1 00:00:00,080 --> 00:00:02,319 This is Carly Beam with the Becker Spine 2 00:00:02,319 --> 00:00:03,699 and Orthopedics podcast. 3 00:00:04,000 --> 00:00:05,919 I'm thrilled to be joined today by Doctor. 4 00:00:05,919 --> 00:00:07,540 Andrew Fanu at Inova. 5 00:00:08,000 --> 00:00:10,400 Andrew, thank you so much for being here 6 00:00:10,400 --> 00:00:10,900 today. 7 00:00:11,199 --> 00:00:12,794 Before we dive into questions, 8 00:00:17,594 --> 00:00:19,755 sure. My name is Andrew Fanous. I am 9 00:00:19,755 --> 00:00:20,494 a neurosurgeon 10 00:00:20,795 --> 00:00:23,135 at Inova Health System in Northern Virginia. 11 00:00:23,835 --> 00:00:26,789 I am based in Alexandria, Virginia. I am 12 00:00:26,789 --> 00:00:29,670 a board certified neurosurgeon, and I'm also fellowship 13 00:00:29,670 --> 00:00:30,170 trained 14 00:00:30,629 --> 00:00:33,530 in complex and minimally invasive spine surgery. 15 00:00:34,149 --> 00:00:37,590 Thank you, doctor Fannous. And first question, can 16 00:00:37,590 --> 00:00:39,030 you tell me what are some of the 17 00:00:39,030 --> 00:00:40,384 most exciting technologies 18 00:00:41,004 --> 00:00:43,344 that you're seeing in spine surgery today, 19 00:00:43,725 --> 00:00:46,045 and how are you incorporating them into your 20 00:00:46,045 --> 00:00:46,545 practice? 21 00:00:47,324 --> 00:00:49,725 Yeah. I mean, we are very lucky that, 22 00:00:50,284 --> 00:00:52,140 spine surgery tends to be a very high, 23 00:00:53,100 --> 00:00:53,579 tech, 24 00:00:54,059 --> 00:00:56,799 subspecialty of neurosurgery and orthopedic surgery. 25 00:00:57,500 --> 00:01:00,559 I would say that the most exciting technologies 26 00:01:00,699 --> 00:01:03,500 today that are really shaping how we as 27 00:01:03,500 --> 00:01:05,760 surgeons are planning and 28 00:01:06,085 --> 00:01:07,784 executing and monitoring our surgeries, 29 00:01:09,125 --> 00:01:09,625 are, 30 00:01:10,325 --> 00:01:11,145 spine robotics, 31 00:01:12,005 --> 00:01:14,105 augmented reality and mixed reality, 32 00:01:15,525 --> 00:01:17,944 AI driven surgical planning and imaging tools. 33 00:01:18,805 --> 00:01:21,689 There are also three d printed and patient 34 00:01:21,689 --> 00:01:22,670 specific implants, 35 00:01:23,769 --> 00:01:24,590 motion preservation 36 00:01:24,890 --> 00:01:25,390 devices, 37 00:01:25,849 --> 00:01:28,109 and, of course, endoscopic spine surgery. 38 00:01:28,489 --> 00:01:30,109 I would say these are the top, 39 00:01:30,729 --> 00:01:31,229 technologies, 40 00:01:32,329 --> 00:01:34,569 that are currently very exciting for us as 41 00:01:34,569 --> 00:01:35,390 spine surgeons. 42 00:01:36,085 --> 00:01:38,265 Great. And I'd love to hear how you're 43 00:01:38,325 --> 00:01:41,284 incorporating any or all of these technologies into 44 00:01:41,284 --> 00:01:42,025 your work. 45 00:01:42,805 --> 00:01:44,405 Yeah. I mean, there are, a lot of 46 00:01:44,405 --> 00:01:46,745 different ways that we have been incorporating 47 00:01:47,125 --> 00:01:47,944 those technologies. 48 00:01:48,245 --> 00:01:49,765 So if you take them sort of one 49 00:01:49,765 --> 00:01:51,959 by one and you take a look at 50 00:01:51,959 --> 00:01:53,340 spine robotics, for example, 51 00:01:54,439 --> 00:01:56,379 as we all know, they're increasing, 52 00:01:57,400 --> 00:01:58,379 accuracy of instrumentation. 53 00:01:59,479 --> 00:02:00,379 They are reducing 54 00:02:01,159 --> 00:02:02,219 exposure to radiation. 55 00:02:03,000 --> 00:02:04,680 They shorten operator of times. 56 00:02:05,224 --> 00:02:07,644 So we are really employing them currently, 57 00:02:08,664 --> 00:02:10,044 mainly for instrumentation, 58 00:02:11,064 --> 00:02:12,525 in larger spine cases. 