When the System Hits Home – A Personal Look at MSK, Pain, and the Benefits Gap

What happens when the people responsible for designing and advising on employee health plans find themselves on the other side—as patients navigating the very system they help build?

In this powerful closing keynote, top benefits advisors and an industry expert share their personal experiences facing musculoskeletal (MSK) conditions—some of the most debilitating and costly issues in today's workforce. Despite their insider knowledge, they still encountered the same pain, delays, financial stress, and insurance obstacles as any plan member would.

Through these real-life stories, attendees will gain a firsthand look at the challenges of navigating MSK care and learn how these experiences reshaped their views on benefit design, pain management, and patient advocacy. From understanding the critical role of cash-pay options to uncovering flaws in access and coverage, this session offers practical takeaways for employers, brokers, and benefit leaders committed to closing the gap between plan design and patient experience.

Prepare to leave inspired, challenged—and more informed—about what it truly means to walk in your employees' shoes.

Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.

Eric Silverman (00:00:11):
Oh goodness. It's like pulling teeth. We have good dental. All right, well welcome back everybody. I'm sure there's a few more people literally going to come back in. I know it's tough; it's the last session, but we're excited. I'll tell you what we're most excited about—and I'm on this panel so you won't hear as much from me every second—but I have a bunch of my colleagues here: Mark, Bruce, Paul, and Claire. Claire's company, thank you for sponsoring this session. The commonality between Paul (Joey, we call him), Mark, myself, and one other panelist who wasn't able to make it—he actually got COVID at the last minute—is that we all had musculoskeletal problems to the extreme that we needed surgery in the last year or so. We'll talk about it more. I don't want to steal Bruce's thunder; he's our fantastic moderator. But so you understand the genesis of this, Bruce, who's an incredible journalist and writer, did an article in EBN magazine. I'm not sure if anybody saw it, but it was a five-part series that covered what all of us experts went through trying to get our surgeries approved and get doctors to listen to us. If it was hard enough for us and we do it for a living, imagine what it is for your employee population. Does that make sense? A novice or an hourly worker having to do the same thing that we do when we struggle to the nth degree. Those are the stories we're going to share. Check out that article, and with that, I'll turn it over to my good friend, Bruce. Thank you, Bruce.

Bruce Shutan (00:02:04):
Well, thank you Eric. I appreciate it. You all deserve props for still being here at this hour. These are two long days back to back, and I know the final session can be a little tricky. I will say as I look around the room, feel free to come up front if you'd like to be a little bit more intimate. It's not mandatory. Dave Ross was great earlier; he's going to be a tough act to follow, but I'm confident we're going to end the conference on a high note. As Eric started to say, he and I were having an informal conversation earlier in the year and he was telling me about his back issues. I mentioned that I knew a couple of guys too who had similar MSK issues. I thought I should interview all of you for an article, and then the article turned into a five-part series. For any of you who want to fill in any blanks, you can find it in the pages of EBN.

Paul Stone (00:03:50):
Did they renew us for another year? I think it's the end of the series. Just five parts.

Bruce Shutan (00:03:56):
Yeah, five parts. Well, this could be the unofficial sixth part.

Paul Stone (00:04:01):
The six-episode movie.

Bruce Shutan (00:04:03):
Turned it into a closing keynote, which is great. I just wanted to introduce myself again. For those of you who don't know me, I'm Bruce Shutan. I'm a contributing editor to EBN. I actually joined a year after they launched in 1988. We all know this subject is top of mind. I snagged a couple of statistics to share: a single musculoskeletal injury can cost between $15,000 and $85,000, with indirect costs potentially doubling or tripling that amount. On a macro level, the National Safety Council estimates that MSKs cost employers nearly $18 billion a year in terms of workers' comp, lost productivity, absenteeism, presenteeism, turnover, and recruitment impacts. The five-part series is called "A Road to Recovery." All three of these gentlemen experienced excruciating chronic pain, and their stories are pretty harrowing. We want to focus on the treatment and lessons learned. Starting with Eric Silverman, founder of Voluntary Disruption, his chronic back problems came to a head following a Taylor Swift concert he took his daughter to last November. He had a severely herniated disc that required a microdiscectomy. David Contorno, who couldn't be here today, had a bad luck streak. He got COVID a few days ago, and prior to that, he was in a car crash and re-injured his back. His story involved acute kidney failure and an opioid addiction that culminated in a microdiscectomy.

