Latest / Becker’s Healthcare Podcast / Brandon P. Hirsch, MD, FAAOS, Orthopaedic Spine Surgeon at DISC Sports and Spine Center

Transcript

Brandon P. Hirsch, MD, FAAOS, Orthopaedic Spine Surgeon at DISC Sports and Spine Center · Becker’s Healthcare Podcast

• 0:00
  This is Carly Beam with the Becker Spine
• 0:02
  and Orthopedics podcast. And today, I'm thrilled to
• 0:04
  be joined by doctor Brandon Hirsch at DISC
• 0:07
  Sports and Spine Center. Doctor Hirsch, thank you
• 0:10
  so much for being here today. Thank you,
• 0:12
  Carly. Thank you for having me. I'm glad
• 0:14
  to be here to chat with you.
• 0:16
  Absolutely. And before we dive into our questions,
• 0:19
  could you introduce yourself and tell us a
• 0:21
  bit about your background?
• 0:23
  Sure. So I'm an orthopedic spine surgeon, in
• 0:26
  practice in Orange County in North San Diego,
• 0:29
  and, I'm in my eighth year of practice.
• 0:32
  Previously was in practice in Arizona,
• 0:35
  trained on the on the East Coast, a
• 0:37
  few different places before heading out West to
• 0:39
  to begin my career.
• 0:42
  Thank you. And to get started, I wanted
• 0:44
  to pick your brain on telehealth
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  and spine surgery. Obviously, telehealth really exploded,
• 0:51
  beginning the COVID pandemic. And now five years
• 0:55
  on,
• 0:56
  where have you seen it be the most
• 0:58
  beneficial
• 0:59
  to your work?
• 1:01
  Yeah. So I think that
• 1:03
  telehealth and telemedicine and spine care
• 1:06
  happen to fit very well together,
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  and it was some something that I was
• 1:11
  even interested in before the pandemic started. And
• 1:13
  the pandemic, I think, just highlighted
• 1:16
  how useful and effective,
• 1:18
  you know, technology can be
• 1:20
  in getting patients in front of,
• 1:23
  spine care providers and spine surgeons who, you
• 1:27
  know, have the expertise that they need.
• 1:29
  So I view telemedicine as a very positive
• 1:33
  development, and I think most patients do as
• 1:35
  well. You know, I recently,
• 1:38
  it's been held up a little bit by
• 1:41
  the lack of a continuation
• 1:43
  from Medicare
• 1:44
  in,
• 1:45
  coverage policy, but I think that that
• 1:48
  I believe that's now been extended once again.
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  I'm not sure whether it's been permanently extended,
• 1:53
  but that was sort of the main obstacle
• 1:56
  to the continued growth that I think is
• 1:58
  getting worked through now, which
• 2:00
  is very welcome.
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  And what do you think will be some
• 2:03
  of the next big game changers in this
• 2:05
  area?
• 2:07
  Well, I think just,
• 2:08
  as
• 2:09
  patients become more comfortable and it becomes more
• 2:12
  commonplace and patients get more experience,
• 2:15
  using telehealth,
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  I think that that
• 2:17
  will improve both their comfort
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  with,
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  you know, using technology to have a discussion
• 2:23
  with the doctor,
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  and it will also help doctors' offices
• 2:28
  and practices
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  get better at sort of the the,
• 2:33
  ins and outs of getting telehealth set up
• 2:36
  set up in a reliable way. You know,
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  if you talk to people,
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  in practices that
• 2:42
  weren't really familiar with telemedicine
• 2:44
  and kinda just started
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  in the pandemic, you know, some practices had
• 2:49
  technological,
• 2:50
  you know, obstacles to overcome to get,
• 2:53
  to get their telemedicine
• 2:55
  platform
• 2:56
  up and running the way they'd like it
• 2:57
  to. But, you know, fortunately, with,
• 3:01
  you know, technology like Zoom or any of
• 3:03
  the other platforms,
• 3:05
  it's now become a very easy to use,
• 3:07
  highly reliable
• 3:09
  way to see patients.
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  And,
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  I think it does
• 3:13
  a number of things that are beneficial for
• 3:15
  both sides.
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  For patients, you know, we live in an
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  era of convenience where convenience is
• 3:22
  is at a premium.
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  Really, in in any part of our life,
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  there are probably people who will be listening
• 3:28
  to this podcast
• 3:30
  that no longer go to a grocery store
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  because they use a product like Instacart,
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  or,
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  you know, Uber Eats or or these things.
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  And so,
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  really, if you look at any other part
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  of our life, technology is constantly making things
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  more convenient and saving us time. So why
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  why would that not be, you know, helpful
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  in health care where
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  time
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  and, you know, resources are
• 3:56
  scarce,
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  for both patients and and their physicians.
