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Imagine this. You're at the Hyatt Regency Chicago

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surrounded by the top minds in the ambulatory

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surgery center industry.

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Welcome to the Becker's 30th annual meeting, the

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business and operations of ASCs from October 30th

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to November 2nd

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2024. Picture the excitement as you collect business

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cards from over a 1000 executive level attendees

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forging priceless connections.

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Feel the buzz of conversations

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as you participate in more than 60 sessions

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led by over

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225 elite ASC speakers.

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Envision yourself gaining actionable insights on topics like

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private equity strategies,

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ASC business growth, and innovations in spine, orthopedics,

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GI, ophthalmology, and cardiology.

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Now imagine yourself listening to inspiring keynotes from

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Hall of Fame boxing world champion, Lila Ali,

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and professional basketball player, Caitlin Clark. Their stories

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will motivate you to take your business to

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new heights. You'll leave with a wealth of

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knowledge and a network of connections to help

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lead your ASC into the next year. Don't

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miss out. Get registered today. Visit beckershospitalreviewdot

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com and click on the events page to

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find the conference website. That's the beckershospitalreview.com

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events page. See you in Chicago.

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This is Laura Dierda with the Becker's Healthcare

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podcast.

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I'm thrilled today to be joined by doctor

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Brian Krenzel, chief quality and development officer at

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OrthoCarolina

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as well as board chair for Viewmont Surgery

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Center, a multispecialty

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ASC in Hickory, North Carolina. Doctor Krenzel, it's

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a pleasure to have you on the podcast

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today.

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Thank you, Laura. I'm excited to be here,

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excited to talk about Viewmont and our recent

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growth as well

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as all things, orthopedic value in nature.

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Fantastic.

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Well, I know we've got a lot to

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talk about and certainly excited to learn more

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about,

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what you're doing at the surgery center. But

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before we dive in, can you tell us

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a little bit more about yourself and your

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background?

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Sure.

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I am a fellowship trained adult reconstruction specialist.

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I have, certainly focused the bulk of my,

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professional practice career in the hip and knee

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replacement realm.

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I have,

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evolved that into some

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leadership roles within OrthoCarolina

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as well

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as outside of OrthoCarolina

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and our surgery center venture here in Hickory.

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Really evolved, I would say, over the past

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dozen years or so

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into the value space, really trying to figure

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out a better way to deliver hip and

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knee replacement,

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through improvements in quality as well as, the

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all important,

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cost drivers

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and trying to identify

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those levers we can pull to to change,

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the

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incredibly high cost of health care throughout our

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country and in our region. So, ultimately,

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really spend a lot of time living in

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that, value realm.

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That's great to hear. Now first and foremost,

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what are some of the biggest issues that

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you're following in health care today? What's top

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of mind for you?

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In my

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space, working in value and in my leadership

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role, really, what we're

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focusing on and seeing as a main driver

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is is where can we find the cost

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containment.

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I think a lot of

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a lot of the aspects of of health

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care focusing on cost have really

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ignored the value piece, however.

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And what I mean by that is we

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see a lot of

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movement towards various side of service shifting,

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potentially even out of the country with some

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of our local employers here in Hickory.

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But the patients aren't necessarily getting

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the highest quality care out of that.

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And when you

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ignore one piece for the other, you're not

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necessarily

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driving value.

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And,

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that value equation quality divided by cost seems

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to be one of the larger hot button

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issues that is

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on the talking points for the orthopedic

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realm, especially with spine and joint replacement surgeries

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being

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as historically costly as they've been in the

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hospital based settings.

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We're seeing this conversation not just being driven

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at the highest level from CMS,

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but also all the way down to the

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more granular level of local health care delivery

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with small business and and how they're able

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to

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manage their health care spends through through,

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population health tools,

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and all the way to bundling,

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the singular episodes of care. A lot of

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lot of

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spectrum there to discuss,

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but, ultimately, one of the key pieces to

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that and one of the biggest things that

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we're seeing is

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is a shift to some of these higher

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cost surgeries like hip and knee replacement

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into the ambulatory surgery space, and that's been

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something

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gaining a lot of traction

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over the past decade, but certainly over the

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past 5 years, and and COVID was a

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big driver in that.

