← Becker’s Healthcare Podcast
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- [00:00]
A
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- [00:36]
B
Is Grace Lynn Keller with the Beckers Healthcare Podcast and we are recording live at the 22nd annual Spine Orthopedic and Pain Management Conference. I'm joined today by Brett Shore, who is an orthopedic surgeon at schor Orthopedics. So Dr. Schor, thanks for joining me today. Let's start off by having you share a little bit more about yourself, your role and your organization.
- [00:55]
C
Hi, thanks for having me again. Yeah, my name is Brett Shore. I am a fellowship trained sports medicine orthopedic surge, particular interest in hips, in kind of comprehensive hip care from treating hip dysplasia and hip impingement and hip replacements as well. So in terms of my role in the organization, so the other organization that I'm here kind of, I guess representing or that I work with is Disc Sports and Spine. And within Disc Sports and Spine I'm one of the primary orthopedic surgeons. A lot of the, a lot of the bandwidth within Disc Sports and Spine is in spine care and they have recently expanded to bring on extremity Orthopedics and I was one of the, one of the early people that joined for that purpose. And then within Shore Orthopaedics I'm the, it's my company, so I'm the president and CEO of that.
- [01:48]
B
Wonderful. Well, thank you for being here. And let's start off with some of the trends and shifts you're seeing right now in the industry that you think are the most important for industry leaders to be paying attention to.
- [01:59]
C
I think one of the things that we see at DISC, and that I think is a trend across the industry is the formation of partnerships between some of the surgery centers and the payers, the insurance providers, in an effort to both minimize healthcare costs both for the patient and for the insurer, and also as a way to try and maximize value for the insurance company. Additionally, I think it's clear that more and more procedures are being moved to the ambulatory setting. I Think back to some of the surgeries that were two to three night or more overnight stays when I was in my training, which was back I finished in 2011. And now a lot of those surgeries either done as 23 hour OBS or same day discharges.
- [02:46]
B
And let's touch on staffing and workforce challenges as these continue to be a concern across healthcare. So how is your organization navigating these pressures and what strategies have you seen work?
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C
Well, yeah, this is definitely a challenging environment for hiring and maintaining good staff. I think one of the areas where I've seen some of the greatest challenges, which is partially in relation to the fact that the medical director of my surgery center is my wife who is an anesthesiologist. Dr. Amy Schorr is the sort of onboarding and collaboration with anesthesia providers with anesthesiologists. And one of the challenges is that the landscape in anesthesia has changed dramatically over the last five to 10 years in terms of both availability and reimbursement. And it can be hard to identify those changes as they're happening. And it can be easy for an organization to kind of get caught on the wrong foot with respect to those changes. And I think one of the keys in maintaining and running an efficient, safe and profitable surgery center is high quality anesthesia care. And it's an area where I'm not sure that it's always, it hasn't always been a priority because the market didn't necessitate it. But at this point, the demand for high quality anesthesiologists is so high that it's an area where both disc sports and spine and other organizations, I think, are putting a greater emphasis on reimbursement and bringing on well trained qualified anesthesiologists.
- [04:31]
B
Absolutely. And as outpatient care continues to grow, how do you see the role of orthopedics evolving within the broader healthcare ecosystem?
- [04:40]
C
Well, I think orthopedics lends itself nicely to outpatient care in general because the majority of our surgeries there are surgeries that are high risk, that have high capacity for blood loss. One of them that I perform is the periacetabular osteotomy pao. That is an operation that technically could probably be done in a surgery center with a 23 hour obs. But there's not going to be a big push for that because most of those patients have a lot of pain and stay overnight. But for the majority of the procedures that we do, as minimally invasive surgery becomes more widespread and as we're able to use products such as transexamic acid to reduce blood loss. Orthopedics is in some ways going to be a leader and a pioneer, I think, in bringing the majority of surgeries into the ambulatory setting, both as a way to improve patient outcomes, but also to reduce health care costs that are associated with inpatient stays.
- [05:44]
B
And then many organizations are also exploring new technologies, partnerships and care models to improve efficiency and outcomes. So are there any innovations or initiatives that you found particularly promising?
- [05:55]
C
Yeah, it's a good question. And this is actually referring back a little bit to one of my previous answers in terms of the trends and shifts. This is one where I think partnerships between the surgery centers and the insurance providers, when done in a way that both checks a couple of boxes, one, is providing safe and effective care. Two, is providing it at a cost savings or value for both the surgery center and for the provider, for the, for the insurance company. And finally, that also improves physician reimbursement, both on the surgical and the anesthesia side. When you can check all those boxes, then it ends up being, I think, a really promising development in the ambulatory surgery model.
- [06:38]
B
And as we wrap up, is there anything else you'd like to share that we didn't touch on today?
- [06:43]
C
I guess the one other thing that I would, that I would, you know, mention in terms of some of the previous topics that we've discussed is the unique challenge that Medicare brings to the ambulatory surgery setting, as there are some procedures that are reimbursed reasonably well with through Medicare, but others which are not. And understanding how to incorporate or choosing not to incorporate Medicare into the ambulatory model and what that means both in terms of physician and in terms of surgeon and anesthesiologist reimbursement, I think is going to be critical for the success of surgery centers going forward as there doesn't seem to be a lot of appetite for increasing the reimbursement rates in Medicare in the federal government anytime soon.
- [07:30]
B
Wonderful. Well, Dr. Brett Short, thanks so much for joining me today on the Beckers Healthcare Podcast. And we are recording live at the 22nd annual Spine, Orthopedic and Pain Management Conference.