Alexander Vaccaro

And we're constantly being inundated by denials, policy changes.

The recent insurance companies that decided on their own to downcode

cpt codes from level four to level three these are the things that we have to do and we go through you know a periodic process payer contract renewals and sort of letting the world know that every day my overhead costs go up we have to deal with inflation we have to do with the cost of capital salary

company, the patient, the government and the physician are protected in terms of maximizing whatever limited dollars are available for everybody.

And then we have to look closely

provide adequate care when every year due to congressional mandates, reimbursement goes down.

It just doesn't make any sense.

So we have to fight that.

So if you look closely at what we provide patients anywhere from more surgical skills to non-operative care, such as injections, stem cells, hyaluronic acid injections for knees, bracing,

high-cost vendors and bring that in-house like all the different ancillaries you see that don't pose a direct conflict like you never want to provide an ancillary where you can increase the cost of care if it's something that you have to prescribe to a patient

When you order a brace from a hospital, an orthotist, it may cost a thousand dollars.

And why can't we make that easy for MSK care?

You know, just say someone comes in, we can organize their imaging studies, we can organize their non-operative care, we can do their physical therapy, we can do their injections, and then we can take them to the journey if they require surgery, make sure that we have support for their family, maybe a meal service, maybe transportation after that.

give them premium opportunities to come in when they need to be seen by someone and not to roll their eyes and have a headache.

I just spoke to one of my partners today who presented Grand Rounds, who discussed his journey after brain surgery.

And it was so frustrating to see the surprise billing, this and that.

Why can't we facilitate that for the patient, for those patients that have the ability to pay extra so we can make their lives so much more comfortable?

So I think that's

we went through that exercise, we realized what costs too much and what doesn't cost too much, but bundle payments were really a race to the bottom.

And once you reach the bottom of, you can't squeeze any more juice out of that orange.