Latest / Becker’s Healthcare Podcast / Reducing Waste and Improving Musculoskeletal Care with Dr. Steve Schutzer

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Reducing Waste and Improving Musculoskeletal Care with Dr. Steve Schutzer · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where they go to
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  - pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
• 0:47
  - and click on the events tab in the
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  - upper right.
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  - This is Scott Becker with the Beckers Health
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  - Care Podcast.
• 0:54
  - We're thrilled today to be joined by a
• 0:56
  - brilliant
• 0:57
  - physician, orthopedic surgeon who's also an entrepreneur.
• 1:01
  - We're joined today by doctor Steven Schutzer.
• 1:04
  - Doctor Schutzer is a University of Virginia graduate.
• 1:06
  - He's the cofounder
• 1:08
  - of Upswing Health,
• 1:10
  - in the orthopedic
• 1:11
  - MSK space,
• 1:13
  - with doctor Jay Kimmel,
• 1:15
  - two brilliant physicians that happen to be really
• 1:17
  - good people.
• 1:19
  - Doctor Schuster, can you take a moment before
• 1:21
  - we get started just to introduce yourself,
• 1:24
  - tell us about your background,
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  - and then we'll talk about sort of musculoskeletal
• 1:28
  - care and what you're seeing and also what
• 1:30
  - you folks do with Upswing Health.
• 1:32
  - Yeah. Thank you very much, Scott. It... It's
• 1:34
  - a pleasure to join you this morning. And
• 1:36
  - quite honestly, your introduction was better than I
• 1:38
  - can do. So thank you very much. I
• 1:40
  - am an orthopedic surgeon. And for thirty six
• 1:42
  - years,
• 1:44
  - my focus was on joint replacement surgery. And,
• 1:47
  - for about twenty... Sixteen years, I was the
• 1:50
  - physician executive overseeing a very large orthopedic,
• 1:53
  - service line, which included sports and joints and
• 1:57
  - spine
• 1:58
  - and trauma.
• 1:59
  - But then my my dear friend and colleague
• 2:02
  - and cofounder, Jay Kim, and I realized that
• 2:04
  - while we had, I wanna say solved, but
• 2:07
  - substantially
• 2:08
  - improved the surgical aspect of orthopedics,
• 2:11
  - We came to realize, Scott, that
• 2:13
  - we had seen over the extent of our
• 2:15
  - career so many patients
• 2:17
  - start their MSK, their orthopedic journey,
• 2:20
  - on the wrong foot,
• 2:22
  - with the wrong resources, leading to the wrong
• 2:24
  - outcomes and waste
• 2:26
  - and so forth. And we set out to
• 2:27
  - build a company quite honestly to give everybody
• 2:30
  - Steve and Jay in their back pocket. I
• 2:32
  - mean, that's not a snapshot what our intent
• 2:34
  - was.
• 2:35
  - And let's talk a little bit about musculoskeletal
• 2:38
  - care today.
• 2:40
  - But right now, where are employers
• 2:43
  - overspending
• 2:44
  - on musculoskeletal
• 2:45
  - care,
• 2:46
  - and where is your unnecessary
• 2:48
  - unnecessary
• 2:49
  - utilization driving cost?
• 2:52
  - And then let's talk back to, like, sort
• 2:54
  - of talk about patients getting started in the
• 2:56
  - wrong foot.
• 2:57
  - Give us an example of that as well.
• 2:59
  - I'd I'd love to hear a little bit
• 3:01
  - of that from where you and doctor Kimball
• 3:03
  - came from in this
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  - with so many patients going in multiple different
• 3:07
  - wrong directions before they get what they really
• 3:08
  - need. Yeah. No. That's
• 3:10
  - that's that's really a crux of the issue.
• 3:12
  - Yeah. In in terms of what employers are
• 3:14
  - overspending,
• 3:15
  - we did a two year study here. We've
• 3:17
  - been managing the state of Connecticut health plans,
• 3:20
  - MSK,
• 3:21
  - for probably four or five years now. So
• 3:22
  - we did a two year study. And, Scott,
• 3:24
  - in every category of MSK spend,
• 3:28
  - imaging,
• 3:28
  - ER visits,
• 3:30
  - cortisone injections, surgeries,
• 3:32
  - physical therapy, in every category of spend, we
• 3:35
  - found employer... Our employer, this particular client was
• 3:38
  - was overspending.
