Dr. Robert S. Bray, Founding Director, DISC Sports & Spine Center

Summary

Becker’s Healthcare Podcast: In-Depth Conversation with Dr. Robert S. Bray

Release Date: August 9, 2025
Host: Grace Lynn Keller
Guest: Dr. Robert S. Bray, Founding Director, DISC Sports & Spine Center

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Introduction

In this insightful episode of the Becker’s Healthcare Podcast, host Grace Lynn Keller engages in a comprehensive discussion with Dr. Robert S. Bray, the founding director of DISC Sports & Spine Center. Recorded live at the 22nd Annual Spine, Orthopedic and Pain Management Conference, the conversation delves into the evolving landscape of U.S. healthcare, focusing on trends, workforce challenges, the role of orthopedics and spine care, and the integration of cutting-edge technologies.

Dr. Bray’s Professional Journey

Dr. Robert S. Bray opens the dialogue by sharing his expansive career trajectory, which spans over two decades with Becker’s Healthcare. His journey began in the United States Air Force, transitioning to a pivotal role at Cedars-Sinai where he managed the inpatient program during his fellowship. Approximately 20 years ago, Dr. Bray established DISC Sports & Spine Center, now a multifaceted conglomerate. He emphasizes his dedication to neurosurgery, specifically focusing exclusively on spine-related procedures with a strong emphasis on minimally invasive techniques.

Dr. Bray [00:55]: "I'm a neurosurgeon, I do only spine and nothing besides spine and that's been my focus for many years. Minimally invasive and its development."

Emerging Trends in Healthcare

Grace Lynn Keller initiates the core of the discussion by inquiring about the current trends and shifts within the healthcare industry that leaders should monitor. Dr. Bray identifies three primary trends reshaping the sector:

1. Transition to Outpatient Care:
   Dr. Bray highlights the significant shift from hospital-based to outpatient settings, noting that even complex, high-acuity procedures such as multi-level arthroplasties and joint replacements are now routinely performed in outpatient centers.

   Dr. Bray [01:39]: "The biggest trend we're seeing right now is that transition from hospital based care to outpatient on a higher and higher acuity level."

2. Evolution of Payer Models:
   Moving away from traditional fee-for-service models, there is a marked migration towards global payments in Ambulatory Surgery Centers (ASCs). Dr. Bray explains how this transition enables ASCs to deliver superior quality care at reduced costs, often up to 50% less per dollar spent.

   Dr. Bray [02:35]: "We're able to move that final product to the payer down a large number, sometimes 30, sometimes up to 50% less on the dollar spent."

3. Integration of Cost Efficiency and Quality Outcomes:
   The necessity to intertwine cost efficiency with quality outcomes is becoming increasingly evident. Dr. Bray emphasizes the importance of collaboration among centers, payers, and vendors to ensure that cost reductions do not compromise patient-centric quality care.

   Dr. Bray [03:00]: "We need to look at cost efficiency and quality outcomes and link those two things together, not be one in the absence of the other."

Addressing Staffing and Workforce Challenges

The conversation seamlessly transitions to the persistent issue of staffing and workforce challenges within healthcare. Dr. Bray candidly discusses how ASCs like DISC Sports & Spine Center navigate these pressures without the financial leverage of larger hospital systems.

• Team Building and Employee Engagement:
  Dr. Bray stresses the importance of fostering a sense of team and recognition among staff to enhance retention and job satisfaction.

  Dr. Bray [04:04]: "We try to build a team where people feel like they're part of it, they're acknowledged, they're part of the growth."

• Leveraging Artificial Intelligence (AI):
  To alleviate workload pressures, Dr. Bray outlines plans to integrate AI technologies aimed at streamlining workflows and reducing administrative burdens, thereby improving overall efficiency and employee satisfaction.

  Dr. Bray [05:00]: "We are doing it by trying to make sure that recognizes people."

The Evolving Role of Orthopedics and Spine Care

Grace Lynn Keller probes further into the expanding role of orthopedics and spine care within the broader healthcare ecosystem, especially in the context of the growing outpatient sector. Dr. Bray provides a nuanced perspective on the various stakeholders and models shaping the future landscape:

• Diverse Market Players:
  He identifies multiple entities, including hospital systems, corporate giants like Optum, independent doctor-owned centers, and private equity firms, each carving out distinct niches within the ASC model.

  Dr. Bray [05:13]: "It's a question of how and when and we are on the so called hockey stick or the logarithmic growth curve now and it's just, it's caught on."

• Private Equity Partnership:
  Dr. Bray shares insights into DISC Sports & Spine Center’s strategic partnership with Chicago Pacific Founders and the management structure, Trius, which has facilitated significant advancements in payer negotiations and corporate-level contracts.

  Dr. Bray [07:00]: "They can sit down at the corporate suite so they're going to exist there's the independents who hold out and they're doctor owned completely and that's good."

• Future Prospects:
  He underscores the inevitability of the ASC model’s dominance and the necessity for physicians to strategize on maintaining autonomy while ensuring sustainable growth within their practices.

  Dr. Bray [07:30]: "Physicians will need to look of each individual product and where they fit. And I think we'll see an entire system evolve."

