1
00:00:00,240 --> 00:00:02,399
This is Carly Beam with the Becker Spine

2
00:00:02,399 --> 00:00:05,200
and Orthopedics podcast. And today, I'm thrilled to

3
00:00:05,200 --> 00:00:07,919
be joined by doctor Michael Virden, a spine

4
00:00:07,919 --> 00:00:10,019
surgeon at Transcendent Care.

5
00:00:10,320 --> 00:00:12,160
Doctor Virden, thank you so much for being

6
00:00:12,160 --> 00:00:12,820
here today.

7
00:00:13,695 --> 00:00:16,114
Appreciate it. Thanks for the opportunity to talk.

8
00:00:16,414 --> 00:00:19,535
Absolutely. Before we dive into our questions, could

9
00:00:19,535 --> 00:00:22,335
you introduce yourself and tell us more about

10
00:00:22,335 --> 00:00:23,074
your background?

11
00:00:24,175 --> 00:00:24,574
Yeah.

12
00:00:25,214 --> 00:00:27,234
My name is Mike Verdin. I'm a neurosurgeon

13
00:00:27,375 --> 00:00:29,899
in Dayton, Ohio. I've been in practice for,

14
00:00:30,519 --> 00:00:31,899
going on sixteen years,

15
00:00:32,200 --> 00:00:32,859
this year.

16
00:00:35,320 --> 00:00:36,780
Been in basically,

17
00:00:37,159 --> 00:00:39,000
spine surgery is is kinda what I do.

18
00:00:39,000 --> 00:00:41,500
Community community spine surgeon in in Dayton.

19
00:00:42,715 --> 00:00:45,835
I've been in a private practice setting essentially

20
00:00:45,835 --> 00:00:47,615
or community setting my whole career.

21
00:00:48,875 --> 00:00:50,414
Started a couple of practices.

22
00:00:50,875 --> 00:00:53,515
I've been involved with startup projects with service

23
00:00:53,515 --> 00:00:55,215
line development as well as

24
00:00:56,039 --> 00:00:58,859
hospital service line development as well. So,

25
00:00:59,559 --> 00:01:00,539
that's about it.

26
00:01:01,159 --> 00:01:03,000
Great. And it sounds like, you know, so

27
00:01:03,000 --> 00:01:04,299
you said you've been in community,

28
00:01:05,799 --> 00:01:09,000
care and private practice for sixteen years. I'd

29
00:01:09,000 --> 00:01:10,459
love to just kind of hear

30
00:01:10,885 --> 00:01:12,724
what are some of the biggest changes that

31
00:01:12,724 --> 00:01:15,545
you've seen in that landscape in your career.

32
00:01:16,805 --> 00:01:18,244
I think over time, it's,

33
00:01:19,284 --> 00:01:21,944
really COVID, in my opinion, gutted the workforce.

34
00:01:22,165 --> 00:01:23,864
So a lot of people who were

35
00:01:25,560 --> 00:01:27,560
late career and not real or mid to

36
00:01:27,560 --> 00:01:29,799
late career not really wanting to to dig

37
00:01:29,799 --> 00:01:31,400
into what was going on has left. So

38
00:01:31,400 --> 00:01:32,060
there's been

39
00:01:32,520 --> 00:01:34,840
a huge experience strain out of the entire

40
00:01:34,840 --> 00:01:37,420
health care system from nursing to administration

41
00:01:37,960 --> 00:01:39,020
to lab, PT,

42
00:01:39,625 --> 00:01:41,384
really all across the board. So it's it's

43
00:01:41,384 --> 00:01:43,644
now much more do it yourself kinda situation.

44
00:01:44,905 --> 00:01:46,905
So we've had to try to use or

45
00:01:46,905 --> 00:01:47,405
develop

46
00:01:48,344 --> 00:01:51,004
technology technique to make it better for us

47
00:01:51,750 --> 00:01:54,870
to evaluate patients, be more efficient. So I

48
00:01:54,870 --> 00:01:57,430
think what's happened post COVID is there's this

49
00:01:57,430 --> 00:01:59,049
push for efficiency and

50
00:01:59,430 --> 00:02:00,810
the there's not a human,

51
00:02:01,350 --> 00:02:04,390
workflow to help help with that, and you

52
00:02:04,390 --> 00:02:05,130
have to

53
00:02:06,144 --> 00:02:08,384
provide the same level of care with less

54
00:02:08,384 --> 00:02:11,344
human resources. So more things need to be

55
00:02:11,344 --> 00:02:13,205
processed oriented or,

56
00:02:13,745 --> 00:02:15,745
instead of people oriented. And I think that's

57
00:02:15,745 --> 00:02:17,525
gonna continue to go,

58
00:02:18,384 --> 00:02:19,205
moving forward.

