1 00:00:00,000 --> 00:00:02,000 This is Carly Beam with the Becker Spine 2 00:00:02,000 --> 00:00:04,639 and Orthopedics podcast. And today, I'm thrilled to 3 00:00:04,639 --> 00:00:07,279 be joined by doctor Brandon Hirsch at DISC 4 00:00:07,279 --> 00:00:10,320 Sports and Spine Center. Doctor Hirsch, thank you 5 00:00:10,320 --> 00:00:12,719 so much for being here today. Thank you, 6 00:00:12,719 --> 00:00:14,240 Carly. Thank you for having me. I'm glad 7 00:00:14,240 --> 00:00:15,779 to be here to chat with you. 8 00:00:16,214 --> 00:00:18,875 Absolutely. And before we dive into our questions, 9 00:00:19,655 --> 00:00:21,574 could you introduce yourself and tell us a 10 00:00:21,574 --> 00:00:22,635 bit about your background? 11 00:00:23,414 --> 00:00:26,214 Sure. So I'm an orthopedic spine surgeon, in 12 00:00:26,214 --> 00:00:28,875 practice in Orange County in North San Diego, 13 00:00:29,414 --> 00:00:31,755 and, I'm in my eighth year of practice. 14 00:00:32,260 --> 00:00:34,600 Previously was in practice in Arizona, 15 00:00:35,380 --> 00:00:37,460 trained on the on the East Coast, a 16 00:00:37,460 --> 00:00:39,859 few different places before heading out West to 17 00:00:39,859 --> 00:00:41,079 to begin my career. 18 00:00:42,020 --> 00:00:44,500 Thank you. And to get started, I wanted 19 00:00:44,500 --> 00:00:46,440 to pick your brain on telehealth 20 00:00:46,875 --> 00:00:50,174 and spine surgery. Obviously, telehealth really exploded, 21 00:00:51,195 --> 00:00:55,214 beginning the COVID pandemic. And now five years 22 00:00:55,274 --> 00:00:55,774 on, 23 00:00:56,475 --> 00:00:58,475 where have you seen it be the most 24 00:00:58,475 --> 00:00:58,975 beneficial 25 00:00:59,434 --> 00:01:00,494 to your work? 26 00:01:01,299 --> 00:01:03,000 Yeah. So I think that 27 00:01:03,380 --> 00:01:05,959 telehealth and telemedicine and spine care 28 00:01:06,260 --> 00:01:08,200 happen to fit very well together, 29 00:01:08,979 --> 00:01:11,140 and it was some something that I was 30 00:01:11,140 --> 00:01:13,859 even interested in before the pandemic started. And 31 00:01:13,859 --> 00:01:15,640 the pandemic, I think, just highlighted 32 00:01:16,504 --> 00:01:18,284 how useful and effective, 33 00:01:18,665 --> 00:01:20,444 you know, technology can be 34 00:01:20,825 --> 00:01:23,325 in getting patients in front of, 35 00:01:23,864 --> 00:01:27,144 spine care providers and spine surgeons who, you 36 00:01:27,144 --> 00:01:29,244 know, have the expertise that they need. 37 00:01:29,739 --> 00:01:32,399 So I view telemedicine as a very positive 38 00:01:33,019 --> 00:01:35,420 development, and I think most patients do as 39 00:01:35,420 --> 00:01:37,439 well. You know, I recently, 40 00:01:38,379 --> 00:01:40,479 it's been held up a little bit by 41 00:01:41,739 --> 00:01:43,039 the lack of a continuation 42 00:01:43,420 --> 00:01:44,159 from Medicare 43 00:01:44,954 --> 00:01:45,454 in, 44 00:01:45,914 --> 00:01:48,414 coverage policy, but I think that that 45 00:01:48,875 --> 00:01:51,754 I believe that's now been extended once again. 46 00:01:51,754 --> 00:01:53,994 I'm not sure whether it's been permanently extended, 47 00:01:53,994 --> 00:01:56,174 but that was sort of the main obstacle 48 00:01:56,314 --> 00:01:58,234 to the continued growth that I think is 49 00:01:58,234 --> 00:01:59,854 getting worked through now, which 50 00:02:00,180 --> 00:02:01,159 is very welcome. 