1 00:00:01,120 --> 00:00:03,279 The Becker's team is excited to announce the 2 00:00:03,279 --> 00:00:06,160 launch of our new CFO and Revenue Cycle 3 00:00:06,160 --> 00:00:06,660 podcast. 4 00:00:07,440 --> 00:00:10,240 Tune in for conversations with finance experts from 5 00:00:10,240 --> 00:00:13,119 the top hospitals and health systems. We'll discuss 6 00:00:13,119 --> 00:00:15,679 key trends and ideas to drive meaningful change 7 00:00:15,679 --> 00:00:18,855 in the industry. Look for Becker's CFO and 8 00:00:18,855 --> 00:00:21,995 Revenue Cycle podcast wherever you listen to episodes. 9 00:00:25,175 --> 00:00:27,755 This is Alan Condon back with the Becker's 10 00:00:27,894 --> 00:00:28,954 ASC podcast, 11 00:00:29,449 --> 00:00:31,929 and I'm delighted to be joined today by 12 00:00:31,929 --> 00:00:36,010 doctor Hugo Ribeau, medical director and CEO of 13 00:00:36,010 --> 00:00:38,750 Georgia Advanced Surgery Center for Women. 14 00:00:39,130 --> 00:00:41,370 Hugo, a pleasure for you making your debut 15 00:00:41,370 --> 00:00:43,630 appearance on the Becker's podcast with us today. 16 00:00:43,994 --> 00:00:45,914 For those of our listeners who may not 17 00:00:45,914 --> 00:00:47,835 be as familiar with you or the work 18 00:00:47,835 --> 00:00:50,015 that you you and your your practice does, 19 00:00:50,074 --> 00:00:51,515 do you mind taking a moment to give 20 00:00:51,515 --> 00:00:52,875 us a little bit more information about your 21 00:00:52,875 --> 00:00:53,854 role and your background? 22 00:00:54,634 --> 00:00:55,134 Sure. 23 00:00:55,515 --> 00:00:56,414 We are 24 00:00:56,789 --> 00:00:59,989 actually a very small ambulatory surgery center, but 25 00:00:59,989 --> 00:01:00,809 we think we're 26 00:01:01,270 --> 00:01:01,770 fairly 27 00:01:02,710 --> 00:01:05,530 pioneering and unique, at least in our state. 28 00:01:05,909 --> 00:01:08,890 We are a GYN only, you know, gynecology 29 00:01:09,109 --> 00:01:11,129 only ambulatory surgery center, 30 00:01:11,670 --> 00:01:12,409 but we 31 00:01:12,844 --> 00:01:15,505 have managed to pretty much convert 32 00:01:15,965 --> 00:01:20,305 every single surgical procedure that is commonly done 33 00:01:20,444 --> 00:01:21,185 in gynecology 34 00:01:21,805 --> 00:01:22,545 other than 35 00:01:22,924 --> 00:01:23,424 oncology 36 00:01:24,125 --> 00:01:26,799 to a completely nonhospital setting. And we're talking 37 00:01:26,799 --> 00:01:27,939 about everything, hysterectomies, 38 00:01:28,799 --> 00:01:30,420 prolapse surgery, urogynecology, 39 00:01:31,519 --> 00:01:33,920 you name it. We we pretty much do 40 00:01:33,920 --> 00:01:34,799 all of ours. And, 41 00:01:36,479 --> 00:01:38,259 we were able to show 42 00:01:38,640 --> 00:01:39,939 as far back as 43 00:01:40,284 --> 00:01:41,584 02/2006 44 00:01:42,685 --> 00:01:44,864 that major procedures that had 45 00:01:45,724 --> 00:01:49,245 previously been confined to hospitals only, usually with 46 00:01:49,245 --> 00:01:51,564 at least one one anywhere from one to 47 00:01:51,564 --> 00:01:53,745 three nights overnight stay in the hospital, 48 00:01:54,469 --> 00:01:57,349 could be done and done very well and 49 00:01:57,349 --> 00:02:00,229 and very, tolerably in an outpatient setting where 50 00:02:00,229 --> 00:02:01,530 the patient goes straight home. 51 00:02:01,909 --> 00:02:02,409 So 52 00:02:02,709 --> 00:02:03,209 we, 53 00:02:03,829 --> 00:02:05,609 you know, did a proof of concept 54 00:02:06,310 --> 00:02:09,030 and ended up presenting our findings at our 55 00:02:09,030 --> 00:02:12,185 annual minimally invasive surgical society meetings 56 00:02:12,805 --> 00:02:15,384 back then. And in 02/2010, 57 00:02:15,764 --> 00:02:17,924 '1 of my two partners and I decided 58 00:02:17,924 --> 00:02:19,784 to develop we had an opportunity, 59 00:02:20,324 --> 00:02:21,064 to acquire 60 00:02:21,525 --> 00:02:23,519 a property, which happened to be in our 61 00:02:23,519 --> 00:02:26,560 own medical office clinic building, which is adjacent 62 00:02:26,560 --> 00:02:29,519 to our hospital. And, we converted it to 63 00:02:29,599 --> 00:02:31,759 we built it out into a, you know, 64 00:02:31,759 --> 00:02:32,259 fully 65 00:02:32,639 --> 00:02:34,739 outfitted ambulatory surgery center. 