• 4:00
  So
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  I think in that
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  regard, as
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  as the technology and and comfort
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  level gets better, I think the
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  the adoption and the the widespread use will
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  get,
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  better. Part of that, you know, I think
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  is the age of the population that's being
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  cared for. I think we're just,
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  you know, kind of at the edge of,
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  you know, the
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  the generation that's the oldest that are receiving
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  health care right now or kind of the
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  last
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  generation
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  that didn't grow up with,
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  the Internet and technology in their hands.
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  But I think once we go into, you
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  know, another fifteen years,
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  even the oldest,
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  people in our population will have had
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  extensive experience using, you know, the Internet, and
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  technology
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  in every part of their lives from from
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  the time they were a young age.
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  That's a really good point you make there.
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  And you mentioned earlier just some challenges
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  of telehealth in terms of government policy, etcetera.
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  I know we're recording this on December 9,
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  but
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  right now, how are you thinking about these
• 5:07
  policy changes, and what do you wanna see,
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  in terms telehealth
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  access?
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  Right. So,
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  you know, during the pandemic, for those who
• 5:16
  may not be familiar,
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  Medicare
• 5:19
  passed a series of regulations
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  that,
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  enhanced or expanded coverage for telemedicine because,
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  you know, no they didn't want anybody seeing
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  people in person at that time.
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  And those had,
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  time limits on them, expiration dates.
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  And as as we got through that, and
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  and out of it, the
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  the expiration dates in a kind of a
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  classic, you know, Washington DC fashion got kicked
• 5:45
  down the road six months or a year,
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  multiple times.
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  And, actually, right before the most recent shutdown,
• 5:54
  was the expiration of the most recent
• 5:57
  extension. And so during the shutdown, there was
• 5:59
  a period of time where Medicare was not
• 6:02
  going to cover,
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  except for very narrow exceptions,
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  telemedicine.
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  And, naturally, the the commercial payers will always
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  follow suit
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  of what Medicare does. And so we experienced
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  very recently a a period of time where
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  there was no telehealth
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  access
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  through, you know, traditional insurance pathways.
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  And,
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  you know, that really
• 6:27
  irritated patients and caused disruptions to their practice.
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  So
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  the
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  implementation
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  and the what I think needs to happen
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  is, number one, Medicare needs to
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  permanently,
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  outline
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  the coverage for telemedicine
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  that will then have the commercial payers follow
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  suit
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  and and,
• 6:50
  provide coverage for it. You know, most likely,
• 6:52
  no one can ever say exactly what the
• 6:54
  commercial payers will do, but but they do
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  tend to follow Medicare policies and guidelines.
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  So I think that's, you know,
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  a must do, and I think that's on
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  the very near horizon and is,
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  is part of the
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  the health care related bills that are in,
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  Congress now.
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  So that's, you know, that's what I see
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  as the first next step. And then beyond
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  that,
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  you know, just the integration of telemedicine
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  into the rest of our
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  software ecosystem in health care, like EMRs, both
• 7:27
  office based EMRs and hospital based EMRs.
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  Right now, a lot of the software platforms
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  do have
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  integrations for telemedicine,
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  but I've had limited experience with them. I
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  find they're not as reliable as a product
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  like Zoom is,
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  and maybe not as intuitive for,
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  patients to
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  use because people are just most familiar with
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  what they use in other parts of their
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  life, and that tends to be products like
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  Zoom at the at the moment.
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  So I think that's gonna be the next
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  phase is how how do we integrate the
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  telemedicine experience into
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  the rest of our health care software,
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  you know, ecosystem to make it a seamless
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  transition to get your care and to provide
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  the care
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  without making it clunky or or challenging. Just
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  trying to eliminate as many obstacles and friction
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  points as possible to make it,
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  natural and easy for for patients to get
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  care this way.
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  And what are some of the other
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  conversations
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  that you're following in terms of just, you
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  know, policy shifts and different discussions going on
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  in Washington, DC?
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  Sure. So I think it's,
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  it's a interesting time in health care and
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  in health care reform and in our overall
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  political environment.
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  But I view the
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  volume on the conversation around
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  health care and pay reform
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  to really be increasing in the last two,
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  three years.
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  I
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  enjoy being, you know, somewhat active in advocacy
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  discussions,
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  you know, online,
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  whether it's platforms like Twitter or LinkedIn.
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  There are a lot of people from different
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  parts of the country, different practice environments,
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  and even non physicians who are really
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  thoughtfully
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  engaged with
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  with each other on what's the best path
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  forward.
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  And I think they're really starting to make
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  make some waves in having people pay attention.
