Episode 291- How A Neurosurgeon Heals Broken Spines With A Broken Health System. With Dr. Rod Oskouian

Spine surgery sits at the crossroads of need, nuance, and noise—and few people explain that terrain better than Dr. Rod Oskouian, a high-volume neurosurgeon who has led a complex spine program and also navigated care as a patient.  Dr. Oskouian and Healthcare Bridge host, Nate Kaufman pull back the curtain on how consolidation, denials, and a flood of administrative demands reshape daily practice, why “low value” labels miss the mark, and what truly predicts safer outcomes when your back—or your future mobility—is on the line.

The conversation starts with the evolution of neurosurgery from community coverage to regional referral, as smaller practices disappear and tertiary centers take on the hardest cases across multiple states. From the OR to the boardroom, Dr. Oskouian unpacks how EMRs, siloed decision-making, and repeated reorganizations increase friction (SEE NATE’S ARTICLE Nathan Kaufman: How silos undermine U.S. healthcare | HFMA). He makes a bold case for a mindset shift: treat physicians as the primary customers of health systems so they have the tools, staffing, and data to deliver better patient care. That shift informs smarter choices about enterprise tech, integrated AI, documentation, imaging, and revenue workflows that either free clinicians to practice medicine—or bury them in clicks and appeals.

Kaufman and Dr. Oskouian into the data debate around spine surgery and “low value care,” exploring how Medicare billing data, coding incentives, and risk profiles can warp conclusions. He argues for outcomes that blend patient-reported measures with wearable-driven biometrics—steps, mobility, vitals, adherence—paired with honest risk adjustment for complex cases. For patients trying to choose a surgeon, they offer a pragmatic playbook: prioritize volume, fellowship-trained teams, multidisciplinary pathways, and centers that live and breathe your specific procedure. And they get personal as Dr. Oskouian recounts a severe ski accident, the authorization gauntlet he faced despite insider knowledge, and the hard lesson that navigating networks can matter as much as medical expertise.

If you care about healthcare strategy, spine outcomes, physician leadership, or how to advocate for yourself when it counts, this conversation delivers grounded insight you can use. Subscribe, share with a friend who’s weighing surgery, and leave a review with your biggest question about choosing the right surgeon—we’ll dig into it on a future show.

Transcript

Mission And Show Introduction

SPEAKER_00 0:00

Welcome to this episode of the Healthcare Bridge, where we explore the vital connections shaping our healthcare landscape. Hosted by Nathan Kaufman, Managing Director of Kaufman Strategic Advisors, the Healthcare Bridge is dedicated to improving healthcare delivery by strengthening the strategic and financial performance of healthcare providers. As part of the Common Bridge family, our focus is on fostering insightful, nonpartisan conversations that drive meaningful change in the healthcare industry. We invite you to join us as we build bridges toward a healthier future. The show is available on Substack, YouTube, and your favorite podcast platforms. Search for the Common Bridge and stay connected.

SPEAKER_02 0:36

This is Nate Kaufman with the Healthcare Bridge. You can find us under the Common Bridge, which is Rich Helpies podcast. Our purpose is to provide an insider's perspective on our crazy healthcare system. You know, there's lots of academics and policy wonks out there who talk about what we need to do to improve our healthcare system. My feeling is if you want to know what to do to improve the healthcare system, let's talk to people who actually deliver healthcare.

Meet Dr. Rod Oscuyan

SPEAKER_02 1:03

So today, our guest is Dr. Rod Ascuyan. Welcome, Rod. Hi, Nate. How's it going? Thanks for having me on. My pleasure. Uh and Rod is a world-renowned neurosurgeon practicing up in Seattle. Rod, why don't you give us a little background of your origin story and a little bit about your current practice? Yeah, thanks.