66 00:02:35,120 --> 00:02:35,939 And it's been 67 00:02:36,355 --> 00:02:38,754 going great ever since, and now we're we're 68 00:02:38,754 --> 00:02:40,534 up we're in our fifteenth year. 69 00:02:41,875 --> 00:02:43,875 Fantastic. So I'd love to just kinda pick 70 00:02:43,875 --> 00:02:46,355 up on something you mentioned there. It's super 71 00:02:46,355 --> 00:02:47,814 impressive in terms of 72 00:02:48,115 --> 00:02:51,075 to your point, converting every surgical procedure that 73 00:02:51,075 --> 00:02:53,699 is commonly done in gynecology, I believe you 74 00:02:53,699 --> 00:02:55,159 said outside of oncology 75 00:02:55,460 --> 00:02:57,240 to the ASC or outpatient setting. 76 00:02:57,620 --> 00:02:59,300 I'd like to just kinda get one bit 77 00:02:59,300 --> 00:03:01,699 deeper there in terms of transitioning some of 78 00:03:01,699 --> 00:03:04,599 those more complex procedures at the gynecology 79 00:03:04,900 --> 00:03:07,564 space to the ASC setting. Kind of, any 80 00:03:07,564 --> 00:03:09,745 tips that you would have for other 81 00:03:10,125 --> 00:03:10,625 physicians, 82 00:03:11,084 --> 00:03:13,324 surgeons in your specialty area who are looking 83 00:03:13,324 --> 00:03:14,864 to do the same at their ASC? 84 00:03:15,644 --> 00:03:16,144 Well, 85 00:03:16,924 --> 00:03:19,099 yeah. I mean, you know, the first inclination 86 00:03:19,099 --> 00:03:20,539 we have is we don't wanna give away 87 00:03:20,539 --> 00:03:22,620 all our ancient Chinese secrets. But, no. I'm 88 00:03:22,620 --> 00:03:24,000 just kidding. We 89 00:03:24,379 --> 00:03:26,079 don't really have it. 90 00:03:26,539 --> 00:03:27,359 The landscape 91 00:03:27,819 --> 00:03:30,219 in our state, like in many other states, 92 00:03:30,219 --> 00:03:30,719 is 93 00:03:32,064 --> 00:03:33,284 somewhat restricted 94 00:03:33,905 --> 00:03:34,625 because of, 95 00:03:35,185 --> 00:03:38,465 these certificate of need laws. Are you familiar 96 00:03:38,465 --> 00:03:39,125 with those? 97 00:03:39,824 --> 00:03:40,644 Yeah. Absolutely. 98 00:03:41,104 --> 00:03:44,004 Yeah. So c o n laws unfortunately, Georgia 99 00:03:44,064 --> 00:03:45,685 is a c o n state, 100 00:03:46,064 --> 00:03:49,039 but Georgia happens to have an exception where 101 00:03:49,180 --> 00:03:50,639 if you're a single specialty 102 00:03:51,419 --> 00:03:51,919 facility 103 00:03:52,219 --> 00:03:54,639 and only the doctors who own that facility 104 00:03:55,259 --> 00:03:57,419 are allowed to operate there, then you get 105 00:03:57,419 --> 00:03:58,080 an exemption 106 00:03:58,459 --> 00:04:00,435 where you don't have to get approval, you 107 00:04:00,435 --> 00:04:02,515 know, from the state or apply for a 108 00:04:02,515 --> 00:04:03,415 formal CLN. 109 00:04:04,034 --> 00:04:07,075 But so there's really and we researched it. 110 00:04:07,075 --> 00:04:09,655 In our state, there's literally only, 111 00:04:10,995 --> 00:04:11,495 like, 112 00:04:12,400 --> 00:04:15,540 one, two, three like, three or four ASCs, 113 00:04:15,680 --> 00:04:18,160 the Duke gynecology in our state, and ours 114 00:04:18,160 --> 00:04:20,319 is the only one that does major procedures 115 00:04:20,319 --> 00:04:21,060 like hysterectomy. 116 00:04:21,680 --> 00:04:22,980 So to convert 117 00:04:23,680 --> 00:04:26,740 major procedures like a hysterectomy to an outpatient 118 00:04:26,800 --> 00:04:27,300 setting, 119 00:04:27,964 --> 00:04:30,064 you have to do sort of a multimodal 120 00:04:30,205 --> 00:04:33,264 approach, which people are just now cluing into. 121 00:04:33,645 --> 00:04:36,285 They they just they call it and sometimes 122 00:04:36,285 --> 00:04:38,865 they goes under the name of ERAS protocols, 123 00:04:39,165 --> 00:04:41,645 e r a s, which stands for enhanced 124 00:04:41,645 --> 00:04:42,944 recovery after surgery. 125 00:04:43,439 --> 00:04:43,939 But, 126 00:04:44,639 --> 00:04:45,139 basically, 127 00:04:46,000 --> 00:04:48,400 there's a way to there are various different 128 00:04:48,400 --> 00:04:49,460 ways to preemptively 129 00:04:50,000 --> 00:04:50,500 address 130 00:04:50,879 --> 00:04:52,740 the things that used to keep patients 131 00:04:53,759 --> 00:04:56,319 needing a hospital after the surgery, which is 132 00:04:56,319 --> 00:04:59,475 pain control and and control of nausea and 133 00:04:59,475 --> 00:04:59,975 vomiting. 