(00:08:06):
To my right is Paul Joey Stone, Regional Vice President of ClearPoint Health, who had a laminectomy in late January, more than four months after he began limping out of nowhere at an industry conference. To my left is Mark Testa, EVP of Regenexx, who is not only a benefits advisor but also a chiropractor and acupuncturist. He had severe neck, arm, and shoulder pain that intensified after a plyometric session. He pursued non-invasive treatments from his company, which offers platelet-rich plasma and bone marrow concentrate injections to help people avoid surgery. Finally, to my far right is Claire Kelly, a clinical specialist with Sword Health, our sponsor for this session. She works with members experiencing MSK issues and will offer her unique perspective as someone with about eight years of experience in orthopedic outpatient settings. Before we get into the healthcare system, I asked everybody for a fun fact. Eric was on the bowling team in college and his first job was pumping gas.

(00:11:20):
Joey once trained with UFC Champion Royce Gracie. Mark has a twin sister who is one minute older. David has met five US presidents. Claire was raised in Green Bay, Wisconsin, and her grandmother started the professional cheerleading organization, the Pack-Tourettes, in the 1950s. My own fun fact is that I covered the Oscars and the Emmys for two years as part of the Hollywood Press Corps. Now, let's get into it. Eric, it obviously pays to know people in high places. How did you work your contacts to find a surgeon?

Eric Silverman (00:12:40):
On December 26th, I was getting out of the car after an hour drive and I felt my calf freak out. It kept getting worse. I needed surgery, but it had nothing to do with my calf; it was all sciatic nerve pain. I've had back challenges for years. Getting an appointment was insane. Eventually, I was told I need a microdiscectomy, which is a 20-minute, non-invasive procedure with a one-inch incision. Getting a surgeon was almost impossible. I have insurance, but I did not want to use it because I wanted to move quickly. I was going to pay whatever to get the pain away. Ultimately, I had the blessing of knowing the right people to find out who the top-quality surgeons were.

(00:14:00):
I found that some surgeons could see me immediately, while others had a three or four-month wait just for a consultation. Interestingly, the surgeons who could see me quickly were often not the ones with the highest quality scores. Do you think your employees would know the difference? I called in favors from a doctor connection. I was able to get a five-out-of-five rated surgeon who was world-renowned. When I called without the favor, I was told it would be four months. When the favor was called in, the office called me back the same day and got me in the next morning at 8:00 AM. We don't want your employee population to have to go through that, which is why we share our stories—to get your team members to that point as well.

Bruce Shutan (00:17:29):
Thank you, Eric. Joey, how did a laminectomy instantly erase pain that was a nine on a scale of one to ten?

Paul Stone (00:17:46):
It frees up the nerves. Everything I had going on was nerve issues, not muscle. I was a consultant for 25-plus years and thought I knew how to navigate the system, but I didn't. I was on a cash-pay program at the time. The surgeon turned me down for three weeks until I convinced him I would pay upfront on the date of surgery. I was in the best shape of my life, but I started limping for no reason. Just like with Eric, it was a nerve being pinched in my back that wasn't allowing the calf muscle to fire. The orthopedic doc looked at my X-ray and said I needed a neurosurgeon. He was an honest doctor who wanted the best for the patient. With the laminectomy, they cut off the lamina bones in the lumbar to free up the nerve. It relieved the pain immediately. It was the worst pain I've ever had in my life.

