August 9, 2025 • 11 mins
This episode recorded live at the Becker’s 22nd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference features Dr. Robert S. Bray, Founding Director, DISC Sports & Spine Center. Dr. Bray shares insights on the accelerating shift toward outpatient spine care, the rise of global payment models, the role of AI across healthcare operations, and the importance of creating sustainable pathways for the next generation of surgeons.
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Episode Transcript
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(00:00):
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tasks for your staff and also helps your
patients cover their out of pocket health care
expenses?
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(00:22):
credit card with promotional financing options to get
the care they want while helping staff do
what they do best, provide care. To learn
more, visit carecredit.com
forward slash beckerspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are recording live at the
twenty second annual Spine Orthopedic and Pain Management
Conference.
(00:43):
I'm currently joined by doctor Robert Bray, who
is the founding director at DISC Sports and
Spine Center. Doctor Bray, thanks for being here.
Let's start off by having you introduce yourself
and tell us a little bit more about
your role and organization.
Thank you for having me.
I've been coming to Becker's for twenty plus
years, so I think people know me quite
well.
I come via the United States Air Force
(01:05):
on through on the way by to Cedars
Sinai where I ran the inpatient program for
years and the fellowship
and then began outpatient surgery about twenty years
ago forming DISC, which is now
a a multi conglomerate.
I'm a neurosurgeon.
I do only spine and nothing besides spine,
and that's been my focus for many years,
minimally invasive in its development.
(01:27):
Wonderful. Well, I'm excited to hear your insights,
and I'd love to start our conversation off
with what trends or shifts you're currently seeing
right now in the industry that you think
are most important for leaders to pay attention
to.
It's
a big topic, and and trends have been
coming for a long time.
I was sort
of misstated that I thought the trend when
I introduced I was gonna go to outpatient
(01:49):
spine twenty years ago that it would take
five or ten years to go.
It's taken twenty years. But the biggest trend
we're seeing right now is that transition from
a hospital based care to outpatient
on a higher and higher acuity level. So
things you would have never thought of being
done as an outpatient, front and backs, multilevel
(02:10):
arthroplasties,
big cases, joint replacement. They're all done routinely
now in outpatient centers. So that's just been
the giant trend.
The the second is the transition of the
payer model.
I was raised in a fee for service.
You sent a bill and you got paid.
That changed. And then,
we we moved through the value care options
(02:32):
from HMOs to to to value care organizations.
And now we're seeing, especially in the ASC,
a big migration to global payments.
And what's happening is as the ASCs can
deliver a better product
at a cheaper
price break point,
we can really move the needle. So we're
(02:53):
going to global payment systems within our disk
model,
and we're able to move that final product
to the payer down a large number, sometimes
30, sometimes up to 50% less on the
dollar spent. So it's a it's a
big a big trend to redo the entire
model.
The third is that people really need to
start
(03:13):
and and are becoming aware of the need
to look at cost efficiency
and quality outcomes
and and link those two numb things together,
not be one in a in absence of
the other. And as we do that, the
the centers,
the payers, and the vendors are gonna all
need to get together
(03:34):
to look at, is it producing a quality
outcome,
data driven?
Do we have a metric to demonstrate it
actually works?
And then everyone needs to get on board
that that's where we're going, to a good
outcome,
patient centric
at a good price price breakpoint.
A 100%.
(03:54):
And I'd love to also touch on staffing
and workforce challenges as those continue to be
a concern across health care. So how is
your organization navigating these pressures, and what strategies
have you seen work well?
As everyone else with a great deal of
difficulty,
ASCs and structures, we don't have the necessarily
the pockets of a Kaiser or the big
hospital system, so we can't always be the
(04:15):
highest pay competitor and just go by our
our our nurses. I think we have to
look at it, and we do try to
look at it
more as we're bringing in someone as a
team member. And I came out of the
military and a lot of special forces
contacts.
