Imagine this. You're at the Hyatt Regency Chicago
surrounded by the top minds in the ambulatory
surgery center industry.
Welcome to the Becker's 30th annual meeting, the
business and operations of ASCs from October 30th
to November 2nd
2024. Picture the excitement as you collect business
cards from over a 1000 executive level attendees
forging priceless connections.
Feel the buzz of conversations as you participate
in more than 60 sessions led by over
225 elite ASC speakers.
Envision yourself gaining actionable insights on topics like
private equity strategies,
ASC business growth, and innovations in spine, orthopedics,
GI, ophthalmology, and cardiology.
Now imagine yourself listening to inspiring keynotes from
Hall of Fame boxing world champion, Lila Ali,
and professional basketball player, Caitlin Clark. Their stories
will motivate you to take your business to
new heights. You'll leave with a wealth of
knowledge and a network of connections to help
lead your ASC into the next year. Don't
miss out. Get registered today. Visit beckershospitalreviewdot
com and click on the events page to
find the conference website. That's the beckershospitalreview.com
events page. See you in Chicago.
This is Laura Dirda with the Becker's Healthcare
podcast.
I'm thrilled today to be joined by April
Ernst, chief operating officer at Orlando Health Jewett
Orthopedic Institute. April, it's a pleasure to have
you on the podcast today.
Thank you, Laura. It is really a pleasure
to be here with you today.
Now I'm looking forward to our conversation and
really digging into some of the great things
that you've been doing at the Jewett Orthopedic
Institute. But before we dive in, can you
tell me a little bit more about yourself
and your background?
Sure.
Interestingly enough, I,
started my career as a respiratory therapist. So
something very far from orthopedics and spine
care, but, I have spent
27 years in,
in hospital operations
and health care,
at Orlando Health in Orlando. Most of my
career has been at Orlando Regional Medical Center,
which was the or is the flagship
for Orlando Health. Started as a respiratory therapist
fresh out of out of school and,
and remained in that field
for the better part of
24 years
before I transitioned
at the the same hospital over into,
project operations.
We were seeing such significant growth at
at our hospital and,
really embracing
institutes and specialized care,
for patients with with different conditions.
And
so we were growing those programs
and, really required someone with a clinical background
to,
facilitate
that,
that growth in those projects
and to ensure that we had clinical team
members at the table as we were,
creating these spaces,
for patients
and that would allow them to work efficiently
and deliver the best care possible.
So, after that,
we,
after that transition into that role,
Orlando Health,
began to build the Orlando Health Jewett Orthopedic
Institute,
and that was right across the street
from the hospital that I was working in.
So I had
a great opportunity to to work on this
project
and really see it started from the ground
up, and this was
pretty much in
early
2021
when we started.
And, then as the facility went up and
the programs,
were being developed, I was given an opportunity
to transfer over
to the Orthopedic Institute,
and so that's where I am today.
That's amazing to hear, and what a great
journey, from a respiratory therapist into more of
administrative and leadership roles and really,
leaning into spaces where you can make a
big impact on the community. So that's great
to hear.
From your position and vantage point,
at the Orthopedic Institute, what are some of
the big headwinds that you're looking at and
planning on for this year? What's top of
mind for you?
So, you know, we we have multiple factors
that create a pretty complex landscape in health
care. Right? No matter what
what the specialty is, the environment
is evolving and changing rapidly.
What we have done is to actually embrace
those headwinds
and treat them as if they are tailwinds,
that push us to be creative in our
strategies
and to be adaptable
and really,
just
encourage us to solve for them,
before they get in front of us, and
and and we're too far behind.
But but some of those things are really
quite an opportunity
in Central Florida where we live.
We have an aging population
here that we're seeing
across the country,
but, also, we're seeing a huge migration of
people to Central Florida moving here. So what
this is creating for us, really is,
a tailwind that's
pushing us. Okay.
We've got to grow, and we've gotta grow
faster.
And what can we do,
in order to to take care of these
patients that are coming into our community? So
real estate,
is something that we are continually look at
looking at. Where are people going in the
market? Where do we need to provide orthopedic
spine care for these patients?
And where do we need to set up
shop? So this is something that our team
is is doing on a a consistent basis.