59
00:02:20,229 --> 00:02:21,669
Got it. And can you talk about some

60
00:02:21,669 --> 00:02:22,490
of the other

61
00:02:22,790 --> 00:02:25,770
biggest health care trends that you're following today?

62
00:02:27,669 --> 00:02:29,990
Well, kind of the rise of,

63
00:02:30,629 --> 00:02:31,129
Ingenic

64
00:02:31,430 --> 00:02:34,094
AI in the clinical space from an office

65
00:02:34,094 --> 00:02:37,794
documentation standpoint. So there's quite a few technologies

66
00:02:38,014 --> 00:02:40,414
out there that listen to the interaction between

67
00:02:40,414 --> 00:02:42,194
the patient and physician and generate

68
00:02:42,574 --> 00:02:44,939
notes or potentially orders off of that.

69
00:02:45,819 --> 00:02:48,060
It's primarily, it seems to me, for the

70
00:02:48,060 --> 00:02:50,699
primary care space or that's the ideal location

71
00:02:50,699 --> 00:02:51,360
for it.

72
00:02:51,900 --> 00:02:54,139
I'm kind of looking to see how that's

73
00:02:54,139 --> 00:02:54,639
gonna

74
00:02:56,139 --> 00:02:59,034
influence or eventually show up in in specialty

75
00:02:59,034 --> 00:03:01,615
clinics like spine or orthopedics or cardiac,

76
00:03:01,915 --> 00:03:03,835
because I think there's a huge need for

77
00:03:03,835 --> 00:03:06,014
that those kind of technologies there.

78
00:03:06,634 --> 00:03:07,134
Mhmm.

79
00:03:07,594 --> 00:03:09,594
And how are you using AI in your

80
00:03:09,594 --> 00:03:11,134
practice if at all?

81
00:03:12,710 --> 00:03:15,349
We are. Actually, we we have been using

82
00:03:15,349 --> 00:03:16,569
a tool that we developed,

83
00:03:17,909 --> 00:03:20,629
to triage patients based on the referral type

84
00:03:20,629 --> 00:03:23,189
so we know how to order or schedule

85
00:03:23,189 --> 00:03:23,930
their appointments.

86
00:03:24,354 --> 00:03:25,955
We've been using that in the clinic for

87
00:03:25,955 --> 00:03:27,335
about three years now.

88
00:03:28,754 --> 00:03:30,534
You know, patients call, get a referral.

89
00:03:30,835 --> 00:03:33,314
My office staff calls a minute. They we

90
00:03:33,314 --> 00:03:33,814
have

91
00:03:34,354 --> 00:03:36,435
a kind of the software based package that

92
00:03:36,435 --> 00:03:37,974
helps question the patients,

93
00:03:38,400 --> 00:03:39,120
And then,

94
00:03:39,520 --> 00:03:40,419
it's a

95
00:03:41,199 --> 00:03:44,020
algorithmic way to triage patients based on,

96
00:03:44,560 --> 00:03:47,120
their symptoms severity, and it's a validated tool

97
00:03:47,120 --> 00:03:48,879
that we've used for a while, and it's

98
00:03:48,879 --> 00:03:50,639
really helped. I mean, my throughput has increased

99
00:03:50,639 --> 00:03:52,735
by a factor of two. In other clinics,

100
00:03:52,735 --> 00:03:54,735
they're out there in their surgical output, this

101
00:03:54,735 --> 00:03:57,375
increased by 10%. So it's really pretty neat.

102
00:03:57,375 --> 00:03:58,655
You have a way to and the patients

103
00:03:58,655 --> 00:04:01,455
get early treatment, right person, right time kind

104
00:04:01,455 --> 00:04:02,114
of thing.