We try to build a team where where
people feel like they're part of it. They're
acknowledged. They're they're part of the growth.
(04:38):
And,
the the next big thing for us to
look at that we're in process of there
is to look at their workload capacity
we're putting onto people and how we can
make that more efficient. I think that's one
of the places we'll see AI come in,
not replacing people, but making their workflow easier.
So I we we do it by trying
to make sure that recognizes people.
(05:00):
Absolutely.
And segueing a little bit more into outpatient
care, this is continuing to grow. So how
do you see the role of orthopedics and
spine evolving within the broader healthcare ecosystem?
Probably the most difficult question you're you're asking
of of where it fits because
in short, I'll give you the answer, I
don't know.
(05:21):
It's not an easy answer.
It's not a matter of if it's going
to an ASC
environment.
It's a matter of how and when. And
and we are on
the the so called hockey stick or the
logarithmic growth curve now, and it's it's just
it's caught on. It's there. There's lots of
people doing. It's an explosion.
(05:42):
So now it's just where it fits and
who. And there's going to be multiple players
in the market.
The hospital systems, obviously, with the rate the
HOPDs and the systems will be developing their
own system, and that's that's good.
There's the corporate level of that, which is
the HCA's of the world that are, you
know, large
(06:03):
delivery care vehicles and and do it very
well.
You can look to
United and with through Optum buying SCA and
and buy and hold. They I don't know
how many hundreds and hundreds of surgery centers
they have now, but that's a a verticalization
of the health care system
through the payer straight through the delivery vehicle.
(06:24):
So they're gonna exist. There's the independents who
hold out, and they're doctor owned completely.
And that's good, and they they like their
autonomy,
but they're capital limited. So they they within
their niche, they can do well, but they're
very capital limited to expand. So
and then the new the new
wave in the market, which I think is
(06:45):
still
wait to see where it goes is a
private equity world. We chose to go there
about three years ago and took in private
equity money, CPF here in Chicago,
Chicago Pacific founders with,
brought into our models. We have our own
management structure called Trius that that manages it.
(07:05):
I've gotta tell you, so far, they're good
people. They're they're they're putting in immense amount
of capital in. They brought a lot of
resources to the table
for contacts. We we have made tremendous
progress with the payers
that, you know, frankly, I just didn't have
the ability to get to. I'd be negotiating
at the local contract level, and they came
in and they can sit down at the
(07:26):
corporate suite. So
I I think the answer is they will
all do well
as long as they have a plan of
where they go.
They are different models. There'll be different applications
in different areas of the country based on
where, you know, intermount west if you're in
the Mid Con
there are a lot of different models.
(07:48):
They all will fit into the system.
I think the physicians need to look within
their how do they maintain
their happy spot, their autonomy enough that they
are not trotting down on the way by,
and how do they survive? So physicians will
need to look
of each individual product and where they fit.
And and I think we'll see an entire
(08:08):
system evolve,
but it's not a question of if that's
gonna be an ASC model anymore.
That question got answered. We're there.
Wonderful. And then as we kinda wrap up
our conversation, I'd love to know what,
partnerships,
care models, technologies,
that are increasing efficiency and outcomes that you
are currently,
(08:30):
exploring or working with? I know you mentioned
AI earlier in our conversation. Is there anything
else specifically that you are seeing,
particularly promising?
I I divide
technology as a much is a big statement
into, four different categories,
and we're looking independently within each category
what type of AI we're gonna do.
(08:52):
Surgical, the operating room is one, obviously,
and, you know, robots or endoscope
navigation systems or or augmented reality. We're looking
at all of them. And the problem is
that today,
all the young surgeons coming through are trained
with these things coming out of their fellowship
to good places. We're on a panel with
the guys from Russian. They're training them to
(09:14):
use all these. They come out. They want
them. Okay. Are they cost efficient? Do they
fit the model? That's one. So we're we're
looking at all of them, and we have
most of them in our centers, but we
need to adapt to the new surgeons. The
second area is the patient facing interface,
and the patient facing interface
is marketing to lead generation and lead generation
to a consult in the office.
