Latest / Becker’s Healthcare Podcast / Building a Patient-First Spine Practice Outside Traditional Models with Dr. John Peloza

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Building a Patient-First Spine Practice Outside Traditional Models with Dr. John Peloza · 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
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  - 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
• 0:19
  - and new cost pressures at the same time.
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  - The spine and orthopedic leaders who are staying
• 0:24
  - ahead aren't just keeping up with the changes.
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  - They are in rooms where the changes get
• 0:29
  - talked about honestly. Becker's twenty third annual Spine
• 0:29
  - Orthopedic and Pain honestly. Becker's twenty third annual
• 0:32
  - Spine Orthopedic and Pain Management Driven ASC Conference
• 0:36
  - is such a space.
• 0:37
  - More than 1,000 attendees,
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  - 275
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  - plus physician and ASC speakers, three days of
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  - programming across the clinical,
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  - operational, and strategic
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  - with CME credits available.
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  - Join us June eleventh through the thirteenth. For
• 0:52
  - the agenda and event details, visit Becker's Hospital
• 0:55
  - Review and click on the events tab in
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  - the upper right.
• 0:59
  - This is Gracelyn Culler with the Becker's Healthcare
• 1:01
  - podcast, and we are recording live at the
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  - twenty third annual Spine Orthopedic and Pain Management
• 1:05
  - Driven ASC Conference.
• 1:07
  - I'm currently joined by doctor John Paloza, who
• 1:09
  - is a physician at Paloza Spine. So doctor
• 1:12
  - Paloza, thank you for joining me today. I
• 1:14
  - would love for you to briefly introduce yourself,
• 1:16
  - your role, and the scope of your organization,
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  - and
• 1:19
  - talk to what's currently commanding most of your
• 1:21
  - attention as a leader.
• 1:23
  - Well, my name is John Paloza. I've been
• 1:25
  - a spine surgeon for over thirty years,
• 1:28
  - fellowship trained,
• 1:30
  - and has seen
• 1:31
  - pretty much most of the,
• 1:35
  - technology and, evolution of spine
• 1:37
  - since it really,
• 1:39
  - increased quite a bit in the, late early
• 1:41
  - nineties.
• 1:43
  - My organization,
• 1:45
  - is actually Midwest Orthopedic Spine Specialist for most
• 1:49
  - in Saint Louis
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  - for most,
• 1:52
  - spine things, but then we've decided now to
• 1:54
  - do a,
• 1:55
  - private cash pay practice that's called Palosa Spine,
• 1:59
  - and it is taking patients from all over
• 2:01
  - the country.
• 2:02
  - So,
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  - what we offer is
• 2:05
  - a very personalized care
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  - and very individualized.
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  - It's not on any insurance, so we're not
• 2:11
  - restricted by insurance restrictions.
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  - And we can also do things that the
• 2:17
  - FDA has not specifically approved,
• 2:20
  - such as multilevel cervical lumbar disc replacement, hybrid
• 2:23
  - disc replacement fusions, and plus all the different
• 2:26
  - minimally invasive techniques for decompression,
• 2:29
  - correction of scoliosis, and those sorts of things.
• 2:32
  - So there's not much we can't do.
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  - The most recent that we've we've been involved
• 2:37
  - in biologics
• 2:38
  - in the spine since bone morphogenetic protein came
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  - out in the late nineties. We're on that
• 2:42
  - FDA trial.
• 2:44
  - And presently, we're on a disc cell injection
• 2:47
  - trial with the FDA. This is my eleventh
• 2:49
  - FDA,
• 2:51
  - trial.
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  - So that's looking good. So we're able to
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  - offer anything from high level conservative care through
• 2:58
  - regenerative technologies,
• 3:00
  - middle invasive technology, including endoscopic,
• 3:04
  - motion devices, as well as fusions.
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  - And in a year marked by rapid change,
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  - what recent decision or pivot required the most
• 3:12
  - leadership conviction from you, particularly when it came
• 3:15
  - to aligning people, resources, or capabilities?