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That makes a lot of sense. And, you

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know, I I can really appreciate having those

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procedures going to the outpatient setting. From your

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perspective, have you seen,

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you know,

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patients as well as clinicians get on board

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with being able to perform more of these

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higher acuity cases in the surgery center, or

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has it been a little bit of a

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a journey to really make that transition?

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Yeah.

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I think there's a small subset of patients

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that are a little bit reluctant. They feel

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safer in the traditional brick and mortar hospital

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as opposed to the ambulatory space. But if

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you take the time to talk to the

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patients to educate them

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on why an ASC may be right for

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them,

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they tend to really favor that even with

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those higher acuity cases. I think most people

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would expect to go to an ambulatory surgery

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center for rotator cuff or an ACL.

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Some people look at you kind of wide

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eyed when you talk about joint replacement or

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spine surgery in that environment.

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In fact, interestingly enough, you're seeing side of

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service shifting from

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carpal tunnel and trigger finger type cases out

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of the ASC even into minor procedure rooms

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that are built in our orthopedic clinics.

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So we're we're seeing

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benefit there,

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where patients may once it paid a facility

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fee at an ASC rate now coming to

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the office to have a carpal tunnel and

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paying an office co pay,

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which is considerable savings for them, and and

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that's been proven to be safe, and reproducible

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from a quality perspective.

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That side of service shift is very powerful.

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Once you explain that to patients

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and they understand it, you get great deal

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of buy in.

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That's really great advice and certainly glad that

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it's worked out well for you. Now I'm

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wondering, you

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know, what when you look ahead,

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what are the things that make you most

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excited and what are you nervous about?

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Well, looking ahead, particularly,

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with what we've been able to create here

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in Hickory, the thing that makes me most

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excited is is to gain

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even more,

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control and impact on the patient relationship that

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I have. I I don't I don't have

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the

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barriers that often come with traditional inpatient care.

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We have a lot of freedom in how

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we choose to deliver care in the ambulatory

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environment,

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giving us a lot of opportunity to innovate

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and to be creative to continue to improve

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outcome and lower cost.

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That gets me very excited both from the,

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ability to control

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that episode of care,

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and then expand,

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the opportunities we can deliver patients.

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In that same vein, it's exciting to build

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new service lines. At our ASC in particular,

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we've

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expanded our spine service line. Recently, we're offering

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numerous,

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ENT cases

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that have,

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that have grown such as the Inspire

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sleep stimulator.

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We're bringing head and neck cancer cases

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into our ASC that have typically been done

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at the hospital.

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We're able to expand the complexity of the

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patient from a health perspective. We're able to

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take a little bit more sick,

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patients to the ASC,

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with our

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anesthesiology

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group we work with being top of the

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line and additionally,

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having overnight stay capabilities at our center as

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well.

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From a worry perspective, I think the one

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worry is that we that we get,

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too aggressive too fast. When you when you

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get some opportunity

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to think outside the box and get some

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of,

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for lack of a better term, freedom, I

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think you need to make sure you're

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paying attention,

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not getting too aggressive

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and getting too far out on the fringes.

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So taking this, with a

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scientific cautious

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stepwise approach as we expand

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indications

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and procedures is is the one place where

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we could slip up, so we need to

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be smart about that.

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That, you know, is really I can imagine

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a fascinating discussion that you're having, and cool

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to hear, you know, you've been able to

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expand the types of cases and types of

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patients you're able to,

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perform cases on at the surgery center.

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I'm wondering, you know, when you look at

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that focus on the value based care and

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focus on

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providing additional care for those types of patients,

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what do you really see as being essential

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as your guiding light going forward? Do you

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foresee more of the of, these types of

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cases going to the surgery center, or what

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comes next?

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Sure.

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I think

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it's certainly been proven to be safe

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to do hip and knee replacement in particular

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to at an ambulatory surgery center,

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in a same day discharge setting.

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I think in my practice, studying my individual

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practice and then looking out at the more

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large scale macro level,

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I think it's very reasonable

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to

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believe that 75 to 80%

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of joint replacement patients

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can safely be done in an ambulatory surgery

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center.

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I've recently

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expanded my indications and and virtually eliminated

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age as a restriction.

