Latest / Becker’s Healthcare Podcast / Leo Spector, MD, Orthopedic Spine Surgeon and CEO of OrthoCarolina

Transcript

Leo Spector, MD, Orthopedic Spine Surgeon and CEO of OrthoCarolina · Becker’s Healthcare Podcast

• 0:00
  Hi, everyone, and welcome to the Becker's Healthcare
• 0:03
  podcast.
• 0:04
  I am Sophie Ades,
• 0:06
  orthopedic reporter with Becker's Healthcare.
• 0:09
  Today, I'm very excited to be joined by
• 0:12
  doctor Leo Spector,
• 0:14
  CEO of OrthoCarolina
• 0:16
  and a practicing orthopedic
• 0:18
  spine surgeon.
• 0:20
  Doctor Spector has spent more than seventeen years,
• 0:24
  with OrthoCarolina
• 0:26
  serving in a range of leadership roles, including
• 0:28
  chief quality officer
• 0:30
  and executive committee member. He now leads one
• 0:33
  of the nation's largest independent orthopedic practices with
• 0:37
  a strategic focus
• 0:39
  on clinical excellence, value based care,
• 0:41
  innovation, and expanding access
• 0:44
  through ambulatory
• 0:46
  surgical centers.
• 0:47
  In addition to his leadership work, doctor Spector
• 0:50
  continues
• 0:51
  to care for patients and remains deeply involved
• 0:54
  in advancing spine care through research and professional
• 0:58
  societies.
• 0:59
  In this episode, we'll explore the key trends
• 1:02
  shaping
• 1:02
  musculoskeletal
• 1:04
  care today,
• 1:05
  how OrthoCarolina
• 1:06
  is responding, and doctor Spector's
• 1:09
  perspective on what it takes to lead through
• 1:11
  a rapidly evolving health care landscape.
• 1:15
  So to start off, I know I I
• 1:17
  started with a big intro there. But, doctor
• 1:19
  Spector, if you could just introduce yourself and
• 1:22
  and share a little bit about your current
• 1:24
  role, that would be great.
• 1:26
  Sure. Sure. Thanks, Sofia. I'm not sure I
• 1:28
  could do much better. That was that was
• 1:29
  a great intro.
• 1:31
  Yeah. So currently serve as the as the
• 1:34
  CEO of OrthoCarolina,
• 1:36
  into my third year now, in that role.
• 1:40
  And as you as you mentioned, I do
• 1:41
  continue to maintain a clinical practice, seeing patients
• 1:44
  one day a week and operating
• 1:46
  one day a week as well as as
• 1:47
  taking, call with my, spine colleagues. I've been
• 1:51
  with the organization now, getting on close to
• 1:53
  twenty years, actually, so that makes me feel
• 1:55
  even older than just 17.
• 1:57
  And, as you mentioned,
• 1:59
  have had various roles in the organization
• 2:01
  both from,
• 2:02
  physician leadership roles to administrative roles, including chief
• 2:06
  quality officer where I had the privilege of
• 2:08
  of overseeing our value based care team as
• 2:10
  we started developing our value based care program,
• 2:13
  you know, some fifteen years ago. And so
• 2:16
  it's really great to,
• 2:18
  see the culmination of all that work coming
• 2:20
  together and having the opportunity now to,
• 2:23
  you know, kinda
• 2:24
  be, at the helm here of of the
• 2:26
  ship. So
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  Yes. Yes. You have a very, very impressive
• 2:30
  background.
• 2:32
  So we're thrilled to have you and just
• 2:34
  talking through some of just the biggest
• 2:36
  trends you're you're sort of seeing today.
• 2:39
  So I guess my first question for you,
• 2:41
  if we're gonna dive right in, when you
• 2:43
  step back and look at the industry right
• 2:46
  now,
• 2:47
  what feels like the biggest
• 2:49
  shift happening in musculoskeletal
• 2:52
  care?
• 2:53
  Care? I think the biggest shift that's occurring
• 2:56
  in musculoskeletal
• 2:57
  care is the shift from,
• 3:01
  inpatient
• 3:02
  hospital based surgery
• 3:04
  to outpatient,
• 3:06
  ambulatory
• 3:06
  or office based surgery.