51 00:02:02,180 --> 00:02:03,380 And what do you think will be some 52 00:02:03,380 --> 00:02:05,540 of the next big game changers in this 53 00:02:05,540 --> 00:02:06,040 area? 54 00:02:07,060 --> 00:02:08,260 Well, I think just, 55 00:02:08,580 --> 00:02:09,080 as 56 00:02:09,460 --> 00:02:12,180 patients become more comfortable and it becomes more 57 00:02:12,180 --> 00:02:14,360 commonplace and patients get more experience, 58 00:02:15,084 --> 00:02:15,905 using telehealth, 59 00:02:16,364 --> 00:02:17,504 I think that that 60 00:02:17,965 --> 00:02:19,985 will improve both their comfort 61 00:02:20,685 --> 00:02:21,185 with, 62 00:02:21,805 --> 00:02:23,965 you know, using technology to have a discussion 63 00:02:23,965 --> 00:02:24,784 with the doctor, 64 00:02:25,164 --> 00:02:27,745 and it will also help doctors' offices 65 00:02:28,284 --> 00:02:29,025 and practices 66 00:02:30,140 --> 00:02:32,640 get better at sort of the the, 67 00:02:33,500 --> 00:02:36,319 ins and outs of getting telehealth set up 68 00:02:36,540 --> 00:02:38,860 set up in a reliable way. You know, 69 00:02:38,860 --> 00:02:40,159 if you talk to people, 70 00:02:40,620 --> 00:02:42,080 in practices that 71 00:02:42,865 --> 00:02:44,564 weren't really familiar with telemedicine 72 00:02:44,865 --> 00:02:46,245 and kinda just started 73 00:02:46,544 --> 00:02:49,344 in the pandemic, you know, some practices had 74 00:02:49,344 --> 00:02:49,844 technological, 75 00:02:50,384 --> 00:02:52,805 you know, obstacles to overcome to get, 76 00:02:53,504 --> 00:02:54,645 to get their telemedicine 77 00:02:55,185 --> 00:02:55,685 platform 78 00:02:56,384 --> 00:02:57,985 up and running the way they'd like it 79 00:02:57,985 --> 00:03:00,859 to. But, you know, fortunately, with, 80 00:03:01,159 --> 00:03:03,159 you know, technology like Zoom or any of 81 00:03:03,159 --> 00:03:04,139 the other platforms, 82 00:03:05,079 --> 00:03:07,639 it's now become a very easy to use, 83 00:03:07,639 --> 00:03:08,539 highly reliable 84 00:03:09,239 --> 00:03:10,459 way to see patients. 85 00:03:10,759 --> 00:03:11,259 And, 86 00:03:12,039 --> 00:03:13,004 I think it does 87 00:03:13,564 --> 00:03:15,564 a number of things that are beneficial for 88 00:03:15,564 --> 00:03:16,385 both sides. 89 00:03:17,245 --> 00:03:19,325 For patients, you know, we live in an 90 00:03:19,325 --> 00:03:22,224 era of convenience where convenience is 91 00:03:22,764 --> 00:03:23,985 is at a premium. 92 00:03:24,444 --> 00:03:26,444 Really, in in any part of our life, 93 00:03:26,444 --> 00:03:28,444 there are probably people who will be listening 94 00:03:28,444 --> 00:03:29,639 to this podcast 95 00:03:30,099 --> 00:03:32,019 that no longer go to a grocery store 96 00:03:32,019 --> 00:03:34,039 because they use a product like Instacart, 97 00:03:35,139 --> 00:03:35,639 or, 98 00:03:36,500 --> 00:03:38,900 you know, Uber Eats or or these things. 99 00:03:38,900 --> 00:03:39,719 And so, 100 00:03:40,739 --> 00:03:42,340 really, if you look at any other part 101 00:03:42,340 --> 00:03:44,965 of our life, technology is constantly making things 102 00:03:44,965 --> 00:03:48,185 more convenient and saving us time. So why 103 00:03:48,245 --> 00:03:50,245 why would that not be, you know, helpful 104 00:03:50,245 --> 00:03:51,784 in health care where 105 00:03:52,324 --> 00:03:52,824 time 106 00:03:53,604 --> 00:03:55,784 and, you know, resources are 107 00:03:56,479 --> 00:03:56,979 scarce, 108 00:03:57,280 --> 00:03:59,620 for both patients and and their physicians. 109 00:04:00,319 --> 00:04:00,819 So 110 00:04:01,120 --> 00:04:02,340 I think in that 111 00:04:02,879 --> 00:04:04,099 regard, as 112 00:04:04,479 --> 00:04:06,900 as the technology and and comfort 113 00:04:07,520 --> 00:04:09,459 level gets better, I think the 114 00:04:09,965 --> 00:04:13,165 the adoption and the the widespread use will 115 00:04:13,165 --> 00:04:13,665 get, 116 00:04:14,125 --> 00:04:15,965 better. Part of that, you know, I think 117 00:04:15,965 --> 00:04:18,524 is the age of the population that's being 118 00:04:18,524 --> 00:04:20,305 cared for. I think we're just, 119 00:04:20,764 --> 00:04:22,785 you know, kind of at the edge of, 120 00:04:22,879 --> 00:04:23,620 you know, the 121 00:04:24,000 --> 00:04:26,319 the generation that's the oldest that are receiving 122 00:04:26,319 --> 00:04:28,000 health care right now or kind of the 123 00:04:28,000 --> 00:04:28,500 last 124 00:04:29,039 --> 00:04:29,539 generation 125 00:04:30,000 --> 00:04:31,939 that didn't grow up with, 126 00:04:32,560 --> 00:04:34,814 the Internet and technology in their hands. 