1 00:00:00,160 --> 00:00:03,060 This is Alan Congdon with the Becker's ASC 2 00:00:03,439 --> 00:00:03,939 podcast. 3 00:00:04,319 --> 00:00:06,740 And today, I'm delighted to be joined by 4 00:00:06,879 --> 00:00:07,379 Alexandra 5 00:00:07,679 --> 00:00:11,759 Hogue, director of operations at Orbis Surgery Center 6 00:00:11,759 --> 00:00:12,500 in Houston, 7 00:00:12,814 --> 00:00:13,314 Texas. 8 00:00:13,934 --> 00:00:14,434 Alex, 9 00:00:14,734 --> 00:00:16,974 pleasure to have you make your debut appearance 10 00:00:16,974 --> 00:00:19,314 on the Beckers AFC podcast with us today. 11 00:00:20,175 --> 00:00:22,835 For folks who mightn't be as familiar with 12 00:00:23,054 --> 00:00:24,894 your surgery center, the work it is that 13 00:00:24,894 --> 00:00:26,751 you do at Orbis Surgery Center, do you 14 00:00:26,751 --> 00:00:29,081 mind giving us a little bit of insight 15 00:00:29,081 --> 00:00:31,411 into into your surgery center and your role 16 00:00:31,411 --> 00:00:33,741 there as director of operations? Yeah. Absolutely. Thank 17 00:00:33,741 --> 00:00:36,072 you so much for having me this afternoon. 18 00:00:36,072 --> 00:00:38,402 But, yes, I am the director of operations 19 00:00:38,402 --> 00:00:40,984 for Orbis. Orbis actually has two locations in 20 00:00:40,984 --> 00:00:43,545 the Houston area. We have an ambulatory surgery 21 00:00:43,545 --> 00:00:45,704 center, but we also have an office based 22 00:00:45,704 --> 00:00:47,625 lab that is in the medical center area 23 00:00:47,625 --> 00:00:48,685 of Houston, Texas. 24 00:00:49,225 --> 00:00:52,479 We primarily focus on endovascular procedures, but we 25 00:00:52,479 --> 00:00:54,899 also have vascular surgeon that does procedures, 26 00:00:55,440 --> 00:00:57,760 at our surgery center along with a couple 27 00:00:57,760 --> 00:01:01,520 other specialties. But endovascular and vascular access is 28 00:01:01,520 --> 00:01:04,239 actually kind of our bread and butter within 29 00:01:04,239 --> 00:01:06,015 our procedures that we do. 30 00:01:06,495 --> 00:01:08,894 In the future, though, within the next year, 31 00:01:08,894 --> 00:01:10,995 we will be opening up a second ambulatory 32 00:01:11,055 --> 00:01:12,674 surgery center to, 33 00:01:13,135 --> 00:01:15,295 cover our office based lab that we currently 34 00:01:15,295 --> 00:01:15,795 have. 35 00:01:16,494 --> 00:01:19,299 Okay. So certainly an exciting time, I guess, 36 00:01:19,299 --> 00:01:21,239 for Orviso Surgery Center with the second, 37 00:01:22,340 --> 00:01:23,959 ASC coming in the future. 38 00:01:24,340 --> 00:01:25,159 It's endovascular 39 00:01:25,620 --> 00:01:27,959 and vascular is your bread and butter. 40 00:01:28,819 --> 00:01:30,340 Excited to kinda dive in and hear a 41 00:01:30,340 --> 00:01:32,020 little bit more about what you're focused on, 42 00:01:32,020 --> 00:01:32,385 Alex. 43 00:01:33,185 --> 00:01:34,865 So so to kick things off, do you 44 00:01:34,865 --> 00:01:36,704 mind, I'm sure, that we can go in 45 00:01:36,704 --> 00:01:38,625 any way direction here. There's so much going 46 00:01:38,625 --> 00:01:41,105 on in health care today, arguably more than 47 00:01:41,105 --> 00:01:43,665 ever. But if you could narrow it down, 48 00:01:43,665 --> 00:01:45,844 what are kind of two or three, 49 00:01:46,530 --> 00:01:48,930 key trends that you're paying close attention to 50 00:01:48,930 --> 00:01:50,290 as it relates to health care and your 51 00:01:50,290 --> 00:01:51,670 s e ASC today? 52 00:01:52,210 --> 00:01:55,010 Yeah. Absolutely. Because, of course, we are opening 53 00:01:55,010 --> 00:01:57,490 a new surgery center. This is something that 54 00:01:57,490 --> 00:01:59,409 I have to kinda keep a eye on 55 00:01:59,409 --> 00:02:02,015 pretty consistently. But one of the first things 56 00:02:02,015 --> 00:02:04,034 is always gonna be reimbursement changes, 57 00:02:04,734 --> 00:02:07,155 within the health care field in general. 