This is Carly Beam with the Becker Spine
and Orthopedics podcast, and I'm thrilled to be
joined today by doctor Susan Sadowsky,
chief medical officer at Desert Sports and Spine.
Doctor Sadowsky,
thank you so much for being here today.
Thank you for having me. So before we
dive into our questions, can you introduce yourself
and tell us a bit more about your
background?
Absolutely.
I am a board certified physiatrist, which is
a specialist in physical medicine and rehabilitation,
with an additional focus in interventional spine and
musculoskeletal
medicine.
And as you, so nicely introduced me, I
am the CMO of our practice, Desert Spine
and Sports Physicians, which I am cofounder with
my husband, doctor Brad Saroski,
here in Arizona.
I also, am the fellowship director for an
accredited
fellowship that we have, by North American Spine
Society and the interventional
spine and musculoskeletal
medicine.
Great. And as chief medical officer and cofounder,
can you talk about some of the biggest
headwinds you're planning for in the next, twelve
months?
Sure. Sure. Yeah. The the headwinds, you know,
it's it's always a it's a balancing act
of of our business, our growing business, and
our mission,
to maintain excellent patient care while managing these
headwinds, always our top priority.
As always, you know, we've got the cost
pressures,
always rising for equipment and supplies
and compensating
staff, facility overhead.
And for us, we're we're in the active
state of growth. So we're always reaching for,
excellent physicians, to meet the growing demands of
our practice, which we
can,
excel through our fellowship in doing that. But
we also need to meet the demands of
our growth, with also advanced practice practitioners, like
PAs and, of course, staff,
all while trying to, protect, mission critical,
culture in our practice.
And other headwinds would be Medicare
always,
and other regulatory and payer challenges. I don't
know if you're aware, but Arizona is one
of the six states that will be,
involved in a Medicare preauthorization
pilot in 2026.
Mhmm. This will, for us,
include certain interventional procedures, including epidural injections,
nerve stimulators,
and mild. So patients will be having
probably a seven day period of preauthorization,
which will put an enormous burden on our
on our back office and and likely risk
delay of care for certain procedures.
So that that's always,
that's on the horizon and and, of course,
other kinds of reimbursement rules, documentation requirements that
that always go on in in in the
world.
Yeah. And I wanna hone in on what
you're saying just now about
prior authorization. So
what have you been doing right now to
get ahead of
this, whether it's communicating with patients, so what
to
expect,
anything on the back end administrative
wise?
Yeah. I mean, we have a really strong
authorization
department within our practice, so I think that's
a solid part of of our business.
I'm doing a lot of
discussion
patients in terms
of what they might be, experiencing in in
the in the year ahead.
I am a
little bit cognizant of the fact that this
might be fairly clunky when the year starts.
So I I think just a lot of
heads up for the patients, and, hopefully, this
won't lead to delay of care in our
our outpatient clinics have
procedure rooms in office, so we're also able
to offer procedures at very low cost to
patients. So we actually are very proud of
that on our website. We, have a transparency
page and and issue all of our cash
prices online. So which means that if a
patient is in extreme pain, and cannot wait
the seven days of preauthorization,
they also, have a a fairly easy route
to to have a procedure,
cash pay if they decide to go that
route. But, yeah, I think just a lot
of education, just making sure our back office
policies are are firm.
So it sound it sounds like you're very
proactive
with
all of this.
Yes. Well, that's a bit
a a a major part of our practice
for a long time in terms of preauthorization.
Unfortunately, a lot of the patients, feel a
little bit blindsided in terms of, what's ahead
of them, as they many of them chose
Medicare over Medicare replacement plans due to the
lack of preauthorization.
So,
this is this is going to be a
a difficult road ahead, I think. So we'll
see how that rolls out.
Yeah. And then you also mentioned, your fellowship.
Can you talk more about that, how, that's
led to growth within the the practice?
Yeah. Sure.
My husband, Brad Svaroski, and I started our,
fellowship in actually, in 2011, a few years
after we started our practice.
And then it became accredited by the North
American Spine Society in 2018,
which is a cohort of about,
25 or so programs around The United States
that meet rigid, criteria to be a part
of. We have a formal match process, etcetera.
