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Hello, and welcome to the Becker's Healthcare podcast.

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I'm joined today by Janet Carlson, executive director

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of ASCs at Commonwealth Pain and Spine. Janet,

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Janet, would you take a moment to introduce

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yourself and, tell us a little bit about

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your background? Yeah. Good morning. Thank you for

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having me. So I am Janet Carlson. I'm

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a registered nurse. I'm the executive director of

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ASCs for Commonwealth Pain and Spine. We are

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located

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in Louisville,

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Kentucky with a clinical footprint in 4 regional

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states in that area.

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I'm building 3 de novo ASCs

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ground up right now, and I'm looking to

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add more ASCs

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to match our clinical

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and ever expanding growing footprint.

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So ASC volume across the country is expected

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to increase by 16% by 2032.

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With this

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growth, what are the most pressing challenges to

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maintain that positive patient experience?

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One of the top things that I think

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impacts patient experience in the ASC

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are the payer contracts and the issues we

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have with reimbursement

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for these cases.

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We are continually

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migrating higher acuity cases from the hospital to

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the ASC,

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and with that comes the cost for

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implants,

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supplies,

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trained,

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clinicians,

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and more labor.

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In addition to that capital expenditure to have

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the equipment there to do the higher acuity

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cases.

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And so a patient experience where they would

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be better off from a safety perspective,

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outcome perspective with a very concierge experience

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in an ambulatory surgery center,

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they may have the challenges

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of having to come out of pocket because

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we don't have adequate payer reimbursement

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contracts. Mhmm. Mhmm.

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And just to kinda add on to that,

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how would you say

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the patient experience differs

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from, you know, in an ASC spine environment

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versus, like, a, you know, a large health

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system?

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So I've worked in the interventional

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and perioperative surgical world in both the inpatient

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setting and the ambulatory setting.

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The big difference for the patient experience in

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an ambulatory setting is the very concierge feel.

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Mhmm.

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Additionally,

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we are much more accessible

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to the patient. We can get a patient

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from clinic

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to posting on the surgical schedule

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a lot sooner than you can within a

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health system.

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One thing that sets us apart from health

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system cases is that these patients

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are able to be managed

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by the same team at the ASC.

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So, for example, my pre assessment

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registered nurses that are making the phone calls

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are the ones that work with our surgeons

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day in and day out and know all

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of our anesthesia selection criteria guidelines.

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The hospital is fragmented. And so, a hospital

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has so many

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silos,

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if you will. So we have a patient

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that needs to go get their labs in

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a certain market. Then we have a patient

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needs to get imaging from another

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department and a different appointment time. Then they

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have to be assessed by anesthesia

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or cleared for cardiac clearance.

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And so that patient is moving around the

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health system.

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And I would argue that it would take

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a lot longer for that patient to get

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to day of surgery than it would for

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the patient in an ASC.

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So

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what are some of the strategies that have

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worked for your organization to, you know, tackle

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some of the challenges you previously mentioned? Mhmm.

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And, you know, what's some advice you have

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for other health care leaders to kinda stay

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ahead?

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So

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we are using

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electronic health record in the ASC.

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It's time for us to put the paper

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charting to bed permanently,

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allowing us to use that platform

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more comprehensively

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so that we

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can fill block time

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using the platform of the software that we

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schedule in. And so that's a challenge right

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there is block utilization and maximizing it. So

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if we are all reading from the same

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sheet of music, understanding the block availability,

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we're able to get people in and seen

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a lot sooner than we would if we

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were phone calls back and forth, text messages

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back and forth. So that's a technology that

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we are adopting with very much success.

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And, you know, out of curiosity, you mentioned

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paper charting. Mhmm. Is that something that's still

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fairly commonly used? Very common. Oh, wow. And

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I'll tell you why.

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Surgery centers that are doing

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one day,

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low acuity but very high volume cases,

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you don't have the time to do the

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full complement of the patient charting

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and also keep up with the surgical volume,

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the pace that the surgeons are moving at.

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And so you can catch up on your

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charting at the end of a very busy

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day like that. Mhmm. But that is the

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one thing that will slow down your patient

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throughput

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and the opportunity for

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maximized

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block utilization to then obviously have increased revenue.

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Mhmm. So

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patient charting

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in paper and ASCs is still widely accepted

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because it hasn't been federal regulatory mandate that

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we go to an electronic medical record like

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the health systems

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have. And so that's

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I find the reason why surgery centers use

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it because of the throughput issue. And then

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the adoption of new technology,

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there's there's always pushback on that in addition

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to the cost. But I would argue the

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cost of a new

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platform

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could quickly be recouped for your return on

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investment

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because you will have that consistent patient through,

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but with no slowdown whatsoever

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based on the charting. Well, isn't there an

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increased amount of AI and notation, like Yeah.

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Tools out there to start templates. Right. And

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so when we dial it in for a

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physician let's just say that it's a carpal

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tunnel.

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Well, there's is it endoscopic carpal tunnel, or

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is it an open incision?

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Okay. Well, we're gonna load both templates,

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and the physician can decide. They may post

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it as one case, but it has to

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convert to the other. We can quickly decide

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to choose the other template,

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and it auto populates the physician preferences.

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And then they go in and dictate very

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quickly postoperatively

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as we're required to do and just add

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the laterality and all the information

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about the surgery, and it's taken care of

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right there for you. Mhmm. Mhmm.

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So, you know, once the surgery's done and

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it's time for the, the patient to

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navigate that that financial aspect of their care,

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You know, how can leaders such as yourself

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ensure that they're well equipped to kinda help

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these patients with with that?

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So I believe

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transparent pricing is something that we excel at

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in the ambulatory space.

