This is Carly Beam with the Becker Spine
and Orthopedics podcast, and I'm thrilled to be
joined today by doctor Franco Vina. Doctor Vina,
thank you for joining us. Oh, thank you
for having me. So before we dive into
some questions, can you introduce yourself and tell
us a bit more about your work and
background?
Sure. So
I am an orthopedic spinal surgeon.
So I have a little bit of an
unusual background coming into medicine.
Funny, I graduated college. And after I graduated
college,
I went into finance. Actually, I went into
Really? Yeah.
I went into financial planning. I went into,
working with people and sending up retirements and
savings and and goals. I I had a
series seven
license to trade stocks. I had a set,
had an insurance license and,
you know, I kind of realized as I
was doing that, one of the things that
attracted me to it is
I really liked
the personal connection to people. I liked helping
people and I liked helping people
achieve their goals or achieve their dreams.
And I liked it, but I always felt
a little bit limited because there wasn't as
much of a personal connection as I was
looking for when I was in the financial
industry.
And,
it's kind of funny. My, my, my father
was a physician and he was an anesthesiologist
and, you know, I grew up and we'd
go to church or we'd go out to
the store and people would pull my dad
over in the store and they would give
him a big hug. And they'd say, doctor
Vina, you took such good care of my
mother or my child. And they just they
they they had this great connection to him.
And I realized, I said to myself every
time, I said, I want that. Right? I
want that connection. And I wasn't experiencing it
where I was working.
So I I decided I wanted to go
to medical school.
And so
How old were you when you decided to
go to med school, if I can ask?
Oh, my gosh. I was about 25.
Uh-huh. So I'd been out of college for
a few years. Right? And so I had
to go back. I did some post baccalaureate
premedical
courses.
And, and I actually, I I got my
EMT. So I worked as an EMT during
that time as well because I wanted to
test this theory that medicine is what I
wanted. I had to test this idea of
a personal connection,
this idea that this is where I wanted
to spend my life.
Mhmm. And, and I loved it. And I
said, you know what? This is for me.
So,
that is actually how I kind of came
into medicine. And along that time, you know,
my dad had had a few health problems.
It really kinda connected me to to what
I wanted to do and and where I
wanted to be. And so that was kind
of my transition to medical school. So I
went down to New Orleans. I went to
Tulane University Medical School, and I I got
my master's in public health simultaneously with my
MD and, you know, came out and and
decided orthopedics was what I wanted to do.
Right. It just,
I, I like to fix things. Right. I
like to make people feel better. Right. I
like, I like to see a problem, fix
it and look at an x-ray or something
and say, wow, that looks great. So
went into orthopedics.
And throughout that time, like disc replacement was
just starting out, like we were doing these,
you know, SB share a t lumbar disc
replacements were just starting. It was becoming a
really exciting time in spine.
And I had a couple really good spine
mentors. I I Andrew Marola and Tom Hair
were,
in in New York as part of my
program.
And,
I really liked the guys and I liked
the work we were doing. I liked working
the biomechanics
lab. And so
I decided to go into spinal surgery because
I I thought it was kind of where
the kind of the cool stuff was happening
and where I could really make a big
difference in making people feel better.
And so yeah. So so I did my
fellowship with Paul McAfee
at, Maryland Spinal Reconstructive
Surgery Fellowship,
and we did some great work in biomechanics
with, Brian Cunningham in the lab and Anton
Dimitryev
in the lab. And,
we were involved in disc replacements and biologic
studies, biomechanical
studies. And that really is what what
really made my career
interesting and really take off. And even though
I'm a private practitioner,
I'll still do I've still been involved
in FDA studies.
I'd like to design implants. So I've worked
with companies in divining, designing implants.
And I've again worked in biologic studies. So
I really try to stay active
academically.
And I've also been part of the North
American Spine Society,
committee on basic science and research. So again,
I've tried to not just be
a private practitioner, which I love being, but
also keep my hands in the academics a
little bit.
Definitely. And before I dive with some spine
related questions, I'm curious. Yep. Was there a
particular,
time in your EMT, a particular
call that you did that really solidified
your interest in medicine?
You know,
so that's
I I will say, and this is this
is interesting.
It was more a personal experience in my
family.
Yeah.
My dad started to have some health problems,
and I saw just the interaction that the
doctors
were having with him
and my mother and my family.
And so I took away the good parts,
like the doctors that really impressed me. I
said, man, I wanna be like that physician.
I wanna do that. And then I saw
the doctors who were not impressing me. I'm
like, oh, I never wanna be like that
person. I'm never gonna treat people that way.
Right? So so it was really that that
part of that personal connection.
