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Becker’s Healthcare Podcast
Brandon P. Hirsch, MD, FAAOS, Orthopaedic Spine Surgeon at DISC Sports and Spine Center
00:18:40
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- [00:00]
A
This is Carly Beam with the Becker Spine and Orthopedics podcast. And today I'm thrilled to be joined by Dr. Brandon Hirsch at DISC Sports and Spine Center. Dr. Hirst, thank you so much for being here today.
- [00:12]
B
Thank you, Carly. Thank you for having me. I'm glad to be here to chat with you.
- [00:16]
A
Absolutely. And before we dive into our questions, could you introduce yourself and tell us a bit about your background?
- [00:23]
B
Sure. So I'm an orthopedic spine surgeon in practice in Orange county in north San Diego, and I'm in my eighth year of practice. Previously was in practice in Arizona, trained on the East Coast, a few different places before heading out west to begin my career.
- [00:42]
A
Thank you. And to get started, I wanted to pick your brain on telehealth in spine surgery. Obviously, telehealth really exploded beginning the COVID pandemic. And now five years on. Where have you seen it be the most beneficial to your work?
- [01:01]
B
Yeah. So I think that telehealth and telemedicine and spine care happen to fit very well together, and it was something that I was even interested in before the pandemic started. In the pandemic, I think, just highlighted how useful and effective technology can be in getting patients in front of spine care providers and spine surgeons who have the expertise that they need. So I view telemedicine as a very positive development, and I think most patients do as well. You know, recently it's been held up a little bit by the lack of a continuation for Medicare in coverage policy, but I think that. That I believe that's now been extended. Once again, I'm not sure whether it's been permanently extended, but that was sort of the main obstacle to the continued growth that I think is getting work through now, which is very welco.
- [02:02]
A
And what do you think will be some of the next big game changers in this area?
- [02:07]
B
Well, I think just as patients become more comfortable and it becomes more commonplace and patients get more experience using telehealth, I think that that will improve both their comfort with using technology to have a discussion with the doctor. And it will also help doctors offices and practices get better at sort of the ins and outs of getting telehealth set up in a reliable way. If you talk to people in practices that weren't really familiar with telemedicine and kind of just started in the pandemic, some practices had technological obstacles to overcome to get their telemedicine platform up and running the way they'd like it to. But, you know, fortunately, with, you know, technology like Zoom or any of the other platforms, it's now become a very easy to use, highly reliable way to see patients. And I think it does a number of things that are beneficial for both sides for patients. You know, we live in an era of convenience, where convenience is, is at a premium, really, in any part of our life. There are probably people who will be listening to this podcast that no longer go to a grocery store because they use a product like Instacart or, you know, Uber Eats or these things. And so really, if you look at any other part of our life, technology is constantly making things more convenient and saving us time. So why, why would that not be helpful in health care where time and resources are scarce for both patients and their physicians? So I think in that regard, as the technology and comfort level gets better, I think the adoption and the widespread use will get better. Part of that, I think, is the age of the population that's being cared for. I think we're just kind of at the edge of the generation that's the oldest that are receiving health care right now are kind of the last generation that didn't grow up with the Internet and technology in their hands. But I think once we go into another 15 years, even the oldest people in our population will have had extensive experience using the Internet and technology in every part of their lives from the time they were a young age.
- [04:52]
A
That's a really good point you make there. And you mentioned earlier just some challenges with telehealth in terms of government policy, etc. I know we're recording this on December 9th, but right now, how are you thinking about these policy changes and what do you want to see in terms of telehealth access?
- [05:13]
B
Right. So, you know, during the pandemic, for those who may not be familiar, Medicare passed a series of regulations that enhanced or expanded coverage for telemedicine because, you know, they didn't want anybody seeing people in person at that time. And those had time limits on them, expiration dates. And as, as we got through that and out of it, the, the expiration dates, in a kind of a classic, you know, Washington, D.C. fashion, got kicked down the road six months or a year, multiple times. And actually right before the most recent shutdown was the expiration of the most recent extension. And so during the shutdown, there was a period of time where Medicare was not going to cover, except for very narrow exceptions, telemedicine. And naturally, the commercial payers will always follow suit of what Medicare does. And so we experienced very recently a, a period of Time where there was no telehealth access through traditional insurance pathways and that really irritated patients and caused disruptions to their practice. So the implementation and what I think needs to happen is number one, Medicare needs to permanently outline the coverage for telemedicine that will then have the commercial payers follow suit and provide coverage for it. Most likely no one can ever say exactly what the commercial payers will do, but they do tend to follow Medicare policies and guidelines. So I think that's a must do and I think that's on the very near horizon and is part of the healthcare related bills that are in Congress now. So that's, you know, that's what I see as the first next step and then beyond that, you know, just the integration of telemedicine into the rest of our software ecosystem in healthcare, like EMRs, both office based EMRs and hospital based EMRs. Right now a lot of the software platforms do have integrations for telemedicine, but I've had limited experience with them. I find they're not as reliable as a product like Zoom is and maybe not as intuitive for patients to use because people are just most familiar with what they use in other parts of their life. And that tends to be products like Zoom at the, at the moment. So I think that's going to be the next phase is how, how do we integrate the telemedicine experience into the rest of our healthcare software ecosystem to make it a seamless transition to get your care and to provide the care without making it clunky or challenging. Just trying to eliminate as many obstacles and friction points as possible to make it natural and easy for patients to get care this way.
- [08:25]
A
And what are some of the other conversations that you're following in terms of just policy shifts and different discussions going on in Washington D.C. sure.
