This is Carly Beam with the Becker Spine
and Orthopedics podcast.
I'm thrilled to be joined today by doctor
Morgan L'Oreal.
Doctor L'Oreal, thank you so much for being
here today.
Thank you, Carly, for having me.
So before we get into our discussion, could
you introduce yourself and tell us a bit
about your background?
Sure.
I'm Morgan L'Oreal. I'm an orthopedic
spine and hand surgeon, and I've spent my
career not just in the OR,
but also advocating for policies that help both
surgeons
and patients.
I currently serve as the president of ISAS,
the International Society for the Advancement of Spine
Surgery,
which has been at the forefront
of spine innovation
for the past twenty five years.
ISAS originally emerged
from the Spine Arthroplasty
Society,
which was founded to advance motion preservation
in spine surgery.
Today,
we continue to drive innovation in everything
from disc regeneration
to minimally invasive techniques,
always
with the goal of improving patient outcomes.
Thank you. And doctor Loria, I know you've
been a you've really been at the forefront
of spine surgeon advocacy.
Can you talk about some of your top
priorities when it comes to physician advocacy this
year? Yes. Absolutely.
Well, as you said, Carly, physician advocacy is
more critical than ever, especially in such a
rapidly evolving field.
My biggest priorities are probably the following,
ensuring reimbursement keeps pace with innovation.
We have the technology,
motion preservation,
biologics, and disc regeneration.
But if insurers don't cover these advancements,
patients don't benefit.
We have to protect physician autonomy.
We must make sure that surgeons,
not payers,
are deciding the best treatments
for their patients.
Finally, bringing spine surgery coding into the minor
era
is a big need.
Many of the procedures we perform today aren't
reflected in current reimbursement models,
and that needs to change.
ISAS plays a big role in pushing for
these reforms.
And with our twenty fifth anniversary this year,
we're more committed than ever to ensuring the
spine surgeons
worldwide
have the tools
and policies in place to deliver the best
care possible.
That's really cool. I I didn't know that
ISS has come into, its twenty fifth year,
so a huge milestone.
I had a couple follow-up questions.
One, you talked about, you know, bringing spine
surgery coding into the modern era. Can you
give me an example of a procedure
that you would like to see
have its codes
modernized?
I I think there's probably two
areas that come to mind.
One of them, for instance,
was the,
decompression
with placement of inner spinous,
spacer,
known to by many as the Coflex because
at the time, it was the only,
device, yeah,
in that realm, that that one code.
It's now expanded to include other,
devices that are seeking FDA approval,
but it remains
undervalued.
And because it was undervalued,
the Coflex device
flatlined
relative to sales.
And
because of its
of it being bundled
rightly or wrongly,
it puts it at odds
with codes that are called sacred cows that
some entrenched societies don't want touched,
potentially, in terms of reconsideration through the RUC
process.
And as such, when this code is analyzed,
let's just say,
it's not
shown in the best light,
and the work's not appreciated.
The
intensity is not appreciated.
I think the newer products that are developing
under this under this code
descriptor,
actually involve more time than the Coflex. And,
hopefully,
we can get that reassessed
in the near future. That's a goal of
mine.
Mhmm. Another
code out there would be the code for
endoscopic lumbar spinal decompression,
which was recognized to have an intensity that
superseded almost everything in spine.
And, frankly,
the current review process was such that it
couldn't adequately be assessed.
And,
CMS rightly made a decision
that it was beyond,
the AMA,
and that each surgeon was going to have
to
negotiate
a payment plan with
each insurer.
And that makes it kind of an untidy
situation to manage, but it was at least
better
than what the alternative
was. And I think we need to have
a plan in place
that pays
parity,
meaning that
if a procedure
achieves the same goal,
improves outcome,
lessens cost,
why can't we reward the surgeon
rather than
torture
him by literally paying him less
and driving him away from providing,
that
treatment, that
potentially wonderful outcome for his patient?
We try to provide patient centered care, and
we're currently prohibited
from doing so with the current payment model.
Mhmm.
And then you also were talking about the
idea, you know, making sure that reimbursements
keep on pace with innovation. I know, like,
for technologies like disc replacement, it's taken some
time for insurers to catch up with that
technology.
So I'm wondering, you know,
of some of the newer spine surgery innovations
out there,
which do you think will see,
you know, payers
reimburse
it sooner, and which ones might be more
of a challenge to get coverage for?
