← Becker’s Healthcare Podcast
Loading summary
Transcript22 lines
- [00:00]
A
This is Carly Beam with the Becker Spine and Orthopedics podcast. And I'm thrilled to be joined today by Dr. Susan Zaroski, Chief Medical Officer at Desert sports and spine. Dr. Swarovski, thank you so much for being here today.
- [00:15]
B
Thank you for having me.
- [00:17]
A
So, before we dive into our questions, can you introduce yourself and tell us a bit more about your background?
- [00:22]
B
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 co founder with my husband, Dr. Brad Surawski here in Arizona. I also am the fellowship director for an accredited fellowship that we have by North American Spine Society in the interventional spine and musculoskeletal medicine.
- [00:59]
A
Great. And as chief Medical officer and co founder, can you talk about some of the biggest headwinds you're planning for in the next 12 months?
- [01:08]
B
Sure, sure. Yeah, the headwinds, you know, it's always, it's a balancing act 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 overh. And for us, 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. 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 pre authorization pilot in 2026. 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 pre authorization, which will put an enormous burden on our, on our back office and likely risk delay of care for certain procedures. So that's always, that's on the horizon and of course other kinds of reimbursement rules, documentation requirements that always go on in the world.
- [02:45]
A
Yeah, and I want to 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, what to expect, anything on the back end. Administrative.
- [03:03]
B
Yeah, I mean, we have a really strong authorization department within our practice, so I think that's a solid part of our business. I'm doing a lot of discussion with my patients in terms of what they might be experiencing 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 think just a lot of heads up for the patients and hopefully this won't lead to delay of care in 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 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 pre authorization, they also have a fairly easy route 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 firm.
- [04:04]
A
It sounds like you're very proactive with all of this.
- [04:08]
B
Yes, well, this has been a major part of our practice for a long time in terms of pre authorization. Unfortunately, a lot of the patients feel a little bit blindsided in terms of what's ahead of them, as many of them chose Medicare over Medicare replacement plans due to the lack of pre authorization. So this is going to be a difficult road ahead, I think. So we'll see how that rolls out.
- [04:32]
A
Yeah. And then you also mentioned your fellowship. Can you talk more about that and how that's led to growth within the practice?
- [04:41]
B
Yeah, sure. My husband, Brad Swarovski, and I started our fellowship 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, have a formal match process, et cetera. And so we train about two to four fellows in interventional, spine and musculoskeletal medicine each year. And we've 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 the end of the day, with nuances, of course. So we're able to offer to our patients. It can consistent and excellent way of management. And then in our fellowship we really work hard to standardize what are the advanced skills that physicians need in this non surgical spine and musculoskeletal medicine space. Whether that's image guided procedures under a fluoroscopy or ultrasound regenerative medicine, which is a big part of our practice with PRP and bone Mac, electrodiagnostics, rehabilitation and health and wellness. So really looking to standardize all these skills and involve helping to produce really the next generation of interventional spine and musculoskeletal physicians.
- [06:13]
A
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?
- [06:24]
B
It's an exciting time. I think in terms of the shift that we have in terms of the tools in our tool bag. When we started this practice, I would say we were more reactive applying band aids to injuries or pain in the spine and musculoskeletal system. And over time there's been a huge expansion in regenerative medicine, especially within our practice. And that would include prp, platelet rich plasma 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 this is probably the most exciting part of what we're offering to Pat now.
- [07:10]
A
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.
- [07:19]
B
Yeah, I mean again, I think that really revolves around the regenerative therapies, so and expanding into, into more biologics. So again, sort of now we have our main workhorses at the PRP and bmac. But for example, we're doing a research project on mesoblast, which is a combination of regenerative cells and hyur acid for degenerative disc disease. So just as an example of the field evolving into other biologic therapies and working on that evidence and to strengthen results.
- [07:51]
A
And Dr. Esofsky, can you talk about how you're collaborating with surgeons as pain medicine experts?
- [08:01]
B
Yeah, we've always had a very healthy, dynamic relationship with our surgical colleagues. I think that that's going to be the way we need to move forward, especially in this space. You how to produce these integrated care models partnering with not only obviously physical therapists in the non surgical space, but orthopedics, spine surgeons and orthopedics and neurosurgery in order to not just be these isolated silos of patient care, but to produce paradigms where we have more seamless management of patients and collaboration, perhaps even sharing data and functional outcomes, all to achieve a better outcome and a more seamless experience.
- [08:45]
A
Right. And you know, my last question. What were some other big healthcare trends that you're following right now?
- [08:53]
B
Yeah, I mean, I think the trend, at least as we see it as non surgical specialists, is, you know, just this really growing role for non surgical therapies. You know, how to delay, how to avoid surgery where appropriate. Right. You know, and hopefully getting more insurance coverage for these things, including regenerative therapies, you know, as the patient demand is growing for that. And that's also, also flipping the script a little bit, focusing on the prevention. Right. And finding things before they become an issue. Preventing rather than treating, obviously working on the fundamentals, movement, exercise, diet. But how to identify early degenerative changes and perhaps even with biologics so we can prevent things from deteriorating and getting so advanced.
- [09:38]
A
Absolutely. Well, Dr. Swolski, thank you for joining us today. It's been a pleasure speaking with you and I look forward to connecting again down the line.
- [09:46]
B
You're so welcome. Have a wonderful day.