59 00:02:13,144 --> 00:02:13,884 Of course, 60 00:02:14,584 --> 00:02:17,004 you know, future trends, you know, beyond navigation 61 00:02:17,144 --> 00:02:19,084 and instrumentation and so on, 62 00:02:20,259 --> 00:02:22,659 I think that spine robotics are gonna become 63 00:02:22,659 --> 00:02:23,479 more autonomous, 64 00:02:24,419 --> 00:02:27,300 and they will offer sort of multilevel trajectory 65 00:02:27,300 --> 00:02:27,800 planning. 66 00:02:28,740 --> 00:02:30,900 And hopefully eventually they will also be able 67 00:02:30,900 --> 00:02:33,159 to help us when we're performing the compressions 68 00:02:33,300 --> 00:02:34,280 in spine surgery. 69 00:02:35,139 --> 00:02:35,625 When it comes 70 00:02:37,064 --> 00:02:39,465 comes to, augmented reality, for example, and mixed 71 00:02:39,465 --> 00:02:39,965 reality, 72 00:02:40,745 --> 00:02:43,564 currently, we are incorporating them in our practice 73 00:02:43,705 --> 00:02:45,164 by using them for visualization, 74 00:02:46,504 --> 00:02:47,564 of patient anatomy 75 00:02:47,879 --> 00:02:50,699 directly into our field of view, as surgeons. 76 00:02:52,199 --> 00:02:52,699 And, 77 00:02:53,560 --> 00:02:54,459 we're hoping, 78 00:02:55,080 --> 00:02:56,360 and I've actually been, 79 00:02:56,759 --> 00:02:57,419 to some 80 00:02:57,879 --> 00:03:00,459 meetings lately where I've seen kind of, more, 81 00:03:00,840 --> 00:03:03,705 evolution of augmented reality and mixed reality systems, 82 00:03:04,645 --> 00:03:07,064 where they are integrating multi functionality 83 00:03:07,685 --> 00:03:10,745 kind of, abilities and capabilities only one platform. 84 00:03:11,444 --> 00:03:13,544 And using those multi functionality 85 00:03:13,925 --> 00:03:16,245 platforms, you hey. You can have the surgeon 86 00:03:16,245 --> 00:03:16,745 use 87 00:03:17,205 --> 00:03:19,740 the AR and MR technologies, not just to 88 00:03:19,740 --> 00:03:20,719 perform surgery, 89 00:03:21,260 --> 00:03:22,480 but also to visualize, 90 00:03:23,340 --> 00:03:24,400 preoperative imaging, 91 00:03:25,020 --> 00:03:26,640 looking at office notes, 92 00:03:27,099 --> 00:03:29,500 you know, recording videos, taking intrapper pictures, and 93 00:03:29,500 --> 00:03:30,240 so on. 94 00:03:30,620 --> 00:03:33,034 So you can actually employ those powerful tools 95 00:03:33,034 --> 00:03:34,955 for not just to perform surgery, but to 96 00:03:34,955 --> 00:03:36,655 do more than just the the surgery. 97 00:03:37,514 --> 00:03:39,135 When it comes to AI driven, 98 00:03:39,675 --> 00:03:40,735 surgical planning 99 00:03:41,034 --> 00:03:41,855 and imaging, 100 00:03:42,875 --> 00:03:44,735 of course, it's very important 101 00:03:45,435 --> 00:03:49,009 because currently, it uses predictive analytics and optimizing, 102 00:03:49,430 --> 00:03:52,129 you know, alignments and implant sizes, 103 00:03:52,750 --> 00:03:53,729 surgical trajectories, 104 00:03:54,509 --> 00:03:56,289 and therefore, it enhances personalization 105 00:03:56,750 --> 00:03:57,409 of surgeries, 106 00:03:58,030 --> 00:04:00,129 which is something that's very desirable nowadays. 107 00:04:01,534 --> 00:04:04,514 But moving forward, we're also hoping that, 108 00:04:04,974 --> 00:04:06,514 we can employ AI, 109 00:04:07,615 --> 00:04:08,835 for risk stratification 110 00:04:09,375 --> 00:04:10,514 and patient selection. 111 00:04:11,775 --> 00:04:13,615 And by doing this, we can actually avoid 112 00:04:13,615 --> 00:04:14,594 post awkward complications. 113 00:04:16,095 --> 00:04:18,120 In my practice, I've also been, 114 00:04:18,600 --> 00:04:21,900 employing three d printed and patient specific implants. 