134 00:05:00,355 --> 00:05:01,014 And so 135 00:05:01,715 --> 00:05:04,835 there are very specific and targeted ways to 136 00:05:04,835 --> 00:05:06,055 do that in gynecology, 137 00:05:06,435 --> 00:05:06,935 and 138 00:05:07,314 --> 00:05:10,935 we borrowed some techniques from certain pioneering surgeons 139 00:05:11,555 --> 00:05:12,455 in our specialty 140 00:05:12,915 --> 00:05:14,629 and in also orthopedics 141 00:05:15,329 --> 00:05:17,169 where you can there there are ways to 142 00:05:17,169 --> 00:05:19,430 put very targeted regional blocks 143 00:05:19,889 --> 00:05:22,149 inside the pelvis in certain locations 144 00:05:22,769 --> 00:05:23,829 so that the patients 145 00:05:24,449 --> 00:05:26,449 just simply don't wake up with all the 146 00:05:26,449 --> 00:05:29,125 all the usual pain. And it's all very 147 00:05:29,125 --> 00:05:31,144 manageable. And if you know what you're doing, 148 00:05:31,204 --> 00:05:32,824 these folks go home with, 149 00:05:33,125 --> 00:05:33,784 you know, 150 00:05:34,084 --> 00:05:34,664 a a few, 151 00:05:35,925 --> 00:05:38,084 a limited number of pain meds that they 152 00:05:38,084 --> 00:05:39,844 can take at home, and and most of 153 00:05:39,844 --> 00:05:41,764 them don't even use those pain meds for 154 00:05:41,764 --> 00:05:42,904 more than a few days. 155 00:05:44,050 --> 00:05:47,110 So, you know, regional targeted pain blocks, 156 00:05:47,490 --> 00:05:47,990 preemptive 157 00:05:48,529 --> 00:05:49,029 prevention 158 00:05:49,410 --> 00:05:52,470 of nausea with, you know, scopolamine patches, 159 00:05:52,850 --> 00:05:53,350 Zofran, 160 00:05:54,050 --> 00:05:54,870 IV hydrocortisone. 161 00:05:55,329 --> 00:05:57,569 There there's various different things that we all 162 00:05:57,569 --> 00:06:00,495 package together, and and it really works well. 163 00:06:01,275 --> 00:06:03,214 So you can do that for both gynecologic 164 00:06:03,355 --> 00:06:04,735 and laparoscopic surgery. 165 00:06:05,595 --> 00:06:08,395 Fantastic. And the only ASC in Georgia, I 166 00:06:08,395 --> 00:06:11,595 believe, that performs hysterectomies on an outpatient basis. 167 00:06:11,595 --> 00:06:13,319 What a what a feather in your cap. 168 00:06:13,560 --> 00:06:16,439 Hugo, moving to there's a lot that's going 169 00:06:16,439 --> 00:06:18,199 on in health care at any one time. 170 00:06:18,199 --> 00:06:19,980 But as it specifically relates 171 00:06:20,839 --> 00:06:24,040 to ambulatory surgery centers and your practice, can 172 00:06:24,040 --> 00:06:26,680 you share what are two or three trends 173 00:06:26,680 --> 00:06:29,615 that you're paying close attention to now, and 174 00:06:29,615 --> 00:06:30,115 why? 175 00:06:31,775 --> 00:06:34,254 So one of the things that's really gathering 176 00:06:34,254 --> 00:06:35,154 a lot of momentum 177 00:06:35,855 --> 00:06:37,855 is, you know, as the cost of health 178 00:06:37,855 --> 00:06:38,995 care keeps skyrocketing, 179 00:06:40,175 --> 00:06:41,715 you probably know that 180 00:06:42,459 --> 00:06:42,959 most 181 00:06:43,500 --> 00:06:46,139 businesses in The United States that have 50 182 00:06:46,139 --> 00:06:49,759 or more employees are effectively self insured. 183 00:06:50,220 --> 00:06:52,220 You know, they they actually pay for all 184 00:06:52,220 --> 00:06:54,560 the claims and the surgeries and the hospitalizations 185 00:06:54,939 --> 00:06:57,294 of their employees. They just use, you know, 186 00:06:57,294 --> 00:06:59,454 Blue Cross or United or Cigna or these 187 00:06:59,454 --> 00:07:01,214 folks most of the time as a third 188 00:07:01,214 --> 00:07:03,694 party administrator just to give them a network 189 00:07:03,694 --> 00:07:06,175 to send patients to. But the actual payment 190 00:07:06,175 --> 00:07:08,014 comes out of those companies themselves, and a 191 00:07:08,014 --> 00:07:09,954 lot of these companies are 192 00:07:10,879 --> 