This is Alan Congdon with the Becker's ASC
podcast.
And today, I'm delighted to be joined by
Alexandra
Hogue, director of operations at Orbis Surgery Center
in Houston,
Texas.
Alex,
pleasure to have you make your debut appearance
on the Beckers AFC podcast with us today.
For folks who mightn't be as familiar with
your surgery center, the work it is that
you do at Orbis Surgery Center, do you
mind giving us a little bit of insight
into into your surgery center and your role
there as director of operations? Yeah. Absolutely. Thank
you so much for having me this afternoon.
But, yes, I am the director of operations
for Orbis. Orbis actually has two locations in
the Houston area. We have an ambulatory surgery
center, but we also have an office based
lab that is in the medical center area
of Houston, Texas.
We primarily focus on endovascular procedures, but we
also have vascular surgeon that does procedures,
at our surgery center along with a couple
other specialties. But endovascular and vascular access is
actually kind of our bread and butter within
our procedures that we do.
In the future, though, within the next year,
we will be opening up a second ambulatory
surgery center to,
cover our office based lab that we currently
have.
Okay. So certainly an exciting time, I guess,
for Orviso Surgery Center with the second,
ASC coming in the future.
It's endovascular
and vascular is your bread and butter.
Excited to kinda dive in and hear a
little bit more about what you're focused on,
Alex.
So so to kick things off, do you
mind, I'm sure, that we can go in
any way direction here. There's so much going
on in health care today, arguably more than
ever. But if you could narrow it down,
what are kind of two or three,
key trends that you're paying close attention to
as it relates to health care and your
s e ASC today?
Yeah. Absolutely. Because, of course, we are opening
a new surgery center. This is something that
I have to kinda keep a eye on
pretty consistently. But one of the first things
is always gonna be reimbursement changes,
within the health care field in general.
As we continue to do certain procedures,
supply costs increase, we just have to make
sure that we're always keeping an eye on
our finances in general.
And those reimbursement changes are gonna be some
of the biggest things that we're taking a
look at consistently.
The next thing that I really, focus on
are those cover procedures for ASCs.
Of course, you know, a lot of procedures
have always traditionally been done at the hospital,
but a lot of the patients don't necessarily
need those there. So as the industry decide
starts to grow a little bit more,
more people are familiar
with what ASCs can do
and how those procedures can be done in
a more cost effective way in ASCs, we're
always kinda on edge waiting to see what
other procedures that our physicians do at the
hospital that they may be able to take
and bring to our ASCs and now become
covered procedures.
This is something, of course, as we are
looking to build our new ASC that we're
gonna be really taking a a look at
so that we can make sure that we
are, offering a lot of those services to
those patients in an outpatient setting. And then
of course, just like everybody,
AI is one of those big trends that
we're paying attention to consistently.
Health care in general is usually a little
bit behind the the eight ball on
being as up to date with a lot
of the changes in technology.
So I think it's very important on our
behalf to really take a look at how
AI is changing things and what benefits it
can be within the ASC space.
You know, of course, with
health care in general, we do have to
be conscious
of any type of, data issues, breaches,
or just how we're gonna make sure that
we keep our patients HIPAA,
information safe. So AI can be a little
daunting in that way, but there's so many
things just with efficiency in general that we
could be using AI in our day to
day operations
that could
tremendously shape the way that we're doing health
care right now.
Mhmm.
Yeah. Yeah. I I mean, I I'd love
to kinda hear just a little bit more
on the first trend that you'd obviously mentioned.
No doubt, AI, ASC corporate procedures, there's anything
we could add in that regard. But as
it relates to reimbursement,
certainly a lot happening in this in this
area at the moment. A lot open the
air at the moment as well. With such
a big, I assume, up front capital cost,
you're opening this new surgery center quite soon.
Is this arguably more challenging for you in
terms of make keep making sure you're up
to date on any potential changes to reimbursement,
whether it be Medicaid, commercial side, supply costs
you mentioned as well. How how are you
managing, I guess,
or trying to proactively manage these costs that
may or may may not change given this
big upfront capital cost, this big investment that
you're making in terms of growing your your
ASC with that second center?
Yes. This is definitely something that's pretty daunting.
