Nonoperative spine care will likely grow as regenerative medicine and opioid-sparing approaches advance, Brad Sorosky, MD, said.
Dr. Sorosky, a physiatrist with Phoenix-based Desert Spine & Sports Physicians, spoke with Becker’s about reducing opioid use in spine patients, his top payer challenges and more.
Note: This conversation was edited for clarity.
Question: What are your strategies to avoid opioid use?
Dr. Brad Sorosky: Our core philosophy centers on a comprehensive health and wellness approach to patient care, which naturally excludes reliance on opioids. Early in my practice, we operated within a traditional pain management model that frequently prescribed opiates, however, we consistently observed poor patient outcomes with this approach.
Consequently, we shifted our focus toward evidence-based alternatives that prioritize functional restoration and long-term wellness. Our practice now actively communicates to the medical community that we welcome all patients seeking pain management solutions, with the exception of those specifically seeking opioid management. This strategy has allowed us to develop expertise in innovative, non-opioid treatment modalities while maintaining our commitment to patient-centered care.
Q: How is regenerative medicine use evolving at your practice?
BS: We maintain an accredited fellowship program in Interventional Spine and Musculoskeletal Medicine through the North American Spine Society, which reflects our commitment to advancing clinical practice with a focus on evidence-based management. We have a privademic practice, which means in addition to being a private practice, we integrate rigorous educational components, including bimonthly didactic sessions and monthly journal clubs with our fellows.
Our monthly journal club, which is open to the community, attracts practitioners who review the latest research in our field including regenerative medicine research. Currently, over 140 level-one evidence studies support the use of biologics such as platelet-rich plasma (PRP), which forms the foundation of our clinical protocols. We primarily utilize PRP and Bone Marrow Aspirate Concentrate (BMAC) in our practice.
However, we maintain a cautious approach toward other “regenerative” options including amniotic products due to insufficient supporting data and concerns about misleading marketing claims regarding stem cell content. Our patient population primarily consists of individuals with mild to moderate osteoarthritic joints and chronic tendinopathies, and we also utilize spinal applications when clinically appropriate.
Q: What do you think will be the next big thing in spine care?
BS: I believe regenerative medicine will play an increasingly significant role in spine care. The evolution mirrors what we’ve witnessed in cardiovascular medicine, where open-heart surgery was once the primary intervention for coronary artery disease, but has largely shifted toward minimally invasive approaches.
I anticipate a similar transformation in spine and musculoskeletal care, emphasizing needle-based procedures and advanced injection techniques over traditional surgical interventions. This approach offers the potential to avoid more expensive and higher-risk surgeries while maintaining excellent patient outcomes.
To be clear, this evolution won’t eliminate the need for surgical options, but rather may allow us to postpone surgical interventions and provide patients with effective alternatives when appropriate.
Q: How are you working with surgeons? How are you approaching the question of who performs minimally invasive spine procedures?
BS: We approach surgeon collaboration with careful consideration and mutual respect. We believe that open dialogue and evidence-based practice create the foundation for effective collaboration. Although interdisciplinary tensions can exist across different specialities, our skill sets complement rather than compete with surgical expertise.
I’ve observed through teaching injection courses that surgeons sometimes underestimate the technical complexity of our procedures. Our training involves thousands of hours developing needle guidance skills, which represents a distinct expertise. Our collaborative philosophy centers on leveraging each specialty’s unique strengths to optimize patient outcomes. We have developed exceptional expertise in needle-based procedures, and when these interventions reach their limitations, our surgical colleagues are positioned to deliver superior results.
Some procedures, like the MILD procedure, can create tension between surgeons and non-surgical specialists, because they challenge traditional treatment paradigms. However, through open dialogue with our surgical colleagues, we typically reach consensus that MILD serves a valuable role for a select population of patients — specifically those with advanced age and significant comorbidities that preclude general anesthesia and surgery. We acknowledge that traditional surgical laminectomy remains superior for patients who can safely tolerate surgery and general anesthesia, but MILD provides a meaningful alternative for those who cannot.
Q: What are your biggest payer challenges right now?
BS: Insurance and Medicare reimbursement represents our most significant operational challenge and source of frustration. While I’m passionate about practicing medicine, navigating payer relationships creates substantial administrative burden.
As we’ve grown to become the largest PM&R group in the United States, we’ve become a frequent audit target for Medicare. The audit process is time-consuming, expensive, and often counterproductive. Despite achieving 100% compliance on our most recent audit, we were immediately subjected to yet another audit which is a large drain on our resources.
Our experience suggests that third-party auditors make significantly more errors than our documentation practices. Data indicates that Medicare recoups $4 to $7 for every dollar spent on these audits, which appears to prioritize revenue collection over quality improvement, particularly given concurrent reimbursement reductions for physicians.
Q: What’s your strategy for increasing patient volume and patient awareness?
BS: Our fundamental strategy focuses on delivering compassionate, innovative care that restores patient function. Rather than pursuing opioid-based symptom management, we prioritize functional restoration and positive patient outcomes as the foundation of our practice growth.
We operate according to clearly defined mission, vision, and values emphasizing trust, transparency, and contributing to healthcare solutions. Beyond clinical excellence, we invest significantly in patient education through digital platforms. Our website features comprehensive educational content allowing patients to learn about their conditions and treatment options at their own pace.
We also publish transparent cash pricing, enabling patients to make informed financial decisions — a unique approach in our field. Additionally, we utilize AI tools to enhance customer service, maintaining our commitment to answering every phone call and scheduling appointments within one week. This comprehensive approach ensures patients receive the support needed to achieve their health goals while building sustainable practice growth through reputation and outcomes.