00:07:13,360 really trying to find where the low hanging 193 00:07:13,360 --> 00:07:15,199 fruit is to trim some of their bigger 194 00:07:15,199 --> 00:07:16,579 costs. And, of course, surgical 195 00:07:16,959 --> 00:07:20,800 expenditures are, you know, high dollar expenses for 196 00:07:20,800 --> 00:07:23,139 a lot of businesses. So there's a whole 197 00:07:23,680 --> 00:07:24,704 industry that's 198 00:07:25,185 --> 00:07:27,345 mushrooming of I don't even know how to 199 00:07:27,345 --> 00:07:29,264 describe them. I don't know if I'd call 200 00:07:29,264 --> 00:07:31,664 them brokers or they're sort of a hybrid 201 00:07:31,664 --> 00:07:32,324 type of 202 00:07:33,024 --> 00:07:33,524 administrator. 203 00:07:34,144 --> 00:07:36,004 They don't give businesses 204 00:07:36,544 --> 00:07:40,529 necessarily access to a network like a traditional 205 00:07:40,529 --> 00:07:42,709 insurance company has, but they seek out 206 00:07:43,329 --> 00:07:43,829 facilities 207 00:07:44,209 --> 00:07:44,949 and doctors 208 00:07:45,329 --> 00:07:46,069 who can 209 00:07:47,329 --> 00:07:48,149 do things 210 00:07:49,250 --> 00:07:51,750 for, I guess, reduced cost, 211 00:07:52,055 --> 00:07:54,214 but yet maintain high quality. And that usually 212 00:07:54,214 --> 00:07:56,314 means ASCs as opposed to hospitals. 213 00:07:56,855 --> 00:07:59,814 And we have been able to develop what 214 00:07:59,814 --> 00:08:02,615 they call bundled rates where, you know, the 215 00:08:02,615 --> 00:08:04,714 entire episode for, say, hysterectomy 216 00:08:05,334 --> 00:08:06,855 is just one price and they know it 217 00:08:06,855 --> 00:08:07,355 upfront. 218 00:08:07,930 --> 00:08:10,410 And it's not your usual, you know, 25 219 00:08:10,410 --> 00:08:11,689 to $35,000. 220 00:08:11,689 --> 00:08:14,490 It's it's way less than that, and it 221 00:08:14,490 --> 00:08:17,629 includes the surgeon, the facility, the anesthesiologist, 222 00:08:18,089 --> 00:08:18,909 and the pathology. 223 00:08:19,209 --> 00:08:22,545 Everything. It includes everything. And so we've been 224 00:08:22,545 --> 00:08:25,845 getting we've developed relationships with multiple 225 00:08:26,305 --> 00:08:27,365 outfits that 226 00:08:27,904 --> 00:08:30,225 send us patients. I mean, at first, I 227 00:08:30,225 --> 00:08:32,465 thought the only folks who are gonna go 228 00:08:32,465 --> 00:08:34,384 for traveling far away from home to get 229 00:08:34,384 --> 00:08:36,465 a surgery were people who are spending, you 230 00:08:36,465 --> 00:08:36,965 know, 231 00:08:37,360 --> 00:08:38,399 $50,000 232 00:08:38,399 --> 00:08:40,500 or more for a joint replacement in orthopedics 233 00:08:40,639 --> 00:08:43,440 or something like that. But, oh, no. There's 234 00:08:43,440 --> 00:08:44,419 lots of gynecology 235 00:08:44,720 --> 00:08:46,480 business out there. I mean, we've we've had 236 00:08:46,480 --> 00:08:47,299 people from, 237 00:08:47,759 --> 00:08:48,340 I mean, 238 00:08:48,879 --> 00:08:50,414 out of state, Texas, 239 00:08:51,035 --> 00:08:52,414 Virginia, I mean, Alaska, 240 00:08:52,955 --> 00:08:55,595 Canada. You wouldn't believe it. These folks will 241 00:08:55,595 --> 00:08:57,434 fly in. And so a lot of these 242 00:08:57,434 --> 00:08:58,894 folks are are marketing 243 00:08:59,434 --> 00:09:02,254 these, I guess, you'd call them surgical benefits, 244 00:09:03,274 --> 00:09:05,215 providers that that 245 00:09:05,669 --> 00:09:06,889 helps steer patients 246 00:09:08,389 --> 00:09:10,649 in in self employed, companies 247 00:09:11,429 --> 00:09:11,929 to 248 00:09:12,470 --> 00:09:14,809 potentially lower cost of care settings. So 249 00:09:15,190 --> 00:09:17,669 the scenario, you know, forgive me if I'm 250 00:09:17,669 --> 00:09:20,485 going on, is that the patient will typically 251 00:09:20,485 --> 00:09:22,585 have a relationship with their own hometown gynecologist, 252 00:09:22,804 --> 00:09:24,565 and they'll find something that needs a surgery 253 00:09:24,565 --> 00:09:26,004 like a hysterectomy or something. Then they 254 00:09:26,804 --> 00:09:28,904 either the patient has been given this information 255 00:09:28,965 --> 00:09:31,845 when