58 00:02:07,694 --> 00:02:10,034 As we continue to do certain procedures, 59 00:02:10,735 --> 00:02:13,134 supply costs increase, we just have to make 60 00:02:13,134 --> 00:02:14,895 sure that we're always keeping an eye on 61 00:02:14,895 --> 00:02:16,354 our finances in general. 62 00:02:16,889 --> 00:02:19,210 And those reimbursement changes are gonna be some 63 00:02:19,210 --> 00:02:20,810 of the biggest things that we're taking a 64 00:02:20,810 --> 00:02:21,790 look at consistently. 65 00:02:22,490 --> 00:02:24,889 The next thing that I really, focus on 66 00:02:24,889 --> 00:02:26,909 are those cover procedures for ASCs. 67 00:02:27,449 --> 00:02:29,495 Of course, you know, a lot of procedures 68 00:02:29,495 --> 00:02:31,754 have always traditionally been done at the hospital, 69 00:02:32,215 --> 00:02:34,155 but a lot of the patients don't necessarily 70 00:02:34,215 --> 00:02:37,414 need those there. So as the industry decide 71 00:02:37,574 --> 00:02:39,435 starts to grow a little bit more, 72 00:02:39,814 --> 00:02:41,034 more people are familiar 73 00:02:41,580 --> 00:02:43,280 with what ASCs can do 74 00:02:43,659 --> 00:02:46,060 and how those procedures can be done in 75 00:02:46,060 --> 00:02:48,699 a more cost effective way in ASCs, we're 76 00:02:48,699 --> 00:02:51,259 always kinda on edge waiting to see what 77 00:02:51,259 --> 00:02:53,259 other procedures that our physicians do at the 78 00:02:53,259 --> 00:02:55,574 hospital that they may be able to take 79 00:02:55,574 --> 00:02:58,375 and bring to our ASCs and now become 80 00:02:58,375 --> 00:02:59,194 covered procedures. 81 00:02:59,895 --> 00:03:02,135 This is something, of course, as we are 82 00:03:02,135 --> 00:03:04,615 looking to build our new ASC that we're 83 00:03:04,615 --> 00:03:06,810 gonna be really taking a a look at 84 00:03:06,889 --> 00:03:08,569 so that we can make sure that we 85 00:03:08,569 --> 00:03:11,050 are, offering a lot of those services to 86 00:03:11,050 --> 00:03:13,930 those patients in an outpatient setting. And then 87 00:03:13,930 --> 00:03:15,389 of course, just like everybody, 88 00:03:15,689 --> 00:03:18,009 AI is one of those big trends that 89 00:03:18,009 --> 00:03:19,789 we're paying attention to consistently. 90 00:03:20,444 --> 00:03:22,685 Health care in general is usually a little 91 00:03:22,685 --> 00:03:25,104 bit behind the the eight ball on 92 00:03:25,405 --> 00:03:27,405 being as up to date with a lot 93 00:03:27,405 --> 00:03:28,784 of the changes in technology. 94 00:03:29,405 --> 00:03:31,965 So I think it's very important on our 95 00:03:31,965 --> 00:03:34,205 behalf to really take a look at how 96 00:03:34,205 --> 00:03:36,959 AI is changing things and what benefits it 97 00:03:36,959 --> 00:03:38,900 can be within the ASC space. 98 00:03:39,199 --> 00:03:40,419 You know, of course, with 99 00:03:40,719 --> 00:03:42,400 health care in general, we do have to 100 00:03:42,400 --> 00:03:43,060 be conscious 101 00:03:43,680 --> 00:03:46,900 of any type of, data issues, breaches, 102 00:03:47,245 --> 00:03:49,004 or just how we're gonna make sure that 103 00:03:49,004 --> 00:03:50,444 we keep our patients HIPAA, 104 00:03:50,925 --> 00:03:53,645 information safe. So AI can be a little 105 00:03:53,645 --> 00:03:56,045 daunting in that way, but there's so many 106 00:03:56,045 --> 00:03:58,605 things just with efficiency in general that we 107 00:03:58,605 --> 00:04:01,004 could be using AI in our day to 108 00:04:01,004 --> 00:04:01,825 day operations 109 00:04:02,205 --> 00:04:02,944 that could 110 00:04:03,300 --> 00:04:05,699 tremendously shape the way that we're doing health 111 00:04:05,699 --> 00:04:06,599 care right now. 112 00:04:07,060 --> 00:04:07,560 Mhmm. 113 00:04:07,860 --> 00:04:09,780 Yeah. Yeah. I I mean, I I'd love 114 00:04:09,780 --> 00:04:11,860 to kinda hear just a little bit more 115 00:04:11,860 --> 00:04:13,939 on the first trend that you'd obviously mentioned. 