115 00:04:23,080 --> 00:04:25,340 They're extremely important because, 116 00:04:25,720 --> 00:04:26,620 these are accustomed, 117 00:04:27,319 --> 00:04:29,980 implants, usually interbodies and interbody cages 118 00:04:30,439 --> 00:04:32,725 that are matching matching the patient's anatomy. 119 00:04:33,504 --> 00:04:36,625 And by doing this, they actually improve osteo 120 00:04:36,625 --> 00:04:37,125 integration 121 00:04:37,584 --> 00:04:39,204 and by extension, fusion. 122 00:04:40,384 --> 00:04:43,685 And when you improve fusion rates, then reduce 123 00:04:43,745 --> 00:04:45,540 failures and revision risks. 124 00:04:46,000 --> 00:04:48,160 Of course, there are some challenges currently with 125 00:04:48,160 --> 00:04:50,180 those kind of technologies. For example, 126 00:04:51,040 --> 00:04:52,819 you know, turnover is currently, 127 00:04:53,439 --> 00:04:55,199 a challenge. It takes about a couple of 128 00:04:55,199 --> 00:04:57,004 weeks. So if you have a patient coming 129 00:04:57,004 --> 00:04:58,925 through the emergency department that needs a surgery 130 00:04:58,925 --> 00:05:00,944 right away, you cannot really use, 131 00:05:01,805 --> 00:05:04,845 patient specific implants at this time. But we're 132 00:05:04,845 --> 00:05:05,904 hoping that, 133 00:05:06,285 --> 00:05:08,204 in the future, we can have a rapid 134 00:05:08,204 --> 00:05:09,089 point of care 135 00:05:09,490 --> 00:05:12,230 printing, especially for trauma and deformity patients. 136 00:05:13,089 --> 00:05:16,209 Motion preservation is another very interesting and very 137 00:05:16,209 --> 00:05:18,529 exciting technology that we have been employing in 138 00:05:18,529 --> 00:05:20,389 our practice as well. 139 00:05:21,089 --> 00:05:22,610 So these are, you know, 140 00:05:23,569 --> 00:05:26,245 technologies that decrease the risk of adjacent level 141 00:05:26,245 --> 00:05:29,285 disease and, you know, addition segment disease by 142 00:05:29,285 --> 00:05:30,264 preserving motion, 143 00:05:31,365 --> 00:05:33,525 rather than fusion, which is what we, you 144 00:05:33,525 --> 00:05:36,264 know, what most spine surgeons currently do. 145 00:05:37,444 --> 00:05:40,509 And of course, by, you know, preventing fusion 146 00:05:40,509 --> 00:05:43,069 and preventing addition segment disease, you're also by 147 00:05:43,069 --> 00:05:43,569 extension 148 00:05:44,110 --> 00:05:44,610 reducing, 149 00:05:45,149 --> 00:05:47,009 reoperation rates down the road. 150 00:05:48,029 --> 00:05:51,329 Limitations currently for this technology is that reimbursement 151 00:05:51,629 --> 00:05:52,964 is still very much lagging. 152 00:05:54,004 --> 00:05:57,225 So we're seeing less adoption of both, cervical 153 00:05:57,285 --> 00:06:00,084 and lumbar spine motion preservation techniques in The 154 00:06:00,084 --> 00:06:00,584 US 155 00:06:01,044 --> 00:06:02,644 and less so in The US than in 156 00:06:02,644 --> 00:06:04,725 places like Europe, for example, where there's better 157 00:06:04,725 --> 00:06:05,225 reimbursement. 158 00:06:06,725 --> 00:06:08,860 And finally, I would say that endoscopic spine 159 00:06:08,860 --> 00:06:11,180 surgery is something that me personally, I'm very, 160 00:06:11,660 --> 00:06:12,560 excited about. 161 00:06:13,020 --> 00:06:16,139 It allows for minimally invasive procedures. It reduces 162 00:06:16,139 --> 00:06:17,120 recovery time. 163 00:06:17,980 --> 00:06:18,460 It, 164 00:06:18,860 --> 00:06:20,644 minimizes muscle damage and 165 00:06:21,024 --> 00:06:22,644 it lowers the risk of complications. 166 00:06:24,144 --> 00:06:24,805 Of course, 167 00:06:26,144 --> 00:06:29,264 the usage of inter subexpine surgery, especially in 168 00:06:29,264 --> 00:06:31,444 the s, has still been limited 169 00:06:32,064 --> 00:06:34,480 mainly because there are very steep learning curve 170 00:06:34,480 --> 00:06:35,220 for surgeons. 