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I, myself, have had surgery centers where we

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will post cash bundle pricing

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on our website. And so folks can decide

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if they wanna use their insurance or not,

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or they'd just rather come out of pocket

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and pay cash, which is a whole another

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conversation, by the way, and the trends that

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are in that area.

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I will say the financial component begins when

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the patient is scheduled from the clinic, and

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they agree with the surgeon to the surgery.

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Once that posting comes across,

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that is when the CPT code revenue cycle,

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they should start working that case right then.

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Your business office manager to then

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verify the patient insurance,

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understand if they have any

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deductible they have to meet, out of pocket

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co pay, and also what their coinsurance is.

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And that needs to be communicated

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as soon as possible, as accurately as possible

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to the patient so that there's no surprises.

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Mhmm. Mhmm. And and with this price transparency

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and potentially, you know, having discussions with them

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around,

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you know, payment plans or things like that

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after the fact? You know, how does that

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that transparency and assistance benefit that, patient provider

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relationship and that trust? So

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I believe patients trust providers that are willing

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to post their prices. Mhmm.

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And we hold ourselves accountable to our quality

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outcomes.

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And we we can have the quality outcomes.

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We can choose

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the procedures

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that are safe for the center and the

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patient.

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We can have the success, and it and

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it just feeds itself. So your quality outcomes,

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your affordable

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pricing,

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and your accessibility,

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all are bonuses to the patient coming. And

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and I've found many patients that are willing

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to pay

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the fees to come and have their surgery

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center

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experience

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intentionally.

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They're also willing to pay the cash, like

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I said, out of pocket Mhmm. Mhmm. And

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not even worry about using their insurance.

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And and and so with this, you know,

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promotion of transparency and also, you know, the

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the financial literacy of the patient, then you

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talked about the growth. But, like, how how

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does that can you kind of elaborate a

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little more on how that benefits your organization?

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So I believe it fosters and engenders trust.

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A 100%.

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It's all about trust.

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So we keep the patient the center of

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the care continuum.

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We all orbit around the patient experience and

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the patient's safe safety and their outcomes.

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And so

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leading with that, then everything else naturally, organically

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falls in line, meaning

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the right culture for the patients

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that the surgeons are selecting to do at

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their surgery center, the surgeons

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being excited, incented, rewarded, and aligned to bring

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their cases to the surgery center that they

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have an ownership stake in.

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It's the best day of their week is

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when it's their day at the ASC. They

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look forward to it. The surgeons do.

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And then the team, the culture of your

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team. So you have folks that are motivated

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to be there, take care of the patient,

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serve our surgeons.

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You're gonna have a wonderful experience all the

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way around, and that conveys to the financial

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aspect of it as well. Mhmm. So I

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think it's all tied together, frankly. Right. Right.

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And that word-of-mouth has to be powerful too,

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not just from the surgeon perspective, but also

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the rest of the staff and the patient.

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I can't tell you how many times we've

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started to do a new procedure

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or a service line or a higher higher

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acuity case,

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and we have excellent outcomes.

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And that person will go to the bridge

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club, to Perch, to the tennis group, to

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their pickleball

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Right. League. And before you know it, word-of-mouth

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is powerful.

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And that has been some of our best

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free marketing, if you will.

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I bet. I bet. And so, Janet, it's

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been an absolutely lovely conversation today. Thank you.

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But before we wrap up, I do have

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to ask, you, do you have any final

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thoughts you'd like to leave with our audience?

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I just think it's an exciting time to

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be in the ASC space.

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The shift there

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is growing exponentially

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year over year. The shift will continue the

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rest of my professional life. Mhmm. And so

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I'm really thrilled to be in this space.

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You're allowed to have a lot of creativity

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in the ambulatory surgery space.

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You have the decision makers at the table.

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You're very accessible to

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the physician owners, the clinicians on your team,

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and your leaders. You all can be very

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adaptable and make decisions quickly

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where there's not a long delayed decision process

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that usually plagues health systems.

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And so it's a wonderful time to be

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in the ASC space, and I just see

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it continuing to grow. And I see physicians

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looking to come out of their employment contracts

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with large health systems and gain some professional

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clinical surgical autonomy back in their practice.

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So before we finish, one last question. Of

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course. You talked about this being an exciting

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time to be in the AC space. Would

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you say throughout your career, this has been

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the most exciting time? It is because it's

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dynamic. Right. You know, we have federally on

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the federal level, we have non competes being

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challenged. Mhmm. And so that's going to start

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that shift from what physicians just naturally do

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right now, come out of fellowship and just

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get employed with a large health system. Obviously,

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they need to they need to start earning

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income to pay off all of their medical

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debt,

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but they haven't learned the business model Mhmm.

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Of the value proposition of working in an

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ambulatory surgery center. It's a new thing to

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them. It's not something that's taught in medical

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school as an option. I didn't learn about

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it in nursing school. Right. Right. This is

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something you have to seek out. But as

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physicians are now challenging the non competes,

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they're looking at alternative

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employment models

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or productivity models in private practice, ownership

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in an ASC.

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These things are going to continue to shift

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the health care away from the health system

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inpatient ORs where there's a need for patients

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to be done in the hospital. And I'm

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happy for them to be done all day

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long there for the safety reasons. But the

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cases that we are seeing could and should

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be done. We can leave more money in

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the proverbial till for the patients if we're

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doing these patients in an ASC. It costs

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so much less for these Medicare patients, and

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that, hence, will allow more money to be

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available to take care of more people. A

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100%.

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A 100%. Well, Janet, thank you again for

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joining us today on the Becker's health care

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podcast. I hope you have a lovely rest

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of your day. It's been my pleasure. Thank

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you.