Obviously, with new changes in, government leadership, you
know that things can kinda change day to
day. I'm frequently looking at the news,
looking at new laws that are being passed
or potentially being passed, not just, from a
federal level, but off also a state level
to make sure that as we are making
this huge investment,
that we're going to be able to recoup,
what we need to to be able to
be successful in the market. Some of the
things that I'm doing right now is we,
because we are a small ASC physician owned
in the area,
one of the challenges that we have consistently
is contracts.
So it's not just that we have to
worry about the Medicare, but we have to,
worry about how a lot of these,
commercial payers are gonna adjust based off of
the laws and different, changes that have,
kinda come about. So one of the things
we've done proactively is, onboard a contracted entity
to assist us with some of our payer
contracting. And, you know, how can we get
ahead of this knowing that, hey, these percentages
might change where we might be looking at,
you know, a cost decrease in one, service
that we provide, but maybe an increase in
another. So we do have somebody right now
that is, a third party that's kinda taken
a look at a lot of the codes
that we're using and how we can stay
ahead of it. Because as soon as those
doors open and we,
work on our accreditation,
we're gonna be full steam ahead, trying to
recoup those funds. So reimbursement is something that's
always at the front of our, our minds
and how we can make sure
that one, we're of course, providing the best
care that we can to patients, but also
going to be able to afford
the new the up in supply cost, the,
change in reimbursement and all those things on
a consistent basis. So,
just really being proactive,
making sure that we are up to date
on the news,
working on payer contracting,
and just how we can be more efficient
in general are kind of our top things
that we're taking a look at with this
new facility.
Mhmm. Yeah. You mentioned, you know, so much
going on at the federal level. You did
kinda mention staying up to date on a
daily basis with the news. Is there anything
that we should be aware of? What's going
on in Texas in your in your at
the state level? Is there anything that,
working its way through policymakers that could potentially
impact ASCs or in your market for the
good or for worse?
Yeah. So, from the state level,
there's,
unfortunately been, one policy that has it kinda
died and came back up a couple of
times, within the state of Texas, and that
specifically regarding,
a facility billing.
As most people know that work within an
ASC,
that is how ASCs stay,
in business. That's how we pay our staff.
That's how we purchase our,
our supplies to run.
So, one of those things that they're trying
to pass is getting rid of facility billing,
which a lot of that is just not
being well versed. A lot of these policy
makers, sometimes they get, you know, information from
outside sources, but just not being well versed
of what that facility fee actually does in
order to kinda keep these facilities running these
ASCs. We know that ASCs are a major
a major, like,
improvement to the health care, delivery in general
because we are able to cut down costs
that you would normally see in the hospital
and also keep our patients safer.
So we really, a lot of times, need,
these policy makers to take a look at
the holistic view of how this works and
how something so what they might not see
as being big or might see is, oh,
we're helping the the patients. But this is
really,
a huge component
that we need in the ASCs to make
sure that we can still stay afloat and,
continue to provide that great care.
Yeah. I mean, those are no doubt two
massive challenges for for ACs and Texas. What
we're really interested is to kinda hear how
you're proactively trying to kinda get ahead of
some of those challenges as well. Not to
stay on too doom and gloom, spend too
much time on a challenging aspect of your
work, but I wanted to flip the script
on here about something a little bit more
upbeat.
What are you most excited about right now?
You did mention, obviously, a lot of excitement
around this the second surgery center coming. Is
that something you'd point to or you want
to expand on, or is there anything else
that springs to mind for you? Yeah. No.
I'm I'm super excited for, the the new
surgery center and just the possibilities that could
come along with it.
Some of the other things that I'm excited
about, and I mentioned it briefly, is just,
about AI and just automation in general. How
can we make sure that we are using
a lot of the new tools and technologies
that are out there to make sure that
our new facility is up and,
pretty much up to date and just forward
thinking in the care that we deliver to
the patients.
I think that we'll be able to be
a lot more efficient,
in our new setting and even in our
current ASC as we're starting to make these
changes.
But, ultimately, I'm I'm also just excited about
what new specialties we can bring on board.
Our new ASC is gonna be four ORs.
So, currently, our,
current ASC has only two ORs. So I'm
just thinking about all of the potential possibilities
of case,
cases and just the different specialties that might
be able to be present within our new
surgery center,
in the coming years.
