Latest / Becker’s Healthcare Podcast / Building a Next Generation Spine Program in Austin with Dr. Akshay Yadhati

Transcript

Building a Next Generation Spine Program in Austin with Dr. Akshay Yadhati · Becker’s Healthcare Podcast

• 0:02
  - The playbook for running a successful ASC in
• 0:04
  - 2026
• 0:06
  - looks almost nothing like it did a few
• 0:07
  - years ago.
• 0:08
  - And the one for 2029
• 0:10
  - probably won't look like this one either.
• 0:12
  - Case complexity is increasing. Payer models are shifting.
• 0:16
  - Technology is creating new possibilities
• 0:18
  - and new cost pressures at the same time.
• 0:21
  - The spine and orthopedic leaders who are staying
• 0:24
  - ahead aren't just keeping up with the changes.
• 0:27
  - They are in rooms where the changes get
• 0:28
  - talked about honestly.
• 0:30
  - Becker's twenty third annual spine, orthopedic, and pain
• 0:33
  - management driven ASC conference is such a space.
• 0:37
  - More than 1,000 attendees,
• 0:39
  - 275
• 0:40
  - plus physician and ASC speakers, three days of
• 0:43
  - programming across the clinical,
• 0:45
  - operational, and strategic
• 0:47
  - with CME credits available.
• 0:49
  - Join us June 11 through the thirteenth.
• 0:52
  - For the agenda and event details, visit Becker's
• 0:55
  - hospital review and click on the events tab
• 0:57
  - in the upper
• 0:58
  - right. Hello. And welcome to the Becker's Healthcare
• 1:00
  - podcast recorded live at the twenty third annual
• 1:03
  - spine, orthopedic, and pain management driven ASC,
• 1:06
  - plus the future of spine conference and the
• 1:08
  - business and operations of ASCs.
• 1:10
  - I'm joined today by doctor Akshay Yaddadi,
• 1:13
  - orthopedic surgeon at Austin Regional Clinic. Akshay, thank
• 1:16
  - you so much for joining us today. Yeah.
• 1:18
  - Thanks for having me. Appreciate it. Could you
• 1:19
  - take a moment to briefly introduce yourself, your
• 1:21
  - role, and the scope of your organization, and
• 1:23
  - what's currently, commanding most of your attention as
• 1:25
  - a leader?
• 1:26
  - Sure. Yeah. So I'm, an orthopedic spine surgeon
• 1:29
  - based in Austin, Texas.
• 1:31
  - I was also trained at University of Utah
• 1:34
  - and then,
• 1:35
  - was a private practice in New England for
• 1:37
  - about seven years before moving to Austin.
• 1:39
  - And we just moved out there in October
• 1:42
  - 2025 to
• 1:43
  - basically allow me to take on the role
• 1:45
  - as their sole orthopedic spine surgeon, for the
• 1:48
  - practice.
• 1:49
  - So ARC
• 1:51
  - is a multispecialty
• 1:52
  - practice,
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  - based in Austin and in, like, the surrounding,
• 1:56
  - you know, suburbs.
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  - It takes about it takes care of about
• 1:59
  - 800,000
• 2:00
  - lives,
• 2:01
  - and they started coming together about forty years
• 2:03
  - ago. And then about ten or fifteen years
• 2:05
  - ago, they started folding in specialty, practices as
• 2:08
  - well.
• 2:09
  - So the orthopedic
• 2:11
  - department didn't have a spine surgeon for several
• 2:13
  - years.
• 2:14
  - So I came in and, you know, took
• 2:15
  - on the role of basically building out
• 2:18
  - the surgical function for the practice.
• 2:21
  - And then over time, you know, our our
• 2:22
  - next kind of focus is gonna be to
• 2:24
  - also
• 2:25
  - build out the more comprehensive care sort of
• 2:28
  - pathway for patients as well. So, yeah, it's
• 2:30
  - been been a big year.
• 2:33
  - You know, the legacy model for,
• 2:35
  - especially spine
• 2:37
  - care for patients within the practice
• 2:39
  - was a relatively restrictive referral
• 2:42
  - model for the group.
• 2:44
  - So
• 2:45
  - it ended up actually kinda choking off, you
• 2:47
  - know, patient flow and then surgical volume.
• 2:50
  - So when I came into the practice, I
• 2:51
  - kinda just employed the,
• 2:53
  - you
• 2:54
  - know, the kind of the opposite model and
• 2:56
  - just made it so that patients really had
• 2:58
  - kinda unfettered access.
• 3:00
  - You know, any and all patients that were
• 3:02
  - dealing with some sort of spine complaint were
• 3:03
  - able to come in and see us.
• 3:05
  - And as a result, I mean, you know,
• 3:07
  - volume really took off pretty quickly, especially, you
• 3:09
  - know, obviously in the office. But even the,
• 3:11
  - you know, the operative volume really did take
• 3:12
  - off,
• 3:13
  - very quickly.