• 3:08
  I I think that's probably the biggest
• 3:11
  shift.
• 3:12
  Obviously, there's the adoption of robotics
• 3:15
  and and the introduction of AI as a
• 3:17
  tool
• 3:18
  in health care and and, you know, things
• 3:21
  like that. But I think truly shifts,
• 3:23
  I really look at that change because
• 3:26
  I'm old enough now to remember, you know,
• 3:28
  being a resident
• 3:30
  and admitting patients on the day of their
• 3:32
  hip or joint surgery and keeping them in
• 3:34
  the hospital for at least three days
• 3:37
  before they went off to rehab for, you
• 3:39
  know, weeks or up to a month.
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  And now
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  we're seeing my hip and knee colleagues do
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  those as same day procedures,
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  not just at the hospital, but now in
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  freestanding ambulatory
• 3:51
  surgery centers. You know, to me, that is
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  a tremendous
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  shift,
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  from how our our surgical technique is, how
• 4:00
  we deliver the care around that procedure,
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  culturally for the surgeon, for the patient expectations
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  of what their expectation is going in.
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  So I think that is just a monumental
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  shift. And at the end of the day,
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  I I think it's a great shift because
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  it's it's lowering the total cost of care.
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  And, you know, I I do think,
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  getting patients into an outpatient setting where they're,
• 4:24
  for the most part, when appropriate, which for
• 4:26
  most most patients it is,
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  you know, the hospital is filled with a
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  lot of sick people, and rightly so. You
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  know, that's that's that's an acute place.
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  You know, when you're having elective, auscule, skeletal,
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  orthopedic procedures, it's great to be in an
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  environment that's different than that. And an ASC
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  is an environment that is strictly focused on
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  outpatient
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  musculoskeletal
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  procedures or outpatient procedures. And so I think
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  that's a huge shift in the industry. I
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  think it's a great shift. I think it's
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  going to continue to lower the total cost
• 4:55
  of care. I think it's gonna continue to
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  improve outcomes,
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  which really is the the goal of all
• 5:00
  this.
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  Absolutely. And I think you hit the nail
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  on the head there.
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  You know, thinking about just the shift to
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  to outpatient care,
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  ASCs,
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  all that
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  exciting stuff, How are you thinking about positioning
• 5:16
  OrthoCarolina
• 5:17
  to sort of stay ahead
• 5:19
  of the curve? I know you guys are
• 5:20
  already, you know, pushing forward and
• 5:23
  have made a lot of great accomplishments thus
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  far, but I'm just curious about, you know,
• 5:29
  yeah, how you're how you're gonna continue staying
• 5:31
  ahead.
• 5:33
  Yeah. Yeah. And and I don't know if
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  we're always, you know, ahead per se. You
• 5:36
  know? We're but we certainly wanna keep up.
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  You know, you wanna be careful. You don't
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  wanna get too far ahead, you know, of
• 5:41
  the way that you want crashing on your
• 5:43
  head. Right?
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  But, you know, I think each each practice,
• 5:46
  each geography, each state are are are unique.
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  A lot of it from ASC perspective does
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  depend on whether it's a certificate of need
• 5:54
  state or not. North Carolina traditionally has been
• 5:57
  a certificate of need state. And for those
• 5:59
  that that don't, you know, know or understand
• 6:01
  what that is, it means that that resource
• 6:02
  is is controlled by the state. And in
• 6:05
  the past, it meant that if we're gonna
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  open up an ambulatory surgery center, it needed
• 6:08
  to be in a joint venture partnership with
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  a hospital.
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  North Carolina
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  has gone through CON reform. And as of
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  late last year, you know, essentially the beginning
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  of this year,
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  CON has been reformed, gotten gotten rid of
• 6:22
  in North Carolina for ambulatory surgery centers. So
• 6:25
  that creates an opportunity for us to kinda
• 6:27
  rethink our ASD strategy.