Integrating Advanced Technologies for Enhanced Outcomes

As the discourse moves towards technological advancements, Dr. Bray categorizes technology integration into four pivotal areas where AI and other innovations are poised to revolutionize operations and patient care:

1. Surgical Technologies:
   Incorporation of robotics, endoscopic navigation systems, and augmented reality in operating rooms to enhance surgical precision and efficiency.

   Dr. Bray [08:40]: "We have most of them in our centers. But we need to adapt to the new surgeons."

2. Patient-Facing Interfaces:
   Utilizing AI for marketing, lead generation, and facilitating seamless consultations, thereby improving patient acquisition and engagement processes.

   Dr. Bray [09:30]: "That's a whole application for AI."

3. Back-Office Operations:
   Implementing AI to manage payer denials and streamline authorization processes, significantly reducing the administrative burden on staff.

   Dr. Bray [09:50]: "We need an agent, an AI agent that does most of that work and I will have happier employees."

4. Data Analytics:
   Emphasizing the critical role of data in analyzing efficiency, workflow, and patient outcomes, Dr. Bray highlights the necessity of robust analytics systems to inform decision-making and ensure sustained operational success.

   Dr. Bray [10:40]: "We just put in an OSPITEC system into our ORs. For data, we have to start looking at data for efficiency."

Final Thoughts and Recommendations

As the conversation draws to a close, Dr. Bray offers a thought-provoking recommendation for Becker’s Healthcare: the need for dedicated forums addressing the future roles and career trajectories of young surgeons. He advocates for conferences that focus not only on immediate financial incentives but also on long-term career sustainability and integration within evolving healthcare systems.

Dr. Bray [11:04]: "We need to look where the new surgeons survive in the long term, where their careers live, how they build, where they grow, and how they integrate into this."

Conclusion

Grace Lynn Keller extends her gratitude to Dr. Bray for his invaluable insights, encapsulating a forward-thinking vision for outpatient care, technological integration, and workforce management within the healthcare landscape. Listeners gain a comprehensive understanding of the dynamic shifts shaping the future of orthopedics and spine care, informed by Dr. Bray’s extensive experience and strategic outlook.

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End of Summary

Transcript

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[Grace Lynn Keller]

Is Grace Lynn Keller with the Becker's Healthcare Podcast and we are recording live at the 22nd annual Spine, Orthopedic and Pain Management Conference. I'm currently joined by Dr. Robert Bray who is the founding director at DISC Sports and Spine Center. Dr. Bray, thanks for being here. Let's start off by having you introduce yourself and tell us a little bit more about your role in organization.

[Dr. Robert Bray]

Thank you for having me. I've been coming to Becker's for 20 plus years so I think people know me quite I come via the United States Air Force on through on the way by to Cedars Sinai where I ran the inpatient program for years in the fellowship and then began outpatient surgery about 20 years ago forming disc, which is now a multi conglomerate. I'm a neurosurgeon, I do only spine and nothing besides spine and that's been my focus for many years. Minimally invasive and it's development.

[Grace Lynn Keller]

Wonderful. Well I'm excited to hear your insights and I'd love to start our conversation off with what trends or shifts you're currently seeing right now in the industry that you think are most important for leaders to pay attention to.

[Dr. Robert Bray]

It's a big topic and trends have been coming for a long time. I was sort of misstated that I thought the trend when I introduced I was going to go to Outpatient's mind 20 years ago that it would take five or 10 years to go. It's taken 20 years. But the biggest trend we're seeing right now is that transition from hospital based care to outpatient on a higher and higher acuity level. So things you would have never thought of being done as an outpatient, front and backs, multi level arthroplasties, big cases, joint replacement, they're all done routinely now in outpatient centers. So that's just been the giant trend. The second is the transition of the payer model. I was raised in a fee for service, you sent a bill and you got paid. That changed and then we moved through the value care options from HMOs to value care organizations. And now we're seeing, especially in the asc, a big migration to global payments. And what's happening is as the ASCs can deliver a better product at a cheaper price breakpoint, we can really move the needle. So we're going to global payment systems within our disk model and we're able to move that final product to the payer down a large number, sometimes 30, sometimes up to 50% less on the dollar spent. So it's a big, a big trend to redo the entire model. The third is that people really need to start and are becoming aware of the need to look at cost efficiency and quality outcomes and link those two things together, not be one in absence of the other. And as we do that, the centers, the payers and the vendors are going to all need to get together to look at is it producing a quality outcome, data driven, do we have a metric to demonstrate it actually works? And then everyone needs to get on board that that's where we're going to a good outcome patient centric at a good price.

[Grace Lynn Keller]

Price break point 100%. And I'd love to also touch on staffing and workforce challenges as those continue to be a concern across healthcare. So how is your organization navigating these pressures and what strategies have you seen work?

