Outpatient Brain Surgery: How Buffalo Built America's Only Neurosurgical ASC

Episode SummaryAnish and Anthony are joined by Dr. Elad Levy — Professor and Chair of Neurosurgery at the University at Buffalo, holder of the L. Nelson Hopkins Endowed Chair, and one of the country's most prolific physician innovators — for a wide-ranging conversation on how he and his partners built Atlas Surgery Center, the only physician-owned outpatient neurosurgery center in the United States, now performing roughly 3,000 cases a year including outpatient angiograms, carotid stenting, brain aneurysm treatment, gamma knife radiosurgery, and complex spine work. Dr. Levy walks through the operational efficiencies that let four staff do the work of fifteen to twenty in a hospital, the negotiated device pricing, the inclusion/exclusion criteria for outpatient cases, the constraints of Medicare's inpatient-only list, and why payers have embraced the model at 90% of hospital rates. The conversation also traces his personal arc — from rowing at Choate and Dartmouth, to neurosurgery training at Pitt, to fellowship under Nick Hopkins in Buffalo — and the field-defining work he and colleagues did to establish mechanical thrombectomy as standard of care in the 2015 New England Journal papers, plus his current work on endovascular brain-computer interfaces with Synchron and ongoing conversations with Neuralink. The episode closes on neurosurgery workforce challenges, the alternative pathway to board certification for foreign-trained surgeons, and why physician ownership may be one of the most underrated levers for rural access to specialty care.Chapters00:00 Welcome and introducing Dr. Elad Levy01:05 The origin of Atlas Surgery Center: outgrowing the hospital03:14 Relationship with the hospital system and how the partnership works04:36 SUNY Buffalo, Kaleida Health, and the Atlas LLC structure06:44 The collective pain points that drove physician ownership07:30 Personal journey: Israel, Italy, and rural northern New York08:14 Choate, Dartmouth, and varsity rowing10:35 Med school, Pitt residency, and falling for neurosurgery12:24 Fellowship under Nick Hopkins in Buffalo14:42 The thrombectomy revolution and the 2015 New England Journal papers16:30 "If I had a tomato, I would throw it at your face" — early endovascular pushback18:03 The COMMAND trial and endovascular brain-computer interfaces with Synchron19:43 Neuralink, Precision, CoreTech, and the Wright Brothers phase of BCI22:07 What can move outpatient: angiograms, aneurysms, stenting, functional, spine25:52 Why ASCs are cheaper: device pricing, staffing, and turnover times28:20 Reimbursement at 90% of hospital rates and the case for site neutrality30:23 Inclusion and exclusion criteria — the "is this your mother?" test31:50 Medicare's inpatient-only list and why it locks patients into hospitals34:35 Financial ethics of physician ownership versus corporate medicine39:53 Could Atlas become a physician-owned hospital? The two-midnight rule41:43 Everyone goes home at four — efficiency as patient access44:27 The hospital industrial complex and regulatory drag45:13 IRB and clinical trial speed in an ASC: weeks versus a year46:29 Neurosurgery workforce, foreign medical graduates, and the alternative pathway50:32 Buffalo as a city of good neighbors — and physician retention53:38 Vetting international training and what board certification really protects55:03 Grey's Anatomy, McDreamy, and the Dartmouth rowing connectionCo-Hosts@anish_koka and @drdigiorgioShow@drsloungepodSubscribeYouTube: https://www.youtube.com/@TheDoctorsLounge