• 3:19
  - That's a lot to cover.
• 3:22
  - The problem right now in health care is
• 3:24
  - its expense,
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  - and it's being driven
• 3:27
  - by
• 3:29
  - a lot of things that are not under
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  - physicians' control.
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  - So what we have to do is create
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  - use all our technological
• 3:40
  - means,
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  - to come up with solutions that actually work,
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  - to have fewer complications,
• 3:48
  - and they give a long term good outcome
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  - so we don't have to redo another operation
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  - down the road.
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  - We have to do it in a venue
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  - that's not so expensive.
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  - So doing
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  - high acuity complex cases that we used to
• 4:03
  - always do in the hospital,
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  - we done in a surgery center instead.
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  - So those are the two main things
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  - conceptually.
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  - Now to put that together in a business
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  - process is the difficult part. You have to
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  - get capital
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  - to build the or buy surgery centers.
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  - We have a lot of experience in that
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  - and presently have three in the Saint Louis
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  - area.
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  - So,
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  - then you have to have staff. You have
• 4:30
  - to have really good staff. In our case,
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  - people who have decades of experience in spine,
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  - as scrub techs and scrub nurses, circulators,
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  - administrators.
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  - We have,
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  - so people who who know what to do
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  - to get things done efficiently.
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  - We also have to have, vendors
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  - who can get us implants
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  - and maintain the supply and of the implants
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  - so we never have problems. We always have
• 5:00
  - everything ready to go at all times.
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  - And then we have to have, on the
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  - physical therapy side, relationships with the therapist so
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  - that they can train our patients after surgery
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  - to maintain a good outcome.
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  - So all that
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  - that's quite a bit that you have to
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  - have,
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  - put together before you even start to think
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  - about doing these things.
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  - The other thing is with a concierge slash
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  - cash pay business, people have to find out
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  - about you. So the marketing,
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  - social media,
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  - AI type driven things are very important.
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  - That also requires
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  - capital.
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  - So
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  - that's where right now building it out
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  - is,
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  - requires
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  - well, there's two things. First off, you have
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  - to have a reputation that you can do
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  - these things, and you know what you're talking
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  - about. And then you have to have the
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  - business savvy
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  - to get it to to a reality.
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  - So that's where we are.
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  - So how do these situations
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  - challenge your assumptions,
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  - and what do they change about how you
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  - approach decision making, talent, or organizational readiness?
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  - Well, my decision making hasn't changed that much
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  - in terms of medical side.
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  - Readiness is to have great staff who really
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  - know what they're doing and and to to
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  - really incentivize them to wanna be in your
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  - practice
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  - because people of that high quality
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  - are in demand.
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  - So
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  - we
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  - wanna make sure they're happy
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  - and compensated,
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  - appropriately
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  - so that we can keep our organization
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  - top notch.
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  - And shifting gears a little bit, when you
• 6:36
  - think about the forces reshaping health care right
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  - now, where do you believe leaders need to
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  - be more decisive, especially while balancing things like
• 6:43
  - speed risk and having the right teams in
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  - place?
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  - Big,
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  - yeah,
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  - multipronged question.
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  - The problem with health care right now is
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  - that
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  - because of government intervention,
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  - it has given monopoly powers
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  - to hospital systems and insurance companies.
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  - Physicians have been pretty much cut out of
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  - that.
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  - So we have to
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  - try to navigate this situation where we really
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  - have
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  - no leverage.
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  - We don't have the financial resources
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  - to fight,
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  - and
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  - the bigger
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  - organizations
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  - really don't
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  - they don't suffer the consequences of things going
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  - wrong like we do. They have no legal
• 7:27
  - exposure in case something happens. So what the
• 7:29
  - physician often finds themselves in,
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  - we have the legal
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  - responsibility
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  - and accountability, but no authority.
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  - We can't change our staff in a hospital
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  - system, for instance. We get who we have.
