Luis Manuel Tumialán, MD, Professor of Neurological Surgery, American Board of Neurological Surgery, Director of the Council of State Neurosurgical Societies, and Chair at Barrow Brain and Spine

Summary

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Becker’s Healthcare Podcast: Episode Summary

Guest: Dr. Luis Manuel Tumialán, Professor of Neurological Surgery, Director of the Council of State Neurosurgical Societies, Chair at Barrow Brain and Spine
Host: Scott Becker
Date: October 12, 2025
Main Focus: The value and challenges of physician-led healthcare—particularly physician-owned hospitals—and advocacy for physician autonomy, remuneration, and solutions to the physician workforce crisis.

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1. Episode Overview

This episode centers on the systemic challenges facing physicians in 2025, the impact of policy on physician autonomy—specifically the prohibition against physician-owned hospitals—and the importance of physician advocacy, entrepreneurship, and socioeconomic acumen. Dr. Tumialán shares his career journey, his advocacy leadership, and practical proposals to improve career satisfaction and effectiveness for U.S. physicians.

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2. Dr. Tumialán’s Background & Philosophical Foundation

• Practice History & Current Role

  • Private practice neurosurgeon at Barrow Brain & Spine, Phoenix, AZ (27-member group).
  • Specializes in minimally invasive and motion-preserving spine surgery.
  • Former Navy physician (11 years, 6 active duty).
  • Chair, Council of State Neurosurgical Societies—focused on increasing physician and neurosurgeon value.

• Personal Motivation

  • Deeply invested in physician autonomy and career fulfillment.
  • “I do not want to become an employed neurosurgeon. And I continue to fight that battle and create an ideal environment for the next generation of spine surgeons to be able to do what it is that I get to do and have fulfillment and career and control over to a certain extent of my life.” (01:53)

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3. Advocacy Work: Improving Physician Value & Remuneration

• Raising Socioeconomic IQ in Medicine

  • Calls for earlier physician training on the “Byzantine arcane system” of medical remuneration, specifically RVUs (Relative Value Units).
  • “Talking to a medical student about remuneration is like talking to your children about procreation. No one wants to do it...when I think it’s essential that we need to increase the socioeconomic IQ of our...burgeoning physicians.” (04:05)

• Coding & Payment Advocacy

  • Describes successful advocacy in preserving separate payments for decompression and fusion surgery—a nuance that restored over "$100 million...being paid out to physicians over the span of a year. Work that was not being remunerated before." (06:04)
  • Details the process: collaboration among spine societies led to new decompression CPT codes (63052, 63053) for lumbar fusions.

• Prior Authorization Frustrations

  • Points out the unfairness: even after prior authorization, 12–15% of claims are denied post-procedure.
  • Emphasizes the analogy: “If you have a contractor do work on your house... If you don’t pay that bill, they’ll put a lien on your house. We get a prior authorization...12 to 15% of the time that will be denied. Even though they did everything to a T. Do we put a lien on that patient? Of course not. We can't.” (06:55)

• Legislative Solution

  • Calls for federal legislation: “That sentence needs to go away. Legislation, federal legislation needs to be... that prior authorization is a guarantee of payment on a clean claim.” (07:34)

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4. Physician Advocacy & How to Effect Change

• Grassroots Action

  • Encourages all physicians to engage directly with elected officials; recounts arranging meetings with U.S. Senators and Representatives thanks to proximity and initiative.
  • “You'll be surprised how close you actually are to your elected officials. There's not that many degrees of separation. And so we begin that dialogue.” (08:50)

• Presenting Solutions, Not Complaints

  • Advocacy relies on providing data, not just anecdote: “Here’s the data on our workforce. Here’s the shortage that we foresee. Here’s what’s happening with medical students...” (09:11)

• Physician Workforce Crisis

  • Burnout and lack of job fulfillment are limiting new entries into the field—even as med school throughput rises.
  • Need for positive role models: “If we create an environment where medical students are around physicians who are saying, ‘Hey, I'm being treated fairly. I have great fulfillment in my job…’” (09:42)