171 00:06:36,399 --> 00:06:39,039 And also because it offers, you know, to 172 00:06:39,039 --> 00:06:41,279 a certain degree limited access to some areas 173 00:06:41,279 --> 00:06:42,020 of the spine. 174 00:06:42,639 --> 00:06:44,319 So it's not really suitable for all kinds 175 00:06:44,319 --> 00:06:44,980 of conditions. 176 00:06:46,080 --> 00:06:47,839 But I do believe that there is, 177 00:06:48,514 --> 00:06:50,915 you know, big, room for improvement when it 178 00:06:50,915 --> 00:06:52,915 comes to endoscopic spine surgery. I think there 179 00:06:52,915 --> 00:06:53,415 is, 180 00:06:54,035 --> 00:06:56,115 there will be more adoption in The United 181 00:06:56,115 --> 00:06:56,615 States. 182 00:06:57,074 --> 00:06:59,394 And I'm hoping that in the next few 183 00:06:59,394 --> 00:07:01,875 years or so, we'll see more adoption to 184 00:07:01,875 --> 00:07:03,794 the point where we're using it to the 185 00:07:03,794 --> 00:07:06,060 same degree that it's being used in, you 186 00:07:06,060 --> 00:07:08,160 know, places like East Asia, for example, 187 00:07:08,699 --> 00:07:10,639 where it's mainstream for spine surgery. 188 00:07:11,339 --> 00:07:14,319 Thank you. And I appreciate the your breakdown 189 00:07:14,459 --> 00:07:15,680 of all these different 190 00:07:16,220 --> 00:07:18,935 areas of spine technologies. I was I was 191 00:07:18,935 --> 00:07:20,794 wondering specifically with endoscopic 192 00:07:21,175 --> 00:07:23,514 spine surgery, what kind of evolutions 193 00:07:23,814 --> 00:07:25,894 do you hope to see in the next 194 00:07:25,894 --> 00:07:26,954 two or three years? 195 00:07:28,214 --> 00:07:30,810 I would really love to see, more integration 196 00:07:30,810 --> 00:07:33,069 of endoscopic spine surgery with, 197 00:07:33,449 --> 00:07:36,009 things like robotics and robotic assistance that are 198 00:07:36,009 --> 00:07:37,389 even stereotypic navigation. 199 00:07:38,170 --> 00:07:40,089 For us, that will provide us with greater 200 00:07:40,089 --> 00:07:40,589 precision. 201 00:07:41,209 --> 00:07:44,475 When we currently use endoscopic spine surgery, we 202 00:07:44,475 --> 00:07:45,855 are forced to use fluoroscopy, 203 00:07:46,955 --> 00:07:49,675 which is very cumbersome. And, of course it's 204 00:07:49,675 --> 00:07:51,134 fair, very high risk of radiation. 205 00:07:51,595 --> 00:07:53,514 But if we can somehow develop in the 206 00:07:53,514 --> 00:07:54,574 next couple of years, 207 00:07:55,194 --> 00:07:55,709 some integration between 208 00:07:58,829 --> 00:08:00,910 between endoscopy and robotics, I think that would 209 00:08:00,910 --> 00:08:02,610 be, a huge thing. 210 00:08:03,310 --> 00:08:06,509 Got it. And you mentioned earlier about, motion 211 00:08:06,509 --> 00:08:07,009 preservation 212 00:08:07,310 --> 00:08:07,718 and challenges with the reimbursement. Can you dive 213 00:08:07,718 --> 00:08:08,289 more into how your, 214 00:08:09,205 --> 00:08:12,745 reimbursement. Can you dive more into how you're 215 00:08:13,045 --> 00:08:15,925 addressing those and how your what your strategy 216 00:08:15,925 --> 00:08:16,745 is for 217 00:08:17,125 --> 00:08:20,085 trying to get those payers to work with 218 00:08:20,085 --> 00:08:20,585 you? 219 00:08:21,444 --> 00:08:23,229 Yeah. I mean, honestly, what we do is 220 00:08:23,229 --> 00:08:24,829 we end up doing what's right for the 221 00:08:24,829 --> 00:08:27,250 patient. So especially for younger patients, 222 00:08:28,269 --> 00:08:30,349 that we know fusion down the road is 223 00:08:30,349 --> 00:08:32,209 going to be detrimental for them. 224 00:08:33,149 --> 00:08:35,789 Regardless of what reimbursement is, we still push 225 00:08:35,789 --> 00:08:39,184 hard for, motion preservation techniques like disc replacements. 