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Just a couple weeks ago, we did an

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86

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year old healthy,

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patient,

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sent them home the same day from an

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ASC.

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Patient's doing beautifully, had good family support.

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So

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the number of patients that can shift over

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there in the joint replacement realm, I think

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we have good science and a good understanding.

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I think that number is a little bit

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perhaps unknown. What percentage of patients could ultimately

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from a spine perspective be done there? I

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think we're gathering data and expanding those indications,

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but

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I'm very comfortable

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with the type of patient that we can

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take to the ASC,

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and that's a large number. And so it's

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gonna have a significant impact on on health

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care spend,

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across the entire country, quite frankly.

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That makes a lot of sense, and you're

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excited for that future to to come. Now

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00:10:59,865 --> 00:11:02,024
before we wrap up our conversation here, what

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do you think most effective health care leaders

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will need in order to be successful in

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the next 2 to 3 years, especially as

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more of health

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care goes into the value based realm and

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outpatient

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procedures become more common?

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I think you have to have a a

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really structured approach to this.

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You have to have physician leaders that are

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willing to

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to step up

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to change the paradigm of care in your

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community to I I don't wanna say take

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risk, but certainly change their practice patterns.

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It has to be driven, I think, by

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physicians, particularly

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in the ambulatory surgery setting where physicians have

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opportunities for equity ownership.

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But

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equally important as in our community with Viewmont

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Surgery Center, you have to have hospital

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00:11:47,154 --> 00:11:48,915
buy in and partners. What you don't wanna

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do is create

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a total war

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between you and your local hospital where you're

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00:11:55,795 --> 00:11:57,634
pulling all of the volume out of the

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facilities

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and leaving them with the highest acuity cases,

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that are not necessarily

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00:12:06,629 --> 00:12:08,870
the best and healthiest of patients that may

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be more costly.

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Our particular situation here in Hickory at Beaumont

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is really unique.

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We have 2 hospitals in our community.

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One is a,

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00:12:20,095 --> 00:12:22,334
for profit private owned facility, and the other

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is a county facility.

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The hospitals

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are both of them joint ventured in our

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ambulatory surgery center.

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So for us to have the ability to

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have recently expanded our surgery center from 3

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rooms to 6 rooms,

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00:12:37,879 --> 00:12:39,879
to have the ability to have renovated our

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00:12:39,879 --> 00:12:42,815
surgery center, we needed to have our hospital

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00:12:42,815 --> 00:12:44,194
partners bought in.

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And in our community,

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we're very fortunate.

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Both of our facilities for our regional medical

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center,

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00:12:51,054 --> 00:12:53,934
which is a Duke, Lifepointe facility and Catawba

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00:12:53,934 --> 00:12:56,350
Valley Medical Center, our county hospital, have had

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00:12:56,350 --> 00:12:57,570
forward thinking leadership

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that has partnered with us in a cooperative

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way

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and not in the manner in which, they've

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obstructed the growth of the center and the

361
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shift to the ASC.

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The physician leaders,

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00:13:11,384 --> 00:13:14,444
having good strong relationships with your hospital partners

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are super important.

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00:13:16,424 --> 00:13:17,485
And then from there,

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it just is a matter of developing the

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culture at your center, getting the right staff,

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having fantastic anesthesia partners like we do.

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Putting all of that together, I think it

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gives you a recipe for success. I think

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doctors can be perhaps a little shortsighted if

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they get too aggressive too quickly,

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about the growth of the center.

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00:13:39,054 --> 00:13:41,695
And they're not considered particularly in smaller communities

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00:13:41,695 --> 00:13:43,554
like ours, unlike bigger cities,

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00:13:43,855 --> 00:13:46,175
of the implications that side of service shift

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00:13:46,175 --> 00:13:48,355
would have for their local hospital facilities.

