1
00:00:02,560 --> 00:00:05,839
Today's clinical providers and health care systems need

2
00:00:05,839 --> 00:00:08,559
a strategic partner that is focused on the

3
00:00:08,559 --> 00:00:10,419
evolution of health care delivery.

4
00:00:10,960 --> 00:00:13,839
At Surgery Partners, we are redefining the health

5
00:00:13,839 --> 00:00:14,580
care industry

6
00:00:14,884 --> 00:00:18,184
as a nation's leading independent operator of surgical

7
00:00:18,245 --> 00:00:20,425
facilities and ancillary services.

8
00:00:20,885 --> 00:00:24,025
With an extensive presence spanning over 180

9
00:00:24,484 --> 00:00:25,704
locations nationwide,

10
00:00:26,324 --> 00:00:28,505
our commitment extends beyond healthcare.

11
00:00:29,045 --> 00:00:30,185
It's about fostering

12
00:00:30,579 --> 00:00:31,399
successful partnerships

13
00:00:31,780 --> 00:00:33,859
that enhance the quality of care in the

14
00:00:33,859 --> 00:00:35,079
communities we serve.

15
00:00:35,700 --> 00:00:38,340
Surgery Partners is more than an operator or

16
00:00:38,340 --> 00:00:41,939
service provider. We are your strategic ally committed

17
00:00:41,939 --> 00:00:43,960
to transforming healthcare delivery.

18
00:00:44,500 --> 00:00:46,215
Learn more at surgerypartners.com.

19
00:00:49,395 --> 00:00:52,215
This is Alan Condon with the Becker's podcast.

20
00:00:52,435 --> 00:00:54,835
I'm thrilled to be joined today by Terry

21
00:00:54,835 --> 00:00:57,655
Boulke, who is the vice president of ambulatory

22
00:00:57,954 --> 00:00:58,935
surgery centers

23
00:00:59,314 --> 00:01:02,210
at Community Health systems. Terry, a real pleasure

24
00:01:02,210 --> 00:01:04,049
to have you, on the podcast with us

25
00:01:04,049 --> 00:01:06,290
today. Before we get started and pick your

26
00:01:06,290 --> 00:01:07,569
brains a little bit, I'd love to turn

27
00:01:07,569 --> 00:01:08,930
the floor over to you to hear a

28
00:01:08,930 --> 00:01:11,010
little bit more about your background and your

29
00:01:11,010 --> 00:01:11,989
role at CHS.

30
00:01:13,204 --> 00:01:14,884
Yeah. Sure, Alan, and great to speak with

31
00:01:14,884 --> 00:01:15,384
you.

32
00:01:15,765 --> 00:01:18,164
I am the vice president of ASCs for

33
00:01:18,164 --> 00:01:20,244
community health systems, which is one of the

34
00:01:20,244 --> 00:01:20,744
largest,

35
00:01:21,524 --> 00:01:24,744
health systems, hospital systems in the United States.

36
00:01:25,125 --> 00:01:25,859
We have

37
00:01:26,260 --> 00:01:28,840
ownership in about 25 ASCs nationwide.

38
00:01:29,859 --> 00:01:30,340
And,

39
00:01:30,659 --> 00:01:32,520
my responsibility is overseeing,

40
00:01:33,379 --> 00:01:35,459
pretty much everything there is to do with

41
00:01:35,459 --> 00:01:35,959
ASCs

42
00:01:36,260 --> 00:01:37,319
in our company.

43
00:01:37,954 --> 00:01:40,194
Prior to that, I was vice president of

44
00:01:40,194 --> 00:01:42,215
operations for 2 different national

45
00:01:42,834 --> 00:01:44,215
ASC management companies.

46
00:01:44,754 --> 00:01:45,974
And prior to that,

47
00:01:46,674 --> 00:01:48,295
I was actually the administrator

48
00:01:48,674 --> 00:01:50,694
of a large surgery center in California.

49
00:01:52,060 --> 00:01:54,459
I think and if I'm not mistaken, also

50
00:01:54,459 --> 00:01:57,420
a past president of ASCO, the Ambulatory Surgery

51
00:01:57,420 --> 00:01:59,280
Center Association as well. Is that correct?

52
00:01:59,819 --> 00:02:00,719
That is correct.