• 3:14
  - Mhmm. So now we're kind of in phase
• 3:17
  - two where whereas phase one was really just
• 3:19
  - to kind of establish market presence,
• 3:21
  - not only for the practice, but really for
• 3:23
  - the region as well. Now phase two is
• 3:25
  - really to kinda to clean that model up
• 3:27
  - and to really kind of refine,
• 3:29
  - you know, the care pathway for patients so
• 3:31
  - that,
• 3:32
  - you know, patients that, you know, really don't
• 3:34
  - need to spend time speaking to a surgeon
• 3:36
  - are gonna be then spending their time,
• 3:38
  - you know, working with our physician extenders. And
• 3:40
  - then eventually, once we bring in, you know,
• 3:42
  - interventional,
• 3:44
  - physiatry or even, like, you know, anesthesia pain,
• 3:46
  - you know, they'll be able to kind of
• 3:47
  - focus their time and efforts
• 3:49
  - speaking with, you know, and working with,
• 3:52
  - providers that are gonna be able to take
• 3:53
  - care of them without surgery.
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  - So that my time is really dedicated to,
• 3:58
  - you know, dealing with really the high acuity
• 4:00
  - patients that really need, know, surgical care quickly.
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  - So we're trying to now really focus on
• 4:05
  - that sort of care pathway and really building
• 4:07
  - out that comprehensive flow for patients. So
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  - And, you know, with this job change and
• 4:11
  - move,
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  - how did it challenge your assumptions? And,
• 4:16
  - what did it change about how you approach
• 4:18
  - decision making talent or organizational readiness today?
• 4:21
  - Yeah. So
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  - what we
• 4:24
  - really had to go up against was
• 4:27
  - a number of things.
• 4:30
  - In terms of just, I think, you know,
• 4:33
  - creating market presence for the for not only
• 4:35
  - for the practice, but also for the,
• 4:37
  - city of Austin itself was
• 4:40
  - one to come in with a mindset of,
• 4:44
  - honestly,
• 4:45
  - disruption, and to really
• 4:47
  - come to the market and approach the market
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  - with the things that we are going to
• 4:51
  - change for the area.
• 4:53
  - You know, in Rhode Island, you know, I
• 4:55
  - was practicing prior.
• 4:58
  - You know, we were
• 4:59
  - kinda ahead of the curve with
• 5:01
  - robotic navigation assistance for spinal, fusions,
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  - and there really wasn't, you know, much of
• 5:06
  - that type of surgery being done in Austin
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  - at all. So
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  - when,
• 5:11
  - you know, I came into the into the
• 5:13
  - practice,
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  - within a couple of months, we performed the
• 5:15
  - first,
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  - robotic posterior body fusions and robotic lateral and
• 5:20
  - body fusions for, the city of Austin,
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  - which was big. You know? It's
• 5:26
  - now allowing us to
• 5:29
  - really put the organization
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  - forward as
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  - the kind of leading edge and,
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  - you know, the organization that's gonna really try
• 5:37
  - try to think over the next five to
• 5:39
  - ten years define the future for the city
• 5:42
  - of Austin.
• 5:43
  - Likewise for, you know, endoscopic surgery, there really
• 5:45
  - wasn't a presence,
• 5:48
  - in Austin itself for endoscopic spinal surgery.
• 5:52
  - So we've done the most endoscopic depressions in
• 5:54
  - Boston within, honestly, the past six months.
• 5:57
  - So we're really trying to
• 5:59
  - put the organization
• 6:01
  - forward as a true market leader.
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  - That was that was a big part of,
• 6:05
  - I think, of our our strategy. One, to
• 6:07
  - kind of
• 6:08
  - establish our market within within,
• 6:11
  - or our presence within the market within the
• 6:12
  - practice just because, I mean, it takes care
• 6:14
  - of 800,000 patients. So it really does mean
• 6:16
  - going out to each one of those primary
• 6:19
  - care offices to really kind of say, hey.
• 6:20
  - We're here. We're trying to now build this
• 6:22
  - for the practice and provide this for the
• 6:23
  - patients.
• 6:25
  - But
• 6:26
  - it's not just about us, you know, absorbing
• 6:29
  - these referrals. It's really more about actually providing
• 6:31
  - the next generation of care for the city.
• 6:34
  - So that's what we're really trying to do.
• 6:36
  - You know, as part of our growth strategy,
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  - we do have two ASCs that are coming
• 6:41
  - online. One is a little bit further along
• 6:42
  - the process. One is probably gonna be along
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  - in the next
• 6:45
  - several months. Mhmm. And it's that second ASC
• 6:48
  - where we'll largely be doing a lot of
• 6:49
  - our outpatient surgeries, for spine.