SPEAKER_01 1:26

I appreciate you uh having me on, Nate. Um, so I grew up in Seattle, and um interestingly enough, I, you know, I grew up at a time when technology was starting to take off. And the school I went to, all the kids' parents worked for Microsoft except for mine. Mine, you know, were um classic immigrant story, you know. Both my parents worked really hard. Um, we grew up with nothing. Um, we had like a one-bedroom apartment. And um, and and all the kids, you know, computers were really popular. And I remember I scraped everything I had to get my first computer. Um, but all the kids that I went to school with ended up going in the tech. I was the only one that went to med school. And um, and then I did my uh undergraduate work at the University of Washington. Um, and then I went to Ho CLA for medical school, and then I did my residency in a really famous program that John Jane used to be the chairman of. Very academic, um, you know, very traditional uh training. Like he wouldn't let you graduate unless you had a hundred or more papers. You had to have like 95th percentile on your boards, and then he made sure that you went into academics. So if you went into private practice, you would be disowned

Training, New Zealand, And Academic Roots

SPEAKER_01 2:46

from the family. Um and so uh I I spent a year um uh in New Zealand and Auckland, and that was fascinating because for me, it was the first time where, you know, it's like when your mom and dad lets you go out with the credit card. Um where I got out of this, you know, where you're kind of in a closed system. And in Virginia, University of Virginia, it was, you know, very traditional academic, work seven days a week, you know, everything was the same way. Like, you know, it was very regimented in terms of like it was a very classic American healthcare system, right? Where, you know, it doesn't matter if you're 90 or 60 years old, like everyone got the same treatment. And in New Zealand, it was my first experience where I was like, okay, you know, um, they just have a different philosophy about surgeons, neurosurgery, tertiary care. So it was a great time in my life. Um, and I spent a year there. Um, and my wife, who's a pediatrician, took the year off. Um, and we had a great year. We just had our first daughter, and she was about one year old. And then I wanted to, um, again, just because of my training and my background, I was only really looking at academic jobs. Um, and so I was looking at UCLA or um some cook some jobs on the East Coast, and then um I ended up at Swedish because I just knew a lot of the people at the time, and there was a lot of stuff going on in Seattle, and it was just when Swedish had decided to go into neurosurgery and they wanted to have a neuroscience institute, and I had to convince I remember my boss that it was going to be an academic practice that I was gonna have. So it was like he made me swear that I would, you know, have fellows, um, and that you know, I would continue to kind of UVA tradition, which is to publish and to, you know, have a fellowship and uh continue to go to all the meetings and all the you know, all the stuff that academic surgeons do, write grants and you know, write books and all this stuff like he just kind of like really preaches.

Building Seattle’s Neuroscience Program

SPEAKER_01 5:06

And and I was really fortunate because when I came back to Seattle, you know, I was able to reconnect with all my old friends, and there's so many cool things that were happening on the tech side that I've been able to get involved in it. Like, for example, we started the Seattle Science Foundation, um, which is now the largest online medical education platform in the world. I think last year we had like 23 million views. And uh again, um, you know, I've been in practice now for almost 18 years, and um it's incredible to see how much things have changed, even from when I started me.

SPEAKER_02 5:44

Well, you anticipated my first question. You are in a practice with four other physicians? That's correct, right? And it's you're known as folks that do complex spine work, so you're a regional referral center. So let's start with how has practice of neurosurgery changed over the last 20 years, both from the standpoint of clinical practice, because few people really get a chance to talk to neurosurgeons, and also from administrative aspects.

SPEAKER_01 6:15

So I would say that from a from like

How Neurosurgery Practice Has Shifted

SPEAKER_01 6:19

a day-to-day uh perspective, you know, from my clinical uh responsibilities, I would say that because of what's happened, and I think this has happened nationally, is that you know, the smaller hospitals and the, you know, I would say the typical community practices that were here when I first started are no longer there. Um and so it's created, and I think this was done both, you know, I think Obamacare kind of accelerated it. Um, but you know, forcing, you know, the private practices to have EMRs and you know, all these things where it just is so expensive on top of everything they were doing. It kind of forced a lot of them to, you know, um hang up the shingle and they got acquired. And that's what happened to Swedish, right? We were kind of a standalone not-for-profit. Um, and then and then we basically got acquired by Providence. And so I would say my practice is now I'd say I'm busier than I've ever been. Um, and I and I would say we cover more and more hospitals. You know, when I first started, we'd really only covered our downtown hospital, and that was it. Then we started covering all the Swedish ERs because the private practice surgeons that were practicing at Swedish uh left. So then we went from covering one ER to covering seven ERs to now where we cover all of Washington in terms of you know, like when when they need to transfer people, and then parts of uh Montana and Alaska, and then and then they call us from Idaho, so we cover kind of like the whammy states. So I would say my