53
00:02:01,260 --> 00:02:03,180
Alright. Well, no better man to speak to

54
00:02:03,180 --> 00:02:06,159
when we're talking about, the ambulatory surgery center,

55
00:02:06,864 --> 00:02:08,944
industries. They're really excited to to dive into

56
00:02:08,944 --> 00:02:09,604
our conversation.

57
00:02:10,305 --> 00:02:11,985
Pleasure to have you on the podcast, Terry.

58
00:02:11,985 --> 00:02:13,824
So to to kick things off,

59
00:02:14,784 --> 00:02:16,544
so much happening in health care at this

60
00:02:16,544 --> 00:02:17,764
time, but particularly

61
00:02:18,064 --> 00:02:20,324
exciting in the outpatient there arena.

62
00:02:20,784 --> 00:02:22,840
When we think about just the growth over

63
00:02:22,840 --> 00:02:24,520
the last decade or so, but maybe it

64
00:02:24,520 --> 00:02:25,659
seems to be accelerating

65
00:02:26,280 --> 00:02:28,520
towards the outpatient setting when we think about

66
00:02:28,520 --> 00:02:31,159
ASCs, urgent care urgent care centers, primary care

67
00:02:31,159 --> 00:02:33,240
centers, and whatnot. I'd love to hear what

68
00:02:33,240 --> 00:02:35,319
are 2 to 3 trends that you're really

69
00:02:35,319 --> 00:02:37,819
following in the ASC space today and why?

70
00:02:39,215 --> 00:02:40,275
Yeah. Great question.

71
00:02:41,134 --> 00:02:41,634
I

72
00:02:42,094 --> 00:02:44,495
I guess I I'd have to say top

73
00:02:44,495 --> 00:02:45,794
of the list is staffing,

74
00:02:46,254 --> 00:02:48,094
you know, more more current just,

75
00:02:49,375 --> 00:02:50,275
trying to

76
00:02:50,769 --> 00:02:52,849
keep ASCs filled with. As you mentioned, the

77
00:02:52,849 --> 00:02:55,489
growth has been significant and trying to keep

78
00:02:55,489 --> 00:02:57,430
up with that growth in staffing,

79
00:02:58,289 --> 00:03:01,110
and most of that's in clinical staff areas,

80
00:03:01,889 --> 00:03:02,709
but also,

81
00:03:03,250 --> 00:03:06,805
probably even a bigger issue is staffing anesthesia,

82
00:03:07,584 --> 00:03:10,245
so being able to have anesthesia providers available

83
00:03:10,305 --> 00:03:11,844
just with the limited,

84
00:03:12,784 --> 00:03:15,264
you know, the traditional ORs opening and then

85
00:03:15,264 --> 00:03:16,965
fewer providers available.

86
00:03:17,584 --> 00:03:19,125
So that's a big one.

87
00:03:19,979 --> 00:03:22,060
Kind of along with that are just costs

88
00:03:22,060 --> 00:03:22,560
overall

89
00:03:23,819 --> 00:03:24,319
have

90
00:03:24,699 --> 00:03:25,199
drastically

91
00:03:26,539 --> 00:03:29,759
increased post COVID, and it's just about everything

92
00:03:29,819 --> 00:03:30,879
across the board.

93
00:03:31,685 --> 00:03:33,604
So that that's been a a real problem.

94
00:03:33,604 --> 00:03:35,044
I'm trying to keep on on top of

95
00:03:35,044 --> 00:03:35,544
that,

96
00:03:36,324 --> 00:03:39,125
keep, you know, trying to look for ways

97
00:03:39,125 --> 00:03:39,625
to

98
00:03:40,164 --> 00:03:42,264
be smarter about how we utilize,

99
00:03:43,205 --> 00:03:45,750
trying to take advantage of, you know, maybe

100
00:03:45,750 --> 00:03:48,330
a sole source or a dual source purchasing

101
00:03:48,550 --> 00:03:49,449
to try and,

102
00:03:49,909 --> 00:03:52,550
keep the prices down, but but the the

103
00:03:52,550 --> 00:03:53,689
increase in costs,

104
00:03:54,709 --> 00:03:57,689
are just a real real issue with ASCs

105
00:03:57,750 --> 00:03:58,250
nationwide.

106
00:03:59,955 --> 00:04:01,894
And, I guess, one more

107
00:04:02,275 --> 00:04:04,514
that kinda goes along with that. A third

108
00:04:04,514 --> 00:04:05,814
one is just reimbursement

109
00:04:06,594 --> 00:04:08,614
is not keeping up with those costs.