• 3:40
  - And we looked in the aggregate. We reduced
• 3:42
  - that utilization
• 3:43
  - by, by 38%.
• 3:46
  - And and it's not rocket science, Scott. And
• 3:48
  - and regardless if it's we're talking about the
• 3:51
  - orthopedic service line or cardiometabolic, whatever it may
• 3:53
  - be, it's about getting the patient. You know,
• 3:56
  - we call them members. We call them patients
• 3:58
  - to the right resource, like, when they need
• 4:01
  - it and get them on the right track
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  - and and navigate them through this morass that
• 4:06
  - we call health care on the most efficient
• 4:08
  - pathway. Because if not, you get
• 4:11
  - these... Not just the waste, and we talk
• 4:13
  - about the 40%
• 4:15
  - waste. And when you talk about
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  - unnecessary surgery, I I think it's a little
• 4:19
  - disrespectful
• 4:20
  - to say just a wasted,
• 4:22
  - spinal surgery. This is somebody's life. I'll tell
• 4:25
  - you a a quick case of mine. It
• 4:28
  - was particularly egregious. This is a gentleman. He's
• 4:30
  - a construction worker.
• 4:32
  - Scott, I took care of him thirty years
• 4:34
  - ago when he fell off a scaffold, and
• 4:35
  - I was doing trauma.
• 4:37
  - And he went to his primary care physician.
• 4:38
  - Again, it's not pointing fingers. It's just a
• 4:41
  - system problem. But he went to his PCP
• 4:43
  - complaining of pain in both of his thighs.
• 4:46
  - PCP said, have you had any,
• 4:49
  - back pain? He's been doing construction work for
• 4:52
  - forty years. The answer was yes, and the
• 4:54
  - thought was it sounds like a spinal problem.
• 4:57
  - So he got an MRI of his spine
• 4:59
  - and, of course, he had something called spinal
• 5:01
  - stenosis and was referred to a neurosurgeon. Long
• 5:04
  - story short, ended up having
• 5:06
  - a massive front and back
• 5:08
  - spine procedure. It's called the three sixty.
• 5:10
  - Had some complications, a bowel
• 5:13
  - up complication, a colostomy, all those horrible things.
• 5:16
  - And all that was tragic. Right? Stop loss
• 5:18
  - claim.
• 5:19
  - But the real travesty, Scott, is when I
• 5:21
  - saw him three months after this procedure,
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  - he no sooner walked into my office, and
• 5:26
  - I knew his problem had nothing to do
• 5:27
  - with his spine. Both of his hips were
• 5:29
  - shut, Scott. He needed bilateral hip arthroplasty and
• 5:33
  - never needed the spine procedure
• 5:35
  - at the first place. So that's just a
• 5:36
  - particularly
• 5:37
  - egregious of many, many, many cases like this.
• 5:40
  - Patients having the wrong procedure,
• 5:43
  - hernia repairs, spine procedures,
• 5:45
  - and so forth just because they got off
• 5:47
  - on the wrong pathway from the start.
• 5:50
  - Thank you. So much of that actually
• 5:53
  - where you see... I know my mother at
• 5:54
  - one point had a knee surgery, and it
• 5:56
  - turned out she really needed a hip surgery.
• 5:59
  - And so I ended up going back, you
• 6:00
  - know, to the same institution, and they did
• 6:02
  - a great job. And she probably could've used
• 6:03
  - the knee surgery, the knee replacement anyways, but
• 6:06
  - it turned out that the real problem was
• 6:07
  - in her hip. And so they went back
• 6:09
  - and did a hip replacement, and it seems
• 6:11
  - fairly common.
• 6:12
  - Talk a little bit about
• 6:14
  - where are employers overspending on m s a...
• 6:17
  - MSK card, musculoskeletal
• 6:19
  - care. I can't even say MSK, but musculoskeletal.