127 00:04:35,295 --> 00:04:37,214 But I think once we go into, you 128 00:04:37,214 --> 00:04:38,915 know, another fifteen years, 129 00:04:39,375 --> 00:04:40,355 even the oldest, 130 00:04:40,814 --> 00:04:42,995 people in our population will have had 131 00:04:43,535 --> 00:04:46,735 extensive experience using, you know, the Internet, and 132 00:04:46,735 --> 00:04:47,235 technology 133 00:04:47,800 --> 00:04:49,720 in every part of their lives from from 134 00:04:49,720 --> 00:04:51,420 the time they were a young age. 135 00:04:52,040 --> 00:04:53,800 That's a really good point you make there. 136 00:04:53,800 --> 00:04:56,540 And you mentioned earlier just some challenges 137 00:04:56,840 --> 00:05:00,620 of telehealth in terms of government policy, etcetera. 138 00:05:00,680 --> 00:05:03,845 I know we're recording this on December 9, 139 00:05:03,845 --> 00:05:04,345 but 140 00:05:05,205 --> 00:05:07,125 right now, how are you thinking about these 141 00:05:07,125 --> 00:05:09,865 policy changes, and what do you wanna see, 142 00:05:10,485 --> 00:05:11,545 in terms telehealth 143 00:05:11,925 --> 00:05:12,425 access? 144 00:05:13,365 --> 00:05:14,185 Right. So, 145 00:05:14,805 --> 00:05:16,725 you know, during the pandemic, for those who 146 00:05:16,725 --> 00:05:17,785 may not be familiar, 147 00:05:18,329 --> 00:05:18,829 Medicare 148 00:05:19,449 --> 00:05:21,230 passed a series of regulations 149 00:05:21,689 --> 00:05:22,189 that, 150 00:05:22,970 --> 00:05:26,430 enhanced or expanded coverage for telemedicine because, 151 00:05:27,050 --> 00:05:29,290 you know, no they didn't want anybody seeing 152 00:05:29,290 --> 00:05:30,990 people in person at that time. 153 00:05:31,555 --> 00:05:32,675 And those had, 154 00:05:32,995 --> 00:05:35,095 time limits on them, expiration dates. 155 00:05:35,474 --> 00:05:38,194 And as as we got through that, and 156 00:05:38,194 --> 00:05:39,495 and out of it, the 157 00:05:40,675 --> 00:05:42,995 the expiration dates in a kind of a 158 00:05:42,995 --> 00:05:45,669 classic, you know, Washington DC fashion got kicked 159 00:05:45,669 --> 00:05:47,850 down the road six months or a year, 160 00:05:48,470 --> 00:05:49,449 multiple times. 161 00:05:50,389 --> 00:05:53,529 And, actually, right before the most recent shutdown, 162 00:05:54,629 --> 00:05:56,889 was the expiration of the most recent 163 00:05:57,464 --> 00:05:59,944 extension. And so during the shutdown, there was 164 00:05:59,944 --> 00:06:02,264 a period of time where Medicare was not 165 00:06:02,264 --> 00:06:03,165 going to cover, 166 00:06:04,105 --> 00:06:05,964 except for very narrow exceptions, 167 00:06:06,904 --> 00:06:07,404 telemedicine. 168 00:06:07,944 --> 00:06:10,605 And, naturally, the the commercial payers will always 169 00:06:10,745 --> 00:06:11,564 follow suit 170 00:06:12,300 --> 00:06:14,879 of what Medicare does. And so we experienced 171 00:06:15,020 --> 00:06:17,339 very recently a a period of time where 172 00:06:17,339 --> 00:06:18,480 there was no telehealth 173 00:06:19,420 --> 00:06:19,920 access 174 00:06:21,580 --> 00:06:24,240 through, you know, traditional insurance pathways. 175 00:06:25,100 --> 00:06:25,600 And, 176 00:06:25,915 --> 00:06:27,214 you know, that really 177 00:06:27,514 --> 00:06:30,415 irritated patients and caused disruptions to their practice. 178 00:06:31,675 --> 00:06:32,175 So 179 00:06:32,795 --> 00:06:33,295 the 180 00:06:33,754 --> 00:06:34,254 implementation 181 00:06:34,795 --> 00:06:36,875 and the what I think needs to happen 182 00:06:36,875 --> 00:06:39,375 is, number one, Medicare needs to 183 00:06:40,029 --> 00:06:40,529 permanently, 184 00:06:41,550 --> 00:06:42,050 outline 185 00:06:42,350 --> 00:06:44,050 the coverage for telemedicine 186 00:06:45,229 --> 00:06:48,189 that will then have the commercial payers follow 187 00:06:48,189 --> 00:06:48,689 suit 188 00:06:49,069 --> 00:06:49,889 and and, 189 00:06:50,509 --> 00:06:52,845 provide coverage for it. You know, most likely, 190 00:06:52,845 --> 00:06:54,605 no one can ever say exactly what the 191 00:06:54,605 --> 00:06:56,685 commercial payers will do, but but they do 192 00:06:56,685 --> 00:06:59,025 tend to follow Medicare policies and guidelines. 