• 6:52
  - And,
• 6:53
  - you know, so now right now, we're kind
• 6:54
  - of in the contract negotiation phase, really really
• 6:57
  - making sure that we're able to kind of
• 6:59
  - account for our, you know, implant costs and
• 7:01
  - implant carve outs because those are the types
• 7:03
  - of things that, you know, with
• 7:06
  - ASC migration
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  - and with the, you know, approved list, you
• 7:10
  - know, now including a lot more,
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  - or the covered list, sorry, including a lot
• 7:14
  - more musculoskeletal procedures.
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  - Those are the types of things that we're
• 7:18
  - I think, you know, if you're
• 7:20
  - in a leadership role, you're, you know, the
• 7:22
  - person that's really trying to move the needle
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  - for your practice or for your organization.
• 7:26
  - It's being mindful of those types of things
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  - because, you know, if you're kind of just
• 7:30
  - accepting your off the shelf,
• 7:32
  - you know, reimbursement schedule from your from your
• 7:34
  - payer and they're not accounting for the implants,
• 7:36
  - you know, they're not,
• 7:39
  - gonna be able to help you sort of
• 7:40
  - also then account for,
• 7:42
  - you know, the technologies that are, you know,
• 7:45
  - becoming more and more implicit to your to
• 7:47
  - spine surgery,
• 7:48
  - you're gonna be kinda, you know, behind the
• 7:50
  - needle. You know, the payers really want to
• 7:52
  - push forward and
• 7:54
  - keep going forward with, you know, the value
• 7:55
  - based models. But, you know, they're really focused
• 7:58
  - on the ninety day kind of global.
• 8:00
  - So it's that ninety day period that they're
• 8:02
  - really focused on. So to help, you know,
• 8:04
  - curb all these, you know, relatively expensive surgeries,
• 8:08
  - you know, we've all seen it. You know,
• 8:10
  - they put in these automatic denial processes,
• 8:12
  - these,
• 8:13
  - really adversarial prior authorization processes.
• 8:16
  - So
• 8:18
  - to help kind of combat that,
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  - it does mean
• 8:22
  - kind of leveraging what you are able to
• 8:24
  - leverage. With us, it's gonna be a really
• 8:27
  - robust nonoperative pathway so that we're really, you
• 8:29
  - know, operating on the patients that really are
• 8:31
  - gonna be benefiting from surgery the most and
• 8:33
  - trying to curb unnecessary surgery and then going
• 8:35
  - back to our payers and saying, hey. You
• 8:37
  - know, we've really built out this really well
• 8:40
  - defined nonoperative pathway for patients
• 8:42
  - to help prevent unnecessary surgery. Now we're we
• 8:46
  - are kind of be leaning on you to
• 8:47
  - kinda come away with these prior the prior
• 8:49
  - authorization processes and the denial processes that are
• 8:51
  - really limiting and then restricting patients that need
• 8:53
  - surgery quickly to actually get to it. So
• 8:55
  - there's a lot of things that, you know,
• 8:56
  - we're kinda coming up against, but
• 8:59
  - it's it's definitely a role that I was,
• 9:01
  - you know, ready for and and wanting to
• 9:04
  - take on. This was kind of the time
• 9:05
  - of my career, so it's been it's been
• 9:07
  - rewarding. It's been rewarding for sure. So when
• 9:09
  - you think about the forces that are really
• 9:10
  - reshaping health care right now, where do you
• 9:12
  - believe, leaders need to be more decisive,
• 9:15
  - especially when balancing speed, risk, and, also having
• 9:18
  - the right teams in place? Yeah. I think
• 9:20
  - a lot of it actually does come back
• 9:22
  - to the kind of,
• 9:24
  - contract negotiations,
• 9:26
  - and those and the kind of emphasis on,
• 9:28
  - like, the, you know, the value based models,
• 9:29
  - especially with that kind of ninety day focus,
• 9:33
  - you know, really being sure that you're able
• 9:34
  - to kind of account for,
• 9:36
  - you know, implant carve outs or at least
• 9:38
  - your implant costs within your facility fees,
• 9:41
  - making sure that you're not just taking, you
• 9:42
  - know, that you're basically Medicare fee schedule or
• 9:45
  - your kind of basic, you know, commercial payer,
• 9:47
  - commercial fee schedule,
• 9:49
  - really leveraging what you can to negotiate for
• 9:52
  - either those carve outs or for consideration with
• 9:54
  - those facility fees. So you're not on the
• 9:56
  - back foot,
• 9:58
  - in, you know, taking those cases to your
• 10:01
  - ASCs because,
• 10:02
  - you know, our
• 10:04
  - our,
• 10:05
  - you know, technologies, they cost what they cost.
• 10:07
  - You know, implants, they cost what they cost
• 10:09
  - right now.