116 00:04:13,939 --> 00:04:17,045 No doubt, AI, ASC corporate procedures, there's anything 117 00:04:17,045 --> 00:04:18,725 we could add in that regard. But as 118 00:04:18,725 --> 00:04:19,865 it relates to reimbursement, 119 00:04:21,045 --> 00:04:22,884 certainly a lot happening in this in this 120 00:04:22,884 --> 00:04:24,245 area at the moment. A lot open the 121 00:04:24,245 --> 00:04:26,404 air at the moment as well. With such 122 00:04:26,404 --> 00:04:29,100 a big, I assume, up front capital cost, 123 00:04:29,100 --> 00:04:31,919 you're opening this new surgery center quite soon. 124 00:04:32,779 --> 00:04:35,259 Is this arguably more challenging for you in 125 00:04:35,259 --> 00:04:36,939 terms of make keep making sure you're up 126 00:04:36,939 --> 00:04:39,120 to date on any potential changes to reimbursement, 127 00:04:39,259 --> 00:04:42,604 whether it be Medicaid, commercial side, supply costs 128 00:04:42,604 --> 00:04:44,685 you mentioned as well. How how are you 129 00:04:44,685 --> 00:04:45,564 managing, I guess, 130 00:04:46,125 --> 00:04:48,845 or trying to proactively manage these costs that 131 00:04:48,845 --> 00:04:51,404 may or may may not change given this 132 00:04:51,404 --> 00:04:53,564 big upfront capital cost, this big investment that 133 00:04:53,564 --> 00:04:55,404 you're making in terms of growing your your 134 00:04:55,404 --> 00:04:56,944 ASC with that second center? 135 00:04:58,000 --> 00:05:00,819 Yes. This is definitely something that's pretty daunting. 136 00:05:00,959 --> 00:05:04,399 Obviously, with new changes in, government leadership, you 137 00:05:04,399 --> 00:05:06,560 know that things can kinda change day to 138 00:05:06,560 --> 00:05:09,300 day. I'm frequently looking at the news, 139 00:05:09,759 --> 00:05:11,839 looking at new laws that are being passed 140 00:05:11,839 --> 00:05:14,904 or potentially being passed, not just, from a 141 00:05:14,904 --> 00:05:17,324 federal level, but off also a state level 142 00:05:17,625 --> 00:05:20,264 to make sure that as we are making 143 00:05:20,264 --> 00:05:21,564 this huge investment, 144 00:05:21,944 --> 00:05:24,360 that we're going to be able to recoup, 145 00:05:24,919 --> 00:05:26,360 what we need to to be able to 146 00:05:26,360 --> 00:05:28,759 be successful in the market. Some of the 147 00:05:28,759 --> 00:05:31,240 things that I'm doing right now is we, 148 00:05:31,560 --> 00:05:34,199 because we are a small ASC physician owned 149 00:05:34,199 --> 00:05:34,939 in the area, 150 00:05:35,479 --> 00:05:37,579 one of the challenges that we have consistently 151 00:05:37,719 --> 00:05:38,459 is contracts. 152 00:05:39,205 --> 00:05:40,644 So it's not just that we have to 153 00:05:40,644 --> 00:05:42,165 worry about the Medicare, but we have to, 154 00:05:42,485 --> 00:05:44,324 worry about how a lot of these, 155 00:05:45,045 --> 00:05:47,605 commercial payers are gonna adjust based off of 156 00:05:47,605 --> 00:05:49,925 the laws and different, changes that have, 157 00:05:50,564 --> 00:05:52,689 kinda come about. So one of the things 158 00:05:52,689 --> 00:05:57,189 we've done proactively is, onboard a contracted entity 159 00:05:57,330 --> 00:05:59,889 to assist us with some of our payer 160 00:05:59,889 --> 00:06:01,730 contracting. And, you know, how can we get 161 00:06:01,730 --> 00:06:04,605 ahead of this knowing that, hey, these percentages 162 00:06:04,605 --> 00:06:07,084 might change where we might be looking at, 163 00:06:07,084 --> 00:06:10,045 you know, a cost decrease in one, service 164 00:06:10,045 --> 00:06:12,045 that we provide, but maybe an increase in 165 00:06:12,045 --> 00:06:14,944 another. So we do have somebody