• 6:22
  - And
• 6:23
  - why is virtual care... And I I get
• 6:25
  - this, but why is virtual care have its
• 6:27
  - limitations? Talk a little bit about those two
• 6:29
  - things. Yeah. So, you know, listen. I had
• 6:31
  - a great career, wonderful career, doing surgery. I
• 6:35
  - loved every patient I operate on.
• 6:37
  - But in reality,
• 6:38
  - orthopedics is largely nonsurgical.
• 6:41
  - Most people with orthopedic conditions, and that, by
• 6:44
  - the way, is half of Americans each year
• 6:47
  - will have some sort of an orthopedic ache
• 6:49
  - or a pain, but most of them are
• 6:51
  - what we call itises and apathies,
• 6:54
  - tendinitis or tendinopathies.
• 6:55
  - Or, you know, I rolled my ankle playing,
• 6:58
  - you know, some soccer this weekend. It's a
• 7:00
  - little puffy. Should I go to the ER?
• 7:02
  - Or I lifted up my grandson who gained
• 7:04
  - a little bit of weight. My back went
• 7:06
  - out or my computer working eight hours a
• 7:08
  - day, my elbow hurt. All of that stuff
• 7:11
  - consumes
• 7:12
  - an enormous piece of a,
• 7:14
  - of a health care spend.
• 7:16
  - And and, again, it comes down to what
• 7:19
  - do you do and, and what... What's the
• 7:22
  - most efficient pathway? And that's
• 7:24
  - what we felt we built. So here we
• 7:26
  - are, two senior orthopedic surgeons seven years ago
• 7:29
  - who said to... And this is before JED
• 7:30
  - or the AI, Scott. We said, we should
• 7:33
  - be able to resolve
• 7:34
  - low acuity MSK with technology.
• 7:37
  - Not everything. And we built our own diagnostic
• 7:40
  - tool, we call it a symptom assessment tool,
• 7:43
  - to answer, and we built
• 7:45
  - it with our 10 subspecialty orthopedic geniuses. And...
• 7:48
  - But we use decision tree logic, which is
• 7:51
  - how physicians think.
• 7:53
  - And we... The member points to where it
• 7:55
  - hurts and ask some ask some questions, and
• 7:58
  - it comes up with a differential
• 8:00
  - list of potential conditions. And you know what?
• 8:02
  - About fifteen percent of our patients, that's all
• 8:05
  - they wanna know. It isn't broken because I
• 8:07
  - can jump up and down on it. I
• 8:08
  - don't need to go to the ER and
• 8:10
  - spend $2,500.
• 8:12
  - And and so we have that as a
• 8:13
  - tool. But we're not a technology company. We're
• 8:15
  - a health care company. And this was Jay's
• 8:18
  - great idea because we we debated who should
• 8:20
  - be the frontline
• 8:22
  - caregiver
• 8:23
  - of Upswing Health. I cost $10 a minute.
• 8:26
  - I'm a senior orthopedic surgeon. Ridiculously expensive.
• 8:30
  - And we went down the lineage of potential
• 8:32
  - caregivers
• 8:33
  - in MSK and Orthopedics. And Jay, having spent
• 8:36
  - his career as a sports
• 8:37
  - surgeon, said, why don't we bring in a
• 8:39
  - national... Or build a national cadre
• 8:42
  - of athletic trainers?
• 8:44
  - And that's what we've done, Scott. And the
• 8:46
  - beautiful thing is our ATs
• 8:48
  - are available within fifteen minutes. That magic time
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  - when people are thinking,
• 8:53
  - maybe I need to go to urgent care
• 8:54
  - or go to the ER, they're available within
• 8:57
  - fifteen minutes,
• 8:58
  - twelve hours a day, seven days a week.
• 9:00
  - And they do that... This is what they're
• 9:02
  - trained to do, Scott. They do that triage
• 9:04
  - and manage
• 9:05
  - what they can manage
• 9:07
  - and escalate what they can't manage to our
• 9:10
  - national network of orthopedic
• 9:12
  - physicians. So that's the three legged stool, technology,
• 9:15
  - athletic trainers, and orthopedic docs.
• 9:18
  - Frank, I'm gonna ask you one question. I
• 9:20
  - gotta make sure you're ready for this question.
• 9:22
  - Yeah.
