John Peloza, MD, has been a fellowship-trained spine surgeon for more than 30 years, long enough to have watched the specialty transform since the early 1990s. For most of his career, he has practiced with Midwest Orthopedic Spine Specialists in St. Louis. Recently, he launched a second, cash-only venture called Peloza Spine, an insurance-free practice that treats patients from across the country and is not bound by payer restrictions — including, he said, procedures the FDA has not specifically approved, such as multilevel cervical and lumbar disc replacement and hybrid disc replacement fusions.
Dr. Peloza has also spent much of his career inside FDA trials, including early work on bone morphogenetic protein in the late 1990s. He is now enrolled in a disc cell injection study — his 11th FDA trial.
His decision to build a cash-pay model, he said, was less about ideology than economics. Health care costs are being driven up by forces outside physicians’ control, and the fix, in his view, is to move complex, high-acuity cases out of hospitals and into surgery centers that can deliver the same outcomes for less.
Building that infrastructure required capital, experienced staff, and reliable device and implant vendors, plus a way to reach patients directly since a concierge, insurance-free practice depends on people finding out about it on their own.
“The other thing is with a concierge/cash pay business, people have to find out about you,” Dr. Peloza said. “So the marketing, social media, AI type-driven things are very important. That also requires capital.”
That same calculation extends to who controls the practice itself. Dr. Peloza said hospital and insurer consolidation, much of it driven by government policy, has left physicians accountable for outcomes without the authority to control the staff, resources or decisions that produce them.
“We have the legal responsibility and accountability, but no authority,” he said.
“The amount of leverage that the big systems have is incredible because they control the legislation pretty much, and so we have to deal with the rules they set up,” Dr. Peloza said.
A small, physician-owned operation, he said, avoids the layers of approval that slow down larger systems. “As a small operation, we’re flexible,” he said. “We can move quickly. We can make decisions quickly.”
Dr. Peloza is not alone in that calculation. Vladimir Sinkov, MD, of Sinkov Spine in Las Vegas, dropped all insurance contracts, including Medicare, about three years ago. Speaking with Becker’s Hospital Review, Dr. Sinkov said the move has allowed him to spend more time with patients without the pressure of maintaining high volume, adding that he is “able to provide the best and most personalized care to my patients.”
Not every surgeon reaches the same conclusion, and the tradeoffs of independence cut both ways. In a separate Becker’s Hospital Review roundup, orthopedic and spine surgeons who chose hospital employment over private practice pointed to advantages such as stronger referral networks and payer leverage, along with relief from the operational burden of running a practice. Those who stayed independent or retained ASC ownership cited the opposite trade: less bargaining power in negotiations, but more control over how, and where, they treat patients.
For Dr. Peloza, that control is inseparable from patient experience. He said every step, from a patient’s first call to post-operative recovery, should feel unhurried and personal. “It should be seamless, pleasant, like going to a spa, rather than going to a big hospital to get hacked,” he said.
That standard, he said, is the only one that matters, regardless of the business model built around it. “If your priority is not the patient, you won’t be successful,” he said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