110
00:04:09,474 --> 00:04:12,594
And, you know, even even in the with

111
00:04:12,594 --> 00:04:15,239
with hospital partners, you know, that can tend

112
00:04:15,239 --> 00:04:15,739
to

113
00:04:16,279 --> 00:04:18,519
bring a lot more leverage and higher rates,

114
00:04:18,519 --> 00:04:19,259
it's still

115
00:04:19,879 --> 00:04:21,259
cutting into those margins

116
00:04:21,879 --> 00:04:22,379
because

117
00:04:23,319 --> 00:04:26,139
the COLAs aren't anywhere near the inflation rate,

118
00:04:26,279 --> 00:04:28,939
not for commercial payers and not for Medicare.

119
00:04:29,665 --> 00:04:30,944
So I think those are kind of the

120
00:04:30,944 --> 00:04:31,685
things that

121
00:04:32,145 --> 00:04:34,305
that I'm concerned about and and trends that

122
00:04:34,305 --> 00:04:36,245
I I watch closely for ASCs.

123
00:04:37,105 --> 00:04:39,264
Yeah. Yeah. No doubt. The reimbursement is obviously

124
00:04:39,264 --> 00:04:41,264
a huge issue and rising costs, like you

125
00:04:41,264 --> 00:04:41,764
said,

126
00:04:42,189 --> 00:04:45,970
impacting pretty much everything from supplies, drugs, facility

127
00:04:46,029 --> 00:04:48,029
costs, and whatnot. And then the first trend

128
00:04:48,029 --> 00:04:50,689
that you mentioned in terms of staffing, clinicians,

129
00:04:50,829 --> 00:04:53,649
but more importantly, like you had mentioned, anesthesia.

130
00:04:54,350 --> 00:04:56,865
I'm curious, just to follow quickly up on

131
00:04:56,865 --> 00:04:58,384
that point, is

132
00:04:58,785 --> 00:05:01,524
we've heard a lot about staffing shortages, workforce

133
00:05:01,584 --> 00:05:03,604
shortages across the health care arena.

134
00:05:03,985 --> 00:05:05,985
Anesthesia is one that we're hearing a lot

135
00:05:05,985 --> 00:05:08,084
more about. When you think about

136
00:05:08,480 --> 00:05:09,459
staffing SCs

137
00:05:10,000 --> 00:05:10,819
with anesthesiologists,

138
00:05:11,600 --> 00:05:14,339
is it relying on a strategy of recruiting

139
00:05:14,639 --> 00:05:17,300
recruiting these talents or maybe through affiliations,

140
00:05:17,600 --> 00:05:19,680
through partnerships with different groups to help staff

141
00:05:19,680 --> 00:05:20,339
for anesthesia?

142
00:05:22,225 --> 00:05:24,944
You know, it's just it's really a market

143
00:05:24,944 --> 00:05:26,165
by market decision

144
00:05:26,865 --> 00:05:30,064
and some markets have been affected less than

145
00:05:30,064 --> 00:05:30,564
others.

146
00:05:31,185 --> 00:05:33,425
And so those were kind of going status

147
00:05:33,425 --> 00:05:36,004
quo or contracting with the group,

148
00:05:37,079 --> 00:05:37,560
and,

149
00:05:38,199 --> 00:05:39,979
you know, just as we always have,

150
00:05:40,680 --> 00:05:43,319
in in other situations, we've had to go

151
00:05:43,319 --> 00:05:44,539
the route of employing,

152
00:05:45,639 --> 00:05:46,139
providers,

153
00:05:46,519 --> 00:05:47,659
anesthesia providers.

154
00:05:48,279 --> 00:05:50,539
And we're we're, you know, really looking,

155
00:05:50,884 --> 00:05:53,365
you know, center by center and working with

156
00:05:53,365 --> 00:05:53,865
the

157
00:05:54,485 --> 00:05:57,524
the surgeons and procedure lists on, you know,

158
00:05:57,524 --> 00:06:00,584
what type of anesthesia makes sense.

159
00:06:01,285 --> 00:06:03,300
We're finding a lot of our centers are

160
00:06:03,779 --> 00:06:06,339
the physicians are are very comfortable with just

161
00:06:06,339 --> 00:06:08,819
an all CRNA model, of which, of course,

162
00:06:08,819 --> 00:06:09,959
is the least expensive.