105
00:04:02,414 --> 00:04:04,814
And, it's been good for the patients and

106
00:04:04,814 --> 00:04:06,435
and of clinical efficiencies.

107
00:04:07,159 --> 00:04:09,240
Yeah. That sounds especially useful too just in

108
00:04:09,240 --> 00:04:09,740
terms

109
00:04:10,040 --> 00:04:11,020
of getting patients

110
00:04:11,319 --> 00:04:13,560
what they need quicker through the help of

111
00:04:13,560 --> 00:04:14,060
AI.

112
00:04:14,439 --> 00:04:15,340
And, like, besides,

113
00:04:15,719 --> 00:04:18,620
you know, these listening tools and triage,

114
00:04:19,319 --> 00:04:22,279
what other applications for AI and SpineCare do

115
00:04:22,279 --> 00:04:24,834
you think will really take front and center

116
00:04:24,894 --> 00:04:26,194
stage in the coming

117
00:04:26,735 --> 00:04:27,394
I think,

118
00:04:29,055 --> 00:04:31,935
so decision support tools kind of for people.

119
00:04:31,935 --> 00:04:34,115
So the whole concept of,

120
00:04:35,339 --> 00:04:36,160
you know, OpenAI,

121
00:04:36,779 --> 00:04:39,180
really, as a technology scrapes the Internet for

122
00:04:39,180 --> 00:04:40,060
knowledge to give you,

123
00:04:40,860 --> 00:04:41,360
suggestions.

124
00:04:41,980 --> 00:04:43,580
Well, I think there's gonna be a back

125
00:04:43,580 --> 00:04:45,819
end where research tools are gonna feed those

126
00:04:45,819 --> 00:04:46,720
kind of machines,

127
00:04:47,194 --> 00:04:50,235
and you're gonna have fresh new research type

128
00:04:50,235 --> 00:04:51,214
data to,

129
00:04:51,995 --> 00:04:52,495
again,

130
00:04:53,035 --> 00:04:55,214
fuel those large machines to

131
00:04:56,074 --> 00:04:58,714
create outputs that are relevant to a patient

132
00:04:58,714 --> 00:05:00,095
or to a patient population.

133
00:05:00,879 --> 00:05:02,439
I was talking to a friend of mine

134
00:05:02,439 --> 00:05:04,300
yesterday. It's like almost each individual,

135
00:05:05,160 --> 00:05:06,839
hospital will be will be its own data

136
00:05:06,839 --> 00:05:08,600
hub, which is, if you think about that,

137
00:05:08,600 --> 00:05:11,080
pretty fascinating. Right? So you can treat the

138
00:05:11,080 --> 00:05:12,459
patients in your community

139
00:05:12,839 --> 00:05:15,074
with the disease states that they're presenting with

140
00:05:15,074 --> 00:05:16,855
based on your own clinical data,

141
00:05:17,634 --> 00:05:19,415
and help evolve care,

142
00:05:20,274 --> 00:05:23,074
for your community, which is really what we

143
00:05:23,074 --> 00:05:25,475
need. We need, like, the right treatment for

144
00:05:25,475 --> 00:05:26,535
the community because,

145
00:05:26,959 --> 00:05:28,500
you know, what is

146
00:05:28,800 --> 00:05:32,020
a disease process that's very common in Detroit

147
00:05:32,160 --> 00:05:34,319
is not the same as it is in

148
00:05:34,319 --> 00:05:36,339
Dubai. They're just very different

149
00:05:36,800 --> 00:05:38,639
based on the way people live and how

150
00:05:38,639 --> 00:05:41,040
their the diseases are presenting. And we're gonna

151
00:05:41,040 --> 00:05:42,795
have tools to be able to

152
00:05:43,275 --> 00:05:45,355
help the people at the bedside get the

153
00:05:45,355 --> 00:05:47,194
patient what they need as soon as they

154
00:05:47,194 --> 00:05:47,694
can.

155
00:05:48,395 --> 00:05:50,715
Absolutely. And really just kind of parsing through,

156
00:05:50,715 --> 00:05:52,814
like, the nuance you said in, you know,

157
00:05:52,955 --> 00:05:54,335
between different communities.

158
00:05:54,795 --> 00:05:55,295
Correct.