right now 166 00:06:15,404 --> 00:06:17,759 that is, a third party that's kinda taken 167 00:06:17,759 --> 00:06:19,519 a look at a lot of the codes 168 00:06:19,519 --> 00:06:21,519 that we're using and how we can stay 169 00:06:21,519 --> 00:06:23,439 ahead of it. Because as soon as those 170 00:06:23,439 --> 00:06:24,720 doors open and we, 171 00:06:25,199 --> 00:06:26,339 work on our accreditation, 172 00:06:26,879 --> 00:06:29,600 we're gonna be full steam ahead, trying to 173 00:06:29,600 --> 00:06:32,615 recoup those funds. So reimbursement is something that's 174 00:06:32,615 --> 00:06:34,935 always at the front of our, our minds 175 00:06:34,935 --> 00:06:36,475 and how we can make sure 176 00:06:36,775 --> 00:06:39,415 that one, we're of course, providing the best 177 00:06:39,415 --> 00:06:41,835 care that we can to patients, but also 178 00:06:41,895 --> 00:06:44,074 going to be able to afford 179 00:06:44,689 --> 00:06:47,329 the new the up in supply cost, the, 180 00:06:47,729 --> 00:06:49,729 change in reimbursement and all those things on 181 00:06:49,729 --> 00:06:51,110 a consistent basis. So, 182 00:06:51,889 --> 00:06:53,269 just really being proactive, 183 00:06:53,810 --> 00:06:55,169 making sure that we are up to date 184 00:06:55,169 --> 00:06:55,910 on the news, 185 00:06:56,464 --> 00:06:57,764 working on payer contracting, 186 00:06:58,305 --> 00:06:59,904 and just how we can be more efficient 187 00:06:59,904 --> 00:07:02,305 in general are kind of our top things 188 00:07:02,305 --> 00:07:03,824 that we're taking a look at with this 189 00:07:03,824 --> 00:07:04,485 new facility. 190 00:07:05,105 --> 00:07:08,305 Mhmm. Yeah. You mentioned, you know, so much 191 00:07:08,305 --> 00:07:10,305 going on at the federal level. You did 192 00:07:10,305 --> 00:07:12,360 kinda mention staying up to date on a 193 00:07:12,360 --> 00:07:14,199 daily basis with the news. Is there anything 194 00:07:14,199 --> 00:07:15,720 that we should be aware of? What's going 195 00:07:15,720 --> 00:07:17,160 on in Texas in your in your at 196 00:07:17,160 --> 00:07:19,000 the state level? Is there anything that, 197 00:07:19,480 --> 00:07:21,959 working its way through policymakers that could potentially 198 00:07:21,959 --> 00:07:23,879 impact ASCs or in your market for the 199 00:07:23,879 --> 00:07:24,939 good or for worse? 200 00:07:25,754 --> 00:07:27,774 Yeah. So, from the state level, 201 00:07:28,074 --> 00:07:28,555 there's, 202 00:07:28,955 --> 00:07:32,714 unfortunately been, one policy that has it kinda 203 00:07:32,714 --> 00:07:34,394 died and came back up a couple of 204 00:07:34,394 --> 00:07:36,875 times, within the state of Texas, and that 205 00:07:36,875 --> 00:07:38,175 specifically regarding, 206 00:07:38,875 --> 00:07:39,930 a facility billing. 207 00:07:40,490 --> 00:07:42,649 As most people know that work within an 208 00:07:42,649 --> 00:07:43,149 ASC, 209 00:07:43,529 --> 00:07:45,389 that is how ASCs stay, 210 00:07:45,930 --> 00:07:47,769 in business. That's how we pay our staff. 211 00:07:47,769 --> 00:07:49,129 That's how we purchase our, 212 00:07:49,689 --> 00:07:51,389 our supplies to run. 213 00:07:51,689 --> 00:07:54,235 So, one of those things that they're trying 214 00:07:54,235 --> 00:07:56,735 to pass is getting rid of facility billing, 215 00:07:57,194 --> 00:07:59,915 which a lot of that is just not 216 00:07:59,915 --> 00:08:02,714 being well versed. A lot of these policy 217 00:08:02,714 --> 00:08:05,754 makers, sometimes they get, you know, information from 218 00:08:05,754 --> 00:08:07,834 outside sources, but just not being well versed 219 00:08:07,834 --> 00:08:11,009 of what that facility fee actually does in 220 00:08:11,009 --> 00:08:13,649 order to kinda keep these facilities running these 221 00:08:13,649 --> 00:08:16,870 ASCs. We know that ASCs are a major 222 00:08:17,490 --> 00:08:18,610 a major, like, 223 00:08:19,089 --> 00:08:22,149 improvement to the health care, delivery in general 224 00:08:22,370 --> 00:08:24,345 because we are able to cut down costs 225 00:08:24,345 --> 00:08:25,964 that you would normally see in the hospital 226 00:08:26,025 --> 00:08:27,805 and also keep our patients safer. 