, in
many aspects, <laugh> and, you know,

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we have a, a large research team and I
think that's one area where, you know,

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I'm I in growth in the futures, you know,

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how do we provide a greater level of
evidence to the work that we're doing,

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right?

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So how can we better understand sort
of the economics of the care that we're

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providing, especially in a surgery
center setting, you know, the,

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the ergonomics of our care and self
sustainability and protecting our bodies

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over time.

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So I'm no longer operating on my senior
colleagues because of the toll that's

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been taken on their body. You know,

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how can we better demonstrate the safety
and complication profiles of all these

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new procedures that are coming out?

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But really collaborating with other
centers to do this in a large perspective

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manner, because I think collaboration
is key. Doing it prospectively is key.

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And, and that's how we're going to
grow spine care is really, you know,

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working from the ground up
and, and providing these,

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these greater levels of evidence and,

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and what we're doing
and why we're doing it.

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Fantastic. Yeah. Dr. Louis, a real,

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real pleasure to have you on the podcast
with us today. I always learn so,

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so much from our conversations
together and, uh,

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look forward to having you on the
podcast again sometime down the line,

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and of course, bumping into
you at a future Becker's event.

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So thank you so much for your time today.

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Awesome, Alan, thanks so
much for your time as well.

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It's so important for leaders at the
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00:13:22,470 --> 00:13:24,040
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00:13:24,550 --> 00:13:27,720
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00:13:27,780 --> 00:13:31,800
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