[Dr. Robert Bray]

Well, as everyone else with a great deal of difficulty, ASCs and structures, we don't have necessarily the pockets of a Kaiser or the big hospital system. So we can't always be the highest pay competitor and just go buy our nurses. I think we have to look at it and we do try to look at it more as we're bringing in someone as a team member and I came out of the military and a lot of special forces contacts. We try to build a team where people feel like they're part of it, they're acknowledged, they're part of the growth. And the next big thing for us to look at that we're in process of there is to look at their workload capacity we're putting onto people and how we can make that more efficient. I think that's one of the places we'll see AI come in not replacing people, but making their workflow easier. So we do it by trying to make sure that recognizes people.

[Grace Lynn Keller]

Absolutely. And segueing a little bit more into outpatient care. This is continuing to grow. So how do you see the role of orthopedics and spine evolving within the broader healthcare ecosystem?

[Dr. Robert Bray]

Probably the most difficult question you're asking of where it fits because in short I'll give you the answer. I don't know it's not an easy answer. It's not a matter of if it's going to an ASC environment it's a matter of how and when and we are on the so called hockey stick or the logarithmic growth curve now and it's just, it's caught on it's there, there's lots of people doing it's an explosion so now it's just where it fits and who. And there's going to be multiple players in the market the hospital systems obviously with the hopds and the systems will be developing their own system and that's good there's the corporate level of that which is the HCAs of the world that are large delivery care vehicles and do it very well. You can look to United through Optum buying SCA and buy and hold I don't know how many hundreds and hundreds of surgery centers they have now but that's a verticalization of the healthcare system through the payer straight through the delivery vehicle so they're going to exist there's the independents who hold out and they're doctor owned completely and that's good and they like their autonomy but they're capital limited so within their niche they can do well but they're very capital limited to expand so and then the new wave in the market which I think is still wait to see where it goes is the private equity world. We chose to go there about three years ago and took in private equity money CPF here in Chicago Chicago Pacific founders with brought into our models we have our own management structure called Trius that manages it. I've got to tell you so far they're good people they're putting an immense amount of capital in they brought a lot of resources to the table for contacts. We have made tremendous progress with the payers that frankly I just didn't have the ability to get to I'd be negotiating at the local contract level and they came in they can sit down at the corporate suite So I, I think the answer is they will all do well as long as they have a plan of where they go. They are different models there'll be different applications in different areas of the country based on where you intermountain west if you're in the mid there are a lot of different models they all will fit into the system. I think the physicians need to look within there how do they maintain their happy spot their autonomy enough that they are not trotting down on the way by and how do they survive? So physicians will need to look of each individual product and where they fit. And I think we'll see an entire system evolve. But it's not a question of if that's going to be an ASC model anymore. That question got answered. We're there.

[Grace Lynn Keller]

Wonderful. And then as we kind of wrap up our conversation, I'd love to know what partnerships, CARE models, technologies that are increasing efficiency and outcomes that you are currently exploring or working with. I know you mentioned AI earlier in our conversation. Is there anything else specifically that you are seeing particularly promising?

[Dr. Robert Bray]

I divide technology is a big statement into four different categories and we're looking independently within each category what type of AI we're going to do surgical. The operating room is one obviously and you know, robots or endoscope navigation systems or augmented reality. We're looking at all of them. And the problem is that today all the young surgeons coming through are trained with these things, coming out of their fellowships at good places. We're on a panel with the guys from Rush and they're training them to use all these. They come out and they want them okay. Are they cost efficient? Do they fit the model? That's one. So we're looking at all of them and we have most of them in our centers. But we need to adapt to the new surgeons. The second area is the patient facing interface and the patient facing interface is marketing to lead generation and lead generation to a consult in the office. And that's a whole application for AI. You know, it used to be a phone tree and then a call center and now that's going to be a big AI push and there's multiple companies here looking at that opportunity. We are looking and testing different things right now. The third is back office functions. Huge place for maximizing the flow. The payers are using AI to deny us. We need to be using AI to deny their denial and go back to them. And you know, an immense amount of time is spent by my staffing. That's why I mentioned it before. The AI, immense amount of time stuck on the phone trying to get things authorized denials. We need an agent, an AI agent that, that does most of that work and I will have happier employees that are not tied up with the time consuming hassle that they have to have. So back office is a big. And the fourth and the final is just which is not tapped on really much at all here is analytics. We just put in an OSPITEC system into our ORs. For data, we have to start looking at data for efficiency, data for flow analysis, and then we're looking at systems right now to integrate patient outcome into that structure. So you need data analytics, and if you don't have data going forward, you're sunk.

[Grace Lynn Keller]

Absolutely. Well, Dr. Bray, thank you for joining me. Is there anything else that we didn't touch on that you'd like to cover or share?

[Dr. Robert Bray]

I have my advice to Beckers, which is you need an entire conference on where does the young surgeon fit and where do they go and where their future will be. Because what we really need to do is not just look to the right now and who's trying to put the money in their pocket, whether it's a vendor or AI or it's a hospital or it's a system. We need to look where the new surgeons survive in the long term, where their careers live, how they build, where they grow, and how they integrate into this. Because as we're building a system, it needs to be about them.

[Grace Lynn Keller]

Absolutely. Well, thank you so much for taking the time to be here on the Becker's Healthcare Podcast. Again, we are recording live at the 22nd annual Spine, Orthopedic and Pain Management Conference.

[Dr. Robert Bray]

Thank you for having me.