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  You know, actually,
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  you you may have seen this or may
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  not have, but,
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  people like Mark Cuban who have, you know,
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  tremendous business acumen, tremendous resources,
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  and a desire to
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  change the status quo
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  are getting seriously involved in health care. He's
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  done that already on the farm you know,
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  on the pharmacy side with his company that
• 9:49
  provides generic drugs at, fair market prices.
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  And he's now engaging with, you know, people
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  that I know, individual physicians,
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  neurosurgeons,
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  people who've you've you've had, you know, feature
• 10:03
  on the Becker's platform
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  are able because of technology, because of Twitter,
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  to have live discussions with people like Mark
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  Cuban
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  to engage, you know, his resources in
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  the
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  progress or the effort toward reform, which, you
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  know, is just
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  a a remarkable and inspiring thing for me
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  at a young stage in my career
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  to to see you know, maybe there is
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  the impetus and enough momentum to,
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  to change things,
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  because clearly,
• 10:35
  you know, what's going on with health care
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  and and how payers work and how health
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  care is paid for is is clearly not
• 10:43
  working for
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  the very vast majority of people in our
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  country.
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  And patients
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  are starting to get an understanding of this,
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  and it's starting to,
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  surface in the political discussions
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  as we approach,
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  you know, an election cycle.
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  So, you know, very,
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  very,
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  focused on that and
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  grateful to have people lending a hand who
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  may not be, you know, physicians themselves, but
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  are business people who are familiar with what's
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  going on in health care. Because,
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  unfortunately, to this point, when, you know, doctors
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  have been doing it kinda on their own,
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  just haven't haven't been able to organize well
• 11:23
  enough or get the right audience
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  or
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  position things the right way at the right
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  time to get real change. And so,
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  you know, I think it's it's really time
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  for us to band together with with those
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  in the business world and the political world
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  to try to advance, you know, reform that's
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  clearly much needed and and obvious to everyone.
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  But often, the pathway to change in our
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  political
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  system is is not an obvious pathway.
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  Yeah. That's a really good point you make
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  about just getting,
• 11:55
  collaborating with people within and also without
• 11:58
  the medical world. And, you know, I was
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  wondering, doctor Hirsch, how are these different conversations,
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  how do you see them directly
• 12:06
  affecting
• 12:07
  spine care?
• 12:08
  Yeah. So anything that impacts access to care
• 12:12
  and health care is gonna have a direct
• 12:14
  impact on spine care. You know, Lobaqin is
• 12:17
  the most common reason that people seek medical
• 12:20
  care, and so it represents a large proportion
• 12:24
  of our overall health care economy as far
• 12:27
  as diagnoses are concerned.
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  And so any,
• 12:31
  reforms or changes that can make it,
• 12:34
  number one, easier for patients to afford their
• 12:37
  care,
• 12:38
  and number two,
• 12:40
  easier for physicians
• 12:42
  to provide the care be because of the
• 12:45
  economics or a reform of prior authorization
• 12:49
  is going to positively
• 12:51
  impact
• 12:52
  spine care.
• 12:53
  And that means, you know, things like,
• 12:56
  more reasonable contracted, you know, rates,
• 12:59
  things like we were just discussing,
• 13:01
  impacting regulation or or legislation around,
• 13:06
  telemedicine care to make sure that that's not
• 13:10
  something that has to get revisited every year
• 13:12
  to extend, you know, temporary
• 13:14
  coverage, but that it becomes a normal
• 13:17
  recognized way for for people to receive and
• 13:20
  people to provide health care.
• 13:22
  So, you know, those are both things. I
• 13:25
  I think that
• 13:26
  the
• 13:27
  tremendous growth of of premiums
• 13:31
  disproportionate to the amount of actual coverage,
• 13:35
  is something that probably is gonna need need
• 13:38
  to be regulated.
• 13:39
  Other areas that I think maybe are further
• 13:42
  away are things like,
• 13:45
  you know, repealing certificate of need laws and
• 13:48
  addressing
• 13:49
  the ban on physician ownership of hospitals.
• 13:52
  Those are those are two large priorities
• 13:55
  subjects
• 13:56
  that would
• 13:57
  really directly impact spine care.
• 14:00
  Much of, you know, spine care can be,
• 14:03
  you know, provide on an outpatient basis.
• 14:05
  Some some does require hospital,
• 14:08
  but the,
• 14:09
  kind of perverse economic incentive of the much
• 14:13
  higher facility fees,
• 14:15
  driving a lot of care
• 14:17
  to a hospital environment when it doesn't really
• 14:20
  need to be in that environment. You know,
• 14:22
  having
• 14:23
  a reform like site neutrality for payments
• 14:27
  would
• 14:28
  really allow true competition and allow us to
• 14:31
  reduce the cost of care because
• 14:34
  we're not just kinda shuffling
• 14:37
  the cards around, you know, as a health
• 14:39
  care provider to where are we gonna maximize
• 14:41
  reimbursement, but where is it the most efficient
• 14:45
  and cost effective
• 14:46
  location and and environment for care?