163
00:06:11,060 --> 00:06:12,120
And then others

164
00:06:12,579 --> 00:06:15,620
are interested in a CRA model with an

165
00:06:15,620 --> 00:06:16,120
MD,

166
00:06:17,035 --> 00:06:17,535
anesthesiologist

167
00:06:18,475 --> 00:06:18,975
supervisor,

168
00:06:19,754 --> 00:06:22,154
and that's kinda usually the 2 models we

169
00:06:22,154 --> 00:06:24,395
end up with. There there aren't a lot

170
00:06:24,395 --> 00:06:27,134
of centers that require anesthesiologists

171
00:06:28,314 --> 00:06:29,134
and MDs.

172
00:06:30,180 --> 00:06:31,400
They're they're very expensive

173
00:06:31,939 --> 00:06:33,939
and usually come at the cost of a

174
00:06:33,939 --> 00:06:36,259
stipend, but we do have some that require

175
00:06:36,259 --> 00:06:38,180
that and and we end up having to

176
00:06:38,180 --> 00:06:39,639
pay a stipend at those centers.

177
00:06:40,660 --> 00:06:43,115
Gotcha. And and I wanted to follow-up as

178
00:06:43,115 --> 00:06:45,694
well just in terms of the ASC sector

179
00:06:45,754 --> 00:06:47,355
more broadly. Like you said at the top

180
00:06:47,355 --> 00:06:50,495
of the the conversation, I think, with CHS,

181
00:06:50,555 --> 00:06:52,895
the 25 ambulatory surgery centers,

182
00:06:53,514 --> 00:06:54,895
in multiple markets.

183
00:06:55,275 --> 00:06:57,595
Obviously, when we think about the for profit

184
00:06:57,595 --> 00:07:00,250
health systems, the tenant really leading the charge

185
00:07:00,250 --> 00:07:02,810
with its USPI with, you know, 100 of

186
00:07:02,810 --> 00:07:05,229
ASCs and Optum's SCA Health,

187
00:07:06,089 --> 00:07:07,550
following closely behind.

188
00:07:07,930 --> 00:07:10,250
But we see you know, what what's interesting

189
00:07:10,250 --> 00:07:11,769
to me is we're seeing a lot more

190
00:07:11,769 --> 00:07:13,229
nonprofit health systems,

191
00:07:14,175 --> 00:07:17,074
you know, jump into these joint venture partnerships

192
00:07:17,214 --> 00:07:19,314
with surgery partners and other,

193
00:07:19,694 --> 00:07:22,574
other ASC operators to really build out their

194
00:07:22,574 --> 00:07:25,774
portfolios, expand deeper into the ASC space. I'm

195
00:07:25,774 --> 00:07:27,209
curious just to get your thoughts.

196
00:07:28,089 --> 00:07:29,949
How do you see, I guess, competition,

197
00:07:30,729 --> 00:07:33,209
health systems in the ASC space, how do

198
00:07:33,209 --> 00:07:35,209
you see competition evolving as we see more

199
00:07:35,209 --> 00:07:37,849
and more health systems evolve, dive deeper into

200
00:07:37,849 --> 00:07:39,709
the ASC space in the coming years?

201
00:07:41,055 --> 00:07:41,535
Well,

202
00:07:42,014 --> 00:07:44,335
I'm an ASC guy at heart, so I

203
00:07:44,335 --> 00:07:45,074
love it.

204
00:07:45,694 --> 00:07:47,795
I think the, you know, the more we,

205
00:07:48,095 --> 00:07:48,915
get into

206
00:07:50,175 --> 00:07:52,735
get more parties involved in ASCs, the stronger

207
00:07:52,735 --> 00:07:53,875
the industry is.

208
00:07:54,620 --> 00:07:56,480
It it's just a a great

209
00:07:57,500 --> 00:08:01,040
way to serve patients and provide fantastic surgery

210
00:08:01,100 --> 00:08:01,600
care.

211
00:08:02,939 --> 00:08:04,620
I I think it's wonderful. I don't see

212
00:08:04,620 --> 00:08:06,000
it competitive at all.

213
00:08:06,459 --> 00:08:08,160
There certainly is a certain competitiveness

214
00:08:08,779 --> 00:08:10,634
to it. But, typically,

215
00:08:11,175 --> 00:08:12,875
you know, typically, there

216
00:08:13,415 --> 00:08:16,214
there's enough room in a community to have

217
00:08:16,214 --> 00:08:18,555
more than one ASC for most size communities.