226 00:08:40,444 --> 00:08:42,845 And it is challenging, and we end up 227 00:08:42,845 --> 00:08:44,204 doing a lot of, you know, peer to 228 00:08:44,204 --> 00:08:44,704 peer, 229 00:08:45,324 --> 00:08:46,625 meetings with the payers. 230 00:08:47,964 --> 00:08:49,725 But, you know, we end up doing what 231 00:08:49,725 --> 00:08:51,210 is right for the for the 232 00:08:52,730 --> 00:08:54,429 continue to advocate for our patients. 233 00:08:55,050 --> 00:08:57,129 Thank you. Thank you. And and then when 234 00:08:57,129 --> 00:09:00,429 it comes to your work in augmented reality, 235 00:09:00,649 --> 00:09:03,210 and can you discuss just kind of by 236 00:09:03,210 --> 00:09:04,825 the numbers, how much 237 00:09:05,365 --> 00:09:07,065 if there are any cost savings, 238 00:09:07,524 --> 00:09:08,504 time efficiency 239 00:09:09,285 --> 00:09:11,125 savings? If you could dive into that more, 240 00:09:11,125 --> 00:09:12,024 that'd be great. 241 00:09:12,565 --> 00:09:13,625 Yeah. There is definitely, 242 00:09:14,404 --> 00:09:16,362 cost savings associated with augmented reality, 243 00:09:17,679 --> 00:09:20,419 systems because it is very helpful, 244 00:09:21,200 --> 00:09:24,320 in performing minimally invasive surgery. So as opposed 245 00:09:24,320 --> 00:09:26,019 to, big open surgeries, 246 00:09:27,759 --> 00:09:29,779 that will require a lot of, 247 00:09:30,245 --> 00:09:33,544 interoperative resources and, of course, hospital resources postoperatively. 248 00:09:34,164 --> 00:09:35,065 You can perform 249 00:09:35,445 --> 00:09:35,945 smaller, 250 00:09:36,565 --> 00:09:37,865 surgeries with smaller incisions, 251 00:09:38,644 --> 00:09:41,464 using augmented reality and mixed reality systems. 252 00:09:42,245 --> 00:09:43,865 So the recovery will be shorter. 253 00:09:44,804 --> 00:09:45,464 The resources 254 00:09:45,850 --> 00:09:47,309 interoperably will be less. 255 00:09:48,169 --> 00:09:50,350 The patient will be discharged faster, 256 00:09:51,529 --> 00:09:52,590 from the hospital. 257 00:09:53,529 --> 00:09:55,690 So of course, in general, that that does 258 00:09:55,690 --> 00:09:56,669 translate into 259 00:09:57,370 --> 00:10:00,444 improved, you know, outcomes, but also, 260 00:10:00,985 --> 00:10:02,845 better uses of, resources. 261 00:10:04,024 --> 00:10:06,845 Thank you. And, obviously, you've been several developments 262 00:10:06,985 --> 00:10:09,945 in federal health care policy from the GOP 263 00:10:09,945 --> 00:10:12,845 spending bill to, CMS and their proposed 264 00:10:13,304 --> 00:10:14,250 2026 265 00:10:14,490 --> 00:10:15,789 physician fee schedule. 266 00:10:16,809 --> 00:10:18,909 I was wondering how you anticipate 267 00:10:19,289 --> 00:10:21,769 these changes or, in fact, the growth of 268 00:10:21,769 --> 00:10:24,509 the spine technologies that we've been talking about. 269 00:10:25,049 --> 00:10:27,289 Yeah. That's a great question, and it's really 270 00:10:27,289 --> 00:10:28,990 what is on everyone's 271 00:10:29,315 --> 00:10:30,134 mind right now. 272 00:10:30,595 --> 00:10:32,434 If you take them kind of one by 273 00:10:32,434 --> 00:10:34,834 one, if you, if we take first the 274 00:10:34,834 --> 00:10:37,414 GOP is the one big, beautiful bill, 275 00:10:38,034 --> 00:10:40,695 which is really spending bill with Medicaid cuts. 276 00:10:41,875 --> 00:10:44,809 You see that there will be tighter Medicaid 277 00:10:44,870 --> 00:10:46,009 budgets and 278 00:10:46,470 --> 00:10:48,409 stricter eligibility for surgeries. 