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00:13:49,134 --> 00:13:52,035
So my suggestion is to, when possible,

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00:13:52,889 --> 00:13:55,470
think think about partnerships, think about,

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00:13:56,410 --> 00:13:58,889
integrating all aspects of your local health care

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00:13:58,889 --> 00:14:01,629
market into it. Again, we're lucky we have

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00:14:01,850 --> 00:14:02,509
a multispecialty

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00:14:02,889 --> 00:14:05,309
center where we have ENT and pain partners

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00:14:05,884 --> 00:14:07,004
that are able to,

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00:14:07,725 --> 00:14:09,964
be involved in this. And I think when

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00:14:09,964 --> 00:14:11,184
you do it that way,

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00:14:11,565 --> 00:14:13,725
you get a huge win and a huge

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00:14:13,725 --> 00:14:16,524
lift for for multiple people as opposed to

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00:14:16,524 --> 00:14:17,985
one subset of physicians,

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00:14:19,029 --> 00:14:19,529
or

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00:14:20,230 --> 00:14:22,169
a hospital entity in and of themselves.

392
00:14:24,230 --> 00:14:25,830
That's really such a great point. And I

393
00:14:25,830 --> 00:14:26,710
know that,

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00:14:27,029 --> 00:14:29,669
kind kind of dynamic that you talked about

395
00:14:29,669 --> 00:14:32,384
between physician surgery centers and hospitals is a

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00:14:32,705 --> 00:14:34,245
very real and evolving,

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00:14:34,865 --> 00:14:35,365
relationship.

398
00:14:35,904 --> 00:14:38,705
I can imagine a lot of, different regions

399
00:14:38,705 --> 00:14:41,904
and cities physicians are trying to navigate that.

400
00:14:41,904 --> 00:14:43,524
And your advice

401
00:14:43,904 --> 00:14:46,804
is certainly helpful to have that stealthy navigation

402
00:14:46,865 --> 00:14:49,559
through, and have a very, you know, strong

403
00:14:49,559 --> 00:14:52,200
working relationship with those folks because, as you

404
00:14:52,200 --> 00:14:54,679
mentioned, it's so important to have all aspects

405
00:14:54,679 --> 00:14:56,600
of the health care system represented in the

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00:14:56,600 --> 00:14:59,419
most appropriate way, within the broader communities.

407
00:15:01,475 --> 00:15:02,375
I I'm

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00:15:03,235 --> 00:15:06,695
really excited that this partnership that we've created

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00:15:06,754 --> 00:15:07,735
will provide

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00:15:08,195 --> 00:15:10,054
for the next 20 years minimum,

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00:15:11,394 --> 00:15:13,875
opportunity for the patients of our community to

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00:15:13,875 --> 00:15:14,375
find

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00:15:15,230 --> 00:15:17,789
really high quality health care that's going to

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00:15:17,789 --> 00:15:18,529
be affordable.

415
00:15:19,629 --> 00:15:20,110
And,

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00:15:20,829 --> 00:15:23,889
and when needed, we have 2 hospital facilities

417
00:15:24,110 --> 00:15:25,089
to take them

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00:15:25,470 --> 00:15:27,409
to that will provide similar,

419
00:15:28,190 --> 00:15:28,690
care,

420
00:15:29,754 --> 00:15:31,375
of that high quality nature,

421
00:15:31,995 --> 00:15:33,375
but, you know, obviously

422
00:15:34,235 --> 00:15:36,654
not going to be something that everybody needs.

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00:15:37,115 --> 00:15:40,334
So this investment we've made in our facility

424
00:15:40,475 --> 00:15:42,679
and our community is one that I think

425
00:15:42,679 --> 00:15:44,220
will pay dividends for everybody,

426
00:15:44,600 --> 00:15:46,759
all of these stakeholders, and most importantly, our

427
00:15:46,759 --> 00:15:48,299
patients and employers locally.

428
00:15:49,799 --> 00:15:52,440
Absolutely. That's, you know, really great to hear.

429
00:15:52,440 --> 00:15:54,039
Well, thank you so much, doctor Krenzel, for

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00:15:54,039 --> 00:15:55,720
joining us on the podcast today. This has

431
00:15:55,720 --> 00:15:57,434
been such a a great conversation, and I

432
00:15:57,434 --> 00:15:59,214
look forward to connecting with you again soon.

433
00:15:59,995 --> 00:16:01,615
Thank you, Laura. Appreciated,

434
00:16:02,394 --> 00:16:04,554
opportunity to speak to you and your time

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00:16:04,554 --> 00:16:05,054
today.