218
00:08:18,694 --> 00:08:19,194
So,

219
00:08:19,814 --> 00:08:20,955
I welcome it.

220
00:08:21,574 --> 00:08:24,389
Absolutely. So like you said, it's certainly an

221
00:08:24,389 --> 00:08:27,350
exciting time to be in the ASC field.

222
00:08:27,350 --> 00:08:29,289
What when you think about the future,

223
00:08:30,229 --> 00:08:31,910
what are you most excited about when it

224
00:08:31,910 --> 00:08:32,730
comes to ASCs?

225
00:08:33,990 --> 00:08:36,309
Well, kind of along the line with your

226
00:08:36,309 --> 00:08:37,610
last follow-up question,

227
00:08:38,394 --> 00:08:38,894
collaboration,

228
00:08:39,834 --> 00:08:40,975
I would have to say,

229
00:08:41,434 --> 00:08:44,014
is is really what I I see now.

230
00:08:44,794 --> 00:08:46,174
And, you know, with the

231
00:08:47,355 --> 00:08:50,235
with the the low reimbursement relative to the

232
00:08:50,235 --> 00:08:51,294
increased cost,

233
00:08:51,789 --> 00:08:52,529
there just,

234
00:08:52,990 --> 00:08:55,070
seems to me that it's better if we

235
00:08:55,070 --> 00:08:55,809
work together,

236
00:08:56,910 --> 00:08:57,889
instead of apart.

237
00:08:58,509 --> 00:09:00,509
And so you you look at, you know,

238
00:09:00,509 --> 00:09:01,009
physicians

239
00:09:02,110 --> 00:09:03,570
wanting to start an ASC

240
00:09:04,110 --> 00:09:04,610
frequently,

241
00:09:05,285 --> 00:09:07,144
combining with health systems,

242
00:09:07,565 --> 00:09:08,065
and,

243
00:09:08,485 --> 00:09:10,585
you know, often there's a three way partnership

244
00:09:11,125 --> 00:09:13,305
with that ASC management companies,

245
00:09:14,245 --> 00:09:15,384
and now, of course,

246
00:09:16,004 --> 00:09:18,184
the reemergence of private equity

247
00:09:18,485 --> 00:09:20,840
into health care into these, so very interested

248
00:09:20,840 --> 00:09:21,580
in ASCs.

249
00:09:22,120 --> 00:09:23,500
You know, I I just think

250
00:09:23,960 --> 00:09:24,700
the future

251
00:09:25,080 --> 00:09:27,580
is really us all collaborating together

252
00:09:27,960 --> 00:09:31,160
and work on our strengths, physicians obviously on

253
00:09:31,160 --> 00:09:32,779
the quality of care and

254
00:09:33,415 --> 00:09:35,195
and do the procedures themselves.

255
00:09:35,815 --> 00:09:37,815
Health systems bring, you know, a lot of

256
00:09:37,815 --> 00:09:39,995
things to the table, particularly leverage,

257
00:09:40,535 --> 00:09:42,715
and that's leverage with managed care payers,

258
00:09:43,415 --> 00:09:44,634
leverage with vendors,

259
00:09:45,399 --> 00:09:48,059
and ASC management companies bring,

260
00:09:49,080 --> 00:09:51,720
just a lot of ASC experience that not

261
00:09:51,720 --> 00:09:53,100
all health systems have.

262
00:09:53,480 --> 00:09:56,039
So I'm excited about that, and that's sometimes

263
00:09:56,039 --> 00:09:58,220
lacking in some of these these arrangements.

264
00:09:58,519 --> 00:09:59,639
So I think they add a lot of

265
00:09:59,639 --> 00:10:00,139
value,

266
00:10:00,695 --> 00:10:03,195
And I think the private equity companies

267
00:10:03,975 --> 00:10:04,955
have made

268
00:10:05,414 --> 00:10:06,154
a good

269
00:10:07,095 --> 00:10:09,034
made some good progress in

270
00:10:09,975 --> 00:10:11,434
bringing physicians together

271
00:10:11,815 --> 00:10:13,274
and helping their leverage

272
00:10:13,649 --> 00:10:16,289
and helping their expertise, helping them get involved

273
00:10:16,289 --> 00:10:17,990
in more more ancillary

274
00:10:18,850 --> 00:10:21,809
services like ASC. So I I I think

275
00:10:21,809 --> 00:10:24,209
that just all of us working together and

276
00:10:24,209 --> 00:10:27,509
collaborating together is really exciting to me.