- [08:37]
B
So I think it's an interesting time in healthcare and in healthcare reform and in our overall political environment. But I view the volume on the conversation around healthcare and pay reform to really be increasing in the last two, three years. I enjoy being somewhat active in advocacy discussions online. Whether it's platforms like Twitter or LinkedIn. There are a lot of people from different parts of the country, different practice environments, and even non physicians who are really thoughtfully engaged with, with each other on what's the best path forward. And I think they're really starting to make, make some waves in having people pay attention. You know, actually you, you may have seen this or may not have, but people like Mark Cuban who have tremendous business acumen, tremendous resources and a desire to change the status quo, are getting seriously involved in healthcare. He's done that already on the pharmacy side with his company that provides generic drugs at fair market prices. And he's now engaging with people that I know, individual physicians, neurosurgeons, people who you've had feature on the Beckers platform, are able, because of technology, because of Twitter, to have live discussions with people like Mark Cuban to engage his resources in the progress or the effort toward reform, which is just a remarkable and inspiring thing for me at a young stage in my career to see maybe there is the impetus and enough momentum to, to change things. Because clearly what's going on with health care and how payers work and how healthcare is paid for is clearly not working for the very vast majority of people in our country. And patients are starting to get an understanding of this, and it's starting to surface in the political discussions as we approach, you know, an election cycle. So, you know, very, very focused on that and grateful to have people lending a hand who may not be, you know, physicians themselves, but are business people who are familiar with what's going on in healthcare. Because unfortunately, to this point, when, you know, doctors have been doing it kind of on their own, just haven't been able to organize well enough or get the right audience or position things the right way at the right time to get real change. And so, you know, I think it's really time for us to band together with, with those in the business world and the political world to try to advance, you know, reform that's clearly much needed and obvious to everyone, but often the pathway to change in our political system is not an obvious pathway.
- [11:52]
A
Yeah, that's a really good point you make about just collaborating with people within and also without the medical world. And, you know, I was wondering, Dr. Hirsch, how are these different conversations? How do you see them directly affecting spine care?
- [12:09]
B
Yeah, so anything that impacts access to care and healthcare is going to have a direct impact on spine care. Low back pain is the most common reason that people seek medical care. And so it represents a large proportion of our overall health care economy as far as diagnoses are concerned. And so any reforms or changes that can make it, number one, easier for patients to afford their care, and number two, easier for physicians to provide the care because of the economics or a reform of prior authorization is going to positively impact spine care. And that means, you know, things like more reasonable contracted, you know, rates, things like, we were just discussing impacting regulation or legislation around telemedicine care to make sure that that's not something that has to get revisited every year to extend, you know, temporary coverage, but that it becomes a normal, recognized way for, for people to receive and people to provide health care. So, you know, those are both things. I think that the tremendous growth of premiums disproportionate to the amount of actual coverage is something that probably is going to need to be regulated. Other areas that I think maybe are further away are things like repealing certificate of need laws and addressing the ban on physician ownership of hospitals. Those are two large priorities subjects that would really directly impact spine care. Much of spine care can be provided on an outpatient basis. Some does require hospital. But the kind of perverse economic incentive of the much higher facility fees driving a lot of care to a hospital environment when it doesn't really need to be in that environment. You know, having a reform like site neutrality for payments would really allow true competition and allow us to reduce the cost of care, because we're not just kind of shuffling the cards around as a healthcare provider to where are we going to maximize reimbursement, but where is it the most efficient and cost effective location and environment for care?
- [14:50]
A
Very well said and I appreciate that overview of everything. And then, Dr. Hirsch, I was wondering, how are you thinking about growth in your own practice next year?
- [15:00]
B
Yeah, so I'm in a somewhat unique practice environment of independent private practice in a market in Southern California that has a lot of spine surgeons, also has a lot of patients, but is fairly saturated. And so I'm always thinking about growth in patient volume and growth in digital footprint. And so, you know, that will be a big part of what I focus on in, in early 2026 is growing, you know, my footprint online, you know, just like we were discussing the growth of telemedicine. Along with that comes growth in how patients find physicians. And these days, if, if you're not visible, you know, online, it's almost as if your practice doesn't exist in real life because that's just the reality of how people are searching for health care. So that'll be a priority. Growing aspects of my practice that are somewhat specialty like spinal endoscopy, disc replacement, are always going to be growth goals. And probably in 2026, I'll have more of an involvement in advocacy discussions both at the society level and at the kind of more grassroots, just physician organization level, because the election cycle toward the end of the year is probably going to be pushing a lot of these potential reform items up to the front of the conversation. I hope as long as some other scandal or topic doesn't distract public's attention from the important topics at hand.
- [16:50]
A
Got it. And then my last question for you is, what do you think will be the biggest disruptor to spine surgery next year?
- [16:58]
B
Yeah, so I think disruption in spine surgery is tough to predict, number one, and usually takes a little more than a year. But I know that the adoption of endoscopy and the ways that surgeons are using it is rapidly progressing, and there's even more and more ability for surgeons to discuss cases with other surgeons in their local market. And because there are more people utilizing that technique in any given market, that allows for even more conversation amongst surgeons. And so I have, you know, several surgeons just in my own market, where I'll plan to go to observe their cases, and they may or may not come to observe my cases. And that, I think, is how we drive real progress and innovation and improvement in the surgical techniques that we offer. So that'll be a major focus. And then on the digital media side of things, at least for my practice, putting resources into that to really transform your. Your online presence. You know, I think that. That I anticipate that's going to bring significant change in the practice volume and types of patients that are coming to see me.
- [18:25]
A
Well, Dr. Hirsch, thank you so much for joining our podcast today. It was a pleasure to speak with you, and I look forward to connecting again down the line.
- [18:34]
B
Absolutely. Thank you very much, Carly, for having me. It was a pleasure.