We're consistently reviewing that market and determining
where the best locations are for us,
in our region. We do have a hub,
on our downtown campus in Orlando
where we have the institute, which is our,
complex that takes care of patients
outpatient and inpatient
all under the same roof. We have a
surgery center,
on one side of our building, and then
we have a hospital on the other side.
So we do see the majority of our
patients that will come downtown
to receive their services on our downtown campus,
but we also, you know, need to solve
for patients that want to receive care in
their
in their communities close to home. So that's
something that we are working through is growth.
It's it's, you know, it's really,
something that is a great opportunity for us
in in expansion.
Also, we're we're looking
constantly at reimbursement pressure.
I think everyone feels that. Health care payment
models,
value based care, that puts pressure on on
our organization.
But but it's good pressure. It's pressure that
reduces cost.
It's pressure that,
makes us do better
in quality,
providing quality care for our patients.
So we have to always have our eye
on that
as we look towards the future. How do
we provide quality care? How do we set
up programs
that,
make it easy for patients to navigate?
How do we ensure that
patients have access
to our team anytime that they need it
in order to provide that quality care, to
have those outcomes recorded,
to have that track record,
with insurance companies, with Medicare.
So that reimbursement
pressure is is not necessarily
as heavy for us.
So always have our eye on that. Also,
the shift towards outpatient care. We know in
orthopedics and spine, we're seeing that flip.
Inpatient,
procedures are now being done in the outpatient
setting.
So we have to look towards the future
where patients going to receive this care. They're
probably going to receive them in surgery centers
and ambulatory surgery centers. So, again, we have
to look at the market, assess the market,
determine where patients are moving to, where they
live, where do we need to invest in
surgery centers,
in their communities so they can receive that
that care.
Rising cost. There's there's always supply chain, and,
we have experienced rising cross rising cost across
the
the country and almost everything.
The same thing applies
for to our implants, to the materials we
use.
Controlling cost is a significant challenge
for for most of us, and this is
something that we always have to have our
eye on. We're also seeing patients. They they
want nonsurgical
alternatives.
So while that may be in biologics,
through physical therapy, through lifestyle modifications,
those are not necessarily something that surgeons,
are embedded in their practice, but we as
an institute,
are looking to that. We want to have
a comprehensive approach
that,
satisfies
patients' needs,
where we can meet patients where they are.
And if there's an opportunity for us to
provide a nonsurgical opportunity,
or or alternative, then then we want to
be the ones that do that.
Also, there's there are advancements in robotics. And
so the technology
advancement
is something
that is
really
abundant,
and it's very rapid.
So keeping up with the latest technology, ensuring
that our our surgeons are trained,
and able to utilize this technology is very
important. We are very, very lucky to have
a bioskills lab,
in our institute,
10 Station Cadaver Lab, that we are able
to bring in our industry partners
with their technology
and train our surgeons right there in our
building so they don't have to go out
for training.
So we do have that advantage that we
can continue to keep our surgeons
up on the the latest technology.
So those are some of the things that
we're looking at as opportunities
as we move into to the next year.
That's really amazing to hear, and thank you
so much for the overview. As you mentioned,
there's so many different, factors that come into
just how you're thinking about growth and development,
whether it's from, as you said, you know,
migration to the Florida area, trying to figure
out where people are going and where
trying to figure out where people are going
and where surgery should be done inpatient versus
outpatient. And then too, you know, I'm very
interested in this idea of, looking at some
of
the costs as well as, you know, reimbursement
shifts
in in health care. I know that's something
top of mind for so many,
orthopedic practices and spine groups across the country
as well.
You mentioned kind of how you're thinking about,
some of the different ways you can measure
and report and check outcomes and and look
at, you know, your relationships with insurance companies
and and value based care as well. Where
are you, you know, when you're thinking about,
some of those different kinds of unique,
payment methodologies
or value based arrangements?
Is that something that you've done for years
at at Jewett Orthopedic Institute, or is it,
you know, something you're dipping your toe into
currently and and trying to figure out what
works best?
Yeah. So as as an organization at Orlando
Health,
this is something that we're we are always
watching.
It's really vital to the success of an
organization.
And,
and what we understand is that insurance companies,
value based care,
that that approach
really wants to ensure
that
patients are receiving
high quality care
because that reduce cost. Right? And it also,
contributes to patient satisfaction.