Bruce Shutan (00:20:27):
It's strange how the body reacts. You feel the pain in one part, but it has nothing to do with that part's root cause. Each of these gentlemen was thoughtful in their journeys. Mark is unique as a clinician who works for Regenexx. You've seen the downside of spinal fusions over 30 years. Tell us about the platelet injections.

Mark Testa (00:21:45):
Spine pain is miserable. As a chiropractor, I couldn't even get adjusted anymore. I worked in a pain clinic for 10 years and saw a lot of spine surgery failures. I was not having spine surgery. At Regenexx, we use the patient's own cells to repair the body. They took my blood, concentrated the platelets, and injected them. Platelets have the natural ability to heal. Instead of using steroids—which might last two hours to two weeks and cause tissue damage—we used blood platelets in the epidural space. This calmed the nerve and helped build new blood vessels. We also injected them into the ligaments to stabilize the spine. I did this three and a half years ago. I don't have any more pain, I didn't have surgery, and I work out all the time. I haven't taken narcotics or anti-inflammatories in years. I was back to work the next day.

Paul Stone (00:26:01):
To that point, I plan on getting that done every few years to help me continue to heal and avoid another surgery. I had steroid shots previously and they didn't touch the pain.

Bruce Shutan (00:26:16):
Claire, offering the clinical perspective, how can PT and conservative treatments help raise the bar on treating MSK conditions?

Claire Kelly (00:26:38):
First, I want to acknowledge how life-altering these issues are. I don't think PT is a cure-all; there is a time and place for surgery. But as a clinician, I see that these injuries often start as small aches and pains that go unaddressed—like someone with terrible posture at a desk or someone playing pickleball too hard. Our system makes it difficult to get quick access to conservative care, so people mask the pain until it needs surgery. As a physical therapist, I look at the puzzle pieces: strength, mobility, lifestyle, and movement patterns. If we can get in there early, we can prevent many surgical interventions.

Paul Stone (00:28:52):
One thing you triggered: the physical pain is unbearable, but the mental anguish is hard to explain. When your employees go through this, it's not just MSK; it's mental health too.

Mark Testa (00:29:20):
That's the biggest missing piece: the fear and anxiety. There is a documented 40% increase in anxiety and depression for people with chronic pain. In the pain clinic, we never talked about that.

Bruce Shutan (00:29:54):
Mark, how can chiropractic care and acupuncture supplement PT, and what happens when insurance-approved sessions run out?

Mark Testa (00:30:25):
I've seen it my whole career. A patient is doing well, but they hit their 20-visit limit and get cut off. That's when people spiral, get steroids, and eventually end up in surgery. Chiropractic patients generally get fewer MRIs and fewer surgeries. Chiropractic and PT should collaborate. I focus on manipulation and dry needling while the PT focuses on exercise. This inexpensive care keeps people functional and off medications. It should be available, because when it's not, people lose their jobs and spiral.

Bruce Shutan (00:33:26):
Eric, tell us about Nurse Deb and how she helped you get on track to find the right clinician.

Eric Silverman (00:34:02):
How many times have you seen someone on Facebook asking for a surgeon recommendation? People comment about the nice aquarium in the waiting room or the nice receptionist. What does that have to do with the quality of care or the cost? We're talking about life-altering scenarios. I couldn't walk or shower for three months. I have a friend, Nurse Deb, who runs a medical management advocacy company. I called in a favor. I showed her the surgeons I was referred to. She told me the ones who could see me early were either unranked or had quality scores of zero or one out of five. She literally told me I'd be better off staying in pain longer than letting those surgeons touch me. Your employees don't have this luxury, which is why you need concierge advocacy programs. Employees need someone to tell them who to see and what to do.

Bruce Shutan (00:39:06):
What did you learn about the importance of communication and steering members to the right resources?