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5. The Physician-Owned Hospital Ban & Its Impact

• Policy Overview

  • Section 6001 of the Affordable Care Act (ACA) bans new physician-owned hospitals in the U.S.—a unique legislative restriction.
  • “There’s no legislation that says a lawyer cannot own their law firm...but a physician cannot own the means of production...in their professional environment.” (11:07)

• Consequences of the Ban

  • The ban curtails competition in healthcare delivery, creates vertical integration, and accelerates physician employment and loss of autonomy.
  • “Once you eliminate competition, you have vertical integration. When you have vertical integration...you lose control. And now all of a sudden the cycle happens.” (11:26)

• Clarifying the Advocacy

  • Not calling for ACA repeal—but for removing this single restrictive section.
  • “The only thing I want is to take, I want to fix what's broken. I want to take one section out, allow for physician ownership of hospitals.” (12:17)

• Quality & Cost Argument

  • Physician-owned hospitals (grandfathered under ACA): disproportionately deliver top-quality, cost-effective care.
  • “There’s 250...physician owned hospitals...5,000 non physician owned...48 out of 100 [top] for cost, quality of care and access...physician owned and nine of the top ten are physician owned.” (12:26)

• Restoring Healthy Balance

  • Warns of loss: "The private practice physician is an endangered species...Everyone's either going to be academic or hospital employed. That's not a healthy environment...We want balance amongst all of them.” (13:45)

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6. Advice for Emerging Physicians

• Socioeconomic Education is Essential

  • “I would say that our socioeconomic IQ is our weak point. It certainly was mine. I had no idea how to code. I had no idea where money was coming from.” (14:41)
  • Referenced Dr. Glaucon Fleck’s comedy as a point: new doctors are not taught how reimbursement works.

• Call to Action

  • Physicians must engage in advocacy, understand the issues, and “get involved.” This builds momentum for lasting change.
  • “The more of us that get involved. We will create a huge groundswell. We build awareness. Change becomes an inevitability.” (15:42)

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7. Memorable Quotes & Moments

• On Prior Authorization:
  “We get a prior authorization...they submit the charges...and 12 to 15% of the time that will be denied. Even though they did everything to a T. Do we put a lien on that patient? Of course not. We can't... No other industry tolerates what we tolerate as physicians.” — Dr. Tumialán (06:55)

• On Physician Ownership:
  “There’s no legislation that says bakers can’t own their ovens, but a physician cannot own...their professional environment.” — Dr. Tumialán (11:08)

• Workforce Warning:
  “I have colleagues of mine who...are already looking for the exit. I think if we create an environment that allows us to talk about that...” — Dr. Tumialán (09:57)

• Advice for Young Physicians:
  “We need to increase our socioeconomic IQ. We need to be part of the process. We need to advocate for ourselves...and get involved.” — Dr. Tumialán (15:30)

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8. Key Timestamps for Important Segments

• Dr. Tumialán’s Background & Practice Philosophy — 00:27–02:40
• Physician Advocacy in Coding & Payment — 03:06–06:31
• Frustrations with Prior Authorization & Call for Reform — 06:32–07:41
• Engaging Legislators & Grassroots Advocacy Advice — 07:50–09:28
• Physician-Owned Hospital Ban: Problems & Solutions — 10:27–13:55
• Advice for Emerging Physicians on Advocacy & Economics — 14:41–15:59

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Conclusion

Dr. Tumialán’s episode is a candid, fast-paced deep dive into the existential challenges American physicians face: unfair reimbursement, regulatory barriers to clinical entrepreneurship, and alarming workforce attrition. He urges peers to champion their own value—and the future of the profession—through direct engagement, legislative advocacy, and by raising their collective socioeconomic intelligence.