they get their health plan enrollment upfront 256 00:09:31,845 --> 00:09:32,825 or a navigator, 257 00:09:33,605 --> 00:09:36,709 you know, benefits navigator contacts them when they 258 00:09:36,709 --> 00:09:38,389 when they start to schedule a surgery and 259 00:09:38,389 --> 00:09:40,709 they'll say, hey. Listen. You know, you can 260 00:09:40,709 --> 00:09:42,549 go to your own doctor here, to your 261 00:09:42,549 --> 00:09:44,230 own hospital here where you had your baby 262 00:09:44,230 --> 00:09:46,629 and have your hysterectomy there, but you'll have, 263 00:09:46,629 --> 00:09:47,289 you know, 264 00:09:48,035 --> 00:09:51,154 through x thousand dollar deductible and 20% co 265 00:09:51,154 --> 00:09:52,134 pay. Or 266 00:09:52,754 --> 00:09:55,875 we've got these crackerjack surgeons who will we'll 267 00:09:55,875 --> 00:09:58,035 pay for you and a companion to fly 268 00:09:58,035 --> 00:10:00,754 out there or or your transportation, your hotel, 269 00:10:00,754 --> 00:10:03,649 your food, and we'll, you know, no deductible, 270 00:10:03,649 --> 00:10:05,809 no co pay, nothing out of pocket. And 271 00:10:05,809 --> 00:10:08,370 so the patients are like, well, sounds good 272 00:10:08,370 --> 00:10:09,649 to me. Is he a good surgeon? And 273 00:10:09,649 --> 00:10:11,970 they're like, yeah. We've vetted him thoroughly. And 274 00:10:11,970 --> 00:10:14,529 so these folks just come on in. I 275 00:10:14,529 --> 00:10:16,105 I did two of these today. As a 276 00:10:16,105 --> 00:10:17,404 matter of fact. One lady 277 00:10:17,785 --> 00:10:20,764 came from seven hour drive away in Alabama 278 00:10:20,904 --> 00:10:23,785 somewhere, and another one came from South Georgia 279 00:10:23,785 --> 00:10:26,585 near Savannah, which is about four four and 280 00:10:26,585 --> 00:10:27,804 a half hours from us. 281 00:10:28,200 --> 00:10:30,679 Wow. Okay. So so this is obviously, I 282 00:10:30,679 --> 00:10:31,179 presume, 283 00:10:31,480 --> 00:10:33,639 what's gonna be a huge area of growth 284 00:10:33,639 --> 00:10:35,879 for for your ASC in terms of these 285 00:10:35,879 --> 00:10:38,220 bundle based rates, bundle based programs. 286 00:10:38,840 --> 00:10:41,714 What is the key to meeting your quality 287 00:10:41,714 --> 00:10:44,294 goals through those bundle bundle based programs, but 288 00:10:44,514 --> 00:10:46,754 also also meeting those financial goals, which are 289 00:10:46,754 --> 00:10:48,214 closely tied together. Right? 290 00:10:48,754 --> 00:10:50,514 Right. Well, so quality goals 291 00:10:51,475 --> 00:10:53,394 one of the things that we've been obsessive 292 00:10:53,394 --> 00:10:56,774 about even before we built our ASC was 293 00:10:57,149 --> 00:10:59,089 tracking our all our surgical outcomes. 294 00:10:59,470 --> 00:11:01,709 So we've made it a point to you 295 00:11:01,709 --> 00:11:04,209 know, we keep a spreadsheet of every single 296 00:11:04,269 --> 00:11:05,809 surgery we've ever done 297 00:11:06,190 --> 00:11:09,709 and whether any complications occurred, when any hospital 298 00:11:09,709 --> 00:11:10,209 readmissions, 299 00:11:10,589 --> 00:11:13,445 any any infections, all of that. And so 300 00:11:13,445 --> 00:11:13,945 we 301 00:11:14,644 --> 00:11:16,565 have a huge amount of data that we 302 00:11:16,565 --> 00:11:19,205 can share with any any broker or provider 303 00:11:19,205 --> 00:11:21,524 that's looking to use our facility. And we've 304 00:11:21,524 --> 00:11:22,745 just got a a 305 00:11:23,125 --> 00:11:25,445 just a really I I have to brag 306 00:11:25,445 --> 00:11:27,384 on it. We have an amazing record of, 307 00:11:27,669 --> 00:11:30,730 I mean, virtually nil in terms of complications 308 00:11:30,790 --> 00:11:33,450 or readmissions or need for reoperation. 