• 9:23
  - Is your chief operating officer
• 9:26
  - as talented as you would expect him to
• 9:28
  - be?
• 9:30
  - Yes.
• 9:31
  - And is that still a Michael Schuster?
• 9:34
  - Yes. Yes. Okay. He is... He's done a
• 9:36
  - fabulous job. Yes.
• 9:38
  - That's the most important question of the day.
• 9:41
  - Yeah.
• 9:42
  - Well, yeah, you know, I wanna come back
• 9:43
  - to... I I didn't answer your last question.
• 9:45
  - I was off on a tangent here, but
• 9:46
  - what are the limits of virtual MSK? And
• 9:49
  - let me address that two ways. It's not
• 9:51
  - as limited as you think. I mean, we
• 9:53
  - learned in medical school two hundred years ago
• 9:55
  - that eighty percent of a diagnosis
• 9:58
  - is taking a good history. We have largely,
• 10:01
  - or many of us, because of the time
• 10:03
  - constraints, forgotten that. We say, hey. Let's get
• 10:06
  - an MRI scan. Right? But when you're doing
• 10:08
  - a telehealth visit, Scott, if I were to
• 10:10
  - see you for a problem, we'd spend thirty
• 10:13
  - minutes on that call. I would know without
• 10:15
  - an X-ray or an MRI
• 10:17
  - most likely what your problem is. Right? So
• 10:19
  - we avoid that initial tendency to to go
• 10:22
  - for, advanced imaging, but we do have limits.
• 10:26
  - Obviously, some of these, Scott, are self selecting.
• 10:29
  - Long bone fractures,
• 10:31
  - open wounds, concussions,
• 10:33
  - they kinda self select. Right? And they go
• 10:35
  - right to an emergency room environment.
• 10:38
  - But other than that, even orthopedic problems
• 10:41
  - that do need surgery. And I wanna make
• 10:43
  - it clear to your listeners, there are patients
• 10:45
  - that don't need physical therapy, don't need injections.
• 10:48
  - They need repair.
• 10:49
  - So if we get somebody who was playing
• 10:52
  - basketball, goes for a layup, and feels a
• 10:54
  - pop in their heel, we're gonna talk to
• 10:56
  - them because they most likely have an Achilles
• 10:59
  - tendon tear, and we will get them an
• 11:01
  - orthopedic
• 11:02
  - surgeon within forty eight hours. Don't want to
• 11:04
  - go to the ER. Don't want to go
• 11:05
  - to urgent care and get sent to see
• 11:07
  - an orthopedic surgeon. Maybe you can get in
• 11:09
  - and maybe you can't. So even those who
• 11:12
  - do need surgery,
• 11:13
  - we can then accelerate that intervention appropriately.
• 11:17
  - Thank you. And talk about when an employee
• 11:20
  - truly needs specialty care. When when they get
• 11:23
  - to that spot, you call it the 15%
• 11:25
  - problem when they actually need to have specialty
• 11:27
  - care or subspecialty care.
• 11:30
  - Yeah. Yeah. And so in in our book
• 11:32
  - of business, 18 of the
• 11:34
  - patients' members escalate out of Upswing. At that
• 11:37
  - point, Scott, we actually become a navigation company
• 11:40
  - because what we don't do... And we are...
• 11:42
  - Yeah. We're physicians first, Scott. What we don't
• 11:44
  - do is say, hey,
• 11:46
  - mister Becker, looks like you've got a torn
• 11:48
  - rotator cuff. Talk to your primary care doc
• 11:51
  - and get a referral. No.
• 11:53
  - There are two options at that point. Some
• 11:54
  - of our clients, like the state of Connecticut
• 11:57
  - and some others, have their own networks that
• 11:59
  - they have built. Their centers of excellence, their
• 12:01
  - preferred providers.
• 12:03
  - We then do a warm handoff
• 12:05
  - to their navigators. Alright? But many of our
• 12:08
  - clients in a smaller market don't.
• 12:10
  - So we spent quite a bit of time
• 12:13
  - building relationships
• 12:15
  - with two extremely good downstream
• 12:18
  - surgical groups. One is called the Ortho Value
• 12:21
  - Network. It's a spin off of the Ortho
• 12:23
  - Forum. These are my national orthopedic colleagues. And
• 12:26
  - the other one is a group called HealthMe.