193 00:06:59,645 --> 00:07:01,345 So I think that's, you know, 194 00:07:01,725 --> 00:07:03,165 a must do, and I think that's on 195 00:07:03,165 --> 00:07:05,645 the very near horizon and is, 196 00:07:06,045 --> 00:07:07,264 is part of the 197 00:07:07,730 --> 00:07:10,230 the health care related bills that are in, 198 00:07:10,850 --> 00:07:11,910 Congress now. 199 00:07:12,529 --> 00:07:14,290 So that's, you know, that's what I see 200 00:07:14,290 --> 00:07:16,129 as the first next step. And then beyond 201 00:07:16,129 --> 00:07:16,629 that, 202 00:07:17,410 --> 00:07:19,750 you know, just the integration of telemedicine 203 00:07:20,129 --> 00:07:22,470 into the rest of our 204 00:07:23,625 --> 00:07:27,064 software ecosystem in health care, like EMRs, both 205 00:07:27,064 --> 00:07:30,045 office based EMRs and hospital based EMRs. 206 00:07:30,745 --> 00:07:32,925 Right now, a lot of the software platforms 207 00:07:33,145 --> 00:07:33,805 do have 208 00:07:34,904 --> 00:07:36,285 integrations for telemedicine, 209 00:07:37,750 --> 00:07:39,669 but I've had limited experience with them. I 210 00:07:39,669 --> 00:07:42,250 find they're not as reliable as a product 211 00:07:42,310 --> 00:07:43,669 like Zoom is, 212 00:07:44,069 --> 00:07:46,250 and maybe not as intuitive for, 213 00:07:47,029 --> 00:07:48,169 patients to 214 00:07:48,870 --> 00:07:51,750 use because people are just most familiar with 215 00:07:51,750 --> 00:07:53,475 what they use in other parts of their 216 00:07:53,475 --> 00:07:55,235 life, and that tends to be products like 217 00:07:55,235 --> 00:07:56,615 Zoom at the at the moment. 218 00:07:56,995 --> 00:07:58,595 So I think that's gonna be the next 219 00:07:58,595 --> 00:08:00,595 phase is how how do we integrate the 220 00:08:00,595 --> 00:08:02,535 telemedicine experience into 221 00:08:03,475 --> 00:08:05,814 the rest of our health care software, 222 00:08:06,250 --> 00:08:08,430 you know, ecosystem to make it a seamless 223 00:08:08,569 --> 00:08:10,970 transition to get your care and to provide 224 00:08:10,970 --> 00:08:11,709 the care 225 00:08:12,169 --> 00:08:15,290 without making it clunky or or challenging. Just 226 00:08:15,290 --> 00:08:18,569 trying to eliminate as many obstacles and friction 227 00:08:18,569 --> 00:08:20,264 points as possible to make it, 228 00:08:20,905 --> 00:08:23,545 natural and easy for for patients to get 229 00:08:23,545 --> 00:08:24,605 care this way. 230 00:08:25,225 --> 00:08:27,004 And what are some of the other 231 00:08:27,305 --> 00:08:27,805 conversations 232 00:08:28,345 --> 00:08:30,985 that you're following in terms of just, you 233 00:08:30,985 --> 00:08:34,024 know, policy shifts and different discussions going on 234 00:08:34,024 --> 00:08:35,245 in Washington, DC? 235 00:08:36,179 --> 00:08:37,620 Sure. So I think it's, 236 00:08:38,500 --> 00:08:41,540 it's a interesting time in health care and 237 00:08:41,540 --> 00:08:44,360 in health care reform and in our overall 238 00:08:44,419 --> 00:08:45,480 political environment. 239 00:08:45,940 --> 00:08:47,720 But I view the 240 00:08:48,335 --> 00:08:50,274 volume on the conversation around 241 00:08:50,975 --> 00:08:52,595 health care and pay reform 242 00:08:53,134 --> 00:08:55,615 to really be increasing in the last two, 243 00:08:55,615 --> 00:08:56,355 three years. 244 00:08:56,894 --> 00:08:57,394 I 245 00:08:58,014 --> 00:09:00,995 enjoy being, you know, somewhat active in advocacy 246 00:09:01,215 --> 00:09:01,715 discussions, 247 00:09:02,350 --> 00:09:03,169 you know, online, 248 00:09:03,470 --> 00:09:05,889 whether it's platforms like Twitter or LinkedIn. 