(09:35):
And that's a whole application for AI. You
know, it used to be a phone tree
and then a call center, and and now
that's gonna be a a big AI push.
And there's multiple companies here looking at that
opportunity. We we are looking and testing different
things right now.
The third is
back office functions.
Huge place for
(09:55):
maximizing the flow. The payers are using AI
to deny us.
We need to be using AI to deny
their denial and and go back to them.
And, you know, an immense amount of time
is spent by my
staffing. That's where I mentioned it before, the
AI. Immense amount of time stuck in the
phone trying to get things authorized denials.
(10:16):
We need an agent,
an AI agent that that does most of
that work, and I will have happier employees
that are not tied up with
the time consuming hassle that they have to
have. So back office is a big and
the fourth and the final is just which
is not tapped on really much at all
here is analytics.
We just put in an Ospitec system into
our RORs for data.
(10:38):
We have to start looking at data for
efficiency, data for flow
analysis,
and then
we're looking at systems right now to integrate
patient outcome into that structure. So you need
data analytics. And if you don't have data
going forward, you're you're sunk.
Absolutely. Well, doctor Bray, thank you for joining
me. Is there anything else that we, didn't
(11:00):
touch on that you'd like to cover or
share?
I I have my advice to Becker's, which
is you need an entire conference on where
does the young surgeon fit and where do
they go and where their future will be.
Because what we really need to do is
not just look to the right now and
who's trying to put the money in their
pocket, whether it's a vendor or AI or
(11:24):
it's a hospital or it's a system. We
need to look where the new surgeons survive
in the long term, where their careers live,
how they build,
where they grow, and how they integrate into
this. Because as we're building a system, it
it needs to be about them.
Absolutely. Well, thank you so much for taking
the time to be here on the Becker's
Healthcare Podcast. Again, we are recording live at
(11:45):
the twenty second annual Spine Orthopedic and Pain
Management Conference.
Thank you for having me.
Looking for a solution that helps alleviate administrative
tasks for your staff and also helps your
patients cover their out of pocket health care
expenses?
Find what you're looking for from CareCredit because
CareCredit is a credit card and more. It's
a helping hand for staff and a flexible
payment solution for patients. For over thirty years,
CareCredit, a Synchrony solution, has offered patients a
(00:22):
credit card with promotional financing options to get
the care they want while helping staff do
what they do best, provide care. To learn
more, visit carecredit.com
forward slash beckerspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are recording live at the
twenty second annual Spine Orthopedic and Pain Management
Conference.
(00:43):
I'm currently joined by doctor Robert Bray, who
is the founding director at DISC Sports and
Spine Center. Doctor Bray, thanks for being here.
Let's start off by having you introduce yourself
and tell us a little bit more about
your role and organization.
Thank you for having me.
I've been coming to Becker's for twenty plus
years, so I think people know me quite
well.
I come via the United States Air Force
(01:05):
on through on the way by to Cedars
Sinai where I ran the inpatient program for
years and the fellowship
and then began outpatient surgery about twenty years
ago forming DISC, which is now
a a multi conglomerate.
I'm a neurosurgeon.
I do only spine and nothing besides spine,
and that's been my focus for many years,
minimally invasive in its development.
(01:27):
Wonderful. Well, I'm excited to hear your insights,
and I'd love to start our conversation off
with what trends or shifts you're currently seeing
right now in the industry that you think
are most important for leaders to pay attention
to.
It's
a big topic, and and trends have been
coming for a long time.
I was sort
of misstated that I thought the trend when
I introduced I was gonna go to outpatient
(01:49):
spine twenty years ago that it would take
five or ten years to go.
It's taken twenty years. But the biggest trend
we're seeing right now is that transition from
a hospital based care to outpatient
on a higher and higher acuity level. So
things you would have never thought of being
done as an outpatient, front and backs, multilevel
(02:10):
arthroplasties,
big cases, joint replacement. They're all done routinely
now in outpatient centers. So that's just been
the giant trend.