Yeah. Yeah. And that ties nicely into to
my next question as well, Alex. So four
ORs in the in the second surgery center
that you're going to be open up, your
current ASC is two ORs.
How are you thinking about growth when the
when that second surgery center opens up? Is
it potentially adding more providers, expanding some of
your specialties, or or anything else that you're
considering, or maybe just case volume? I'd love
to hear a little bit more on that.
Yeah. It'll be a combination of all three.
Of course, case volume is one of those
things that you always wanna focus on within
your your current spaces, but then also in
our future spaces. But adding new providers,
we have an interest in, like I said,
being multi specialty.
So we wanna make sure that, one, our
facility is set up in a way that
we are attractive to other, physicians.
I think that being in Houston, Texas, we
have a a good setup where there is
some appetite for,
a lot more independent physicians to be able
to come to a surgery center and do
some of that work versus being at a
hospital. So we're really excited about that. And
then the last thing is really,
expanding though those procedures that we're doing. One
of the things that I'm actually going to
be discussing when I'm at backers is adding
those, additional service lines. There's a lot of
things sometimes our physicians are able to do,
but they've only been,
allocated to being done at the hospital.
So what kind of things can we do
within our surgery center
to make it easy
for our providers to transition some of those
procedures to outpatient? You know, some stuff, of
course, we need to be mindful and make
sure it's still safe for the patient depending
on, the acuity level of the patients that
we're seeing. But there's plenty of procedures that,
our vascular surgeon right now,
does that might be able to be outpatient
that he's doing at the hospital that we
can transition and do in that outpatient setting.
So there we're we're doing a combination of
all those things that you listed, to try
to make sure that we're focused on growth
for,
not only our new surgery center, but also
our current surgery center to make sure that
we're make being efficient and making the best
out of, you know, our operational function that
we have already.
So, Alex, really appreciate the the great level
of insight. A lot of exciting things happen
at your surgery center. Something that's popped up
time and time again in my conversations recently
with, ASC physician owners, ASC administrators, director of
operations like yourselves is that challenge or not
that that migrating those higher acuity complex procedures
safely and effectively
to the ASC, the outpatient setting.
In your opinion, what do some folks, some
centers potentially get wrong,
or or some of the watch outs, the
red flags that they really have to be
careful about when safely and effectively migrating some
of those higher complex procedures to the ASC
setting?
Yes. So there's a couple different things that
sometimes people will use as oversight when adding
some of these complex procedures. One of the
things is definitely going to be, the supplies
and the cost associated with some of these
procedures.
A lot of times when you're working in
an ASC space, you're pretty accustomed to the
specific cases that you're used to doing. You
know what,
you have a kind of a plan of
what you usually order, how you order it,
how much it's gonna be. But a lot
of times, that's an oversight, and there's sometimes
people will cut corners in what they're ordering
for supplies associated with some of those cases,
which could be a detriment depending on, the
type of procedure that you are transitioning
to your surgery center. Another thing that I
would say is your patient population. Who are
you treating,
at your surgery center for these complex,
cases?
So as things get more complex, you also
have to be mindful of anesthesia times, how
long your patient's gonna be down. Is this
gonna be effective for your patient population?
Is it something where these patients maybe have,
a different acuity level and need to be
done at the hospital because of,
some of those comorbidities
versus,
a very healthy person that might be able
to endure those complex cases within an ASC.
I do think that there's plenty of space
for procedures
to be done within the ASC that are
still being considered
super complex and only being done at the
hospital.
But I do think that we do have
to take the time to really dig deep
and make sure that we are looking into
all the cost cost associated, all of the
risk associated
with these procedures?
And do we have the means to be
able
to transition this patient if there were something
that goes wrong during that procedure?
Mhmm. Yeah. I think so. It's so very
very important to kinda keep in mind. So
next and takeaways and insights there for any
other ASC administrators,
physician physician owners on the call today.
Alex, so greatly appreciate your perspective. Really, really
looking forward to meeting you and having you
speak at our spine orthopedic and pain management
driven ASC event next month. Thank you so
much for taking the time. Yeah. No. Thank
you. I appreciate the time today.