309 00:11:33,990 --> 00:11:36,149 So the folks that we've developed a relationship 310 00:11:36,149 --> 00:11:38,149 with know that they're getting a a very 311 00:11:38,149 --> 00:11:41,029 reproducible product and, you know, if anybody has 312 00:11:41,029 --> 00:11:42,549 an issue, they can always come back and 313 00:11:42,549 --> 00:11:43,964 we'll take care of it. I can't even 314 00:11:43,964 --> 00:11:45,325 remember the last time we had to do 315 00:11:45,325 --> 00:11:48,764 that. So our quality data is unassailable. Our 316 00:11:48,764 --> 00:11:50,764 infection rate is zero. I mean, it's always 317 00:11:50,764 --> 00:11:52,384 gonna be way lower in the hospital, 318 00:11:52,924 --> 00:11:53,825 in an ASC. 319 00:11:54,445 --> 00:11:55,904 But overall, complications, 320 00:11:56,284 --> 00:11:59,779 transfusions, all of that is just vanishingly low. 321 00:12:00,320 --> 00:12:02,500 So that that's that's well established. 322 00:12:03,279 --> 00:12:05,360 That data that you've got in on hand 323 00:12:05,360 --> 00:12:07,460 for every single procedure that you performed, 324 00:12:07,920 --> 00:12:11,534 zero complications, zero emissions, I imagine now more 325 00:12:11,534 --> 00:12:13,695 more than ever, that data, having that on 326 00:12:13,695 --> 00:12:16,595 hand is so so crucial to ASCs, owners, 327 00:12:16,735 --> 00:12:17,954 CEOs like yourselves. 328 00:12:18,254 --> 00:12:19,855 And while you're like you said, I guess, 329 00:12:19,855 --> 00:12:21,695 going into these conversations with some of these 330 00:12:21,695 --> 00:12:23,774 maybe health plans or maybe establishing some of 331 00:12:23,774 --> 00:12:26,059 these bundle by bundle based payment relationships. 332 00:12:26,839 --> 00:12:29,819 Yeah. They the each new relationship we develop 333 00:12:30,120 --> 00:12:32,620 typically has some sort of credentialing, 334 00:12:33,079 --> 00:12:34,620 but you'd be kind of amazed. 335 00:12:35,799 --> 00:12:38,379 A lot of them, they don't even ask 336 00:12:38,894 --> 00:12:42,014 that much about surgical outcomes or complication rates 337 00:12:42,014 --> 00:12:44,735 or anything. They just wanna make sure people 338 00:12:44,735 --> 00:12:47,535 are licensed, that there's no liability issues, that 339 00:12:47,535 --> 00:12:49,695 we've been up in operation for a certain 340 00:12:49,695 --> 00:12:51,820 amount of time, and that we have, you 341 00:12:51,820 --> 00:12:52,960 know, fully credentialed 342 00:12:53,340 --> 00:12:53,840 Medicare 343 00:12:54,299 --> 00:12:54,799 certified, 344 00:12:55,179 --> 00:12:58,559 you know, state, joint commission accredited, everything. 345 00:12:59,419 --> 00:13:01,580 It's it's almost a tiny bit of a 346 00:13:01,580 --> 00:13:03,440 wild west out there. They're they're mainly, 347 00:13:03,745 --> 00:13:06,144 if their patients are happy and nobody complains 348 00:13:06,144 --> 00:13:08,465 and they're getting a a great huge deal 349 00:13:08,465 --> 00:13:10,325 on their surgeries, they don't even 350 00:13:11,024 --> 00:13:11,684 I'm almost 351 00:13:12,304 --> 00:13:15,345 taken aback by how they don't really ask 352 00:13:15,345 --> 00:13:17,285 for that much in terms of 353 00:13:17,740 --> 00:13:20,139 data and quality outcome numbers. We have it 354 00:13:20,139 --> 00:13:22,220 all. And I I strongly feel that every 355 00:13:22,220 --> 00:13:24,460 person who's a surgeon should keep track of 356 00:13:24,460 --> 00:13:26,700 every single procedure they do and whether there 357 00:13:26,700 --> 00:13:29,100 were or weren't any complications, so, you know, 358 00:13:29,100 --> 00:13:30,960 for self improvement if nothing else. 359 00:13:31,340 --> 00:13:32,000 You know? 360 00:13:32,375 --> 00:13:34,634 Yeah. No. Fascinating to hear that. Hugo, 361 00:13:35,254 --> 00:13:37,334 kind of following on from that, I wanted 362 00:13:37,334 --> 00:13:38,315 to get your perspective. 363 00:13:38,695 --> 00:13:41,174 When you look ahead the next twelve months, 364 00:13:41,174 --> 00:13:43,115 twenty four months at your ASC, 365 00:13:43,495 --> 00:13:45,660 how are you thinking about growth? Is it 366 00:13:45,660 --> 00:13:48,799 adding new procedures, adding new physicians, providers? 367 00:13:49,340 --> 00:13:50,779 What what's our kind of next step as 368 00:13:50,779 --> 00:13:51,919 you plan for the future? 