• 6:29
  Our ASC strategy in the past has always
• 6:31
  had to be a joint venture of the
• 6:33
  hospital system,
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  and or one of the, you know, large,
• 6:37
  management companies.
• 6:39
  This gives us the ability to rethink that.
• 6:40
  You know? And doesn't mean that we don't
• 6:43
  wanna continue joint venturing with good hospital partners
• 6:46
  or with with good management companies,
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  but it does
• 6:50
  really change
• 6:52
  the dynamic of what are those partners bringing
• 6:54
  a value to that relationship.
• 6:56
  In the past, what they were bringing was
• 6:58
  the COM because we couldn't get that. We
• 7:00
  were bringing the surgery
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  and the patients, and the management company was
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  bringing that expertise. And so I think in
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  the past, that kind of relationship between the
• 7:10
  the medical practice, North Carolina,
• 7:11
  the hospital partner, and the management company made
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  sense.
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  Post CON,
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  we now have two ASCs that we wholly
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  own,
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  and we manage ourselves.
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  And so we can do all three of
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  those things. Now the question in the future
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  as we go to scale that is, should
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  we do that on our own,
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  or should we look for partnerships? But it
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  changes the nature of that partnership.
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  And so for me, when I look at
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  that partnership on go forward basis, I have
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  to look at first and foremost and say,
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  how is that partnership gonna benefit our patients?
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  Right? Number one. How is it gonna benefit
• 7:45
  our teammates that are working at that surgery
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  center? And then how is it gonna benefit
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  the practitioners?
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  So it just it's just changing that. And
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  so for us,
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  strategically, we're looking at growing our ambulatory surgery
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  center footprint.
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  We want them to be single specialty orthopedic
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  centers because that's what we know that's what
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  we do.
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  And we're reevaluating the relationships, the existing ones
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  we have, and on a go forward basis,
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  you know, how that will look.
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  Mhmm.
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  Yes. And I love that you mentioned the
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  part
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  patient first. Right? Because I think that there's
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  so,
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  you know, much
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  business,
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  you know, around health care right now, and
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  I think that things get very complicated. And
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  sometimes, you know, the patients can get sort
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  of lost in the mix of that.
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  So I appreciate, you know, you bringing that
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  up first,
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  especially when looking at your partnerships because that's
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  huge.
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  We were talking about this a little bit
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  earlier,
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  in our chat before, but
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  when you think about value in orthopedic care
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  today,
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  can you explain a little bit just for
• 8:54
  you what that actually means in practice?
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  Sure. You know, I think people talk about
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  value based care, and in some ways, you
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  know, it may be an an an overused
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  term. People talk about the value equation,
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  you know, being,
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  you know, related to the the cost and
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  the outcomes. And and, obviously,
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  you know, you wanna lower that cost and
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  and improve the outcome.
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  At the end of the day, you know,
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  for me, when you think about, you know,
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  value care, it it really should start with
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  what's valuable to the
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  patient. Right? Because, you know, you hate to
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  say it, but
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  you are a consumer of a good. Right?
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  You are patient. You need care. You're you're
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  consuming a resource consuming good. So what's valuable,
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  you know, to Sophie when she goes to
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  get care? And,
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  obviously, it's gonna be very individual. But I
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  think the things that that really
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  resonate are, you know, access.
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  Patients and people don't wanna be seen just
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  from nine to 3PM. You know? People want
• 9:58
  to be seen, you know, eight to eight.
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  They wanna be able to see seven days
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  a week.
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  They want the ability to make appointments online.
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  They want the ability to get some virtual
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  care. Right? So I think I think access
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  is a big part of that value.
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  Obviously, we know the cost of of care
• 10:14
  in United States continues to rise. It's expensive.
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  It it creates a tremendous financial burden, and
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  so we look at ways that we can
• 10:23
  lower that cost of care. And so how
• 10:25
  can we lower the cost of care?
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  But when you lower the cost of care,
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  like you and I were talking about earlier,
• 10:30
  Sophie, less expensive doesn't mean less better. Right?
• 10:33
  Less expensive can actually be a better product.