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  - We try to train them, but if it's
• 7:44
  - not working out,
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  - you as a surgeon is are expendable.
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  - So that's tough.
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  - The amount of,
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  - leverage that, the big systems have is incredible
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  - because they control
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  - the legislation pretty much,
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  - and so we have to deal with the
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  - rules they set up.
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  - And like everything in government, everything it touches
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  - does poorly,
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  - so they create a problem, and then they
• 8:13
  - create more legislation to address the problem, which
• 8:16
  - then makes it worse. And then more legislation,
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  - it just keeps getting worse.
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  - So
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  - the way to fix all that is to
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  - get government out of the way and let
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  - the market compete.
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  - These guys had to compete on quality and
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  - cost, we would win, but that's not how
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  - it's done.
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  - So if you're a leader, you have to
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  - understand that, know,
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  - what you can and can't do.
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  - As a small
• 8:40
  - operation,
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  - we're flexible.
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  - We can move quickly.
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  - We can make decisions quickly. We don't have
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  - to wait to go through, like,
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  - four or five committees to to get an
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  - answer.
• 8:52
  - So,
• 8:53
  - right now, we'll see where it goes. But
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  - right I I think where things are headed
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  - are unsustainable
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  - because it's too expensive and the cost keep
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  - going up.
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  - So a more market based approach, I think,
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  - is what
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  - needs to be done. I don't have much
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  - hope that's gonna happen
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  - because the other side has so many resources.
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  - And wrapping our conversation,
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  - as uncertainty has become the norm, what leadership,
• 9:17
  - habit, or mindset has been most critical in
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  - keeping your organization and your people moving forward?
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  - Well, everybody has to understand what the goal
• 9:24
  - is. So what's the priorities of your organization?
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  - In medicine,
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  - if your priority is not the patient,
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  - you won't be successful,
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  - not an not at the doctor level.
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  - The only way I'm graded by my outcomes.
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  - So particularly when people are paying
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  - cash or concierge,
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  - the thing that really counts is their outcome
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  - and their experience.
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  - So they have to whatever it is, the
• 9:51
  - problem is, we have to solve it so
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  - their pain goes away, so they're functional, and
• 9:55
  - they can live their life. And we have
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  - to do it at a price that they
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  - can afford,
• 9:59
  - which means
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  - no complications,
• 10:03
  - one time doing something,
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  - and then their experience has to be very
• 10:07
  - good because
• 10:08
  - spine surgery, spine conditions are scary.
• 10:12
  - Surgery particularly is frightening, and that fear is
• 10:14
  - real. So we have to understand that, and
• 10:18
  - it's addressed by having a thorough evaluation so
• 10:21
  - they have a diagnosis,
• 10:22
  - that they're confident in the procedure is gonna
• 10:24
  - help them, that it's performed
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  - as well as possible, and postoperatively,
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  - they have a seamless care. So from time
• 10:32
  - they call us till they're finished, it should
• 10:35
  - be seamless, pleasant,
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  - like going to a spa rather than going
• 10:39
  - to a big hospital to get hacked.
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  - So,
• 10:43
  - I would say that's important that that your
• 10:45
  - priority is your patient. And, also, you it
• 10:48
  - is a business, so you have to stay
• 10:50
  - in business.
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  - And that's becoming more and more of a
• 10:53
  - problem if you're, in,
• 10:56
  - a private physician
• 10:58
  - because reimbursements keep going down and down and
• 11:01
  - down. It should be eventually
• 11:03
  - in a lot of cities now, there are
• 11:05
  - no private practice physicians. They're all hospital employed
• 11:08
  - or they're in private equity or something like
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  - that.
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  - Absolutely. Well, doctor Palosa, thank you so much
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  - for joining me today on the Becker's Healthcare
• 11:15
  - Podcast. Again, we are recording live at the
• 11:17
  - twenty third annual Spine Orthopedic and Pain Management
• 11:19
  - Driven ASC Conference.
• 11:21
  - Thank you.