Scaling Endoscopic Spine Surgery to Protect Rural Access with Dr. Kai Lewandrowski & Dr. Morgan Lorio
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What is the background of the guests and their expertise?
This is Carly Beam with the Becker Spine and Orthopedics Podcast and today we have two wonderful guests. Both are experts not only in spine surgery but also just understanding healthcare policy. Thank you both for joining us and can you introduce yourselves?
Thank you, Carly. I'm Morgan Lurio. I'm past president of ISAS and chair emeritus for the Coding and Reimbursement Task Force.
Carly, my name is Kyle Lewandowski. I'm an orthopedic spine surgeon in Tucson, Arizona. I'm affiliated with the University of Arizona, and I'm active with Morgan Lurio under the ISAS umbrella.
Great to have both of you on. And Dr. L'Oreal, I want to start with you with our questions. So one of the things I really want to discuss with both of you is CMS's rural transformation model and patient access. And to start, Dr. L'Oreal, why is this conversation so timely right now?
Okay, Carly. Well, this isn't about a scope. It's about whether patients can access spine care where they live. If rural patients have to drive four hours for a 60-minute decompression, then the system is misaligned. Bread and butter spine surgery should be local, sustaining community-based private practices, and complex revision strategies should remain in tertiary care centers. That's how access and expertise coexist.
Got it. And then, you know, Dr. Lewandrowski wanted to pivot slightly and all, everything that we're talking about right now is going to converge by the end of this podcast. But Dr. Lewandrowski wanted to raise a point of interest with endoscopic decompression. Clinically speaking, would you say endoscopic decompression is mature enough to scale?
Absolutely, Carly. We spent the last 10, 12 years developing clinical evidence on the application of the endoscopic million invasive decompression in an outpatient setting. We worked up the patient selection criteria. We published clinical protocols. come to find out, thinking that was the most significant hurdle in terms of insurance authorization, but it actually wasn't. Most surgeons are performing the endoscopic surgery now, and we've done some survey work that revealed that the main hurdle is actually logistical and implementation.
Can you dive deeper into that, this idea that the barrier is implementation, and what can surgeons do to address that?
We developed some content to help surgeons with their discussions locally in the surgery center. But what it comes down to is that the cost for the capital equipment is high. The endoscopes have high maintenance costs. They don't last that long. They last on average 35 to 50 surgeries. Then they're essentially broken. So when you look at all the hidden costs, which include sterilization, reprocessing, cleaning. They sound like trivial issues, but for small surgeries, they can turn into real problems where they just don't have the staffing to process these scopes on time so that this ASC can make money. In a hospital setting, it's similar. You may be competing with other service lines that are racking up costs.
So integrating the endoscopic technique platform is not as trivial. And we've learned that from multiple service studies that we've done nationally and internationally.
Why is the CMS rural transformation model important for patient access?
Thank you for breaking that down. And, you know, turning back to you, Dr. Lorio, I want to pick your brain about this idea of access fragility. Can you talk about what that looks like in real life and why it happens to begin with?
Well, when a spine surgeon leaves a rural region, care doesn't get delayed. It vanishes. A procedure doesn't improve access if it can't fit inside the building.
Can you talk about what's driving this issue?
Well, transformation isn't about expanding benefits. It's about making delivery viable. And rural hospitals don't fail because surgeons lack skill. They fail because systems lack margins.
Got it. And Dr. Lewandrowski, I'd love to hear your perspective on what's making delivery so challenging operationally.
One of the problems, Carly, that we run into consistently is the endoscopic protocol requires a targeted diagnostic workup.
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Chapters
4 chapters
1
What is the background of the guests and their expertise?
0:00–3:47
2
Why is the CMS rural transformation model important for patient access?
3:47–9:03
3
Is endoscopic decompression mature enough to scale in rural settings?
9:03–13:08
4
What logistical challenges do surgeons face with endoscopic spine surgery?
13:08–13:46
Speakers
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