249 00:09:06,429 --> 00:09:08,750 There are a lot of people from different 250 00:09:08,750 --> 00:09:10,929 parts of the country, different practice environments, 251 00:09:11,470 --> 00:09:14,450 and even non physicians who are really 252 00:09:14,990 --> 00:09:15,490 thoughtfully 253 00:09:15,870 --> 00:09:17,009 engaged with 254 00:09:18,795 --> 00:09:21,514 with each other on what's the best path 255 00:09:21,514 --> 00:09:22,014 forward. 256 00:09:22,475 --> 00:09:24,875 And I think they're really starting to make 257 00:09:24,875 --> 00:09:27,215 make some waves in having people pay attention. 258 00:09:27,595 --> 00:09:28,495 You know, actually, 259 00:09:29,115 --> 00:09:30,634 you you may have seen this or may 260 00:09:30,634 --> 00:09:31,355 not have, but, 261 00:09:32,210 --> 00:09:35,250 people like Mark Cuban who have, you know, 262 00:09:35,250 --> 00:09:37,910 tremendous business acumen, tremendous resources, 263 00:09:38,289 --> 00:09:39,669 and a desire to 264 00:09:40,049 --> 00:09:41,509 change the status quo 265 00:09:41,970 --> 00:09:44,929 are getting seriously involved in health care. He's 266 00:09:44,929 --> 00:09:46,690 done that already on the farm you know, 267 00:09:46,690 --> 00:09:49,464 on the pharmacy side with his company that 268 00:09:49,464 --> 00:09:52,684 provides generic drugs at, fair market prices. 269 00:09:53,304 --> 00:09:56,284 And he's now engaging with, you know, people 270 00:09:56,584 --> 00:09:59,004 that I know, individual physicians, 271 00:09:59,544 --> 00:10:00,044 neurosurgeons, 272 00:10:01,110 --> 00:10:03,429 people who've you've you've had, you know, feature 273 00:10:03,429 --> 00:10:04,730 on the Becker's platform 274 00:10:05,190 --> 00:10:07,909 are able because of technology, because of Twitter, 275 00:10:07,909 --> 00:10:10,389 to have live discussions with people like Mark 276 00:10:10,389 --> 00:10:10,889 Cuban 277 00:10:12,309 --> 00:10:15,529 to engage, you know, his resources in 278 00:10:15,909 --> 00:10:16,409 the 279 00:10:17,424 --> 00:10:20,065 progress or the effort toward reform, which, you 280 00:10:20,065 --> 00:10:20,964 know, is just 281 00:10:21,424 --> 00:10:24,065 a a remarkable and inspiring thing for me 282 00:10:24,065 --> 00:10:25,845 at a young stage in my career 283 00:10:26,225 --> 00:10:28,544 to to see you know, maybe there is 284 00:10:28,544 --> 00:10:30,704 the impetus and enough momentum to, 285 00:10:31,660 --> 00:10:32,720 to change things, 286 00:10:33,660 --> 00:10:34,639 because clearly, 287 00:10:35,179 --> 00:10:37,820 you know, what's going on with health care 288 00:10:37,820 --> 00:10:40,779 and and how payers work and how health 289 00:10:40,779 --> 00:10:43,019 care is paid for is is clearly not 290 00:10:43,019 --> 00:10:43,919 working for 291 00:10:44,325 --> 00:10:47,125 the very vast majority of people in our 292 00:10:47,125 --> 00:10:47,625 country. 293 00:10:48,085 --> 00:10:49,225 And patients 294 00:10:49,605 --> 00:10:52,105 are starting to get an understanding of this, 295 00:10:52,404 --> 00:10:53,785 and it's starting to, 296 00:10:54,485 --> 00:10:56,585 surface in the political discussions 297 00:10:57,045 --> 00:10:57,945 as we approach, 298 00:10:58,490 --> 00:10:59,870 you know, an election cycle. 299 00:11:00,329 --> 00:11:02,029 So, you know, very, 300 00:11:02,409 --> 00:11:02,909 very, 301 00:11:03,690 --> 00:11:05,069 focused on that and 302 00:11:05,449 --> 00:11:08,649 grateful to have people lending a hand who 303 00:11:08,649 --> 00:11:11,049 may not be, you know, physicians themselves, but 304 00:11:11,049 --> 00:11:13,745 are business people who are familiar with what's 305 00:11:13,745 --> 00:11:15,365 going on in health care. Because, 306 00:11:15,825 --> 00:11:18,304 unfortunately, to this point, when, you know, doctors 307 00:11:18,304 --> 00:11:20,325 have been doing it kinda on their own, 308 00:11:20,785 --> 00:11:23,424 just haven't haven't been able to organize well 309 00:11:23,424 --> 00:11:25,125 enough or get the right audience 310 00:11:25,825 --> 00:11:26,325 or 311 00:11:26,789 --> 00:11:28,629 position things the right way at the right 312 00:11:28,629 --> 00:11:30,730 time to get real change. And so, 313 00:11:31,110 --> 00:11:33,110 you know, I think it's it's really time 314 00:11:33,110 --> 00:11:35,990 for us to band together with with those 315 00:11:35,990 --> 00:11:37,990 in the business world and the political world 316 00:11:37,990 --> 00:11:40,464 to try to advance, you know, reform that's 317 00:11:40,464 --> 00:11:43,345 clearly much needed and and obvious to everyone. 