• 14:50
  Very well said, and I appreciate that overview
• 14:52
  of everything.
• 14:53
  And then doctor Hirsch, I was wondering, how
• 14:55
  are you thinking about growth in your own
• 14:57
  practice next year?
• 15:00
  Yeah. So I'm in a, you know, somewhat
• 15:02
  unique practice environment of of independent,
• 15:05
  private practice in a market in Southern California
• 15:08
  that has,
• 15:09
  a lot of spine surgeons, also has a
• 15:11
  lot of patients, but but is fairly saturated.
• 15:14
  And,
• 15:16
  so I'm always thinking about growth in patient
• 15:19
  volume,
• 15:20
  and growth in
• 15:22
  digital footprint.
• 15:24
  And so,
• 15:25
  you know, that will be a big part
• 15:26
  of what I focus on in in early
• 15:29
  twenty twenty six is growing,
• 15:32
  you know, my footprint online, you know, just
• 15:34
  like we were discussing,
• 15:36
  the growth of telemedicine.
• 15:39
  Along with that comes growth in how patients
• 15:42
  find physicians.
• 15:43
  And,
• 15:45
  these days, if if you're not visible,
• 15:48
  you know, online, it's almost as if your
• 15:50
  practice doesn't exist in real life, because that's
• 15:54
  just the reality of how,
• 15:57
  how people are searching for health care.
• 15:59
  So that, you know, that'll be a priority,
• 16:02
  you know, growing
• 16:03
  aspects of my practice that are somewhat
• 16:07
  specialty like spinal endoscopy,
• 16:10
  disc replacement,
• 16:11
  you know, are always gonna be,
• 16:13
  growth goals.
• 16:14
  And, you know, probably in 2026, I'll have
• 16:17
  more of an involvement in advocacy discussions,
• 16:22
  both at the society level and
• 16:24
  at
• 16:25
  the kind of more grassroots, just physician organization
• 16:28
  level
• 16:29
  because the election cycle toward the end of
• 16:31
  the year is probably
• 16:33
  gonna be pushing
• 16:34
  a lot of these
• 16:36
  potential reform items up to the front of
• 16:38
  the conversation. I I hope as long as,
• 16:41
  you know, some other scandal or topic doesn't
• 16:44
  distract public's attention from, you know, the important
• 16:48
  topics at hand.
• 16:50
  Got it. And and then my last question
• 16:52
  for you is, what do you think will
• 16:54
  be the biggest disruptor to spine surgery next
• 16:57
  year?
• 16:58
  Yeah. So I I I think disruption in
• 17:00
  spine surgery
• 17:01
  is tough to predict, number one, and usually
• 17:04
  takes
• 17:05
  a little more than a year. But I
• 17:07
  know that,
• 17:09
  the adoption
• 17:10
  of endoscopy and the ways that,
• 17:13
  surgeons are using it is rapidly
• 17:16
  progressing,
• 17:17
  and there's even more and more ability for
• 17:20
  surgeons to
• 17:21
  discuss cases
• 17:22
  with other surgeons in their local market. And
• 17:25
  because there are more people
• 17:27
  utilizing that technique
• 17:28
  in any given market, that allows for even
• 17:31
  more conversation,
• 17:33
  amongst surgeons. And so I have, you know,
• 17:35
  several surgeons just in my own market
• 17:38
  where I'll plan to
• 17:40
  go to observe their cases, and and they
• 17:44
  may or may not come to observe my
• 17:46
  cases. And that,
• 17:48
  I think is how we drive real progress
• 17:50
  and innovation and improvement in the
• 17:53
  surgical techniques that we offer.
• 17:55
  So that'll be a a major focus. And
• 17:57
  then, you know, on the
• 18:00
  digital media, you know, side of things,
• 18:03
  you know, at least for my practice,
• 18:05
  putting resources into that to really
• 18:09
  transform
• 18:10
  your
• 18:12
  your online presence.
• 18:13
  You know, I think that that I I
• 18:15
  anticipate that's going to bring
• 18:18
  significant,
• 18:19
  change in the practice volume and types of
• 18:22
  patients that are coming to see me.
• 18:25
  Well,
• 18:26
  doctor Hirsch, thank you so much for joining
• 18:29
  our podcast today. It was a pleasure to
• 18:31
  speak with you, and I look forward to
• 18:32
  connecting again down the line.
• 18:34
  Absolutely. Thank you very much, Carly, for having
• 18:36
  me. It was a pleasure.