I I think on the ambulance was just
more of me really realizing
that, you know, this is this is gonna
be my life's calling. This is what I'm
gonna do.
That's incredible. And I know you have a
fascinating background also with
finance, and I imagine that probably helps a
lot with your, private practice in just the
business
end of things. So I wanna ask you
I know I know, like, a lot there's
some other spine surgeons out there who they've
also, you know, pursued,
MBA,
extra business education. But is there a particular
business skill that you think every single spine
surgeon, especially in private practice, but, you know,
in any setting, is there a particular
business or financial skill that every spine surgeon
should know?
Yes.
And the the number one is how to
read an Excel spreadsheet
and how to come up with your own.
Mhmm. So it's it's knowing how to do
a spreadsheet and putting the numbers out in
front of you and making sure you have
good data.
So that a lot of that may come
from your billing company or if you have
in house billing. But a really big
issue is a lot of doctors try to
make decisions without good data. And if you
don't have the good data and you can't
put it in front of you and see
it, it's impossible to make a good decision.
Got it. And, you know, kind of thinking
about that as well, obviously, you know, reimbursements
have been huge headwind for just all
all of, all of health care. And I'm
wondering how you're,
tackling that, how you're anticipating any of those
challenges in your work.
Sure.
So reimbursement
has been
quite an issue. And and I'll say it's
it's a little different for me because I
had practiced I was a private practitioner up
in Buffalo, New York for about twenty years.
And
so I was used to New York insurance
companies, let's say, New York workers' compensation
rules.
And then about a year and a half
ago,
we moved down. My family and I, we
decided to
kind
of move out of the
as my wife likes to call it, the
Arctic Tundra
and, moved down to Florida where we would
vacation, love to come. So we just moved
down to Naples, Florida, and we live in
Naples, and I practice out of Naples and
Fort Myers.
And so the insurance down here is much
different.
It's a much different population. So I'm gonna
answer this and what I've seen over the
past year and a half practicing down in
Florida.
Mhmm. When I was up in New York,
the insurance cutbacks weren't as, significant to me
because I was doing a lot of, like,
the New York workers' compensation
or, you know, we had some of the
the auto accidents. We had,
you know, other other insurance
policies and programs,
but down here, it's very heavily Medicare, which
I wasn't doing so much up there. It's
very heavily
HMO, which I was not doing up in
Buffalo.
So
these cutbacks insurance rates are have really, I
guess, affected
down here a lot more than I was
used to up there. So I will say
that the cutbacks in insurance are very challenging.
The the constant,
peer reviews are very challenging.
And
I I will say that the thing that
I found the most archaic
is the way that these insurance companies reimburse
us, and I'll give you an example.
So I was going through,
with our billing team,
really my AR, and I was looking at
accounts receivable over ninety days. And I saw
that let's say if I was doing a
two level ACDF,
they wouldn't pay me for the first level,
but they would pay me for the second
level and deny the first level.
Or they would decide that they would reimburse
my physician assistant
to assist me
on a code, but they wouldn't pay me
to do the code.
Mhmm. And it's this constant back and forth
of these insurance companies just
I'm gonna say screwing with us.
I mean, honestly, in any other
industry, this would be illegal and these people
would be in jail. Like, we have a
major problem with our insurance carriers in the
way they are treating physicians.
They're treating us as second class citizens.
They are devaluing
what we do
and they are delaying as much as possible
to pay our bills. And so what I
saw down here is if they have sixty
days, we we can't for example,
we can't get reimbursed until
they have our op note, but I'm not
allowed to send them the op note until
they ask for it.
Mhmm. So they'll wait until almost sixty days.
On day 59, they'll ask for my op
note to stretch it out as long as
they can. And then we'll get my op
note, and 50% of the time, they'll lose
it. And thirty days later, they'll ask for
it again.
And then
we run into the problem of, again,
they'll approve the second level, but not the
primary level.
They'll pay my PA, but they won't pay
me. And so that just drags out these
billing cycles. And it's something that I wasn't
as used to,
up in New York as I see down
here in Florida.
Got it. Thank you for breaking that down.
And then, you know, I also wanna pick
your brain on spine innovation and biologics.
First off, can you talk about just some
of the spine innovations that are really exciting
you the most right now? I know you
touched some on disc replacement earlier and biologics
as well, but love to hear your thoughts
on these.
Oh, yeah. So
so what really excites me, and I know
everybody wants to hear about, you know, some
new implant or technique, but I'm gonna be
a little more basic than that. I think
what really excites me is now
we're having
patients start to take ownership of their health.
We're start we're having patients understand that what
they eat really matters.
How they exercise really matters.
