Building a Patient-First Spine Practice Outside Traditional Models with Dr. John Peloza

- The playbook for running a successful ASC in - 2026 - looks almost nothing like it did a few - years ago. - And the one for 2029 - probably won't look like this one either. - Case complexity is increasing. Payer models are shifting.

- Technology is creating new possibilities - and new cost pressures at the same time. - The spine and orthopedic leaders who are staying - ahead aren't just keeping up with the changes. - They are in rooms where the changes get - talked about honestly. Becker's twenty third annual Spine - Orthopedic and Pain honestly.

Becker's twenty third annual - Spine Orthopedic and Pain Management Driven ASC Conference - is such a space. - More than 1,000 attendees, - 275 - plus physician and ASC speakers, three days of - programming across the clinical, - operational, and strategic - with CME credits available. - Join us June eleventh through the thirteenth. For - the agenda and event details, visit Becker's Hospital - Review and click on the events tab in - the upper right.

- This is Gracelyn Culler with the Becker's Healthcare - podcast, and we are recording live at the - twenty third annual Spine Orthopedic and Pain Management - Driven ASC Conference. - I'm currently joined by doctor John Paloza, who - is a physician at Paloza Spine. So doctor - Paloza, thank you for joining me today. I - would love for you to briefly introduce yourself, - your role, and the scope of your organization, - and - talk to what's currently commanding most of your - attention as a leader.

- Well, my name is John Paloza. I've been - a spine surgeon for over thirty years, - fellowship trained, - and has seen - pretty much most of the, - technology and, evolution of spine - since it really, - increased quite a bit in the, late early - nineties. - My organization, - is actually Midwest Orthopedic Spine Specialist for most - in Saint Louis - for most, - spine things, but then we've decided now to - do a, - private cash pay practice that's called Palosa Spine, - and it is taking patients from all over - the country.

- So, - what we offer is - a very personalized care - and very individualized. - It's not on any insurance, so we're not - restricted by insurance restrictions. - And we can also do things that the - FDA has not specifically approved, - such as multilevel cervical lumbar disc replacement, hybrid - disc replacement fusions, and plus all the different - minimally invasive techniques for decompression, - correction of scoliosis, and those sorts of things. - So there's not much we can't do.

- The most recent that we've we've been involved - in biologics - in the spine since bone morphogenetic protein came - out in the late nineties. We're on that - FDA trial. - And presently, we're on a disc cell injection - trial with the FDA. This is my eleventh - FDA, - trial.

- So that's looking good. So we're able to - offer anything from high level conservative care through - regenerative technologies, - middle invasive technology, including endoscopic, - motion devices, as well as fusions. - And in a year marked by rapid change, - what recent decision or pivot required the most - leadership conviction from you, particularly when it came - to aligning people, resources, or capabilities? - That's a lot to cover.

- The problem right now in health care is - its expense, - and it's being driven - by - a lot of things that are not under - physicians' control. - So what we have to do is create - use all our technological - means, - to come up with solutions that actually work, - to have fewer complications, - and they give a long term good outcome - so we don't have to redo another operation - down the road. - We have to do it in a venue - that's not so expensive. - So doing - high acuity complex cases that we used to - always do in the hospital, - we done in a surgery center instead.

- So those are the two main things - conceptually. - Now to put that together in a business - process is the difficult part. You have to - get capital - to build the or buy surgery centers. - We have a lot of experience in that - and presently have three in the Saint Louis - area.

- So, - then you have to have staff. You have - to have really good staff. In our case, - people who have decades of experience in spine, - as scrub techs and scrub nurses, circulators, - administrators. - We have, - so people who who know what to do - to get things done efficiently.

- We also have to have, vendors - who can get us implants - and maintain the supply and of the implants - so we never have problems. We always have - everything ready to go at all times. - And then we have to have, on the - physical therapy side, relationships with the therapist so - that they can train our patients after surgery - to maintain a good outcome. - So all that - that's quite a bit that you have to - have, - put together before you even start to think - about doing these things.

- The other thing is with a concierge slash - cash pay business, people have to find out - about you. So the marketing, - social media, - AI type driven things are very important. - That also requires - capital. - So - that's where right now building it out - is, - requires - well, there's two things.