318 00:11:43,345 --> 00:11:46,704 But often, the pathway to change in our 319 00:11:46,704 --> 00:11:47,204 political 320 00:11:47,504 --> 00:11:49,845 system is is not an obvious pathway. 321 00:11:51,470 --> 00:11:52,990 Yeah. That's a really good point you make 322 00:11:52,990 --> 00:11:54,269 about just getting, 323 00:11:55,070 --> 00:11:58,210 collaborating with people within and also without 324 00:11:58,830 --> 00:12:01,149 the medical world. And, you know, I was 325 00:12:01,149 --> 00:12:04,370 wondering, doctor Hirsch, how are these different conversations, 326 00:12:04,754 --> 00:12:06,054 how do you see them directly 327 00:12:06,434 --> 00:12:06,934 affecting 328 00:12:07,315 --> 00:12:08,215 spine care? 329 00:12:08,835 --> 00:12:12,355 Yeah. So anything that impacts access to care 330 00:12:12,355 --> 00:12:14,115 and health care is gonna have a direct 331 00:12:14,115 --> 00:12:17,394 impact on spine care. You know, Lobaqin is 332 00:12:17,394 --> 00:12:20,115 the most common reason that people seek medical 333 00:12:20,115 --> 00:12:23,200 care, and so it represents a large proportion 334 00:12:24,779 --> 00:12:27,179 of our overall health care economy as far 335 00:12:27,179 --> 00:12:28,720 as diagnoses are concerned. 336 00:12:29,340 --> 00:12:30,639 And so any, 337 00:12:31,100 --> 00:12:34,160 reforms or changes that can make it, 338 00:12:34,644 --> 00:12:37,605 number one, easier for patients to afford their 339 00:12:37,605 --> 00:12:38,105 care, 340 00:12:38,884 --> 00:12:39,945 and number two, 341 00:12:40,404 --> 00:12:41,865 easier for physicians 342 00:12:42,804 --> 00:12:45,684 to provide the care be because of the 343 00:12:45,684 --> 00:12:48,825 economics or a reform of prior authorization 344 00:12:49,580 --> 00:12:50,639 is going to positively 345 00:12:51,179 --> 00:12:51,679 impact 346 00:12:52,059 --> 00:12:52,879 spine care. 347 00:12:53,500 --> 00:12:55,679 And that means, you know, things like, 348 00:12:56,299 --> 00:12:59,039 more reasonable contracted, you know, rates, 349 00:12:59,580 --> 00:13:01,120 things like we were just discussing, 350 00:13:01,899 --> 00:13:05,360 impacting regulation or or legislation around, 351 00:13:06,115 --> 00:13:09,654 telemedicine care to make sure that that's not 352 00:13:10,034 --> 00:13:12,355 something that has to get revisited every year 353 00:13:12,355 --> 00:13:14,294 to extend, you know, temporary 354 00:13:14,834 --> 00:13:16,934 coverage, but that it becomes a normal 355 00:13:17,394 --> 00:13:20,639 recognized way for for people to receive and 356 00:13:20,639 --> 00:13:22,179 people to provide health care. 357 00:13:22,879 --> 00:13:25,200 So, you know, those are both things. I 358 00:13:25,200 --> 00:13:26,100 I think that 359 00:13:26,720 --> 00:13:27,220 the 360 00:13:27,919 --> 00:13:30,340 tremendous growth of of premiums 361 00:13:31,200 --> 00:13:34,514 disproportionate to the amount of actual coverage, 362 00:13:35,695 --> 00:13:38,414 is something that probably is gonna need need 363 00:13:38,414 --> 00:13:39,235 to be regulated. 364 00:13:39,934 --> 00:13:42,434 Other areas that I think maybe are further 365 00:13:42,975 --> 00:13:44,514 away are things like, 366 00:13:45,534 --> 00:13:48,429 you know, repealing certificate of need laws and 367 00:13:48,429 --> 00:13:48,929 addressing 368 00:13:49,230 --> 00:13:52,050 the ban on physician ownership of hospitals. 