• 10:10
  - So really trying to, I think, you know,
• 10:13
  - push back on that is gonna be really
• 10:14
  - the way that we'll be able to kinda
• 10:15
  - move the needle
• 10:17
  - because, you know, the payer, on the other
• 10:18
  - side actually ends up losing out as well
• 10:20
  - because if you can't really, you know, financial
• 10:22
  - support doing, you know, your outpatient cases in
• 10:24
  - your ASC because
• 10:25
  - you haven't negotiated for the appropriate schedule, then
• 10:27
  - you're just taking those back to the to
• 10:29
  - the hospital, you know, outpatient departments anyway. So
• 10:31
  - Mhmm.
• 10:32
  - And, to close us out, you know, as
• 10:34
  - uncertainty has become the norm, what leadership have
• 10:37
  - it or mindset has been most critical in
• 10:39
  - keeping your organization and your people moving forward?
• 10:42
  - Yeah. I think,
• 10:44
  - you know, being mindful of overall just the
• 10:46
  - operational efficiencies because,
• 10:48
  - especially for our practice,
• 10:50
  - you know, building up the spine surgical function,
• 10:52
  - you know, it's it's a it's relatively brand
• 10:54
  - new to the organization. So really trying to,
• 10:57
  - one,
• 10:58
  - obviously, build our presence. But now that we
• 11:00
  - have our presence sort of established, really trying
• 11:02
  - to smooth out the referral patterns, smooth out
• 11:06
  - the flow of patients
• 11:07
  - to us and the care streams for them
• 11:10
  - so that we actually look like we know
• 11:11
  - what we're doing.
• 11:12
  - You know, we're now, I think, at the
• 11:14
  - point where we're starting to actually being able
• 11:15
  - to leverage our volume and our data over
• 11:18
  - the past several months to go to the
• 11:20
  - hospital organizations, to go to our payers and
• 11:23
  - say, this is what we've already done with
• 11:25
  - relatively,
• 11:26
  - honestly, immature,
• 11:27
  - you know, surgical function within the past six
• 11:29
  - months. This is our vision. This is where
• 11:32
  - we're heading,
• 11:33
  - and, you know, this is where we need
• 11:36
  - partnership and consideration,
• 11:38
  - you know, in sort of achieving our goals.
• 11:40
  - And then I think the daily habit that
• 11:43
  - sort of kind of followed as a result
• 11:44
  - of that,
• 11:46
  - you know, because it's a new function and
• 11:48
  - because we have, you know, a lot of
• 11:49
  - things ahead of us to actually build out
• 11:50
  - a comprehensive
• 11:51
  - care pattern is kinda staying
• 11:54
  - to somewhat
• 11:55
  - kinda in the weeds a little bit, and
• 11:57
  - at at the very least,
• 11:59
  - monitoring
• 12:00
  - and supervising the management of the weeds. You
• 12:03
  - know, if you kinda get yourself in there
• 12:05
  - a little bit too much, you know, that
• 12:06
  - feel the weeds can, you know, can certainly
• 12:08
  - kinda turn into, like, a pool of quicksand.
• 12:10
  - So being careful of that, I think, is
• 12:12
  - is important.
• 12:14
  - But leaning on,
• 12:16
  - you know, your operators,
• 12:18
  - staying in really constant communication with them, I
• 12:20
  - mean, it's a lot of, you know, evening
• 12:21
  - emails and text messages going back and forth
• 12:24
  - to try to stay ahead of, you know,
• 12:27
  - you know, potential problems or issues that are
• 12:29
  - kind of, you know, maybe on the horizon.
• 12:31
  - It's an it's a big part of the
• 12:33
  - first, I'd say, like, you know, twelve to
• 12:35
  - eighteen months of a new function especially. So
• 12:37
  - for me, that's those are the, you know,
• 12:39
  - the big things right now.
• 12:40
  - Well, doctor Yate, before I let you go,
• 12:43
  - did you have any final thoughts you wanna
• 12:44
  - leave with our audience?
• 12:45
  - No. I mean, I appreciate your time.
• 12:49
  - ARC is definitely, you know, here to try
• 12:51
  - and start kinda moving the needle forward for
• 12:53
  - the city Austin.
• 12:55
  - I've been a part of the, you know,
• 12:56
  - of the conference for the past three years,
• 12:57
  - and it's been a great opportunity just to
• 12:59
  - get out and meet with our leaders to
• 13:01
  - just get our get our insight, gather ideas,
• 13:04
  - and, you know, try to actually use the
• 13:05
  - data to then, you know, change what you're
• 13:08
  - doing in the future to see, you know,
• 13:10
  - how we can keep, you know, improving and
• 13:12
  - making this a better field. Awesome. Well, thank
• 13:14
  - you again for joining us, and have a
• 13:15
  - great rest of your day. Absolutely as well.
• 13:16
  - Thank you.