• 12:28
  - And with both of those companies,
• 12:31
  - we now have an integration
• 12:33
  - where my patient care coordinator navigator can go
• 12:35
  - on to
• 12:37
  - their platform, put in the diagnosis, put in
• 12:39
  - the region,
• 12:41
  - and we will then get an expedited appointment
• 12:43
  - with a shoulder surgeon in Duluth, Minnesota
• 12:46
  - or New Mexico, wherever that may be, and
• 12:49
  - do that warm handoff. Now I mentioned eighteen
• 12:52
  - percent. Maybe fifteen percent need surgery. What about
• 12:55
  - the other three percent? There is a role,
• 12:58
  - albeit in our view, a small role for
• 13:00
  - regenerative medicine.
• 13:02
  - And we're absolutely
• 13:03
  - on board with with referrals to regen... We
• 13:06
  - have a a a a vendor partner of
• 13:08
  - ours that does regenerative medicine, but not everybody
• 13:11
  - with a sore back obviously needs stem cells
• 13:14
  - or PRP. So bottom line, answer your question,
• 13:16
  - is we then take it upon ourselves as
• 13:19
  - physicians
• 13:20
  - to manage the care through the full spectrum,
• 13:23
  - including those downstream referrals. And all we ask,
• 13:26
  - as you probably know, Scott, there are laws
• 13:28
  - against,
• 13:29
  - sharing, referral fees. All we ask for that
• 13:32
  - referral
• 13:33
  - is an expedited appointment and to know the
• 13:35
  - clinical outcome of that intervention.
• 13:39
  - Fantastic. And and talk about some of the...
• 13:41
  - One of the things that
• 13:43
  - front and center and moving quickly in some
• 13:45
  - areas, not in other areas,
• 13:47
  - is what I think of as price transparency
• 13:50
  - and consumerism.
• 13:52
  - Any thoughts there on what's evolving with price
• 13:54
  - transparency?
• 13:55
  - Where does it matter in
• 13:58
  - musculoskeletal
• 13:58
  - care? Where does it not,
• 14:01
  - and and consumerism?
• 14:02
  - Oh, man. Scott, we can go on for
• 14:04
  - two hours. That... You know, of all of
• 14:06
  - the bright spots that are fueling
• 14:09
  - the the transformation... And there are a bunch.
• 14:11
  - We can, again, we can talk about that
• 14:12
  - forever.
• 14:13
  - But the fundamental
• 14:16
  - bright spot is transparency.
• 14:17
  - It's really interesting that there's actually
• 14:20
  - two things that both political parties agree upon,
• 14:24
  - Internet scam and price transparency in health care.
• 14:27
  - Right? That's that's the attention it's gotten at
• 14:30
  - the national level.
• 14:32
  - Why is trans... Transparent... First of all, Scott,
• 14:35
  - when you go to buy a toaster oven,
• 14:37
  - you you know exactly what you're gonna buy
• 14:39
  - and how much it cost. Right? You know
• 14:41
  - how good it is. Right? Health care is
• 14:43
  - the only one that's been cloaked
• 14:45
  - in mystique. Right? There's an old saying, no
• 14:48
  - mystery, no margin. Right? So the fundamental
• 14:51
  - element to fuel this transformation is price transparency.
• 14:55
  - That's the underpinning
• 14:57
  - of every other bright spot. Why?
• 15:00
  - Because it's the basis of a functional
• 15:02
  - marketplace, a functional market. We don't have a
• 15:05
  - health system. As you know, we have a
• 15:07
  - sick care system.
• 15:09
  - What do you need for a functional marketplace
• 15:11
  - like any other marketplace for toaster ovens or
• 15:14
  - cars? You need transparency
• 15:16
  - and pricing. You need an informed buyer and
• 15:19
  - a willing seller where the buyer can walk
• 15:22
  - away.
• 15:23
  - Right?
• 15:24
  - Of all of those bright spots, you've got
• 15:26
  - transparency fueling
• 15:28
  - all of them.