369 00:13:52,670 --> 00:13:54,850 Those are those are two large priorities 370 00:13:55,309 --> 00:13:55,809 subjects 371 00:13:56,509 --> 00:13:57,410 that would 372 00:13:57,950 --> 00:14:00,529 really directly impact spine care. 373 00:14:00,945 --> 00:14:03,105 Much of, you know, spine care can be, 374 00:14:03,105 --> 00:14:05,445 you know, provide on an outpatient basis. 375 00:14:05,985 --> 00:14:08,004 Some some does require hospital, 376 00:14:08,545 --> 00:14:09,445 but the, 377 00:14:09,904 --> 00:14:13,264 kind of perverse economic incentive of the much 378 00:14:13,264 --> 00:14:14,644 higher facility fees, 379 00:14:15,629 --> 00:14:17,009 driving a lot of care 380 00:14:17,789 --> 00:14:20,509 to a hospital environment when it doesn't really 381 00:14:20,509 --> 00:14:22,269 need to be in that environment. You know, 382 00:14:22,269 --> 00:14:22,769 having 383 00:14:23,470 --> 00:14:26,370 a reform like site neutrality for payments 384 00:14:27,230 --> 00:14:27,730 would 385 00:14:28,325 --> 00:14:31,605 really allow true competition and allow us to 386 00:14:31,605 --> 00:14:33,705 reduce the cost of care because 387 00:14:34,644 --> 00:14:36,745 we're not just kinda shuffling 388 00:14:37,205 --> 00:14:39,445 the cards around, you know, as a health 389 00:14:39,445 --> 00:14:41,544 care provider to where are we gonna maximize 390 00:14:41,605 --> 00:14:45,049 reimbursement, but where is it the most efficient 391 00:14:45,110 --> 00:14:46,169 and cost effective 392 00:14:46,950 --> 00:14:49,450 location and and environment for care? 393 00:14:50,230 --> 00:14:52,730 Very well said, and I appreciate that overview 394 00:14:52,789 --> 00:14:53,529 of everything. 395 00:14:53,909 --> 00:14:55,735 And then doctor Hirsch, I was wondering, how 396 00:14:55,735 --> 00:14:57,975 are you thinking about growth in your own 397 00:14:57,975 --> 00:14:59,434 practice next year? 398 00:15:00,294 --> 00:15:02,375 Yeah. So I'm in a, you know, somewhat 399 00:15:02,375 --> 00:15:04,794 unique practice environment of of independent, 400 00:15:05,575 --> 00:15:08,154 private practice in a market in Southern California 401 00:15:08,294 --> 00:15:08,955 that has, 402 00:15:09,610 --> 00:15:11,450 a lot of spine surgeons, also has a 403 00:15:11,450 --> 00:15:14,009 lot of patients, but but is fairly saturated. 404 00:15:14,009 --> 00:15:14,509 And, 405 00:15:16,009 --> 00:15:19,210 so I'm always thinking about growth in patient 406 00:15:19,210 --> 00:15:19,710 volume, 407 00:15:20,250 --> 00:15:21,629 and growth in 408 00:15:22,490 --> 00:15:23,389 digital footprint. 409 00:15:24,090 --> 00:15:24,910 And so, 410 00:15:25,394 --> 00:15:26,915 you know, that will be a big part 411 00:15:26,915 --> 00:15:29,555 of what I focus on in in early 412 00:15:29,555 --> 00:15:31,335 twenty twenty six is growing, 413 00:15:32,035 --> 00:15:34,675 you know, my footprint online, you know, just 414 00:15:34,675 --> 00:15:35,654 like we were discussing, 415 00:15:36,675 --> 00:15:37,815 the growth of telemedicine. 416 00:15:39,039 --> 00:15:42,100 Along with that comes growth in how patients 417 00:15:42,240 --> 00:15:43,139 find physicians. 418 00:15:43,919 --> 00:15:44,419 And, 419 00:15:45,039 --> 00:15:47,539 these days, if if you're not visible, 420 00:15:48,080 --> 00:15:50,720 you know, online, it's almost as if your 421 00:15:50,720 --> 00:15:54,179 practice doesn't exist in real life, because that's 422 00:15:54,485 --> 00:15:56,345 just the reality of how, 423 00:15:57,205 --> 00:15:59,225 how people are searching for health care. 424 00:15:59,764 --> 00:16:01,865 So that, you know, that'll be a priority, 425 00:16:02,325 --> 00:16:03,225 you know, growing 426 00:16:03,685 --> 00:16:07,065 aspects of my practice that are somewhat 427 00:16:07,740 --> 00:16:09,519 specialty like spinal endoscopy, 428 00:16:10,220 --> 00:16:10,960 disc replacement, 429 00:16:11,340 --> 00:16:12,779 you know, are always gonna be, 430 00:16:13,259 --> 00:16:14,160 growth goals. 