After more than 8,000 spinal surgeries under his belt, Dr. Robert Bray had more than a few ideas about what he'd like to see in his dream practice.

And technological advances in the last five years that can enable intricate, minimally invasive surgery to be performed outside a hospital gave Bray his chance.

Last summer, after spending $12 million to renovate an empty office building in Marina del Rey, stocking it with hundreds of thousands of dollars worth of state-of-the-art equipment, working out partnerships and convincing more than 20 medical professionals to join his experiment, Bray opened the D.I.S.C. Diagnostic and Interventional Spine Care integrated surgical center.

Staff at the 55,000-square-foot facility can turn what was once a multi-day hospital stay into a time- and cost-efficient outpatient procedure. While the bulk of his patients still pay cash, Bray said, the hybrid surgi-center also became cash-flow positive in January, ahead of schedule. And his administrative overhead is so low that the actual cost is prompting favorable attention from private insurers.

One sticking point: the way D.I.S.C. conducts patient treatment in an outpatient setting is so different from conventional methods that the proper billing codes don't really exist. Noting that the center's records system was set up to provide rich data for clinical trials, Bray said he also expects payers will want to see more patient outcome evidence before adding it as a provider.

"I wanted to enable the personal attention that is all-too-often missing in the health care industry today along with the access to the latest techniques and equipment," he said. "I'm hoping that payers will see the value and efficiency in patients being able to get seamless care under one roof with a team of specialists working together."

D.I.S.C.'s medical staff includes spinal and orthopedic surgeons, pain management specialists, chiropractors, physiatrists (physical rehabilitation), and psychiatrists. Using an integrated medical records and referral system that Bray had a company create for him, a patient can come in for evaluation and often get non-surgical treatments, such as a spinal block, in the same visit. Surgical patients also are treated and released the same day.

Part of what makes that possible is technology that Bray helped develop. The Baylor College of Medicine graduate was the founding director of the spine program for Cedars-Sinai Medical Center, and is a longtime clinical investigator as well as the holder of several surgical-related patents.

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