277
00:10:28,355 --> 00:10:30,834
Yeah. Yeah. I mean, when you think about

278
00:10:30,834 --> 00:10:33,554
it, it really wasn't that far long ago

279
00:10:33,554 --> 00:10:35,574
when, you know, patients were

280
00:10:35,954 --> 00:10:38,754
requiring 1, 2, 3 night stays in a

281
00:10:38,754 --> 00:10:42,115
hospital for the procedures like spine surgeries, hip,

282
00:10:42,115 --> 00:10:44,700
knee replacements, and, you know, these procedures are

283
00:10:44,700 --> 00:10:46,620
being done routinely in the a s in

284
00:10:46,620 --> 00:10:48,860
ASCs now with patients up and out the

285
00:10:48,860 --> 00:10:50,779
door in in a couple of hours. And

286
00:10:50,779 --> 00:10:52,139
no doubt a lot of that comes down

287
00:10:52,139 --> 00:10:54,700
to collaboration like you've mentioned, but also just

288
00:10:54,700 --> 00:10:57,495
the the advent and technology. So really excited.

289
00:10:57,495 --> 00:10:59,254
And when you think about the future, kind

290
00:10:59,254 --> 00:11:00,774
of the next steps for the ASC space

291
00:11:00,774 --> 00:11:01,595
down the line.

292
00:11:02,375 --> 00:11:04,855
Absolutely. And, you know, hospitals are an important

293
00:11:04,855 --> 00:11:05,595
part of that.

294
00:11:05,975 --> 00:11:07,754
We need hospitals, obviously.

295
00:11:08,215 --> 00:11:09,735
There are a lot of cases that can't

296
00:11:09,735 --> 00:11:10,715
be done in ASCs,

297
00:11:11,279 --> 00:11:12,480
but there are a lot of cases that

298
00:11:12,480 --> 00:11:14,879
can, like you say. So the the more

299
00:11:14,879 --> 00:11:16,800
we can collaborate, I think the better the

300
00:11:16,800 --> 00:11:18,100
health system will be.

301
00:11:18,800 --> 00:11:20,720
Yeah. Absolutely. And then I get, like, to

302
00:11:20,720 --> 00:11:22,420
going back to what you said initially,

303
00:11:23,360 --> 00:11:26,774
just thinking about CHF and your role there,

304
00:11:26,934 --> 00:11:27,434
25

305
00:11:27,735 --> 00:11:29,035
ASCs that you've mentioned,

306
00:11:29,575 --> 00:11:31,115
how are you thinking about

307
00:11:31,495 --> 00:11:34,134
growth in your role, growth at CHS and

308
00:11:34,134 --> 00:11:36,695
the ASC span spectrum over the next 1

309
00:11:36,695 --> 00:11:37,915
to 2 years or so?

310
00:11:39,095 --> 00:11:40,080
Very strong growth.

311
00:11:40,639 --> 00:11:42,340
I think because of

312
00:11:44,160 --> 00:11:45,460
the cost increases,

313
00:11:46,160 --> 00:11:47,059
I think there

314
00:11:48,160 --> 00:11:49,139
are some headwinds

315
00:11:49,840 --> 00:11:51,059
as far as growth,

316
00:11:51,759 --> 00:11:53,460
as far as building new centers,

317
00:11:54,174 --> 00:11:56,195
because the costs have just

318
00:11:56,894 --> 00:11:57,795
almost doubled

319
00:11:58,254 --> 00:12:00,495
post COVID, which is kind of crazy to

320
00:12:00,495 --> 00:12:01,634
build a new ASC.

321
00:12:02,654 --> 00:12:03,475
And so

322
00:12:03,934 --> 00:12:04,835
I think that's

323
00:12:05,295 --> 00:12:06,595
a bit of a headwind.

324
00:12:07,615 --> 00:12:08,115
But

325
00:12:09,639 --> 00:12:11,399
I think when we look at the growth

326
00:12:11,399 --> 00:12:12,220
of procedures,

327
00:12:13,240 --> 00:12:15,820
both moving to ASCs and also

328
00:12:17,000 --> 00:12:17,500
procedures

329
00:12:18,120 --> 00:12:18,620
in

330
00:12:19,080 --> 00:12:22,700
other cases moving into hospitals, I think that

331
00:12:23,014 --> 00:12:24,634
there's plenty of room for

332
00:12:25,254 --> 00:12:25,754
both

333
00:12:26,615 --> 00:12:29,414
the subsectors of healthcare of the hospital and

334
00:12:29,414 --> 00:12:32,375
the ASC industries to continue to grow and

335
00:12:32,375 --> 00:12:33,514
continue to thrive,

336
00:12:34,455 --> 00:12:36,059
and continue to do well.