369 00:13:52,460 --> 00:13:53,919 Well, our primary 370 00:13:54,540 --> 00:13:56,399 directive, so to speak, is just 371 00:13:56,779 --> 00:13:59,019 continuing to develop relationships with, 372 00:13:59,554 --> 00:14:00,454 people who do 373 00:14:00,914 --> 00:14:03,634 direct to employer contracting, like, you know, cutting 374 00:14:03,634 --> 00:14:06,454 up the middleman, so to speak. That's we 375 00:14:06,754 --> 00:14:09,074 we're we're not quite maxed out as far 376 00:14:09,074 --> 00:14:09,574 as, 377 00:14:10,514 --> 00:14:12,194 you know, all our all our time is 378 00:14:12,194 --> 00:14:12,694 filled. 379 00:14:13,100 --> 00:14:15,200 As far as recruiting new surgeons, 380 00:14:15,980 --> 00:14:18,480 that's a that's a unfortunate and sad, 381 00:14:19,500 --> 00:14:21,340 difficult thing that that is is 382 00:14:22,220 --> 00:14:23,660 yeah. That's one of the things I guess 383 00:14:23,660 --> 00:14:24,960 we wanted to bring up. 384 00:14:25,575 --> 00:14:28,634 For private private practice independently 385 00:14:29,014 --> 00:14:30,075 owned ASCs, 386 00:14:30,615 --> 00:14:32,535 it is it's tough going just like it 387 00:14:32,535 --> 00:14:34,795 is for just our regular medical practice. 388 00:14:35,254 --> 00:14:37,035 Trying to recruit has become 389 00:14:37,495 --> 00:14:40,450 probably the number one difficult issue for us 390 00:14:40,450 --> 00:14:40,950 because, 391 00:14:41,490 --> 00:14:44,070 as you know, hospitals are buying up practices 392 00:14:44,210 --> 00:14:46,230 right and left, and they're buying up ASCs 393 00:14:47,090 --> 00:14:49,570 because they're trying to, you know, protect their 394 00:14:49,570 --> 00:14:52,805 referral streams and keep all everything being referred 395 00:14:52,805 --> 00:14:53,865 to the hospital. 396 00:14:54,485 --> 00:14:56,325 And what the hospitals are offering a lot 397 00:14:56,325 --> 00:14:59,045 of these doctors, it's just it's very tough 398 00:14:59,045 --> 00:15:00,965 for us to match as a private practice 399 00:15:00,965 --> 00:15:01,465 group. 400 00:15:01,845 --> 00:15:03,785 And so getting a doctor to 401 00:15:04,149 --> 00:15:05,370 come join our group 402 00:15:05,750 --> 00:15:07,029 and they'd have to be part of the 403 00:15:07,029 --> 00:15:08,870 group to be able to operate there because 404 00:15:08,870 --> 00:15:11,110 of these CON laws. But getting a doctor 405 00:15:11,110 --> 00:15:12,709 to come join our group has been has 406 00:15:12,709 --> 00:15:13,929 been very challenging, 407 00:15:14,709 --> 00:15:16,629 not because I mean, we have a fantastic 408 00:15:16,629 --> 00:15:18,225 opportunity for somebody who's 409 00:15:19,105 --> 00:15:21,904 good at minimally invasive surgery. It's just, you 410 00:15:21,904 --> 00:15:24,225 know, our location we're close enough to Atlanta. 411 00:15:24,225 --> 00:15:26,944 We're only 40 from Atlanta, but the town 412 00:15:26,944 --> 00:15:29,365 is called Cartersville. And when people say Cartersville, 413 00:15:29,504 --> 00:15:31,024 Georgia, where the hell is that? They think 414 00:15:31,024 --> 00:15:32,544 it's out in the middle of nowhere. And, 415 00:15:32,544 --> 00:15:34,629 you know, it seems like all these docs, 416 00:15:34,629 --> 00:15:36,169 especially coming out of residency, 417 00:15:36,629 --> 00:15:38,389 they all wanna go, you know, practice in 418 00:15:38,389 --> 00:15:40,409 a big city or a big metro area. 419 00:15:40,629 --> 00:15:42,570 And then, you know, a lot of them 420 00:15:42,709 --> 00:15:43,209 don't 421 00:15:43,589 --> 00:15:46,070 really wanna work and develop a a a 422 00:15:46,070 --> 00:15:49,485 private practice, but it's it's real our area 423 00:15:49,485 --> 00:15:51,644 is growing so fast. We we really could 424 00:15:51,644 --> 00:15:52,784 use another doc. 425 00:15:53,164 --> 00:15:55,325 That's just a challenge. Try to we need 426 00:15:55,325 --> 00:15:57,245 a doc who has a long term outlook 427 00:15:57,245 --> 00:15:59,085 where they wanna settle in the community, build 428 00:15:59,085 --> 00:16:02,399 a practice, and establish their reputation here, and 429 00:16:02,700 --> 00:16:05,120 and, that's just been a a big challenge. 