431 00:16:14,779 --> 00:16:17,899 And, you know, probably in 2026, I'll have 432 00:16:17,899 --> 00:16:21,360 more of an involvement in advocacy discussions, 433 00:16:22,524 --> 00:16:24,544 both at the society level and 434 00:16:24,845 --> 00:16:25,345 at 435 00:16:25,725 --> 00:16:28,465 the kind of more grassroots, just physician organization 436 00:16:28,605 --> 00:16:29,105 level 437 00:16:29,404 --> 00:16:31,725 because the election cycle toward the end of 438 00:16:31,725 --> 00:16:32,705 the year is probably 439 00:16:33,245 --> 00:16:34,225 gonna be pushing 440 00:16:34,684 --> 00:16:35,665 a lot of these 441 00:16:36,089 --> 00:16:38,970 potential reform items up to the front of 442 00:16:38,970 --> 00:16:41,769 the conversation. I I hope as long as, 443 00:16:41,769 --> 00:16:44,409 you know, some other scandal or topic doesn't 444 00:16:44,409 --> 00:16:48,269 distract public's attention from, you know, the important 445 00:16:48,490 --> 00:16:49,709 topics at hand. 446 00:16:50,294 --> 00:16:52,534 Got it. And and then my last question 447 00:16:52,534 --> 00:16:54,134 for you is, what do you think will 448 00:16:54,134 --> 00:16:57,095 be the biggest disruptor to spine surgery next 449 00:16:57,095 --> 00:16:57,595 year? 450 00:16:58,294 --> 00:17:00,534 Yeah. So I I I think disruption in 451 00:17:00,534 --> 00:17:01,355 spine surgery 452 00:17:01,735 --> 00:17:04,640 is tough to predict, number one, and usually 453 00:17:04,640 --> 00:17:05,140 takes 454 00:17:05,519 --> 00:17:07,440 a little more than a year. But I 455 00:17:07,440 --> 00:17:08,180 know that, 456 00:17:09,440 --> 00:17:10,259 the adoption 457 00:17:10,559 --> 00:17:12,579 of endoscopy and the ways that, 458 00:17:13,039 --> 00:17:15,220 surgeons are using it is rapidly 459 00:17:16,085 --> 00:17:16,585 progressing, 460 00:17:17,605 --> 00:17:20,164 and there's even more and more ability for 461 00:17:20,164 --> 00:17:21,144 surgeons to 462 00:17:21,605 --> 00:17:22,585 discuss cases 463 00:17:22,964 --> 00:17:25,285 with other surgeons in their local market. And 464 00:17:25,285 --> 00:17:26,744 because there are more people 465 00:17:27,045 --> 00:17:28,345 utilizing that technique 466 00:17:28,730 --> 00:17:31,450 in any given market, that allows for even 467 00:17:31,450 --> 00:17:32,509 more conversation, 468 00:17:33,609 --> 00:17:35,930 amongst surgeons. And so I have, you know, 469 00:17:35,930 --> 00:17:38,029 several surgeons just in my own market 470 00:17:38,570 --> 00:17:40,430 where I'll plan to 471 00:17:40,825 --> 00:17:44,025 go to observe their cases, and and they 472 00:17:44,025 --> 00:17:46,585 may or may not come to observe my 473 00:17:46,585 --> 00:17:47,805 cases. And that, 474 00:17:48,265 --> 00:17:50,505 I think is how we drive real progress 475 00:17:50,505 --> 00:17:52,605 and innovation and improvement in the 476 00:17:53,160 --> 00:17:55,019 surgical techniques that we offer. 477 00:17:55,799 --> 00:17:57,799 So that'll be a a major focus. And 478 00:17:57,799 --> 00:17:59,500 then, you know, on the 479 00:18:00,360 --> 00:18:02,700 digital media, you know, side of things, 480 00:18:03,160 --> 00:18:05,259 you know, at least for my practice, 481 00:18:05,880 --> 00:18:08,625 putting resources into that to really 482 00:18:09,244 --> 00:18:09,744 transform 483 00:18:10,365 --> 00:18:10,865 your 484 00:18:12,044 --> 00:18:13,505 your online presence. 485 00:18:13,964 --> 00:18:15,804 You know, I think that that I I 486 00:18:15,804 --> 00:18:17,585 anticipate that's going to bring 487 00:18:18,125 --> 00:18:18,625 significant, 488 00:18:19,484 --> 00:18:22,440 change in the practice volume and types of 489 00:18:22,440 --> 00:18:24,619 patients that are coming to see me. 490 00:18:25,240 --> 00:18:25,740 Well, 491 00:18:26,599 --> 00:18:29,319 doctor Hirsch, thank you so much for joining 492 00:18:29,319 --> 00:18:31,480 our podcast today. It was a pleasure to 493 00:18:31,480 --> 00:18:32,759 speak with you, and I look forward to 494 00:18:32,759 --> 00:18:34,220 connecting again down the line. 495 00:18:34,519 --> 00:18:36,440 Absolutely. Thank you very much, Carly, for having 496 00:18:36,440 --> 00:18:37,419 me. It was a pleasure.