337
00:12:36,620 --> 00:12:38,860
I I think that, you know, with with

338
00:12:38,860 --> 00:12:39,360
the

339
00:12:40,620 --> 00:12:41,759
the the lower reimbursement

340
00:12:42,220 --> 00:12:43,919
increases in the ASC level,

341
00:12:44,620 --> 00:12:47,820
I think that the partnerships with hospitals are

342
00:12:47,820 --> 00:12:50,240
probably more important now than they've ever been.

343
00:12:51,315 --> 00:12:52,054
And so

344
00:12:52,754 --> 00:12:55,875
with those partnerships, I I do think that

345
00:12:55,875 --> 00:12:57,654
ASCs are still a great investment.

346
00:12:58,674 --> 00:13:00,434
I just think, you know, anyone who's looking

347
00:13:00,434 --> 00:13:01,174
into that,

348
00:13:01,634 --> 00:13:03,809
needs to be very disciplined in their approach

349
00:13:04,289 --> 00:13:05,909
and evaluate their opportunities

350
00:13:06,210 --> 00:13:07,830
because of the higher costs

351
00:13:08,210 --> 00:13:10,690
and the lower reimbursement. You just need to

352
00:13:10,690 --> 00:13:11,830
make sure that that,

353
00:13:12,529 --> 00:13:15,190
pro form a is solid and the assumptions

354
00:13:15,330 --> 00:13:16,950
are valid before investing.

355
00:13:18,144 --> 00:13:21,105
Mhmm. Like you said, it's now cost twice

356
00:13:21,105 --> 00:13:23,504
as much to build a new ASC as

357
00:13:23,504 --> 00:13:24,884
it did pre pandemic.

358
00:13:25,424 --> 00:13:26,565
Does that mean that,

359
00:13:27,105 --> 00:13:29,745
CHS' strategy is shifting a little bit more

360
00:13:29,745 --> 00:13:32,325
on the side of potential mergers and acquisitions

361
00:13:32,625 --> 00:13:34,539
or how does that kind of play out?

362
00:13:35,879 --> 00:13:36,940
No, not at all.

363
00:13:39,159 --> 00:13:39,659
We're

364
00:13:40,440 --> 00:13:41,740
just very disciplined

365
00:13:42,679 --> 00:13:45,320
in when we build de novos, the new

366
00:13:45,320 --> 00:13:45,820
ASCs,

367
00:13:46,440 --> 00:13:48,620
we have several in the pipeline

368
00:13:49,934 --> 00:13:51,394
to build and

369
00:13:51,934 --> 00:13:53,554
they're all just great projects.

370
00:13:54,414 --> 00:13:56,034
It takes more volume

371
00:13:56,975 --> 00:13:59,074
to make a project successful

372
00:13:59,375 --> 00:14:00,754
now than it did before

373
00:14:01,134 --> 00:14:02,995
and that's kind of the key. So

374
00:14:04,080 --> 00:14:05,540
it hasn't at all

375
00:14:06,160 --> 00:14:08,660
slowed our interest in de novo projects.

376
00:14:09,200 --> 00:14:11,300
And we do both de novos and acquisitions,

377
00:14:12,320 --> 00:14:15,300
but we're very, very favorable on ASCs

378
00:14:16,014 --> 00:14:18,274
and looking to grow in that space,

379
00:14:18,894 --> 00:14:20,995
as much as makes sense for us.

380
00:14:22,014 --> 00:14:24,654
Gotcha. Yeah. Certainly, it's such an exciting time

381
00:14:24,654 --> 00:14:26,574
in the ASC space. And it's been a

382
00:14:26,574 --> 00:14:28,700
real pleasure having you on your first podcast

383
00:14:28,700 --> 00:14:30,740
with us, Terry. I really, really appreciate the

384
00:14:30,740 --> 00:14:32,420
time, and, I look forward to connecting with

385
00:14:32,420 --> 00:14:33,560
you again down the line.

386
00:14:34,260 --> 00:14:35,960
Yeah. Thanks, Alan. Great talk.