So this is something that we are doing
at Orlando Health Jewett Orthopedic Institute. This is
almost on a daily basis that we are
reviewing our quality metrics,
not not only just with our administrative team,
but our frontline staff,
with our physicians,
with
our,
our caregivers in the clinics, with our navigators.
We've institute instituted a nurse navigation program
that allows us to be
walking step by step, hand in hand with
the patient along their journey
with us from
the moment that they're scheduled for surgery
until they are are discharged,
from rehab, you know, until they complete that
journey with us.
And all the while,
we are ensuring that
all of the the quality standards are met.
And those those standards are things like, what
is the length of stay for a patient?
We know that it's best to be able
to get patients out and back home
from the hospital after surgery as quick as
we possibly can. You're in a safer environment
in in your home, right, when when you
look at it from,
the quality perspective. We're also looking at where
are we discharging our patients to. The best
environment to discharge our patients to is home.
If if we are
having to focus efforts on
preparing patients to go to a skilled nursing
facility or,
an inpatient rehab facility,
then maybe that patient's not necessarily
a great candidate right now for surgery, and
maybe we need to optimize them before we
have surgery so that we can ensure that
they go home. So, we are really working
on our presurgical
optimization
with our patients,
making sure that
they receive the proper nutrition prior to surgery.
Believe it or not, we have malnourished patients,
and we need to take care of those
patients to make sure they're in prime condition
prior to their surgery
as well as our patients that
are obese.
So we have those patients that that along
that that span
that we have to solve for,
and we wanna solve for them up front.
You know, you have comorbidity, comorbidity, such as
as
diabetes,
cardiovascular diseases, osteoporosis.
We have to solve for those
before we do surgery to ensure best outcomes
for those patients. We don't want those patients
to be readmitted after they're sent home
with with complications.
We want them to have a successful,
surgery and a successful recovery
in their home,
with very minimal, if any,
complications
or readmissions.
And and so those are the things that
we are working on, and and that requires
a a laser
light focus
on
really connecting with the patient
throughout their entire journey. So we don't leave
anything, any uncertainties
to them.
We want to solve all of that for
them with them.
I love that. That's such a a great
way to think about it and really make
sure,
you know, those
kind of new,
technologies
and new ways of connecting with patients and
really serving them better are coming to the
forefront.
Now I'm wondering, you know, given your your
position, how do you see the field of
spine orthopedics evolving over the next 2 to
3 years? What's,
going to be be paramount for,
practices
in surgeons and those in the industry as
they're trying to make sure, as you mentioned,
they're able to care for patients and and
really,
expand access to care?
Yeah. I I think that what we're seeing
is, you know, the continued push to
the outpatient setting. Right? So
really planning for that. And and it takes
it takes a good 3 years
to to plan for facilities that can take
pay take care of patients in in the
outpatient setting. So,
you have to start your strategic planning 3
to 5 years in advance. You have to
be looking towards the future
at all times and be willing to adjust
as needed
in order to solve for that pay patient
population.
So ensuring that that you have,
enough outpatient,
settings for patients to receive care, ambulatory
surgical center,
are are a must. And, you know,
not only is it good for patients, they
go in, they have their surgery, they go
home the same day,
but it it provides care at a lower
cost.
So
these these are things that are important
to patients, important to payers. So you we
we really are focusing on
how we can get in front of
that complete shift and flip towards,
providing care in an ambulatory setting. Also,
advancements
in robotics.
As I mentioned before, the use of robotic
systems technology
is advancing
so rapidly
that you have to be able to look
ahead and determine
what types of technology,
is gonna be most beneficial
to
your practice, to your surgeons,
and and get ahead of that and be
part of that be part of that
push in technology
with industry.
Form partnerships
with industry,
that are are no longer adversarial
but beneficial to each. You know, I think
there's that nash that that natural
tension
that's created
between
industry partners
and
providers, health care providers like ourselves.
But what we've done is actually
turn that to a relationship.
We we have some great industry partners that
we're at the table with,
every month,
and we are working to solve for these,
these advancements in in technology
together.
We're part of their solution. We're part of
their their development.
So I think that that is something
that, is very important that orthopedics and spine
care providers
are a part of and and is and
that is being being at the table when
when new technology is being creative
or created.