• 10:36
  And that's the key because while you're lowering
• 10:38
  the cost of care, you need to be
• 10:39
  improving the outcomes.
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  Because, ultimately,
• 10:43
  if you don't improve the outcomes, then it
• 10:45
  ends up costing society and and that that
• 10:47
  individual more. And so to me,
• 10:51
  value based care is all about expanding access,
• 10:54
  finding ways that we can lower the cost,
• 10:57
  having repeatable and reproducible and better outcomes that
• 11:00
  benefit our our patients. And that may be,
• 11:03
  you know, a young athlete getting back on
• 11:05
  the playing field. It may be, you know,
• 11:07
  a grandparent being able to, you know, bend
• 11:10
  down and and play with their grandkids.
• 11:12
  You know, it it just may be, you
• 11:14
  know, you and I get back to work
• 11:15
  or or whatever it may be. And so
• 11:17
  for everybody, that's that's different. And so you
• 11:19
  do have to also figure out what's what's
• 11:21
  important to the patient because like we're talking
• 11:23
  before, right, the patient is at the center
• 11:25
  of this whole journey. We we forget that
• 11:27
  sometimes in in health care. Yes. Like you
• 11:29
  said, it's a big business. We have to
• 11:30
  remember it's a business
• 11:32
  about caring for people.
• 11:34
  Right. And that you kinda led me to
• 11:36
  my follow-up question there was, what does, you
• 11:39
  know, value look like to
• 11:41
  a patient on a real episode of care?
• 11:44
  Where are you actually,
• 11:45
  you know, lowering costs or improving outcomes?
• 11:50
  Yeah. And I think there there are a
• 11:51
  number of ways that we do that. You
• 11:54
  know, one way and and one relationship that
• 11:56
  we spoke about a little bit earlier is
• 11:58
  in the direct to employer space. Right? And
• 12:00
  so just one specific example
• 12:02
  is our relationship with the North Carolina State
• 12:05
  Health Plan through,
• 12:07
  Lambton, who's a direct to employer. And so
• 12:09
  in that value based relationship, we have been
• 12:11
  able to offer bundle payments for not just
• 12:14
  total hips and total knees, but all orthopedic,
• 12:18
  procedures.
• 12:19
  And for for a patient, what that means
• 12:22
  is they're getting access to high quality physicians
• 12:25
  that have been vetted,
• 12:27
  with good outcomes, and it's a zero out
• 12:29
  of pocket. And nowadays, deductibles, you know, are
• 12:33
  are they earn thousands of dollars often. Right?
• 12:36
  So, you know, it's very expensive,
• 12:38
  to get care
• 12:39
  just directly out of pocket, let alone, you
• 12:41
  know, your your monthly
• 12:43
  premiums that you're paying. And so that's a
• 12:45
  very specific, you know, way that that we're
• 12:47
  doing value.
• 12:48
  Other ways are, you know, our hand partners
• 12:51
  are really pioneer in our office based,
• 12:55
  surgeries. You know, they're
• 12:57
  taking carpal tunnel surgeries, which used to be
• 12:59
  done in the hospital, which would, you know,
• 13:01
  obviously have a pretty significant facility fee associated.
• 13:04
  They've moved it to the ambulatory surgery center,
• 13:07
  which, again, a lower cost facility, but still
• 13:09
  had a facility fee. They're now doing it
• 13:11
  in our office,
• 13:12
  which has no facility fee.
• 13:15
  So they've they've tremendously lowered the cost of
• 13:17
  that procedure, which lowers the cost directly,
• 13:21
  for that patient. And for the patient, the
• 13:22
  experience is great. They walk into the office
• 13:24
  like they're being seen. They have the procedure
• 13:26
  done. They walk out. You know, there's no
• 13:28
  registering, you know, with with the hospital and
• 13:30
  going through all that rigmarole
• 13:32
  or even at the surgery center. So, again,
• 13:34
  I think, you know, it depends a little
• 13:35
  bit on on the patient, but I think
• 13:37
  Yeah. What most patient want is they want
• 13:40
  lower cost,
• 13:41
  repeatable outcomes, and that are convenient.