Eric Silverman (00:39:35):
I revamp my communication style now. An HR professional told me they email employees but nobody reads it. Marketing departments spend millions to get customers, but how much is spent marketing benefits to employees? If you can't do it on your own, there are firms that specialize in this so your employees don't have to go through the emotional pain we did.

Bruce Shutan (00:42:14):
Joey, why don't all employers build a cash-pay option into their plans?

Paul Stone (00:43:02):
It's new and different. It's still a challenge because providers aren't always set up for it. However, when they accept it, you often pay much less than insurance rates. My surgery would have been over $100,000 through insurance, but the cash price was likely around $26,000. Also, remember that a doctor's incentives aren't always aligned with yours; if they work for a hospital, they are going to feed that hospital system.

Bruce Shutan (00:45:07):
Mark, what lessons are applicable to everyone in this room?

Mark Testa (00:45:29):
We need a larger continuum of care. There is inexpensive imaging available—I negotiated a $150 MRI rate here in Nevada. We need quick access to conservative care. Regenerative therapies should be the next step before surgery. This helps people avoid surgery and saves the plan money.

Bruce Shutan (00:48:11):
Claire, what is the call to action for employers?

Claire Kelly (00:48:38):
One in two people will have an MSK issue. Conservative care is the gold standard, but it's a pain to get to. If you have to go twice a week for eight weeks, that's time away from work and family. People drop out after four sessions and go back to the doctor for a high-cost image or surgery. We need to implement proactive solutions that remove friction and stop the snowball toward surgery.

Bruce Shutan (00:50:27):
Let's open it up for questions.

Eric Silverman (00:51:04):
While you're writing your questions, my chiropractor was the one who told me I needed an MRI because I wasn't bouncing back. I called to schedule it and the insurance denied it. They said a cash MRI would be $750. I just paid it because I was in pain. Insurance kept denying the surgery even after peer-to-peer reviews. The morning of my surgery, they finally approved it. But I was ready to write a check myself.

Mark Testa (00:53:45):
Prior authorizations are designed to make people stop fighting. Most people don't know how to fight the system.

Eric Silverman (00:54:23):
And the employee gets mad at the health insurance company and the employer. That reflects on you in HR.

Audience Member 1 (00:55:38):
Do they get addicted to painkillers too?

Mark Testa (00:55:40):
Yes. People in pain are greater utilizers of the healthcare system. Their sleep, mood, and diabetes get worse. Weight goes up. Addiction in your population might just be someone taking opiates to get through a flare-up, which leads to anxiety and insomnia.

Audience Member 2 (00:56:28):
Do you believe the problem is geographical? I live in Cleveland and have access to the Cleveland Clinic.

Eric Silverman (00:56:50):
I'm in Baltimore with Hopkins around the corner and it didn't matter. Every hospital system will market themselves as the best.

Mark Testa (00:57:35):
Texas is the spinal fusion capital of the country. So there's a flip side to proximity.

Bruce Shutan (00:57:51):
Show of hands, how many have had significant MSK issues in your company? (Many hands go up).

Eric Silverman (00:58:21):
The night before my surgery, a PA called to go over meds. He listed a muscle relaxer and a narcotic. I asked why they were prescribing narcotics if the surgeon said I'd have immediate relief. He didn't have a response. That's how people get addicted. The next morning, my surgeon said he had no idea why they were giving me narcotics and told me to just take Tylenol. He was right.

Bruce Shutan (01:01:19):
Happy endings all around. Thank you for toughing it out. Safe travels home.

Eric Silverman (01:01:34):
Don't go home yet! Thank you to the panelists. I'm passionate because I'm not in pain anymore. Thank you to the sponsors and vendors. Please fill out the surveys honestly. Heather, did I miss anything?

Audience Member 1 (01:03:12):
There is a reception next door in the Palmer Room. Also, fill out the evaluation form for your SHRM credits.

Eric Silverman (01:03:47):
If you have questions, let us know. We are officially adjourned. Thank you!