279 00:10:49,029 --> 00:10:51,909 So it will slash Medicaid provider taxes. It 280 00:10:51,909 --> 00:10:52,970 will tighten eligibility, 281 00:10:54,069 --> 00:10:55,850 and it's going to add work requirements. 282 00:10:57,190 --> 00:10:59,855 And this could reduce volume of spine surgery 283 00:11:00,554 --> 00:11:01,855 referrals from Medicaid, 284 00:11:02,394 --> 00:11:04,475 especially when it comes to rural areas and 285 00:11:04,475 --> 00:11:05,534 low income areas. 286 00:11:06,394 --> 00:11:07,134 In addition, 287 00:11:08,315 --> 00:11:11,375 I would say that rural and community hospitals 288 00:11:11,514 --> 00:11:12,254 may face, 289 00:11:13,195 --> 00:11:14,250 operational strains, 290 00:11:15,983 --> 00:11:17,610 even though there will be increased funding for 291 00:11:17,610 --> 00:11:21,149 rural hospitals, this may not offset the overall 292 00:11:21,289 --> 00:11:21,789 cuts. 293 00:11:22,490 --> 00:11:24,750 And as a result, you know, spine tech, 294 00:11:25,210 --> 00:11:27,529 vendors may see kind of lower uptake in 295 00:11:27,529 --> 00:11:28,384 these areas, 296 00:11:28,845 --> 00:11:31,004 of, you know, rural areas and community hospital 297 00:11:31,004 --> 00:11:33,404 areas, and they may need to shift their 298 00:11:33,404 --> 00:11:35,904 focus to better funded hospital systems, 299 00:11:36,684 --> 00:11:38,705 on sometimes even to private pay markets. 300 00:11:39,404 --> 00:11:40,940 When it comes to the CMS and the 301 00:11:40,940 --> 00:11:43,019 twenty twenty six physician fee schedule that is 302 00:11:43,019 --> 00:11:43,519 proposed, 303 00:11:44,139 --> 00:11:46,700 it's also a mixed bag because there will 304 00:11:46,700 --> 00:11:49,040 be higher base conversion factors. 305 00:11:50,220 --> 00:11:53,740 CMS is proposing about a 3.7% 306 00:11:53,740 --> 00:11:56,884 boost to physician payments for 2026. 307 00:11:56,884 --> 00:11:58,664 However, when it comes to, 308 00:11:59,205 --> 00:12:00,345 procedure based, 309 00:12:01,284 --> 00:12:02,985 specialties like spine surgery, 310 00:12:03,524 --> 00:12:06,004 there will be about a 2.5% 311 00:12:06,004 --> 00:12:06,504 cut. 312 00:12:06,965 --> 00:12:08,985 They're calling it the efficiency cut, 313 00:12:10,325 --> 00:12:13,000 and that adjustment is probably going to end 314 00:12:13,000 --> 00:12:13,480 up, 315 00:12:13,879 --> 00:12:14,700 kind of offsetting, 316 00:12:15,799 --> 00:12:16,299 the 317 00:12:16,759 --> 00:12:17,259 proposed 318 00:12:17,720 --> 00:12:19,259 boost in physician payments. 319 00:12:20,519 --> 00:12:21,019 The 320 00:12:21,799 --> 00:12:22,934 CMS 2020 321 00:12:23,095 --> 00:12:25,115 physician fee schedule also proposing, 322 00:12:25,495 --> 00:12:28,715 you know, mandatory ambulatory specialty models or ASMs. 323 00:12:29,735 --> 00:12:30,875 It's a new model, 324 00:12:31,575 --> 00:12:34,375 and it's mainly targeting spine and heart failure 325 00:12:34,375 --> 00:12:34,875 management. 326 00:12:35,735 --> 00:12:38,519 And it rewards usage of digital tools, 327 00:12:39,379 --> 00:12:40,120 care coordination, 328 00:12:41,059 --> 00:12:42,440 and outcome tracking. 329 00:12:43,700 --> 00:12:46,500 So, you know, as a result, the spine 330 00:12:46,500 --> 00:12:47,000 surgeons, 331 00:12:48,259 --> 00:12:51,095 their effective reimbursement may stagnate or may even 332 00:12:51,095 --> 00:12:51,595 decline. 333 00:12:52,534 --> 00:12:53,995 And that's going to make, 334 00:12:54,695 --> 00:12:58,154 investments in high cost technologies less financially appealing. 