Call to action:
“Let’s return the physician entrepreneur...We need a healthy balance...The more of us that get involved, we will create a huge groundswell. We build awareness. Change becomes an inevitability.” (13:50, 15:40)

Transcript

[A]

This is Scott Becker with the Becker's Healthcare podcast. We're thrilled today to be joined by a brilliant surgeon, a brilliant physician. We're joined today by Luis manuel Tumiellen and Dr. Allen's going to talk to us a little bit about physician owned hospitals, the prohibition on physician owned hospitals and a lot more. Dr. Toomey Allen, can you take a moment to introduce yourself and tell us a little about your practice and your history?

[B]

Yeah. Thank you for having me on this podcast, Scott, and, and helping me build awareness for these issues that are challenging the ability to practice medicine in 2025 and moving forward. My name is Luke, as you mentioned, I'm a private practice physician with barrel brain and spine. We are the 27 neurosurgery group that services several hospital systems in the Phoenix area. I am a minimally invasive spine surgeon. I have a very strong focus on motion preservation in the cervical and lumbar spine and developing technologies that will allow us to preserve motion, not stop that motion. But at times you do need to do that. I trained in Atlanta, Georgia at Emory and then I had a stint in. I spent 11 years in the world's finest Navy and of those 11 years, six active, five reserve. I spent time as an operational physician and then I was able to practice medicine and I guess what would, could only be considered the, what would be a capitated system. And I felt the frustrations of working in that type of environment at the end of my naval career and was very happy to join a private practice and be untethered from those things. And those are the, that's. I have a strong interest in socioeconomics. So much so that I, I ventured into a, the socioeconomic arm of neurosurgery, which is the Council of State Neurosurgical Societies. And, and over the span of 15 years now I, I currently reside as the chair of that organization. And that chair or that the Council of State Neurosurgical Societies is dedicated to one thing, increasing the value of the neurosurgeon, increasing the value of the, of the physician. And so that, that's in a nutshell, what my journey. I do not want to become an employed neurosurgeon. And I continue to fight that battle and create an ideal environment for the next generation of spine surgeons to be able to do what it is that I get to do and have fulfillment and career and control over to a certain extent of my life.

[A]

So what an amazing practice. And for people that don't know bureau spine bureau neuro is one of the great Great practices in the country. Tremendous, tremendous reputation as just a great, great, highest quality practice. And talk about some of your advocacy work. And then also tell us if you're still a Georgetown Hoya fan or both. Tell us about the advocacy work and what you're most focused on there. And also tell us if you're a Georgetown fan.

[B]

Well, I'll start with the Georgetown fan. I'm a huge Hoya fan and big. My fondest memories are going to be spent over the Potomac and on the Jesuit campus there at Georgetown. What a great environment to start a medical career. Advocacy work is just, you know, one of the things that we do is we build awareness. We do small things which are actually not that small, but not. How about this, they're not as noticeable. For example, we advocate for a surgeon who does a decompression with a fusion. At one point there was a de facto bundle. It's in around the same area. And we read this article in this one piece, and so what we're going to do is we're going to go ahead and bundle it and we go.

[A]

No, no, no, no, no, no.

[B]