Consolidation And System Complexity

SPEAKER_01 8:12

practice has become um more of a tertiary regional center, so we get all the very complex patients. And then what I think, and I think from that standpoint, I think it's it's definitely um something that I didn't expect. Um and then and then on the on the sort of I'd say the administrative or healthcare side of it, I think it's it's changed even more dramatically in the sense that you know when I first started, um, you know, I had one, there was there was one administrator that I kind of worked with. And then as as things have evolved, you know, now it's got it's so complex, you know, that there's just such a matrix in terms of the organization. And and and I think for me, that's probably been the most challenging. You know, we've had something like I can't even count. I think we've had five or six CEOs, um, you know, first for like our our health system, and then our other health system had, you know, probably like two or three. Um, and then and that doesn't include all the, you know, they they kind of reorganize every few years in terms of you know, trying to figure out what's the best management model that they have. And I'd say when I look back at my residency, you know, they didn't teach me any of this stuff. Um and it's interesting, Nate. And um, you know, there that you don't really understand the complexity of healthcare in the US until you actually start practicing. And then when you start practicing, you really realize you have no idea how how decisions are made. So um it's definitely um it's definitely evolved. Uh and um, and I think, you know, when I look back on it, um, I would have never predicted that these two things um would be kind of independent of each other.

SPEAKER_02 10:24

So, a question about your practice. One of the things you hear in the media is about spine surgery and uh, you know, there's unnecessary spine surgery going on and all of that stuff, and that Medicare could save all kinds of money if I don't know that we did less spine surgery. What's your perspective on the need for spine surgery, the authorization for spine surgery, and the overuse

Is Spine Surgery Overused

SPEAKER_02 10:49

of spine surgery?

SPEAKER_01 10:51

I think that's an excellent question. In fact, um it's it's interesting because um most of the data they use, um, and in fact, recently just another article came out where they only look at Medicare data. Um, and that's kind of tricky, you know, and they and they had this paper come out in Giama. I don't know if you saw it, but they they called, you know, they put spine surgery, pacemakers, Tavars, you know, all these things that are kind of they call it low-value care. Okay. So, and then what's always difficult, and just being an academic person, when you really slice and dice the data, they're using Medicare data, they're using billing data, they're using outcomes, and uh if you think about Medicare patients, these are the sickest of the sickest. And then, for example, they go, okay, well, tavars and pacemakers and fusions, they're costly and they don't work, right? That's the that's the message that they send out. And if you look at that population, if you if that's that's the that's what their message is, I think if you really peel the layers of the onion away, I think um part of what's gone on is that the cost of healthcare has gone up, but where's the cost really? I think it's if you look, you know, when I look at our stuff, you know, physician reimbursement's gone down, um hospital reimbursements um gone up over the years, and then if you look at the number of administrators, um that has skyrocketed, right? So the overhead has gone up, and then pharmaceutical companies continue to, you know, do well, insurance companies do great, device companies are doing fine, but then you know, we're the bad guys or bad, you know, we're the we're the people that are causing, you know, like all the healthcare costs, especially in spine. Um, it's really I think it's hard to, you know, when um when you have this data continue to come out, it's really disheartening because I think it's they're sending the wrong message. Um and actually when you look, for example, like when you look at these Tavar patients, the ones that have critical AR sinosis where they get a stent, um they actually do, when you look at their overall outcomes and how they do, they actually do remarkably well. Um, and so I just think, you know, I mean, yes, these devices are expensive, um, but in the grand scheme of like, you know, and um, you know, the economics of this is when they have an agenda, and their agenda is do less procedures. I think you can kind of spin the data in such a way to make it look like that.

SPEAKER_02 13:53

Do you find a lot of denials and having to do peer-to-peer reviews for your patients?