And so we train about two to four
fellows in interventional,
spine and musculoskeletal
medicine each year, and we're actually
very happy to say that we've trained 22
fellows that are out in the world practicing
in academic and private practice spaces.
With that fellowship, we have used our fellows,
for growth. Right? It's a year long interview
practice. We all end up practicing
the same flavor of medicine at end of
the day with Nuances, of course. So we're
able to to offer to our patients a
consistent and excellent,
way of management.
And then in our fellowship, we we really
work hard to standardize, you know, what are
the advanced skills that that physicians need in
this, nonsurgical
spine and musculoskeletal
medicine space,
whether that's, you know, image guided procedures under
a fluoroscopy or ultrasound,
regenerative medicine, which is a big part of
our practice, with PRP and and bone MAC,
electrodiagnostics,
rehabilitation,
and and health and wellness. So really looking
to standardize all these skills, and and helping
to produce really the next generation of, interventional
spine and musculoskeletal
physicians.
That's great. And you're thinking about just the
future of spine.
How do you see, the spine orthopedic field
evolving
in the next two to three years?
Yeah. It's it's an exciting time, I think,
in terms of of the shift that we
have in terms of the tools in our
tool bag. You know, when we started this
practice,
I would say we were more, reactive
applying Band Aids to injuries or or pain
in the spine and musculoskeletal
system. And and over time, there's been a
huge expansion in regenerative medicine, especially, within our
practice, and and that would include,
PRP, platelet rich plasma,
and and bone marrow aspirate concentrate, which is
AKA stem cells. You know? And as this
is the biologics are gaining stronger evidence and
broader acceptance. You know, the shift is really
towards not a Band Aid, but true, tissue
restoration and healing. And and this is probably
the most exciting part of, what we're offering
to patients now.
Mhmm. And I'd love to hear your perspective
on just kind of the most interesting innovations
that you think will start taking front and
center stage.
Yeah. I mean, again, I think that really
revolves around the regenerative therapies. So and and
expanding into into more biologics. So, again, sort
of now we have our our main workhorses
of the PRP,
and and BMAC.
But for example, we're doing, a research project
on on meso blast, which is, a combination
of regenerative cells and hyaluronic acid for degenerative
disc disease. So just as an example of
of the field evolving into other biologic therapies
and working on that evidence,
and to strengthen results.
And doctor Swarovski, can you talk about how
you're
collaborating
with surgeons as,
pain medicine,
experts?
Yeah. We've also we've always had a very
healthy dynamic relationship with our surgical colleagues. I
I think that that's gonna be the way
we need to move forward, especially in this
space, you know, is how to
produce these integrated
care models partnering with, you know, not only,
obviously, physical therapists in the nonsurgical space, but,
orthopedics,
spine surgeons, and orthopedics and neurosurgery,
you know, in order to not just be
these isolated
silos of patient care, but, you know, to
produce
paradigms,
where we have more seamless,
management of patients and and collaboration,
perhaps even, sharing data and functional outcomes,
all to, you know, achieve a better outcome
and and a more seamless experience.
Right. And, you know, my last question,
what were some other big health care trends
that you're following right now?
Yeah. I mean, I think the trend, at
least as we see it as as nonsurgical,
specialists is, you know, just this really growing
role for nonsurgical therapies. You know, how to
delay, how to avoid surgery where appropriate. Right?
You know? And and hopefully getting more insurance
coverage for these things, including regenerative therapies,
you know, as as the patient demand is
is growing for that. And and that's also,
you know, flipping the script a little bit,
focusing, on the prevention, right, and finding things
before they become an issue,
preventing rather than treating.
You know, obviously working on the fundamentals, movement,
exercise, diet,
but, how to identify early degenerative changes and
perhaps even with biologics so, you know, we
can prevent things, from deteriorating and and getting
so advanced.
Absolutely.
Well, doctor Sadowsky, thank you for joining us
today. It's been a pleasure speaking with you,
and I look forward to connecting again down
the line. You're so welcome. Have a wonderful
day.