If we go back to the history of these codes and everything, everything stems from understanding the history of how we got here, because we're in a very Byzantine arcane system with the RBU system, which is how all physicians get paid, which is one of the things that they should teach physicians the first day of medical school, because you need to know how it is that you are going to make it in this world. But of course, talking to a medical student about remuneration is like talking to your children about procreation. No one wants to do it. It's a bad thing to do. Apparently, when I think it's essential that we need to increase the socioeconomic IQ of our, of our burgeoning physicians. But for, you know, one of the advocacy elements that we did was we said, look, we, we believe that the history of the code used to be that an orthopedic surgeon did the orthodesis, a neurosurgeon did the decompression. These are two separate pieces of work as, as difficult as that sounds to untether. That's the history of the codes. One's muscular, skeletal, one's nervous system, and therefore these. The work was already parceled out. And so you have to preserve the value of that work. And so a physician should be remunerated for that. That additional work for decompression with a lumbar fusion, as small as that may be, that little nuance that resulted in since the development of the 63052 and 63053 codes, the decompression codes with lumbar fusions. As part of the advocacy that we collaborated with the spine section, A, NS, CNS, NASS and ISAS. All of that results in over $100 million that are being paid out to physicians over the span of a year. Work that was not being remunerated before. So that's an example of advocacy. Another example is making surgeons aware. Hey, do you realize that you are not being paid for work that you've had prior authorized? We are the only industry, Scott, that that would tolerate this. If you have a contractor do work on your house and they give you an estimate. Here, here, Scott, this is what we're going to do to your house. This is what you want this? You want your kitchen redone? Here's our estimate. And guess what? The estimate always goes over. And then when the work is done, they go, okay, here's what you owe us. If you don't pay that bill, they'll put a lien on your house. We get a prior authorization. Physicians listening to this podcast will be surprised. Some won't, but some may that they will get a prior authorization to do a procedure where the approved codes were xyz. They do a procedure on such and such a date that cover XYZ. They submit the charges for XYZ and 12 to 15% of the time that will be denied. Even though they did everything to a T. Do we put a lien on that patient? Of course not. We can't. What do we do? We knock on the door, introduce ourselves to the next patient that's going to that needs care and we just keep going on. No other industry tolerates what we tolerate as physicians. But that's to increase the awareness all of a sudden builds a groundswell of support. Wait a second. Why do we tolerate this? And hopefully it'll lead to a legislation where a. Because we all get this. We get the prior authorization is not a guarantee of payment. That sentence needs to go away. Legislation, federal legislation needs to be. If we're advocating for physician. We're trying to deal with the physician work shortage should be that prior authorization is a guarantee of payment on a clean claim. If I do exactly what I said I was going to do and anyone's mind of what is fair, you should be paid 12 to 15%. That doesn't happen.

[A]

And how do we change that? How does that get changed? That does seem incredibly unfair, you know. So tell us how does that get changed or what can be done?

[B]

Well, I mean, it's, it's, it's, you know, one of the. We are involved with our political action committee. We have a NeuroPAC, our Washington committee is very involved. And they, they, they set up meetings with our elected officials. And I was fortunate to be able to meet with Senator Cassidy from Louisiana, who's a, an ob. Gyn. No, he's a gastroenterologist. Senator Marshall from Kansas, whom I also was able to meet through this pack. And they say the same thing. You reach out, reach out to your elected official, reach out to your congressman, reach out to your senator. As lofty as that may seem, I'd mention that to my wife. And next thing you know, she sets up meetings and I have a zoom meeting with Senator Kelly's legislative assistant. And then I. And then Senator G. So. And then Congressman Schwier, who, as it turns out, go, his sister goes to my church. Cassidy made the point to say, you'll be surprised how close you actually are to your elected officials. There's not that many degrees of separation. And so we begin that dialogue. It's not a ranting and raving, but rather data. Here's the data. Here's the data on our workforce. Here's the shortage that we foresee happening. Here's what's happening with medical students that are graduating. They're being around a bunch of physicians who appear to be burned out or complaining about their jobs. And guess what? After they graduate medical school, they don't go into practice. So even though you may increase the throughput for medical school, you're not having enough physicians enter the workforce because of the rate of burnout, because of the rate of the job fulfillment not being what they thought it was. What we need to do is create an environment where medical students are around. Physicians are saying, hey, I'm being treated fairly. I have great fulfillment in my job, and I've got a long, fulfilling career in front of me. And what we need to do is also keep physicians in the workforce. I have colleagues of mine who are, I would consider myself mid career, and they are already looking for the exit. I think if we create an environment that allows us to talk about that.

[A]

Because the stats are alarming. There's about, you know, a million 100,000 practicing physicians at most, and something like 30, 40% are going part time by 40 to 50, and we're losing a lot. And how do we, how do we make the whole thing work better for physicians so they stay excited and enthused and treated well because we are such in dire need, particularly in many, many specialties.