And being down here in Florida, the fact
that people can walk outside twelve months a
year, that really matters in their recovery.
So what excites me the most is being
able to work with patients to try to
optimize their biology.
We talk about their nutrition,
sleep,
exercise,
and also nutraceuticals.
And I'm very interested in more some of
the naturopathic
nutraceuticals
to try to bring down inflammation
Mhmm. Rather than always taking NSAIDs or other
types of prescription medications.
And so we're working with our patients there
as well
as the, you know, kind of an ERAS
protocol
of
eating
right before the surgery,
through the surgery, and after the surgery to
optimize wound healing
and success.
So that's the stuff that's, that's exciting me
that along with the biologic stuff,
the PRP
stem cells, the allogeneic nucleases.
So I'm, I'm very interested in not just
the implants, but I'm very interested in the
biologics because without good biology,
we can't have a successful surgery.
Definitely. And, two quick follow ups. I'm wondering,
you know, in terms
of the ERAS protocols,
what have you found
to be the most effective across your patients?
Sure. Well, number one is we gotta bring
up their albumin.
So we see a lot of, you know,
patients come in, especially in the in the
in the Florida market. They're sarcopenic. Right? Maybe
they're they're a little underweight.
Right? They don't have a lot of muscle.
They're not eating a lot of good protein.
I know starting this and I'm talking starting
six weeks ahead of surgery.
But
when you get into it, there are also
some good
products and I've developed one that
works with carbohydrates in the first week before
surgery and then having carbohydrates
about three hours prior to surgery
and then a carbohydrate
and protein
following the surgery
for about two weeks. So these are good
protocols that have been shown to
benefit patients in terms of wound healing and
recovery. You know, particularly your diabetic patients, your
older patients, your patients with, you know, real
wound healing issues and wound healing,
problems.
Got it. And then in terms of spine
biologics,
how do you see innovation
there,
evolving, you know, in 2026?
So I think in biologics, what we're gonna
see in in 2026,
we're seeing a few things
come out in 2026.
One of them
is
when it comes down to Infuse.
And, you know, North American Spine Society
comes out with their opinion papers and their
guides,
and they just put out an opinion or
a guide that's out right now for public
it's in the public comment period about use
of Infuse, where for a while it was
only for
anterior lumbar interbody devices, you know, in a
cage in the front of the lumbar spine.
And so when we, we look about the
indications that North American Spine Society has brought
together as, as guidelines for usage, we're seeing
it now
in the posterolateral
spine and long fusion constructs.
We're seeing it in antibody devices,
right? We're
seeing it used in the posterior cervical spine.
So it's it's really kind of interesting. So
I think there's going to be some development
of more of the BMPs
because we're starting to see that people want
to use them outside of just that interbody
cage. So I think we're going to see
a lot of more BMP coming forward.
I also think we're going to see in
terms of biologics,
again, more
stem cell products. And I mean,
autologous stem cells that we take from the
patients
and we put back into the patients.
Allogeneic
nucleuses. So,
a donated nucleus pulposus to inject back into
the patient's nucleus pulposus,
we're going to see more of that happening.
So I think it's really gonna be biologics
first
because remember the hardware
that we put in is only there to
hold everything in place until the biologics take
effect and the fusion takes place if we're
doing a fusion surgery.
Yeah. In terms of we can change the
biology in the disc, we could change the
biology in the joints. That's when we really
have a home run.
Got it. And then my last question for
you, how are you thinking about practice growth
over the next, twelve to twenty four months?
Sure.
My practice growth, it may sound a little
counterintuitive,
but to grow my practice, I plan to
see less patients.
So
so to grow my practice, really, what I'm
what I'm looking what I what I'm doing
and starting to do is start to decrease
the number of insurance carriers that I accept.
Mhmm. Because they have become insurance carriers have
become very difficult.
Right? And I'm not someone that can plow
through 40 or 50 patients a day,
but I can't give the patients the time
they need. I'm just wired that my new
patients are forty
minutes. I'm wired that before surgery,
it's gonna be half an hour.
Right? Follow-up patients.
I I can't do ten or fifteen minutes
with a patient because I don't think that
I'm giving them the care they deserve.
And to do that, I can't see some
of the low paying insurances. So,
really, I'm looking to move more out of
network.
Mhmm.
Looking to do I would say the the
better paying insurances. I'm looking to take cash
Mhmm.
And move along with more of, like, an
accelerated access program.
And that being said too, more do more
of my
restorative
or regenerative spine work
and take the time with the patients that
are really interested in healing more naturally and
healing in a way
where
I can take the time with them in
the office. We can talk about their nutrition.
We can talk about their sleep. We can
talk about
their
their activity.