159
00:05:55,819 --> 00:05:57,660
And what are some other things that are

160
00:05:57,660 --> 00:06:00,379
really exciting you right now in spine and

161
00:06:00,379 --> 00:06:01,360
in health care?

162
00:06:02,620 --> 00:06:04,860
You know, I think it's not exciting, but

163
00:06:04,860 --> 00:06:07,019
it's certainly a huge opportunity is this whole

164
00:06:07,019 --> 00:06:08,560
care the access,

165
00:06:10,275 --> 00:06:12,835
model that they're talking about for for,

166
00:06:14,035 --> 00:06:17,074
Medicare patient population. So we're gonna be forced.

167
00:06:17,074 --> 00:06:17,654
I think

168
00:06:18,035 --> 00:06:20,134
organizations are gonna be forced to

169
00:06:21,580 --> 00:06:23,120
treat for value. Meaning,

170
00:06:23,660 --> 00:06:25,580
not everybody you're not gonna get paid per

171
00:06:25,580 --> 00:06:27,340
per piece meal. You're gonna get paid per

172
00:06:27,340 --> 00:06:29,040
patient population or per disease

173
00:06:29,420 --> 00:06:30,879
state for the patient population.

174
00:06:31,259 --> 00:06:33,259
It's kind of an old fashioned version of

175
00:06:33,259 --> 00:06:36,384
capitated medicine under a certain disease state. And

176
00:06:36,384 --> 00:06:38,964
so whoever owns that whole entire

177
00:06:40,225 --> 00:06:41,444
system of care

178
00:06:41,824 --> 00:06:42,564
is gonna

179
00:06:43,024 --> 00:06:44,645
provide the best care usually,

180
00:06:45,745 --> 00:06:48,725
have the whole patient population, quote, unquote, captive.

181
00:06:49,079 --> 00:06:51,479
That would be surgical and nonsurgical, and then,

182
00:06:51,479 --> 00:06:53,399
again, have the data to prove that their

183
00:06:53,399 --> 00:06:55,740
model of care is most effective.

184
00:06:56,120 --> 00:06:58,459
So it's a real opportunity. You know? I

185
00:06:58,839 --> 00:07:00,360
I think as a physician, I am

186
00:07:01,334 --> 00:07:02,935
I create a lot of data, and I

187
00:07:02,935 --> 00:07:04,774
generate a lot of data, and I become

188
00:07:04,774 --> 00:07:06,154
I become the tool that,

189
00:07:06,615 --> 00:07:08,615
applies the data. I think that's how we're

190
00:07:08,615 --> 00:07:11,014
gonna change. The medicine's gonna change. It's gonna

191
00:07:11,014 --> 00:07:13,254
not you're not in the health care business

192
00:07:13,254 --> 00:07:15,415
anymore. You're in the health care data business.

193
00:07:15,415 --> 00:07:16,475
And I feel like

194
00:07:16,870 --> 00:07:19,189
once people wake up to that, their whole

195
00:07:19,350 --> 00:07:21,110
I think a lot of the relationships could

196
00:07:21,110 --> 00:07:21,610
change.

197
00:07:22,470 --> 00:07:24,550
Very well said. And can you talk about

198
00:07:24,550 --> 00:07:27,050
how you're thinking about growth over the

199
00:07:27,430 --> 00:07:29,750
next twelve to twenty four months, whether it's,

200
00:07:29,750 --> 00:07:31,625
you know, expanding practice locations,

201
00:07:32,165 --> 00:07:34,725
increasing your volume, or, you know, just kind

202
00:07:34,725 --> 00:07:36,564
of expanding on this value based care that

203
00:07:36,564 --> 00:07:37,545
you're talking about?

204
00:07:39,045 --> 00:07:40,884
I think there's gonna be more of a

205
00:07:40,884 --> 00:07:42,824
push, not it's gonna be effective

206
00:07:43,365 --> 00:07:45,959
quality volume. Right? So we can't just so

207
00:07:46,120 --> 00:07:47,479
a lot of times when we hear models

208
00:07:47,479 --> 00:07:49,959
about it's gonna be quality based outcomes or

209
00:07:49,959 --> 00:07:52,139
no volume is gonna stay the same.

210
00:07:52,519 --> 00:07:55,180
There's gonna be a premium for quality volume.