Well,
that's a good question, Carly. I think that,
these posterior,
truly totally posterior spine procedures because,
they
circumnavigate
or
negate the potential for the need for a,
cosurgeon will
clearly identify all the work that's done,
with
these procedures. And I'm hoping as such
that,
the aura views generated will match the actual
work form by performed by the surgeon
with the
anterior,
disc replacements, at least lumbar. Many surgeons require
an access surgeon,
and I'm not so sure, frankly, that the
RVUs,
no matter how they're divvied up,
or,
adequately covering the,
surgeons that is both of them involved in
that process.
So that that's one issue.
I think you said what what might find,
problems moving forward.
It
there is a ever
enlarging
overlap
of orthoneurospine
with pain,
and there are technologies
that are developing,
that are used by both.
And
that
in the past was dealt with in a
more collaborative fashion, but it has become more
of a turf
war, but it is inevitable that there,
will be folks
from multiple fields,
performing some of these procedures.
And if they're done,
percutaneously,
I would suggest
that if they achieve the same goal with
the same
outcome, with the same benefit, and they actually
decrease cost,
well, my god, they ought to be paid
with parity,
rather,
than again,
pay, that poor surgeon
or proceduralist
less,
to achieve that end.
Well, thank you for breaking that down. And
I had a couple other questions for you.
You know, kind of bouncing off what we're
talking about just now. Can you talk about
some of the spine innovations in general that
are exciting you?
Yes.
Spine surgery,
is an exciting phase of transformation currently. Disc
regeneration,
but also disc repair. We're closer than ever
to restoring function instead of just stabilizing the
spine,
and that is a paradigm shift.
Another example is three d printing for custom
implants.
These personalized three d printed
implants match a patient's unique anatomy
and are improving outcomes
and reducing complications.
Another thing that stands out is AI and
its predictive analytics.
Everybody's talking about it. Artificial intelligence is helping
us to plan surgeries,
assess
risk, and personalized treatments like never before.
Mhmm.
And endoscopic and minimally invasive techniques are becoming
adopted
at a faster rate here in The US.
The trends towards smaller incisions,
faster recovery, and precision based procedures is only
going to accelerate further.
One of the most exciting shifts we're seeing
in spine surgery is something I mentioned earlier
is the rise of posterior motion preserving solutions
like the TOPS system
and three Spine's MODIS device.
What makes these technologies so compelling
is they allow us to work in a
familiar,
recumbent prone position,
total posterior spine,
optimizing direct open decompression
while also unloading the posterior facets,
effectively addressing
what is truly a three column problem.
Rather than rigid fixation,
these implants restore controlled motion,
offering patients an alternative to fusion
while maintaining stability
and function.
It's a natural evolution in how we think
about spinal reconstruction.
This challenge now the challenge now is integrating
these advancements
into mainstream practice
and ensuring payers recognize the value.
Those are all very exciting trends you're talking
about here, especially when it comes to things
like personalized medicine and, you know, using AI
to
support, you know, just
better outcomes for patients. And
my last question, doctor L'Oreal,
when you think about the payer physician relationship,
how do you think it will change? How
do you want it to change? And are
you optimistic or
nervous about it?
There are some things, frankly, that, have, popped
up very recently that I can't speak out
to, but,
the insurers
now
realize
that their customers
know what's been going on.
Mhmm. And that's come,
to their realization recently.
And I don't really wanna go into details
further. I think everybody knows what I'm talking
about.
But, the CEOs from
the five major payers are aware,
that they're gonna need to deliver something,
to,
their customer patients
if this current insurance game is to continue.
So I'm cautiously optimistic,
but I know we still have work to
do. Right now, the pair of physician relationship
feels like an uphill battle,
especially when it comes to newer treatments like
total disc replacement
or regenerative
therapies.
That said, we're seeing progress.
The data is becoming undeniable.
Motion preservation and biologics
aren't just experimental anymore.
They're frankly essential.
We need insurers to take a long term
view
instead of just looking at upfront cost.
A well placed disc replacement
or regenerative procedure can now prevent bigger, costlier
interventions
down the line.
ICS continues to push for these changes,
advocating not just for new technology,
but for the reimbursement of policies that will
allow patients to access them.
It's a long game,
but I believe we're moving in the right
direction.
Well, I'm glad to hear that you're sounding
overall optimistic about things despite
any challenges.
And I wanna thank you for joining us
today on the podcast, doctor L'Oreal. It's been
a pleasure to speak with you as always,
and I hope we can connect again down
the line. Thank you, Crowley, for having me.