The the second is the transition of the
payer model.
I was raised in a fee for service.
You sent a bill and you got paid.
That changed. And then,
we we moved through the value care options
(02:32):
from HMOs to to to value care organizations.
And now we're seeing, especially in the ASC,
a big migration to global payments.
And what's happening is as the ASCs can
deliver a better product
at a cheaper
price break point,
we can really move the needle. So we're
(02:53):
going to global payment systems within our disk
model,
and we're able to move that final product
to the payer down a large number, sometimes
30, sometimes up to 50% less on the
dollar spent. So it's a it's a
big a big trend to redo the entire
model.
The third is that people really need to
start
(03:13):
and and are becoming aware of the need
to look at cost efficiency
and quality outcomes
and and link those two numb things together,
not be one in a in absence of
the other. And as we do that, the
the centers,
the payers, and the vendors are gonna all
need to get together
(03:34):
to look at, is it producing a quality
outcome,
data driven?
Do we have a metric to demonstrate it
actually works?
And then everyone needs to get on board
that that's where we're going, to a good
outcome,
patient centric
at a good price price breakpoint.
A 100%.
(03:54):
And I'd love to also touch on staffing
and workforce challenges as those continue to be
a concern across health care. So how is
your organization navigating these pressures, and what strategies
have you seen work well?
As everyone else with a great deal of
difficulty,
ASCs and structures, we don't have the necessarily
the pockets of a Kaiser or the big
hospital system, so we can't always be the
(04:15):
highest pay competitor and just go by our
our our nurses. I think we have to
look at it, and we do try to
look at it
more as we're bringing in someone as a
team member. And I came out of the
military and a lot of special forces
contacts.
We try to build a team where where
people feel like they're part of it. They're
acknowledged. They're they're part of the growth.
(04:38):
And,
the the next big thing for us to
look at that we're in process of there
is to look at their workload capacity
we're putting onto people and how we can
make that more efficient. I think that's one
of the places we'll see AI come in,
not replacing people, but making their workflow easier.
So I we we do it by trying
to make sure that recognizes people.
(05:00):
Absolutely.
And segueing a little bit more into outpatient
care, this is continuing to grow. So how
do you see the role of orthopedics and
spine evolving within the broader healthcare ecosystem?
Probably the most difficult question you're you're asking
of of where it fits because
in short, I'll give you the answer, I
don't know.
(05:21):
It's not an easy answer.
It's not a matter of if it's going
to an ASC
environment.
It's a matter of how and when. And
and we are on
the the so called hockey stick or the
logarithmic growth curve now, and it's it's just
it's caught on. It's there. There's lots of
people doing. It's an explosion.
(05:42):
So now it's just where it fits and
who. And there's going to be multiple players
in the market.
The hospital systems, obviously, with the rate the
HOPDs and the systems will be developing their
own system, and that's that's good.
There's the corporate level of that, which is
the HCA's of the world that are, you
know, large
(06:03):
delivery care vehicles and and do it very
well.
You can look to
United and with through Optum buying SCA and
and buy and hold. They I don't know
how many hundreds and hundreds of surgery centers
they have now, but that's a a verticalization
of the health care system
through the payer straight through the delivery vehicle.
(06:24):
So they're gonna exist. There's the independents who
hold out, and they're doctor owned completely.
And that's good, and they they like their
autonomy,
but they're capital limited. So they they within
their niche, they can do well, but they're
very capital limited to expand. So
and then the new the new
wave in the market, which I think is
(06:45):
still
wait to see where it goes is a
private equity world. We chose to go there
about three years ago and took in private
equity money, CPF here in Chicago,
Chicago Pacific founders with,
brought into our models. We have our own
management structure called Trius that that manages it.