First off, you have - to have a reputation that you can do - these things, and you know what you're talking - about. And then you have to have the - business savvy - to get it to to a reality. - So that's where we are. - So how do these situations - challenge your assumptions, - and what do they change about how you - approach decision making, talent, or organizational readiness?

- Well, my decision making hasn't changed that much - in terms of medical side. - Readiness is to have great staff who really - know what they're doing and and to to - really incentivize them to wanna be in your - practice - because people of that high quality - are in demand. - So - we - wanna make sure they're happy - and compensated, - appropriately - so that we can keep our organization - top notch. - And shifting gears a little bit, when you - think about the forces reshaping health care right - now, where do you believe leaders need to - be more decisive, especially while balancing things like - speed risk and having the right teams in - place?

- Big, - yeah, - multipronged question. - The problem with health care right now is - that - because of government intervention, - it has given monopoly powers - to hospital systems and insurance companies. - Physicians have been pretty much cut out of - that. - So we have to - try to navigate this situation where we really - have - no leverage.

- We don't have the financial resources - to fight, - and - the bigger - organizations - really don't - they don't suffer the consequences of things going - wrong like we do. They have no legal - exposure in case something happens. So what the - physician often finds themselves in, - we have the legal - responsibility - and accountability, but no authority. - We can't change our staff in a hospital - system, for instance.

We get who we have. - We try to train them, but if it's - not working out, - you as a surgeon is are expendable. - So that's tough. - The amount of, - leverage that, the big systems have is incredible - because they control - the legislation pretty much, - and so we have to deal with the - rules they set up.

- And like everything in government, everything it touches - does poorly, - so they create a problem, and then they - create more legislation to address the problem, which - then makes it worse. And then more legislation, - it just keeps getting worse. - So - the way to fix all that is to - get government out of the way and let - the market compete. - These guys had to compete on quality and - cost, we would win, but that's not how - it's done.

- So if you're a leader, you have to - understand that, know, - what you can and can't do. - As a small - operation, - we're flexible. - We can move quickly. - We can make decisions quickly.

We don't have - to wait to go through, like, - four or five committees to to get an - answer. - So, - right now, we'll see where it goes. But - right I I think where things are headed - are unsustainable - because it's too expensive and the cost keep - going up. - So a more market based approach, I think, - is what - needs to be done.

I don't have much - hope that's gonna happen - because the other side has so many resources. - And wrapping our conversation, - as uncertainty has become the norm, what leadership, - habit, or mindset has been most critical in - keeping your organization and your people moving forward? - Well, everybody has to understand what the goal - is. So what's the priorities of your organization?

- In medicine, - if your priority is not the patient, - you won't be successful, - not an not at the doctor level. - The only way I'm graded by my outcomes. - So particularly when people are paying - cash or concierge, - the thing that really counts is their outcome - and their experience. - So they have to whatever it is, the - problem is, we have to solve it so - their pain goes away, so they're functional, and - they can live their life.

And we have - to do it at a price that they - can afford, - which means - no complications, - one time doing something, - and then their experience has to be very - good because - spine surgery, spine conditions are scary. - Surgery particularly is frightening, and that fear is - real. So we have to understand that, and - it's addressed by having a thorough evaluation so - they have a diagnosis, - that they're confident in the procedure is gonna - help them, that it's performed - as well as possible, and postoperatively, - they have a seamless care.

So from time - they call us till they're finished, it should - be seamless, pleasant, - like going to a spa rather than going - to a big hospital to get hacked. - So, - I would say that's important that that your - priority is your patient. And, also, you it - is a business, so you have to stay - in business. - And that's becoming more and more of a - problem if you're, in, - a private physician - because reimbursements keep going down and down and - down.

It should be eventually - in a lot of cities now, there are - no private practice physicians. They're all hospital employed - or they're in private equity or something like - that. - Absolutely. Well, doctor Palosa, thank you so much - for joining me today on the Becker's Healthcare - Podcast.

Again, we are recording live at the - twenty third annual Spine Orthopedic and Pain Management - Driven ASC Conference. - Thank you.