SPEAKER_01 13:59

Oh, yeah, all the time. I mean, all the insurance

Denials, Delays, And Peer Reviews

SPEAKER_01 14:03

companies are are guilty of this, and the policies, and this is part of the problem, is each one has their own policy. For example, in spine fusion, uh, this is a this is one we we battle all the time, where they go, okay, well, um, you know, they'll say that this procedure is experimental, um, and they'll create some, they'll create their own policy, and then they'll say, well, we have our own, you know, policy, and then it has to go through our medical director and our review process, and then and they use, and I've seen this, and I think you've probably seen this in the news. Well, then nobody actually reviews it. It just gets it gets denied as a first step because they don't want you to, they don't think you'll appeal it. So then, and it's interesting, in fact, I just was involved in in a recent one where you know, finally got to the physician, and um, and you know, and then you know, the physician's like, okay, it's approved. But it took like six months to get through all this stuff. And I'm really fortunate because, you know, I have a lair, I've got, you know, a nurse, I have my fellows, I've got a team. Um, but can you imagine if I didn't have any of that stuff? Most doctors, this patient would have never ended up getting surgery. Well, was it was the patient in pain? No, this was actually, it was very interesting. It was a it was a it was a nurse who had a very difficult, had multiple, multiple surgeries, and then she had fractured the rods in her spine. And so she developed this thing called campcormia, where she was like literally bent over 90 degrees. And so um she needed to have a pretty extensive reconstruction, and then um, and then just based on the previous surgeries and everything they had, um, it was just very difficult to get her surgery approved. Wow. And again, I mean, this is typical, you know, where you know, she was um from eastern Washington, and and this, you know, she had good insurance, but the insurance company

Can Neurosurgeons Stay Independent

SPEAKER_01 16:12

knew that this was going to be like two, three hundred thousand dollars, and they did everything they could to, you know, it was just like every single thing I had to appeal. And um, and uh, we finally actually got her on the schedule, but it was really frustrating.

SPEAKER_02 16:28

So you mentioned earlier that you are employed by a healthcare system. There's those out there that feel that there's a conspiracy on the part of health systems to control the doctors and to to eliminate independent practice and all that. You kind of mentioned it. I find that most or many neurosurgeons are now employed by health systems. Is it possible to be an independent practice in neurosurgery today?

SPEAKER_01 16:53

I don't I don't think it's I don't think it's impossible. I think you can do it. I think if you do, um, you know, a lot of my a lot of my colleagues like in New York and LA, there's certain marks in markets you can do it. I think you could do it in Seattle, San Francisco. You would have to unfortunately go the fee-for-service model where you set your, you know, say this is my cost for my surgical fees. But, you know, you wouldn't necessarily be able to do Medicare. You certainly couldn't do Medicaid or, you know, some of the other governmental programs. Um and you basically, I think, would have, you know, have to have a pretty thin staff. But I mean, I still have a lot of friends who, you know, and you'd have to do all that out of network stuff, which a lot of doctors like myself, you know, I agree with you. I don't think there's some conspiracy by the, you know, the larger health systems. Um, I just think that the way that it's set up, um, you know, I think that all the mergers that were done, I don't think the hospital, you know, running a hospital is not like a roll-up business where you go in and you go, okay, well, now we have 20 hospitals, you

Silos, Scale, And System Design

SPEAKER_01 18:12

know, um, we can, and this this is, I think, what's happened a lot of these larger health systems. They go, well, now instead of having like, you know, there's some efficiency of scale, but then you can't, you know, for example, let uh let's say if you have a pharmaceutical or pharmacy, they go, okay, we're gonna shut all the pharmacies down, we'll have one pharmacy, right? Um, we're gonna have all the IT be in one place. We're gonna have HR is gonna be in one location. And I think with healthcare, there's you can certainly do that with some things, but I think it's hard to um do uh, you know, command center for everything just because healthcare is so complicated.

SPEAKER_02 18:56

Yeah, I sent you the article I just wrote for in HFMA on the sub that exact subject, that there are too many silos and nobody looking at the overall picture. So one of the things that I say is uh health systems employing physicians is a great idea, except they don't know how to do it and physicians make lousy employees. From your perspective, if you could give advice to a health system about how to work with employed physicians better in a time when finances are constrained or very difficult, what would be your suggestion?