(07:05):
I've gotta tell you, so far, they're good
people. They're they're they're putting in immense amount
of capital in. They brought a lot of
resources to the table
for contacts. We we have made tremendous
progress with the payers
that, you know, frankly, I just didn't have
the ability to get to. I'd be negotiating
at the local contract level, and they came
in and they can sit down at the
(07:26):
corporate suite. So
I I think the answer is they will
all do well
as long as they have a plan of
where they go.
They are different models. There'll be different applications
in different areas of the country based on
where, you know, intermount west if you're in
the Mid Con
there are a lot of different models.
(07:48):
They all will fit into the system.
I think the physicians need to look within
their how do they maintain
their happy spot, their autonomy enough that they
are not trotting down on the way by,
and how do they survive? So physicians will
need to look
of each individual product and where they fit.
And and I think we'll see an entire
(08:08):
system evolve,
but it's not a question of if that's
gonna be an ASC model anymore.
That question got answered. We're there.
Wonderful. And then as we kinda wrap up
our conversation, I'd love to know what,
partnerships,
care models, technologies,
that are increasing efficiency and outcomes that you
are currently,
(08:30):
exploring or working with? I know you mentioned
AI earlier in our conversation. Is there anything
else specifically that you are seeing,
particularly promising?
I I divide
technology as a much is a big statement
into, four different categories,
and we're looking independently within each category
what type of AI we're gonna do.
(08:52):
Surgical, the operating room is one, obviously,
and, you know, robots or endoscope
navigation systems or or augmented reality. We're looking
at all of them. And the problem is
that today,
all the young surgeons coming through are trained
with these things coming out of their fellowship
to good places. We're on a panel with
the guys from Russian. They're training them to
(09:14):
use all these. They come out. They want
them. Okay. Are they cost efficient? Do they
fit the model? That's one. So we're we're
looking at all of them, and we have
most of them in our centers, but we
need to adapt to the new surgeons. The
second area is the patient facing interface,
and the patient facing interface
is marketing to lead generation and lead generation
to a consult in the office.
(09:35):
And that's a whole application for AI. You
know, it used to be a phone tree
and then a call center, and and now
that's gonna be a a big AI push.
And there's multiple companies here looking at that
opportunity. We we are looking and testing different
things right now.
The third is
back office functions.
Huge place for
(09:55):
maximizing the flow. The payers are using AI
to deny us.
We need to be using AI to deny
their denial and and go back to them.
And, you know, an immense amount of time
is spent by my
staffing. That's where I mentioned it before, the
AI. Immense amount of time stuck in the
phone trying to get things authorized denials.
(10:16):
We need an agent,
an AI agent that that does most of
that work, and I will have happier employees
that are not tied up with
the time consuming hassle that they have to
have. So back office is a big and
the fourth and the final is just which
is not tapped on really much at all
here is analytics.
We just put in an Ospitec system into
our RORs for data.
(10:38):
We have to start looking at data for
efficiency, data for flow
analysis,
and then
we're looking at systems right now to integrate
patient outcome into that structure. So you need
data analytics. And if you don't have data
going forward, you're you're sunk.
Absolutely. Well, doctor Bray, thank you for joining
me. Is there anything else that we, didn't
(11:00):
touch on that you'd like to cover or
share?
I I have my advice to Becker's, which
is you need an entire conference on where
does the young surgeon fit and where do
they go and where their future will be.
Because what we really need to do is
not just look to the right now and
who's trying to put the money in their
pocket, whether it's a vendor or AI or
(11:24):
it's a hospital or it's a system. We
need to look where the new surgeons survive
in the long term, where their careers live,
how they build,
where they grow, and how they integrate into
this. Because as we're building a system, it
it needs to be about them.
Absolutely. Well, thank you so much for taking
the time to be here on the Becker's
Healthcare Podcast. Again, we are recording live at
(11:45):
the twenty second annual Spine Orthopedic and Pain
Management Conference.
Thank you for having me.
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