335 00:12:58,855 --> 00:13:00,534 But on the other hand, there will be 336 00:13:00,534 --> 00:13:01,835 new opportunities created, 337 00:13:02,855 --> 00:13:03,830 by the, 338 00:13:04,370 --> 00:13:04,870 ambulatory 339 00:13:05,250 --> 00:13:06,309 specialty model, 340 00:13:07,490 --> 00:13:09,509 through remote monitoring, telehealth, 341 00:13:10,450 --> 00:13:12,870 patient engagement platforms, and so on. 342 00:13:13,649 --> 00:13:15,350 I think the takeaways for, 343 00:13:16,529 --> 00:13:17,955 the spine sector is 344 00:13:18,915 --> 00:13:20,835 that there will be a shift to value 345 00:13:20,835 --> 00:13:21,654 driven propositions. 346 00:13:24,355 --> 00:13:26,134 Surgeons will need to engage, 347 00:13:27,154 --> 00:13:29,894 early into alternative payment models, 348 00:13:30,995 --> 00:13:31,495 and 349 00:13:32,035 --> 00:13:33,809 there will be a focus on 350 00:13:34,210 --> 00:13:35,250 data data and, 351 00:13:36,129 --> 00:13:37,590 sort of evidence based medicine. 352 00:13:39,809 --> 00:13:40,309 The 353 00:13:40,769 --> 00:13:42,070 CMS would increasingly 354 00:13:42,450 --> 00:13:44,789 reward data driven outcome tracking. 355 00:13:45,889 --> 00:13:48,529 So the surgeons will need to be, very 356 00:13:48,529 --> 00:13:49,455 careful about that. 357 00:13:50,415 --> 00:13:52,254 And I think the market winners will be 358 00:13:52,254 --> 00:13:54,754 the ones who are offering measurable value. 359 00:13:56,575 --> 00:13:57,075 And, 360 00:13:58,735 --> 00:14:00,654 you know, since CMS is, 361 00:14:00,975 --> 00:14:03,315 is going to focus on value based shift. 362 00:14:03,850 --> 00:14:06,250 And I imagine that some of the AI 363 00:14:06,250 --> 00:14:08,750 tools, AR tools, and some of the technologies 364 00:14:08,889 --> 00:14:11,870 that we've been we've been discussing will hopefully 365 00:14:11,929 --> 00:14:12,750 help and 366 00:14:13,129 --> 00:14:13,950 help surgeons 367 00:14:14,730 --> 00:14:17,210 get that data that they need to show 368 00:14:17,210 --> 00:14:17,950 their value. 369 00:14:18,674 --> 00:14:21,095 Absolutely. That's a great point. So, 370 00:14:21,394 --> 00:14:22,294 really, AI, 371 00:14:22,674 --> 00:14:24,215 enhanced surgical assistance, 372 00:14:24,995 --> 00:14:28,134 is gonna play a larger role in, predicting, 373 00:14:29,394 --> 00:14:31,955 the most effective surgical approaches and the tools 374 00:14:31,955 --> 00:14:32,934 for each patient. 375 00:14:33,715 --> 00:14:35,769 And, of course, when you employ eye to 376 00:14:35,769 --> 00:14:38,909 analyze thousands of databases from previous surgeries, 377 00:14:39,690 --> 00:14:42,429 I can also recommend optimal approaches for achieving 378 00:14:42,649 --> 00:14:44,029 the best possible outcome. 379 00:14:44,490 --> 00:14:47,610 And it can also perform predictive analytics down 380 00:14:47,610 --> 00:14:48,190 the road. 381 00:14:48,809 --> 00:14:50,394 So you you can use softwares, 382 00:14:51,495 --> 00:14:52,714 to predict complications, 383 00:14:53,894 --> 00:14:56,534 healing times, you know, patient specific risks based 384 00:14:56,534 --> 00:14:59,414 on the unique anatomy and pathology and history 385 00:14:59,414 --> 00:15:00,154 of the patient. 386 00:15:00,855 --> 00:15:02,980 That would ensure that the surgeons are, you 387 00:15:02,980 --> 00:15:05,720 know, being more informed before making decisions, 388 00:15:06,340 --> 00:15:09,620 and that will result in more individualized treatment 389 00:15:09,620 --> 00:15:10,120 plans. 390 00:15:10,580 --> 00:15:11,639 And this would, 391 00:15:12,340 --> 00:15:15,345 further reduce complications and improve surgical precision down 392 00:15:15,345 --> 00:15:16,945 the road, which is really what CMS is 393 00:15:16,945 --> 00:15:17,924 looking for ultimately. 