• 15:29
  - And the ones that I'm most ambitious about
• 15:32
  - are direct contracting
• 15:34
  - around the major carriers
• 15:36
  - and and cash pay. That doesn't mean people
• 15:39
  - carry a backpack of cash. It just means
• 15:41
  - that there's a transparent price for an office
• 15:44
  - visit, cortisone injection, MRI scan, whatever it may
• 15:49
  - be.
• 15:50
  - And the beautiful thing about both of those,
• 15:52
  - direct contracting and cash pay, is that those
• 15:55
  - numbers
• 15:56
  - are closer to the true cost of delivering
• 15:59
  - that service than the fictitious price points we
• 16:02
  - have now from our insurance companies. Right? They're
• 16:05
  - just pulled out of a hat.
• 16:07
  - Yeah. 100%. And there and there's no question
• 16:09
  - that once we get into the spot
• 16:11
  - of using, you know, we call in business
• 16:14
  - other people's money for anything,
• 16:16
  - the cost accelerate, the spend is less careful,
• 16:20
  - and and there's less getting to a true
• 16:22
  - market price. And we set up so much
• 16:24
  - of health care
• 16:26
  - around using other people's money versus consumer money
• 16:29
  - to pay for stuff. So we've ended up
• 16:31
  - with
• 16:32
  - one of the causes of rampant health care
• 16:34
  - inflation.
• 16:35
  - Doctor Schuchter,
• 16:37
  - one more question.
• 16:38
  - What are you most focused on and excited
• 16:40
  - about as we go into 2027,
• 16:43
  - end of this year 2027?
• 16:45
  - Where are you most focused and excited?
• 16:47
  - Yeah. As my my
• 16:48
  - my dear friend and partner, doctor Kim,
• 16:52
  - I have a condition called EO,
• 16:54
  - eternal optimism, and, sometimes it gets me into
• 16:57
  - trouble. But I do feel, and and many
• 17:00
  - of my colleagues,
• 17:01
  - would agree,
• 17:02
  - that there are some tailwinds
• 17:04
  - for the transformation, and it's coming from all
• 17:07
  - sorts of macro trends. We've covered a few
• 17:09
  - of them here. But going to 2027,
• 17:11
  - I think we're finally seeing
• 17:14
  - an awakening
• 17:15
  - of the self funded employer space. Right? I
• 17:18
  - think we're starting to move the employers from
• 17:21
  - the back seat of the car to the
• 17:23
  - driver's seat where they belong. They pay 60%
• 17:25
  - of the health care cost across this country.
• 17:28
  - And, you know, under the influence of the
• 17:30
  - CAA, the Consolidated Appropriation Act of 2021,
• 17:34
  - updated in 2026,
• 17:36
  - a number of the
• 17:37
  - lawsuits there are now pending in front of
• 17:39
  - the courts.
• 17:40
  - I think employer... Employers are finally saying, hey.
• 17:43
  - You know, we are the fiduciary here just
• 17:45
  - like a four zero one k plan. I've
• 17:47
  - gotta look at my data, not only look
• 17:49
  - at it, analyze it, and make
• 17:52
  - health care decisions that are prudent and in
• 17:54
  - the best interest of my members. That's what's
• 17:57
  - really exciting me. Listen.
• 17:59
  - The bad news is the premiums are going
• 18:01
  - up. I've heard as much as 20%
• 18:04
  - in 2027.
• 18:05
  - Shocking.
• 18:06
  - And you talk about non sustain... Or nonsustainable.
• 18:09
  - 20% increase in premiums.
• 18:12
  - Right? I think we're at the crossroads.
• 18:14
  - The watershed moment is gonna be in 2027,
• 18:17
  - and I'm optimistic.
• 18:20
  - Doctor Schuster, I I wanna thank you so
• 18:22
  - much for joining us today on the Becker's
• 18:23
  - HealthCare podcast. We really appreciate you joining us.
• 18:26
  - It's always interesting.
• 18:28
  - The best to you and doctor Kimbell, two
• 18:30
  - of the best out there. Thank you so
• 18:31
  - much for joining us. Yeah. Scott, thanks for
• 18:33
  - the opportunity. Have a great weekend.