• 13:44
  And so a lot of different ways that
• 13:45
  we're doing that.
• 13:47
  Absolutely.
• 13:49
  Yeah. Thank you for for sharing all that,
• 13:52
  and, you gave those concrete examples, which I
• 13:55
  appreciate very much,
• 13:58
  and I think our audience will too.
• 14:01
  But,
• 14:02
  you know, the next thing I wanted to
• 14:04
  ask you is just as you're looking a
• 14:06
  few years out,
• 14:08
  what do you think will really separate the
• 14:11
  groups that win,
• 14:14
  from the ones that fall behind?
• 14:17
  Yeah. I mean, it's a challenging time in
• 14:18
  health care. I suppose it's always a challenging
• 14:21
  time in health care. Right?
• 14:23
  You know, reimbursement
• 14:25
  does continue to decline, you know, on on
• 14:27
  a on a per procedure or or per
• 14:31
  care basis. You know, the cost of delivering
• 14:33
  care continues to rise. So it is a
• 14:35
  it is a challenging industry. Again, it's it's
• 14:37
  a large industry. It consumes a lot of
• 14:39
  dollars. So,
• 14:40
  but it is it is challenging as a
• 14:42
  business owner.
• 14:44
  You know, I think those that are gonna
• 14:45
  be successful,
• 14:47
  I think you need economies of scale.
• 14:50
  I think you need to deliver a a
• 14:53
  superior product to the market, so to speak.
• 14:56
  And so, again, that's why at OrthoCarolina,
• 14:58
  we're focused on value, which we've just talked
• 15:01
  a lot about, about access, about making sure
• 15:03
  we can meet our our patients where they
• 15:05
  are,
• 15:06
  and caring for that whole community because you
• 15:08
  you need to be caring for the the
• 15:10
  whole community.
• 15:12
  I think we have got to be cognizant
• 15:14
  of of technology and changes. So whether it's
• 15:16
  like you talked about the big shifts from
• 15:18
  the hospital to the ASC, if that's the
• 15:20
  shift, then then we've gotta be certainly riding
• 15:23
  that that wave, if not trying to get
• 15:25
  a little bit on the front side of
• 15:26
  it. You know, AI is an incredible tool
• 15:30
  that is affecting and changing how all of
• 15:32
  us, you know, do things. And so we
• 15:34
  have to look at that and look at
• 15:35
  that sensibly.
• 15:37
  As my IT
• 15:39
  head of IT reminds me, AI is not
• 15:41
  a strategy.
• 15:42
  It is simply a tool to help enable
• 15:44
  us to succeed.
• 15:46
  But but, again, it is a tool, and
• 15:48
  you've got to adopt those tools. Right? So
• 15:50
  just as new technologies come, you have to
• 15:52
  be willing to adopt it. And that means
• 15:54
  if you're gonna adopt the technology, you gotta
• 15:56
  make sure you're training people to be able
• 15:58
  to use it. Right? So if we're not
• 16:00
  if we're not hiring teammates and educating teammates
• 16:03
  to use a tool again, if we're gonna
• 16:05
  stay with AI, which is one of many
• 16:07
  tools,
• 16:08
  then if they can't use that, then then
• 16:10
  they're not gonna be successful. We won't be
• 16:12
  successful as an organization.
• 16:15
  I think the biggest thing probably at at
• 16:17
  the end of the day is that
• 16:19
  people, companies,
• 16:21
  North Carolina have to realize that what got
• 16:24
  us here may not get us there, that
• 16:26
  old saying.
• 16:27
  And just because we've been successful
• 16:30
  doesn't mean that if we continue to do
• 16:32
  the same old, same old, we're gonna be
• 16:33
  successful in the future. And that's tough. It's
• 16:36
  hard to convince people of change, especially
• 16:40
  physicians, especially surgeons. They don't like change.
• 16:43
  They like to do the same thing, same
• 16:45
  way every time, which is good if you're
• 16:46
  having surgery performed on you. You want that
• 16:48
  kinda
• 16:49
  repeatable. But if you're running a business, you
• 16:51
  have to have a willingness to change and
• 16:52
  adapt. And sometimes the hardest time to change
• 16:54
  and adapt is when you're doing well because
• 16:56
  it feels kinda comfortable.