[B]

Well, I mean there's going to be several opinions on that. I have mine. One of the things that we need to bring back is the physician entrepreneur. And one of the topics that we had broach, broach in the beginning is the ban on physician owned hospitals. So section 6001 was a little recognized section that was, I wouldn't say it was snuck in, but it certainly did not get a lot of attention when it went in. And that is the only piece of legislation that exists in the books where one type of profession has been singled out and precluded from a business enterprise. There's no legislation that says a lawyer cannot own their law firm. There's no legislation that says bakers can't own their ovens, but a physician cannot own the means of production of baker, their enterprise, of their, of their, in their professional environment. And once you've done that, what that allowed is eliminated the competition. Once you eliminate competition, you have vertical integration. When you have vertical integration, you have purch, you have physician practices that are struggling, they get acquired, you lose control. And now all of a sudden the cycle happens. A simple, because this is, it would be ludicrous. And then I think someone, you know, I, I, I had a post, I'm a social media neophyte. I don't know I rely on other people to do these. But I posted something with regards to the repeal on a piece that I wrote for our, our, one of our society publications where it was said, oh, so you want to repeal the Affordable Care Act? No, no, I don't want to repeal the Affordable Care Act. You, you completely. That's a huge 1100 page bill that, that only Nancy Pelosi read. I don't want to repeal that. The only thing I want is to take, I want to fix what's broken. I want to take one section out, allow for physician ownership of hospitals. Because we see when we look at the grandfathered physician owned hospitals, there's 250 of them that remain in our country. There's 5,000 non physician owned hospitals. Somehow 48 of the top 48 or 48 out of 100, the top 48 for cost, quality of care and access to care, physician owned and nine of the top ten are physician owned. So there's something about a physician being involved. And so for quality, for access to care and for the cost of care, you want physicians involved. And also it allows for physicians to have fulfillment, to be part of the ownership process. And also to be remunerated for success that they have in achieving metrics. And that is the realization of the Affordable Care Act. Right. We're supposed to increase quality. We're supposed to increase access and decrease cost. So the, the experiment that we ran with section 6. 01 has now been realized. It doesn't, it didn't materialize that time to try something new. We, and like I said what Senator Cassidy told me, you'd be surprised how close you are. You ask what the solution is or how a solution, a pathway is. Let's everyone listening to this podcast should just say, hey, I need to reach out to my elected official, talk to their legislative assistant, provide them the data and recognize we are facing a huge physician shortage. We need to do something about it. What are the things that we can do? Obviously we can increase throughput, but also let's return the physician entrepreneur. The private practice physician is an endangered species. We're on a trajectory that everyone's either going to be academic or hospital employed. That's not a, that's not a healthy environment for the next generation. We want balance amongst all of them. I'm not criticizing academics, I'm not criticizing hospital employed. I am criticizing an imbalance by not empowering private practitioners. We need a healthy balance of all three of those demographic practices.

[A]

We could not agree with you more, Dr. Allen. You've had a great career. Any advice for emerging physicians?

[B]

I would say that our socioeconomic IQ is our weak point. It certainly was mine. I had no idea how to code. I had no idea where money was coming from. Dr. Glaucon Fleck, who does all of these spoofs on YouTube as a great example of where he's, he's, he's asking a. Someone studying for the boards, all of these maple syrup disease things like that, but the kid has no idea how he's going to get paid. He goes, well, I, I do medicine and then I get paid by the money people. That, that's about as sophisticated as I was when I graduated medical school when I finished residency. We need to increase our socioeconomic iq. We need to be part of the process. We need to advocate for ourselves. Look, practicing your trade is very important. Having people say, look, I do this, I do that. They're swelled with the importance of the job that they do. But in order, if they truly believe that they need to empower themselves to be able to practice at that level, which means they need to advocate for themselves, which means that they need to understand the issues and get involved. The more of us that get involved. We will create a huge groundswell. We build awareness. Change becomes an inevitability.

[A]

Dr. Toomey. Allen. What a pleasure to visit with you. Brilliant. I could not agree with your sentiments more. Thank you for joining us today on the Beckers Healthcare podcast. We look forward to having you back on. Thank you very much for joining us.

[B]

It's my privilege to be here. Scott. Thank you for giving me an outlet to communicate with my colleagues.

[A]

Thank you very, very much.