394 00:15:18,464 --> 00:15:20,245 Yeah. And then and then Doctor. Fanucchi, 395 00:15:20,704 --> 00:15:23,424 talk about, just minimally invasive surgery. How will 396 00:15:23,424 --> 00:15:25,184 that evolve in the next two to three 397 00:15:25,184 --> 00:15:26,784 years? I know we discussed a little bit 398 00:15:26,784 --> 00:15:29,850 about endoscopic spine, but how about other minimally 399 00:15:29,850 --> 00:15:30,829 invasive techniques? 400 00:15:32,009 --> 00:15:34,009 Yeah, I think there is a lot of, 401 00:15:34,809 --> 00:15:35,309 exciting 402 00:15:35,690 --> 00:15:37,370 developments that will happen in the next two 403 00:15:37,370 --> 00:15:39,049 to three years when it comes to minimally 404 00:15:39,049 --> 00:15:40,350 invasive spine surgery. 405 00:15:40,809 --> 00:15:43,475 I think, we will see smarter robotics, 406 00:15:44,254 --> 00:15:46,274 and the surgeons will rely more, 407 00:15:46,735 --> 00:15:49,054 on robotics for, you know, both routine and 408 00:15:49,054 --> 00:15:50,034 complex cases. 409 00:15:50,654 --> 00:15:52,735 And that will reduce human error and will 410 00:15:52,735 --> 00:15:53,634 increase consistency. 411 00:15:54,495 --> 00:15:55,759 I think there will be, 412 00:15:56,700 --> 00:16:00,399 more patient centered approaches with advancement in imaging 413 00:16:00,460 --> 00:16:02,160 and augmented reality, 414 00:16:02,540 --> 00:16:04,000 biologics, and so on. 415 00:16:04,540 --> 00:16:07,340 Spine surgery will be more individualized down the 416 00:16:07,340 --> 00:16:09,820 road, and it's going to target the patient's 417 00:16:09,820 --> 00:16:11,295 exact anatomy and pathology, 418 00:16:11,835 --> 00:16:14,555 which will, result hopefully in faster recovery for 419 00:16:14,555 --> 00:16:15,215 the patients. 420 00:16:16,075 --> 00:16:18,555 There will be enhanced precision as well using 421 00:16:18,555 --> 00:16:20,014 AI and augmented reality, 422 00:16:21,195 --> 00:16:24,179 to push the boundaries of precision and personalization 423 00:16:24,559 --> 00:16:25,620 in spine surgery. 424 00:16:26,320 --> 00:16:28,720 And probably one of the most exciting parts 425 00:16:28,720 --> 00:16:29,220 of, 426 00:16:29,600 --> 00:16:31,679 minimally invasive spine surgery in the next couple 427 00:16:31,679 --> 00:16:32,340 of years 428 00:16:32,720 --> 00:16:34,320 is going to be the shift towards outpatient 429 00:16:34,320 --> 00:16:34,399 surgery. 430 00:16:37,524 --> 00:16:39,764 So as we're employing more and more, less 431 00:16:39,764 --> 00:16:40,825 invasive techniques, 432 00:16:41,365 --> 00:16:42,184 we'll see, 433 00:16:42,565 --> 00:16:44,345 even more complex spine surgeries, 434 00:16:45,684 --> 00:16:47,945 being performed in outpatient settings. 435 00:16:48,725 --> 00:16:50,399 And, you know, if you combine all of 436 00:16:50,399 --> 00:16:51,300 those exciting, 437 00:16:51,920 --> 00:16:54,559 areas together, ultimately, we'll see that those changes 438 00:16:54,559 --> 00:16:55,300 will improve, 439 00:16:56,080 --> 00:16:58,740 patient outcomes, decrease recovery times, 440 00:16:59,759 --> 00:17:01,034 decrease the risk of complications, 441 00:17:01,995 --> 00:17:03,855 making spine surgery less invasive, 442 00:17:04,394 --> 00:17:05,214 more accessible, 443 00:17:05,515 --> 00:17:07,134 and, highly efficient. 444 00:17:07,914 --> 00:17:08,414 Absolutely. 445 00:17:09,034 --> 00:17:11,515 Well, doctor Fanous, thank you so much for 446 00:17:11,515 --> 00:17:13,424 joining us today. It's been a pleasure to 447 00:17:13,424 --> 00:17:15,584 speak with you, and I look forward to 448 00:17:15,584 --> 00:17:17,124 connecting with you down the line. 449 00:17:17,584 --> 00:17:18,244 My pleasure.