SPEAKER_01 19:33

I think it's a that's a great question, Nate, because

What Health Systems Owe Physicians

SPEAKER_01 19:36

um, you know, I I think I've I've been on both sides where, you know, and again, when I I think most health systems, especially in the larger ones, I think there's there's no question that they have there's all these silos that develop. Um, and I think when I look at, for example, like in my practice, you know, um we have um there's so many things that physicians have to do from a regulatory standpoint, you know, um insurance, you know, um documentation, you know, getting all of our, you know, like certification for our licenses. And I mean, there's so many things that we have to do credentialing, um, that like that's one aspect of you know, of being a physician. But I think there's there's another part to it, and I think this is where my comment going back to, you know, they never taught any of this stuff in med school is that it's a it's a business, right? So I think most doctors, like when we go to med school, we're not taught about IBITA, we're not taught about, you know, Medicare, we're not taught about private insurance, we're not taught, but now all these things are, you know, when you we have, and and this is the other thing that's happened is you know, these terms get kind of thrown around, and not a lot of systems, and and I think ours is the same, you know, they have like the business to what we do, and the docs usually aren't involved in that. And you'd be shocked, yeah, it would be shocking for me to tell you this, but they just aren't. You know, we're not in, you know, we're not at the table when they're making financial decisions or big decisions. For example, what EMR do they want to use? What imaging system? Now, there might be docs like in management that that are involved in it. Um, but there's the the doctors that are on the ground, I feel like there's a disconnect between what what decisions are actually made, and there's a disconnect between the physicians that are you know on like dealing with you know the emergency room, you know, all these these, I mean, and I think they're big decisions, like for example, um what uh what AI system are they gonna you know use um to implement you know from a um enterprise level, right? And so they'll

Physician Leadership Lessons

SPEAKER_01 22:11

get a physician who's really smart and hasn't practiced in 15 years. And they go, oh yeah, well, this is a great system, you know, we're gonna use this AI system. But then you go, oh wow, it doesn't integrate with you know our EMR. Or it doesn't, you know, for example, for us, you go, okay, there's no, there's no, you can't code on it, you can't um use it for for you know your off notes, you can't use it for billing. Well, you know, there goes 90% of like what I would use AI for.

SPEAKER_02 22:46

I always find that you have to be number one, radically transparent with your doctors. You also have to find the right leaders because you can't have every doctor in the room on every decision. And you've been the leader of this complex spine program up in Seattle. Any thoughts on physician leadership and the do's and don'ts?

SPEAKER_01 23:05

Nate, that's something I think um uh I've learned a lot along the way. Um, and I've learned a lot from working with people like you, honestly, because like I said, it's not a skill set that we're taught. In fact, you know, when you look at training and neurosurgery training, it's the most elite, it's like the Navy SEALs of residency, right? We've been used to, I've been programmed, it's like you want to kill your competition. That's the way, that's the way neurosurgery works. The only reason you get through is because all these other people have died off in the process. That's how that's how that training is. So for me, in terms of like leadership, we never got any classes, you know, and and um we never, you know, like even the attendings that I work with, you know, God bless them all, but you know, they there was no, it was like it was their way or the highway, you know. I mean, that's just how the training is. And I've learned along the way, you know, um, and uh, and I'm continuing to learn. I mean, it's it's one of these things. I think um leadership is something that in residency and medicine is not really taught well. I think you kind of learn as you go along the process,

A Surgeon Becomes A Patient

SPEAKER_01 24:26

and I think, and I and and again, like for me, um it's really interesting because it's so important, as you said, you know, you want to be able to have an impact, you want to help the system, you want to try to be involved um in decisions that are gonna affect, like, you know, like the spine program or you know how they do the marketing. And it's something I I think I'm not very good at, but I'm learning.

SPEAKER_02 24:56

So I'm gonna do a HIPAA violation here and mention the fact that I am aware that you had a significant skiing accident several years ago. You were in the hospital, you had surgery, you were in the hospital for some time and rehab. What did you learn being a patient that you didn't know before?