• 16:57
  But if you realize that things are changing,
• 17:00
  you've gotta change with it. So I think
• 17:02
  folks that are willing to do those things
• 17:03
  will be successful. I think folks that dig
• 17:06
  in and are unwilling to change,
• 17:07
  unwilling to adopt new tools and technologies,
• 17:11
  those that figure that what made them successful
• 17:13
  will continue on, make them successful.
• 17:15
  I think those folks, you know, unfortunately, will
• 17:18
  not. I always try
• 17:20
  to remind my partners of the fun story
• 17:21
  of Blockbuster and and Netflix
• 17:24
  and how that ultimately
• 17:26
  worked out at the end because I think,
• 17:27
  you know, it's the irony of all ironies,
• 17:30
  right, that
• 17:31
  Netflix went to Blockbuster and said, hey. You
• 17:33
  know, please invest in us. Blockbuster said, heck
• 17:35
  no. And now Netflix has a documentary on
• 17:38
  the very last Blockbuster still open. Right? I
• 17:40
  mean, it's a total
• 17:42
  role reversal because, you know, one company saw
• 17:44
  the future. Another company, which was incumbent, had
• 17:47
  the opportunity to change but chose not to,
• 17:49
  and it it didn't work out too well
• 17:50
  for them.
• 17:52
  What a great analogy that was. I mean,
• 17:56
  that was epic in my opinion.
• 18:00
  It was but it's a great way to
• 18:01
  explain it. I mean, it's just I think
• 18:03
  the key theme here is you just have
• 18:05
  to keep
• 18:06
  evolving. Right?
• 18:08
  Keep evolving with the new technologies,
• 18:10
  like you said, with AI
• 18:12
  huge right now. Right? Continuing to sort of
• 18:15
  use that as as a tool and integrating
• 18:18
  it into your practice.
• 18:19
  Not letting it replace you because it can't
• 18:22
  replace you if you integrate it.
• 18:25
  But, yeah, so great great points there, doctor
• 18:29
  Spector.
• 18:30
  Thank you so much.
• 18:32
  That is about all the questions I had
• 18:34
  for,
• 18:35
  this session. Is there anything else we didn't
• 18:39
  touch on? You wanted to make sure we
• 18:41
  did it at all?
• 18:43
  No. I think I think we had all
• 18:45
  the main messages, you know, like we talked
• 18:46
  about. I mean, at the end of the
• 18:47
  day, this is about caring for patients. You
• 18:49
  know, patients need to be the center of
• 18:52
  everything we do. And and, you know, our
• 18:54
  our strategy is is very simple, provide value
• 18:56
  to those patients, provide them access, and care
• 18:59
  for all of them in this community. And
• 19:00
  so we've been dedicated to that for twenty
• 19:02
  years. We're gonna continue to be dedicated to
• 19:04
  that. How we deliver that, obviously, is gonna
• 19:07
  have to adopt
• 19:08
  with the times and change.
• 19:11
  You know, I think health care is is
• 19:12
  a is a tough
• 19:14
  tough field, but it's a worthwhile field. And
• 19:16
  I think the future of health care is
• 19:18
  still exciting,
• 19:19
  despite the challenges that we do face today.
• 19:22
  Absolutely.
• 19:23
  Well, doctor Spector, thank you so much. This
• 19:26
  has been such a great conversation, and thank
• 19:28
  you for sharing your perspective and the work
• 19:31
  you're leading at OrthoCarolina.
• 19:34
  That is all for today's episode of Becker's
• 19:37
  Healthcare
• 19:38
  podcast. A big thank you to doctor Leo
• 19:40
  Spector
• 19:41
  for joining us and sharing his insights on
• 19:43
  the future
• 19:44
  of MSK care,
• 19:46
  value based innovation,
• 19:48
  and physician leadership.
• 19:50
  Thanks for listening, everyone, and we'll see you
• 19:53
  next time.