211
00:07:55,720 --> 00:07:57,879
And how I think that needs to be

212
00:07:57,879 --> 00:07:59,959
built is by having a standard way to

213
00:07:59,959 --> 00:08:01,339
just take a patient in,

214
00:08:01,685 --> 00:08:04,564
And that's what essentially triage is. Right? A

215
00:08:04,564 --> 00:08:07,045
standard way to evaluate a patient, a standard

216
00:08:07,045 --> 00:08:09,145
way to work a patient up, a standard.

217
00:08:09,365 --> 00:08:10,745
And there's so much variability,

218
00:08:12,165 --> 00:08:12,665
across

219
00:08:14,019 --> 00:08:16,419
the regions for, say, spine care. Right? What

220
00:08:16,419 --> 00:08:19,220
what is the standard treatment in your community

221
00:08:19,220 --> 00:08:21,540
for this mixed bundle as these set of

222
00:08:21,540 --> 00:08:23,779
five s one on a healthy 45 year

223
00:08:23,779 --> 00:08:26,579
old? It is wildly different, the places I've

224
00:08:26,579 --> 00:08:27,079
lived.

225
00:08:27,475 --> 00:08:27,975
So,

226
00:08:28,754 --> 00:08:31,475
I think those nuances are not gonna go

227
00:08:31,475 --> 00:08:33,955
away, but you're gonna they're gonna value the

228
00:08:33,955 --> 00:08:34,455
outcome.

229
00:08:35,315 --> 00:08:35,815
So,

230
00:08:36,835 --> 00:08:37,495
you know,

231
00:08:38,355 --> 00:08:40,350
I was watching the movie, The Founder. It's

232
00:08:40,429 --> 00:08:42,029
about Ray Kroc up in your your neck

233
00:08:42,029 --> 00:08:43,789
of the woods at the founder of McDonald's,

234
00:08:43,789 --> 00:08:45,949
and he had a revelation when he was

235
00:08:45,949 --> 00:08:48,029
told that he wasn't in the hamburger business,

236
00:08:48,029 --> 00:08:49,809
that he was in the real estate business.

237
00:08:50,350 --> 00:08:52,429
And I kinda feel like we're in the

238
00:08:52,429 --> 00:08:53,250
data business.

239
00:08:53,789 --> 00:08:54,289
So

240
00:08:54,695 --> 00:08:57,254
we have to own what we're producing and

241
00:08:57,254 --> 00:08:59,414
then look at what we're doing and and

242
00:08:59,414 --> 00:09:02,134
and ask ourselves, is this really valuable? And

243
00:09:02,134 --> 00:09:03,995
then can you market what you do?

244
00:09:04,774 --> 00:09:07,254
Absolutely. And I'm wondering, you know, obviously, a

245
00:09:07,254 --> 00:09:09,334
lot of opportunities, a lot of exciting things

246
00:09:09,334 --> 00:09:12,120
going on. What are some of the biggest

247
00:09:12,179 --> 00:09:13,399
headwinds that you're

248
00:09:14,019 --> 00:09:16,679
preparing for going into 2026?

249
00:09:18,100 --> 00:09:18,679
I think

250
00:09:19,299 --> 00:09:21,320
in in my market, consolidation

251
00:09:22,980 --> 00:09:23,960
and or

252
00:09:25,735 --> 00:09:27,814
integration vertically. So there's not a lot of

253
00:09:27,814 --> 00:09:30,314
room for independent practice to function.

254
00:09:31,014 --> 00:09:33,174
I think you have we definitely are gonna

255
00:09:33,174 --> 00:09:35,495
have to partner with hospital systems no matter

256
00:09:35,495 --> 00:09:37,894
where you are from an economies of scale

257
00:09:37,894 --> 00:09:39,355
standpoint. You know,

258
00:09:40,709 --> 00:09:42,009
I think that there's

259
00:09:42,949 --> 00:09:45,449
reimbursements declining to a point where it's punitive

260
00:09:45,509 --> 00:09:48,009
to do cases to do clinic.

261
00:09:48,470 --> 00:09:50,949
You can't do clinic because you'll lose money

262
00:09:50,949 --> 00:09:52,709
in the clinic, which seems crazy, but the

263
00:09:52,709 --> 00:09:54,409
reimbursement has gotten so low.