SPEAKER_01 25:14

So that actually made that was one of those experiences I think it changed my life forever. You know, as a neurosurgeon, um, you know, I've never like stared death. Um, and you know, I remember it was a bad ski accident, and um, I basically had missed a turn, and I went off uh the edge of um uh a cliff, and I really thought I was gonna die. You know, and thank God um there was about a foot and a half of snow that came the night before, and I had a really bad landing and I broke my leg. And um, and I think that whole experience really changed my perspective. I think when you're a patient and you see, you know, um, and this happened in Big Sky, Montana, which again, um, there was a there's a nice emergency room there. I got great care, but you see how how complex the the uh health system is. And I thought I thought I had great insurance, right? And so I landed in the ER, and then everything that was happening, you know, was um was a learning experience for me. And um, and even I remember, you know, the fracture of my leg was so bad, and I developed compartment syndrome, and then I had to go to a regional trauma center, which is Harperview, and they did a phenomenal job, you know, but you know, all these things, like all that stuff was was um quote unquote out of network. Um again, I mean, it ended up getting resolved, and uh, but you realize, okay, yeah, your insurance, you know, what's what's considered in network, you know, is it a if it's not you know life-threatening, you have to get some sort of pre-authorization, um, things like that. And I had been discharged home, but then I had, you know, the the information had been re-relay from the emergency room to the surgeon, and then they had scheduled my surgery, but there was kind of, you know, so you realize, you go, wow, you know, our health system, and here I'm a neurosurgeon, it's so complicated. And then I think the thing that I that uh I learned the most, Nate, from all this, is it's very very interesting because this was a different health system, and um uh is that and I think this is part of the problem that has gone on in the US, and it I can't believe it took me this long to figure this out. But if you look at most sort of businesses, or you know, um, let's say if you go, okay, you have a company, right? Your customer is,

Who Is The Real Healthcare Customer

SPEAKER_01 28:06

you know who your customer is, and this is what you're doing. In healthcare, it's kind of interesting, and this is where it kind of dawned on me, is that most health systems, I think, regardless of where you are, if you ask them to say, okay, what's the business that you're in, and who's your customer, they will tell you it's the patients, right? They'll say, Well, we're here to serve you know the community, and we we do cancer care or you know, we do um orthopedic care. That's what we do. When I think it's actually the opposite. I think it should be the health system should say, our customers are our doctors, right? And then, and so the focus should be okay, we're gonna do as much as we can to make sure our doctors are happy, they're productive, they have all the tools they need, um, you know, whether it's from technology or you know, clinics, and and we're gonna try to minimize, you know, make like our goal is to make our doctors as happy as possible. And we're gonna recruit the best doctors and pay them really well, and then um, and then they're gonna be very productive, and in return, they will take care of like uh our patients, you know, and I think I wish Medicare had that same concept. And I remember my old chairman, John Jane, um uh, God bless him, he was so smart. He said, Rod, when I started neurosurgery back in the 50s, you know, we got $5,000, $6,000 for laminectomy. Now we get $500. And he said, you know, what they should do is if you do laminectomy, they should pay you $50,000 now. If you look, if you do the economics, right? over that period of time. And what that does, and I I remember him saying this, and he's like, it would, it would, and I'm not saying people are doing unnecessary surgery, but it would make it so physicians are very selective. And you would do the surgery at the right time and and right thing. But I think instead with Medicare and all the insurance companies, they they think if they if they devalue something, quote unquote, make it a low value, that their costs will go down. And I'm not sure you can, I don't know if that pencils out.

SPEAKER_02 30:37

So when you had your accident, I know you kind of looked around where to go because it was a very complicated case. Did you shop based on price or did you shop based on the fact that you're an insider and you know who the best of the best is honestly it's being an insider.

SPEAKER_01 30:54

And that's where again I think even with my insurance and everything they kept telling me that if I went to this doctor it would be out of network,

How Patients Choose The Right Surgeon

SPEAKER_01 31:06

right? And so I had to actually fight for myself to get that finally I was like look this there's this yes these other surgeons can do it but this guy does you know five or you know this this surgeon does four or five hundred of these surgeries a year and and there it's this is all they do. These are the these are this is the group I want to go to and it's kind of like my practice you know where you want to go somewhere where they do lots of these surgeries and so usually that's a place that there's fellows you know they run multiple rooms they're operating six seven days a week you know and the surgeons are they're just very skilled at what they do. And in medicine you want that right you don't want someone doing one of these a month.