Mhmm. So to build my practice, I'm thinking
about seeing less patients.
And spending and then spending more time
with the ones that you are seeing. Spending
more times
exactly. Spending more time with the ones that
I am seeing. And then just real quick,
this you mentioned this accelerated
access program. Can you just kind of dive
a little bit more to what that entails?
Sure. So some some of the private, sorry,
some of the primary care guys would call
it, like, a concierge service, a concierge medicine.
Because right now, we've got patients that wait,
you know, six weeks to come in and
see us. And when people really hurt, they
don't wanna wait six weeks, but they're gonna
get wait six weeks to get into anybody.
So it's more of like a subscription program
where
for a certain monthly fee, I'll have a
couple spots open during the day. And if
someone needs to come in that day, they
come in that day. If we need to
come in and let's say they have Medicare
part b and we don't need authorization for
an injection and the injection would be the
right thing for the patient at that time,
then we could do the injection that day.
We're not
kicking them out another four or six weeks.
So it's really it's it's it's to make
it's to give patients the ability
to have better access to myself and to
my team.
Yeah. Doctor Rovinj, can you talk more? Is
there anything else you're doing to really,
optimize patient outcomes and care?
Yes.
As a matter of fact, I am. So
I've been you know?
And you can imagine as a spinal surgeon,
people have come to me for twenty years
always asking what they can take for pain.
And, you know, patients are smart. They've they've
realized that narcotics are a very bad way
of life.
That, you know, they've been taking these NSAIDs
and their kidneys are shutting down or they're
burning holes in their stomach or or just
they're counteracting all these other medications that they're
taking.
Alright. So
patients have always been asking me, doc, is
there anything all natural? Anything all natural I
can take? Anything that'll work? And, you know,
I went out there and
I I looked
and I tried to find something all natural
that would
be a good product for patients and their
inflammation.
And I really saw that there wasn't really
anything
out there.
And so I was talking with my my
physician assistant at the time, Justin Surratt,
and,
you know, he and I decided we'd start
to do a literature search. And we went
out and we found out in the scientific
literature, like,
what all natural ingredients do help with inflammation?
What helps bring down c reactive protein and
blood tests?
What helps to,
have patients recover faster
after working out or after their physical therapy.
So we really decided that we wanted to
put together some new nutraceutical for our patients,
kinda
take the guesswork out of it because we
found our patients were taking the wrong ingredients
or they were taking a product with no
real scientific backing
or they may be they were taking the
right ingredient like turmeric, but they were taking
only about a quarter of the effective dose.
And as you know, if you don't take
the effective dose,
then you're not gonna have any good effect
from any type of medication or or nutraceutical.
So what we did is we put together
our own nutraceutical.
So we have one called relief that is
for inflammation as an anti inflammatory.
We have another one for joint health. We
have them for neuropathy.
We we have multiple others.
And so what we've learned to do is
we've been
providing these to our patients and patients can
have subscription service. And so they come to
their house every month. And really I'm also
trying to help other docs do well, right?
I'm trying to help other physicians build their
business
and help other physicians to help their own
patients.
And so what I've been doing is we've
been white labeling these. So
physicians are out there, they're a part of
a practice and their patients are looking for
something all natural.
Well, they want something they can trust. Right?
They want something that's made in The United
States. It's non GMO.
Right? It's nothing artificial is in it because
people are not looking for all these artificial
things anymore.
So
what we do is we help those physicians
to have this program in their own offices
and, again, white label it so their brand
is on it. Right? And their their patients
subscribe.
And and physicians have found that their patients
are incredibly happy that suddenly they're able to
take something all natural, they're able to take
something effective,
and they're able to take something that was
recommended by their physician. And, you know, it's
got their physician's
logo on it. It's got their physician's brand
on it. So that's really something else I'm
trying to bring out to the the other
physicians
and help other practices grow and become successful
in this arena.
That's really cool. And, I mean, honestly, you're
not the first physician that I've heard who's
also, you know, created
their own kind of side hustle, their own
little extra project to give patients just another
way to really optimize their health just outside
the the office or OR.
Yeah. Yeah. And, you know, we're we're doing
those also with an ERAS program for pre
and post op nutrition.
So, you know, I've been very interested in
nutrition
and, you know, some of the the nutraceuticals
as a way to help our patients and
and, you know, help our practices.
Got it. Well, hey, doctor Vino, thank you
so much again for taking the time to
chat on today's podcast. This is a great
conversation. And I think if if anything, I
think it's important.
The big lesson is that it's never too
late to start.
And
Yeah. I look forward to connecting again in
the future, and you have a good rest
of your day. Great. Thank you so much.