Becker’s Healthcare Podcast – December 6, 2025

Guest: Dr. James Mooney, Complex & Minimally Invasive Spine Surgeon, VCU Health
Host: Carly Beem

Episode Overview

This episode features Dr. James Mooney, newly appointed spine surgeon at Virginia Commonwealth University (VCU). Dr. Mooney shares his insights into current spine surgery trends, the integration of artificial intelligence (AI) in clinical and operative workflows, the industry shift from RVU-based compensation to value-based care, and his vision for expanding the VCU spine program. The conversation covers technological advances, clinical decision-making, practice transformation, and future disruptors in spine surgery.

Key Discussion Points & Insights

1. Introducing Dr. James Mooney

• Dr. Mooney describes his background:
  • Residency at University of Alabama (7 years, neurosurgery)
  • Fellowship in complex & minimally invasive spine at University of Pittsburgh
  • New faculty at VCU with focus on program growth
  • [00:33]

    "I'm a complex and minimally invasive spine surgeon here at Virginia Commonwealth University in Richmond, Virginia… excited to be in Richmond and growing the program here." – Dr. Mooney

2. Top Trends in Spine Surgery

a. Artificial Intelligence (AI) in Surgery

• AI is revolutionizing surgical planning, execution, and decision-making.
• Potential applications:
  • Radiographic planning
  • Algorithmic selection of surgical candidates
  • Real-time intraoperative monitoring and adjustment
  • Standardization of clinical decisions through evidence-based algorithms
  • Ongoing need for safety monitoring of AI systems
• [01:15]

  "Ultimately I think we're heading towards a future where every surgery is ultimately planned and executed according to evidence-based algorithms." – Dr. Mooney

b. Shift from RVU Metrics to Value-Based Care (VBC)

• Moving away from volume-based compensation towards outcomes and patient-centered metrics.
• Importance of registries and health system analytics in tracking and rewarding outcomes.
• [02:58]

  "How do we shift things to more of a patient centered outcome? And ultimately registries and health system analytics will help us progress towards that point…" – Dr. Mooney

c. Minimally Invasive Techniques & Patient-Specific Technologies

• Growth of ultra-MIS (minimally invasive surgery) and endoscopic methods, inspired by long-standing practice in Asia.
• Emphasis on tailoring the surgical approach to each patient.
• Anticipates adoption of 3D-printed implants and patient-specific technologies at VCU.
• [03:47]

  "It's important for a center that provides spine care to be able to offer the full gamut of care ranging from the most minimally invasive approach with an endoscopic surgery to a big deformity correction." – Dr. Mooney

3. Realities and Challenges of Implementing Value-Based Care

• Acknowledges the difficulty of replacing entrenched compensation models.
• Calls for broader industry advocacy and frontline surgeon participation.
• [05:59]

  "I don't have the specific solution, but I think it's going to take a lot of, you know, lobbying from our organizations and participation from spine surgeons that are at the front line to really make this a reality." – Dr. Mooney

4. Current Practical Applications of AI at VCU

• Clinical Documentation: AI tools within EPIC streamline clinic note generation.
• Surgical Planning: Incorporation of patient-specific rods and planning software, enabling preoperative to postoperative comparison and outcomes tracking.
• Data Collection: Large-scale data acquisition and analytics are being facilitated through these new technologies.
• [06:57]

  "We've just incorporated patient specific rods and software into our surgical planning… And there's a massive amount of data that can be acquired over time using those paradigms." – Dr. Mooney

5. Importance of Dual Training: Minimally Invasive and Complex Spine Surgery

• Training in both fields allows nuanced decision-making, ensuring the "least invasive surgery that we can offer to achieve the goals of surgery."
• Cites patient examples where imaging suggests extensive surgery but symptoms support a simpler, less invasive option.
• Deformity training improves planning for even small procedures, reducing future complications.
• [09:19]

  "My goal is to offer the patient the least invasive surgery that we can offer to achieve the goals of surgery. And so a lot of times in these cases… minimally invasive decompression could give them years of relief before they need a big surgery." – Dr. Mooney

6. Anticipated Disruptors in Spine Surgery for 2026

• Sees AI as a continuously growing influence.
• Predicts that true change will come from convergence of innovations: AI, data, minimally invasive techniques, and interdisciplinary collaboration.
• [10:53]

  "I don't think it's going to be one specific thing, but really a combination of all of these things we're talking about." – Dr. Mooney

7. Plans for Growth at VCU Spine Center

a. Clinical Expansion

• Increasing access to comprehensive spine care in the Richmond area and satellite locations like Fredericksburg and Williamsburg.
• Actively working with local athletic programs for sports medicine growth.

b. Technology Implementation

• Integration of minimally invasive surgery systems.
• Adoption of patient-specific hardware, AI planning, and robotics.
• Building collaborations with other specialties.

c. Academic and Research Growth

• Expanding research in predictive analytics and outcomes.
• Partnership with engineering for 3D printing.
• Joining the American Spine Registry for longitudinal data.

d. Educational Initiatives

• Advanced training and technology exposure for residents.
• Aspiration to establish a fellowship.
• [11:38], [13:08]

  "Our goals as a spine department are to increase access to care… And then all of the AI planning, robotics and enabling technologies that are really going to help transform things at VCU." – Dr. Mooney
  "We're trying to really grow our research footprint, looking into predictive analytics, outcomes data… and ultimately potentially get a fellowship down the road." – Dr. Mooney

Notable Quotes & Memorable Moments

• "Right now, if you ask five different spine surgeons how to approach a case, you might get five different answers. How do we utilize AI to help standardize decision making for spine surgeons and help choose the best option for each unique patient?" – Dr. Mooney [01:58]
• "It's easy to talk about, but actually instituting it is a lot bigger of a challenge." – Dr. Mooney on value-based care [05:29]
• "Then anytime you operate on a patient, if you fuse a segment of the spine, you're subjecting the rest of the spine to more motion and potential breakdown and need for future surgery." – Dr. Mooney [09:59]
• "There’s not going to be one single factor, but a combination of all these things that are intersecting at such an exciting time." – Dr. Mooney [10:53]

Key Timestamps

• 00:33 – Dr. Mooney’s background and training
• 01:15 – 04:48 – Trends in spine surgery: AI, value-based care, minimally invasive techniques
• 05:29 – 06:23 – Challenges of transitioning to value-based care
• 06:39 – 08:09 – Real-world AI applications at VCU Health
• 08:16 – 10:33 – Importance of dual training in complex and minimally invasive spine surgery
• 10:43 – 11:38 – Predicting the next disruptor in spine surgery and plans for VCU growth
• 11:38 – 14:17 – Detailed outline for clinical, research, and educational expansion at VCU

Conclusion

Dr. James Mooney provides an insider’s look at the future of spine surgery, emphasizing a thoughtful, patient-centered approach that blends cutting-edge technology with personalized care. He underscores the importance of collaboration, innovation, and adaptability—qualities he aims to embed within VCU’s evolving spine program. This episode offers a concise yet comprehensive overview of where academic spine surgery is headed and what it takes to be at its forefront.