430 00:16:06,059 --> 00:16:08,059 Well, if there's any physicians listening to this 431 00:16:08,059 --> 00:16:08,559 podcast, 432 00:16:08,940 --> 00:16:10,399 maybe they'll reach out to you. 433 00:16:10,860 --> 00:16:11,360 Yeah. 434 00:16:11,660 --> 00:16:14,054 Yeah. If if anybody wants a very very 435 00:16:14,054 --> 00:16:16,315 high volume successful g wine practice 436 00:16:16,934 --> 00:16:18,695 and and and it's a good town. It's 437 00:16:18,695 --> 00:16:21,095 close enough to Atlanta. We, I mean, litter 438 00:16:21,174 --> 00:16:23,735 we literally go to Atlanta pretty frequently, go 439 00:16:23,735 --> 00:16:25,575 out to dinner, go to shows, go to 440 00:16:25,575 --> 00:16:27,539 sports events. It's really just a suburb. 441 00:16:28,179 --> 00:16:29,699 I mean, there are people in our county 442 00:16:29,699 --> 00:16:32,419 who commute daily to Atlanta for jobs, so 443 00:16:32,419 --> 00:16:33,639 it's really not that far. 444 00:16:34,339 --> 00:16:35,240 Mhmm. Fantastic. 445 00:16:36,019 --> 00:16:38,019 Hugo, last question for you before I let 446 00:16:38,019 --> 00:16:40,339 you go. Some fascinating conversation so far. I 447 00:16:40,339 --> 00:16:42,519 learned a lot more about you, your ASC. 448 00:16:42,875 --> 00:16:44,235 There's a lot of challenges in health care. 449 00:16:44,235 --> 00:16:45,434 We're kinda ending on a little bit more 450 00:16:45,434 --> 00:16:46,575 of an upbeat question. 451 00:16:47,195 --> 00:16:49,355 What are you most excited about when you 452 00:16:49,355 --> 00:16:52,154 think about your ASC, health care more broadly? 453 00:16:52,154 --> 00:16:54,174 Kinda what what what really gets you going? 454 00:16:55,240 --> 00:16:55,740 Well, 455 00:16:56,200 --> 00:16:57,320 one of the things we, 456 00:16:57,800 --> 00:16:59,960 often say to each other, us three docs 457 00:16:59,960 --> 00:17:03,180 who who are partners in this ASC is, 458 00:17:03,800 --> 00:17:06,059 if you enjoy doing surgery as a physician, 459 00:17:06,359 --> 00:17:09,080 having your own ambulatory surgery center is is 460 00:17:09,080 --> 00:17:09,580 like 461 00:17:09,934 --> 00:17:12,095 the best dream possible for a surgeon. Not 462 00:17:12,095 --> 00:17:14,414 having to deal with hospitals, trying to, you 463 00:17:14,414 --> 00:17:17,394 know, begging for OR time at a hospital, 464 00:17:17,535 --> 00:17:19,214 not getting the OR time when you want 465 00:17:19,214 --> 00:17:20,894 it, just being able to schedule your own 466 00:17:20,894 --> 00:17:22,734 cases whenever you want it. That's that is 467 00:17:22,734 --> 00:17:25,319 an incredible luxury for us, and we just 468 00:17:25,480 --> 00:17:27,559 are we it just puts a huge smile 469 00:17:27,559 --> 00:17:28,759 on our face every day to go to 470 00:17:28,759 --> 00:17:30,919 our own surgery center. I literally just walked 471 00:17:30,919 --> 00:17:32,359 down the hall from my office, and I'm 472 00:17:32,359 --> 00:17:34,679 in in our own surgery center. So it's 473 00:17:34,679 --> 00:17:35,179 great. 474 00:17:35,880 --> 00:17:37,240 There's a lot to be said to that, 475 00:17:37,240 --> 00:17:39,159 and all respect for you physician owners and 476 00:17:39,159 --> 00:17:42,234 ASC owners out there. Hugo, really, really appreciate 477 00:17:42,234 --> 00:17:43,595 you taking the time out of your busy 478 00:17:43,595 --> 00:17:44,095 schedule. 479 00:17:44,474 --> 00:17:46,234 Certainly learned a lot, and no doubt our 480 00:17:46,234 --> 00:17:48,394 our audience will have as well. Look forward 481 00:17:48,394 --> 00:17:49,934 to connecting with you again down the line. 482 00:17:50,234 --> 00:17:52,154 Yes. I I appreciate your call. And if, 483 00:17:53,035 --> 00:17:54,414 if anybody out there 484 00:17:54,720 --> 00:17:57,039 has ever thought of, as a gynecologist or 485 00:17:57,039 --> 00:17:58,799 a minimally invasive g y n surgeon, has 486 00:17:58,799 --> 00:17:59,460 thought of 487 00:17:59,919 --> 00:18:01,700 trying to develop their own ASC, 488 00:18:02,319 --> 00:18:04,160 I would love to talk to them and 489 00:18:04,160 --> 00:18:06,559 and tell them how to do contracting, how 490 00:18:06,559 --> 00:18:09,059 to get good rates for your surgeries, and 491 00:18:09,200 --> 00:18:11,325 how to how to market it to employers. 492 00:18:12,424 --> 00:18:14,044 Fantastic. Thank you. Hugo. 493 00:18:14,505 --> 00:18:15,005 Alright.