Implants,
you know, we are also seeing some talk
about
3 d printing. We we actually had a
a half a 3 d printer in our
facility that we've been able to use,
to to create
certain anatomy
and,
have our our physicians be able to look
at that and and and determine what's what
their best approach to surgery to their procedure
is going to be using patients'
own customized,
anatomy. It's it's there. It's their
anatomy right there that we're able to print,
and our surgeons
can potentially practice their case,
before
before actually performing it on
on their patients. We're seeing,
augmented
augmented and virtual reality
that is something that is consistently used in
our practice
in,
our our surgical cases.
And,
this is really being embraced by our team.
And we, you know, we know AI
can can be scary. Right? And and and
what does AI really mean? You know? And
and how do you really want to use
AI in the future? We know it's here.
We know that we're going to have to
learn
how to work
with it. And so how do we best
do that? What is best for our practice?
What is best for our surgeons?
Telemedicine
patients really want to,
receive care in their home, and so we're
looking at that. We have incorporated telemedicine into
our practices,
probably similar to many others out there. But
this is just providing convenient care for our
patients,
in their home environment,
reducing the burden on them
to, you know, have to come in for
a clinic visit. Transportation
can be a challenge for for a lot
of patients. So how can we meet our
patients where they are and provide
the the best care to them,
using technology
that we have at our fingertips.
I love that. I I think there's so
much there as you mentioned, just thinking about
the technology,
whether it's robotics and and how that can
make the most sense for each individual practice
or artificial intelligence and incorporating that into the
broader
operations as well as clinical care. I I
can imagine there's just so much information and
so much change. It's, you know, sometimes overwhelming,
but at the same time, really exciting to
think about how,
health care is changing
in really able to better serve patients in
the future.
Now I I know we've talked a lot
about growth,
you know,
throughout our conversation, but I'm wondering, you know,
when you think about the future, both near
and long term, what do you see as
some of the best opportunities for growth and
development going forward?
Yeah. So,
this this is something that we work on
every day and we talk about every day,
and I think it's very important that
orthopedic spine practices and and organizations that support
them do.
You have to always be looking towards the
future and how are we gonna care for
patients in the future.
And, you know, we we've talked about some
of those things, but I think,
the the
trends
suggest, and we know that it is here.
We know that
we have to become
a comprehensive care provider for our patients.
We have to be patient centered.
We have to leverage our technology,
our care models,
our outcomes.
We have to reduce costs. We have to
enhance the patient experience.
So we always have to be looking towards
that and how we can do
that more efficiently,
more effectively.
We know that
meeting patients where they are in the outpatient
setting in their communities,
is very, very important.
So looking forward,
we talked about this before as well, Florida
being just a place where we are seeing
a huge population,
boom.
Where do we invest
in those facilities to take care of those
patients? Ambulatory surgery centers
are are that, and and those are the
things that we have to focus on and
we have to start planning for right now.
We have to plan for these today.
Construction costs are rising.
How do we solve for that?
So, those are the things we're looking at,
and we we also are embracing
robotics as we've talked about and the navigation
systems.
These are really
important as they continue to improve
daily.
The the development that's being done in this
area
significant,
and we know that patients are more likely
to choose us if we have,
cutting edge robotic systems. We just know that.
Patients ask for that. So we want to
be able to offer that, and we also
have to make sure that we're training
our surgeons
and all of our physicians to be able
to
use this technology
and provide the best care for their patients.
So utilizing our bioskills lab is very important
in in this area of technology and really
being ready to take care of of patients.
So,
you know,
I mentioned biologics
a little bit earlier. Patients are seeking that.
It's a big buzzword.
Again, there's some controversy to that because we
know as care providers, there are only there's
only so much that that biologics can do.
And making sure that our patients understand
what that is and not giving them false
or misleading information,
is very important. So having experts in in
biologics
to be able
to explain these things, explain the benefits,
explain the limitations
of of these products to our patients is
very, very important, but to be able to
offer it to those
that it's indicated
for.
So those are things that that we're we're
looking forward to really,
again,
quality is is something that that will drive
almost everything we do. Quality is at the
center of it because ultimately at the end
of the day,
the patient demands
quality
care. So we,
need to be able to deliver that, and
that is in turn what will contribute to
our growth
and will contribute to our our reputation
and advance
the vision of of the Orlando Health Jewett
Orthopedic forward.
That's amazing to hear. April, thank you so
much for joining us on the podcast today.
This has been such a a fun conversation,
and I look forward to connecting with you
again soon.
Very good. Thank you so much, Laura. It
was a great time.