SPEAKER_02 31:57

What's your advice to patients? I mean I know because I'm an insider I can make a few phone calls and figure out who's the guy or gal that I need to refer to for a particular thing. But the average patient there's academics saying just give the average person the money you would give the insurance companies and let them go buy their own healthcare how would they know where to go?

SPEAKER_01 32:22

They wouldn't Nate and and what's interesting in fact if you go like if you do a Google review on me, right? There's probably like and I operate on four or five hundred patients a year it's like trying to figure out what restaurant to go to the reviews are always the people that are unhappy and they're it's it's they'll write like you'll have like 20 negative reviews even in a great restaurant you know so these and then and the way these search engines work like for example Google, you know these reviews don't ever go down they're there forever. And and so that's a not a great way um and so I think if unless you're an insider I actually don't know I mean that's a great question. It's really complicated.

SPEAKER_02 33:11

One last question because we're running low on time but I'm just curious like when we hear about outcomes and how they measure

Measuring Outcomes And What Matters

SPEAKER_02 33:19

outcomes it's infection rates and it's readmissions and it's mortality is anybody really measuring the outcome of spine surgeries then?

SPEAKER_01 33:28

So yes and no so we do lots of what's called pros, patient reported outcomes and it's very difficult because for example you'll have a workmanscom patient who you do a dysquectomy and they're disabled for life. They need handicap parking and everything they fill out is negative everything's bad right and then you have um you know the 90 year old who had a dontoid fracture who who bakes you an apple pie and is doing great. So I think it's really difficult and it's very subjective. I think the future and this is where I think tech is going to help I think outcomes should be don't measure how many steps do you take what's your blood pressure are you you know are you doing your PT I mean all these things now they can track right like I see you have you have an um an iPhone watch Apple watch and an oil ring. Yeah and an oil ring so you know people and this is what another interesting thing people are they're paranoid about their privacy but I'm like look if you have an iPhone you don't have privacy they already have all your data and so when I show people um uh um you know that they're being tracked they freak out I'm like well what do you you know like how do you think these steps are you know they're being recorded and it's they're biometrics they call it so I think it's gonna shift towards biometrics and I think it'll help the doctors it'll help the patients um but using now for example and this is what's done a lot Nate and you've seen this where they use Medicare billing data this is very dangerous. And they do this for these low valued procedures and then they go and they use these things called patient safety indicators and the hospital it's so you would not believe this but the hospital will try to code everything right because they get more reimbursement. So the hospitals will say oh this patient needed a blood transfusion this this this this they have high blood pressure diabetes right so they're medically complex so they get this modifier and so they get a little bit extra money. Well what does that do to your outcomes? Now your outcomes look terrible you know because you have the sickest and that's what's happened to us here like for if you look at my practice say oh gosh this is a disaster they have their PSIs are high they have all these things and length of stay is this but then when you look at it well yeah we're getting all the sickest patients um and so it's a subset of the like general population so I think it's hard to measure outcomes right now.

Closing Insights And Takeaways

SPEAKER_01 36:11

But I think in the future I think tech's gonna help.

SPEAKER_02 36:13

So I'll tell you this if I need spine surgery Rod, just save me a seat. I'll be up there and expect you to do it because you have a great program. So our guest today Dr. Rod Oscuyan I really appreciate your candor and honesty about what you think about healthcare healthcare is extremely complex and a lot of it doesn't make sense as you've heard there are a lot of opinions out there about what should be done but one thing you should remember is if you need healthcare seek the guidance of an insider because your life may depend on it. Thank you, Dr. Ascuyan this is Nate Kaufman with the Healthcare Bridge.

SPEAKER_00 36:52

Thank you for joining us on this episode of the Healthcare Bridge. We hope you gained valuable insights into how strategic and financial analysis can transform healthcare delivery. Remember building stronger connections in our healthcare system is a collective effort and we're honored to be part of that journey with you. Be sure to subscribe and stay tuned for more conversations that aim to bridge gaps and create a healthier future for all you can find all your healthcare bridge episodes at the Common Bridge on Substack, YouTube and your favorite podcast platform