Spine neurosurgeon at Craniospinal Center in Los Angeles says letting insurance companies run health care systems will create ‘an even more divorced two-tiered system’

Brian Gantwerker, MD, is a spine neurosurgeon at the Craniospinal Center in Los Angeles.

Dr. Gantwerker will participate in the panels “The Simple Way CHWs Can Become Patient-Centric in the Digital Age” and “Best Ideas for Balancing the Needs of Patients, Surgeons, and Employees Without Breaking the Budget” at the meeting Becker’s ASC annual. As part of an ongoing series, Becker speaks with healthcare leaders who plan to speak at the Oct. 27-29 conference in Chicago.

For more information and to register, click here.

Question: What’s the smartest thing you’ve done in the past year to set your organization up for success?

Brian Gantwerker: I think the smartest thing has really been to focus on the client/patient experience in the office. We haven’t changed personnel for some time; I basically had the same team working with me for eight to almost 13 years in one instance. We really focus on how patients flow through the office and their first contact experience when they call the office. They are very clear about which insurance we accept and which we do not; we set expectations right away. We will ask them to bring their files and so on, so that there are no surprises. Then when they’re actually in the office, I make sure we allocate enough time for each appointment to really make sure patients are super comfortable when they leave the office, so there’s no outstanding issues. If they’re going to have surgery, then they watched their movies with me and I explained the philosophy and the reason for what I’m offering or why I’m not offering surgery.

It’s a real goal that we’ve been focused on, and I think one of the smartest things we’ve done is to just stretch the date a bit longer and allow a lot more time to interact with the patients. Unfortunately, there was a bit of a wait for people to come see me, but that’s the trade-off.

Q: What are you most excited about right now and what makes you nervous?

BG: What probably makes me most nervous is the obvious game insurance companies play to get the most out of medicine. There is a reluctance in Congress to confront the main driver of health care costs, which are insurance premiums from insurance companies and Big Pharma, so they continue to go after doctors and reimbursement of physicians. The No Surprises Act, while a very good piece of legislation, was applied asymmetrically to favor insurance companies. I think what’s really scary is that the bureaucracy within Medicare centers just seems to be deaf or willfully ignorant of what really drives the cost of care. It’s really scary because over 110,000 doctors left practice in 2021 – that should give everyone pause, and I don’t think you can develop doctors fast enough to really close that gap.

Letting one health insurance company run the whole system is not the way to achieve equity in health care, and it’s another way to create an even more divorced two-tiered system. It’s not fair to people. I think it’s fixable, but we have to realize that the people telling you health care is too expensive are the same people who are posting $5 billion in profits per quarter. This must stop. If we don’t stop it, we’re going to keep rolling down the hill in that bed of thorns at the bottom of the hill.

What excites me, however, is that the subject of spine surgery is now becoming mainstream; there are a lot of great things to come with robotics, but I think the main thing is that doctors have a new, renewed sense of efficiency. Physicians notice what is happening around them, take stock, and become effective leaders. They manage to get up and push back.

Q: How do you see growth over the next 12 months?

BG: I think growth is good, but I think stability is better. People are obsessed with quarterly statements and growth, growth, growth. My practice has been stability and slow growth. I had to make some changes; I had to close one of my practices because it cost money to see patients there. So we did some consolidations, but we will now have more than one pool in the whole region. We offer a great alternative to big box medicine with super quick appointments. All in all, it’s very important to orient doctors and patients around me, to be slow and steady, and to be as consistent as possible. Sometimes I have to make changes like closing an office, but you have to maintain the same stability and quality as you try to change and move things around to be more favorable to your bottom line.

If you grow too much and find that your pending times are too long, it doesn’t make too much sense. If you open three, four or five sites, that might sound good – I know some of my colleagues love the fact that they open public clinics – but I think you end up diluting the quality of what you do. Consistency is essential, and reproducibility is also essential.

Q: What will healthcare executives and leaders need to be effective leaders over the next five years?

BG: They need to realize that there is a cost to having good people working in new organizations. I think the consistent assessment of a nurse or doctor or other healthcare worker’s ability to provide good care instead of paying less for it is really what got hospitals into trouble difficult in which they currently find themselves. The pandemic has made the situation worse. A lot of nurses just put their hands on the stakes and said, “I’m leaving because they don’t pay me enough to make it worth it — I can earn 10 times what I earn and I don’t have to take call”, and so on. I think when hospitals say they’re bleeding red, I really have little sympathy for them. Because for a long time they didn’t pay their nurses and staff what they were worth. People aren’t USB sticks that you unplug and plug back in whenever you feel like it. When you devalue your staff, here’s what you get: increased costs and deteriorating results. I think health care executives really have to swallow all of this and they have to understand that they have to pay their people what they’re worth.

Q: What is your strategy for recruiting and retaining great teams?

BG: I’m really looking for experience. I’m not looking for the cheapest person. I’m very lucky, I have one member of my staff who has been with me from the literal beginning, and another has been with me for almost eight years now. I obviously focused on their experience, their personality types, their ability to think independently and be creative in solutions. And I also think that on your side, you have to be ready to listen when things aren’t going well. You have to give people what they ask for. I encourage people to speak up when you hire them, to have an open door policy. Always be respectful and even if their ideas aren’t feasible, explain why they aren’t, but sometimes you’ll find that the efficiencies you thought you had really aren’t effective at all.

I think it’s important that you have seasoned staff who are independent, able to solve problems but also able to work as a team. It’s very hard to find, but it’s worth finding that good rental.

Kristan F. Talley