264
00:09:54,789 --> 00:09:55,769
The amount of

265
00:09:56,095 --> 00:09:58,495
volume you have to take on to make

266
00:09:58,495 --> 00:10:00,575
it up or the cost that you have

267
00:10:00,575 --> 00:10:03,875
to assume to attain the patient pool is

268
00:10:04,254 --> 00:10:05,394
is not is counterproductive.

269
00:10:05,934 --> 00:10:08,115
So I don't think that that

270
00:10:08,700 --> 00:10:10,700
model is gonna be sustainable. I don't think

271
00:10:10,700 --> 00:10:12,700
any of the older model that we're used

272
00:10:12,700 --> 00:10:13,759
to fee for service

273
00:10:14,460 --> 00:10:17,279
is sustainable in any way, shape, or form.

274
00:10:17,420 --> 00:10:19,740
We're in we're definitely in a strange new

275
00:10:19,740 --> 00:10:20,639
world where

276
00:10:21,184 --> 00:10:22,784
the models are gonna be laid out there,

277
00:10:22,784 --> 00:10:25,044
and we have to iterate way through it.

278
00:10:25,664 --> 00:10:27,424
Got it. And, you know, just my last

279
00:10:27,424 --> 00:10:29,105
question for you and might have touched on

280
00:10:29,105 --> 00:10:30,644
it a bit already, but

281
00:10:31,105 --> 00:10:34,159
if you can pinpoint a a single key

282
00:10:34,159 --> 00:10:37,679
disruptor to spine surgery in the next next

283
00:10:37,679 --> 00:10:38,899
year, what would it be?

284
00:10:42,399 --> 00:10:45,440
Migration of of technologies out of the Operating

285
00:10:45,440 --> 00:10:47,625
Room and into the clinic. I think that's

286
00:10:47,845 --> 00:10:50,084
really where we don't we haven't thought about

287
00:10:50,084 --> 00:10:52,184
it much yet. But how are

288
00:10:52,964 --> 00:10:55,845
most surgeons that I know are neuro or

289
00:10:55,845 --> 00:10:56,985
ortho spine are

290
00:10:57,365 --> 00:11:00,184
not technophobes. We embrace technology development,

291
00:11:01,129 --> 00:11:02,889
but that has not shown up in the

292
00:11:02,889 --> 00:11:03,389
way

293
00:11:03,769 --> 00:11:04,269
of

294
00:11:04,730 --> 00:11:08,029
office or operations and or service line development.

295
00:11:08,970 --> 00:11:11,470
And that migration now will

296
00:11:12,570 --> 00:11:15,610
whoever embraces that and uses that information to

297
00:11:15,610 --> 00:11:16,110
grow

298
00:11:16,475 --> 00:11:17,535
and to handle

299
00:11:18,394 --> 00:11:21,455
obstacles to care delivery will likely succeed.

300
00:11:23,115 --> 00:11:23,934
And I think

301
00:11:24,315 --> 00:11:27,134
those who refuse to acknowledge that,

302
00:11:28,554 --> 00:11:31,295
will probably not won't be able to scale.

303
00:11:32,740 --> 00:11:35,059
It's just a matter of the volume coming

304
00:11:35,059 --> 00:11:37,620
in cannot be handled by a human anymore.

305
00:11:37,620 --> 00:11:39,480
There needs to be some element of machine,

306
00:11:40,820 --> 00:11:41,959
learning or

307
00:11:42,419 --> 00:11:42,919
identification

308
00:11:44,625 --> 00:11:45,925
to parse through

309
00:11:47,024 --> 00:11:49,264
the silver tsunami that's coming at all of

310
00:11:49,264 --> 00:11:49,764
us.

311
00:11:51,425 --> 00:11:53,425
Got it. Well, thank you so much for

312
00:11:53,425 --> 00:11:56,065
joining us today, doctor Verdin. It's been a

313
00:11:56,065 --> 00:11:57,985
pleasure speaking with you, and I look forward

314
00:11:57,985 --> 00:11:59,365
to connecting down the line.

315
00:11:59,720 --> 00:12:01,580
Thank you very much. I appreciate the opportunity.

316
00:12:01,720 --> 00:12:03,080
Have a good day. You. Have a good

317
00:12:03,080 --> 00:12:04,059
day. Bye.