227 00:08:28,264 --> 00:08:30,504 So we really, a lot of times, need, 228 00:08:30,985 --> 00:08:32,904 these policy makers to take a look at 229 00:08:32,904 --> 00:08:35,065 the holistic view of how this works and 230 00:08:35,065 --> 00:08:37,544 how something so what they might not see 231 00:08:37,544 --> 00:08:39,809 as being big or might see is, oh, 232 00:08:39,809 --> 00:08:42,129 we're helping the the patients. But this is 233 00:08:42,129 --> 00:08:42,629 really, 234 00:08:43,009 --> 00:08:44,069 a huge component 235 00:08:44,370 --> 00:08:46,289 that we need in the ASCs to make 236 00:08:46,289 --> 00:08:49,009 sure that we can still stay afloat and, 237 00:08:49,329 --> 00:08:51,269 continue to provide that great care. 238 00:08:52,084 --> 00:08:54,084 Yeah. I mean, those are no doubt two 239 00:08:54,084 --> 00:08:56,404 massive challenges for for ACs and Texas. What 240 00:08:56,404 --> 00:08:57,764 we're really interested is to kinda hear how 241 00:08:57,764 --> 00:09:00,084 you're proactively trying to kinda get ahead of 242 00:09:00,084 --> 00:09:02,164 some of those challenges as well. Not to 243 00:09:02,164 --> 00:09:03,684 stay on too doom and gloom, spend too 244 00:09:03,684 --> 00:09:05,684 much time on a challenging aspect of your 245 00:09:05,684 --> 00:09:08,019 work, but I wanted to flip the script 246 00:09:08,019 --> 00:09:09,860 on here about something a little bit more 247 00:09:09,860 --> 00:09:10,259 upbeat. 248 00:09:10,980 --> 00:09:12,659 What are you most excited about right now? 249 00:09:12,659 --> 00:09:14,500 You did mention, obviously, a lot of excitement 250 00:09:14,500 --> 00:09:16,820 around this the second surgery center coming. Is 251 00:09:16,820 --> 00:09:18,100 that something you'd point to or you want 252 00:09:18,100 --> 00:09:19,379 to expand on, or is there anything else 253 00:09:19,379 --> 00:09:21,445 that springs to mind for you? Yeah. No. 254 00:09:21,445 --> 00:09:24,085 I'm I'm super excited for, the the new 255 00:09:24,085 --> 00:09:26,085 surgery center and just the possibilities that could 256 00:09:26,085 --> 00:09:27,304 come along with it. 257 00:09:27,684 --> 00:09:29,205 Some of the other things that I'm excited 258 00:09:29,205 --> 00:09:31,205 about, and I mentioned it briefly, is just, 259 00:09:31,524 --> 00:09:34,370 about AI and just automation in general. How 260 00:09:34,370 --> 00:09:36,850 can we make sure that we are using 261 00:09:36,850 --> 00:09:38,549 a lot of the new tools and technologies 262 00:09:38,769 --> 00:09:40,690 that are out there to make sure that 263 00:09:40,690 --> 00:09:42,529 our new facility is up and, 264 00:09:43,250 --> 00:09:45,089 pretty much up to date and just forward 265 00:09:45,089 --> 00:09:47,089 thinking in the care that we deliver to 266 00:09:47,089 --> 00:09:47,750 the patients. 267 00:09:48,684 --> 00:09:50,445 I think that we'll be able to be 268 00:09:50,445 --> 00:09:51,424 a lot more efficient, 269 00:09:52,044 --> 00:09:53,804 in our new setting and even in our 270 00:09:53,804 --> 00:09:55,884 current ASC as we're starting to make these 271 00:09:55,884 --> 00:09:56,384 changes. 272 00:09:56,924 --> 00:10:00,044 But, ultimately, I'm I'm also just excited about 273 00:10:00,044 --> 00:10:02,125 what new specialties we can bring on board. 274 00:10:02,669 --> 00:10:04,850 Our new ASC is gonna be four ORs. 275 00:10:05,149 --> 00:10:07,009 So, currently, our, 276 00:10:07,549 --> 00:10:10,350 current ASC has only two ORs. So I'm 277 00:10:10,350 --> 00:10:12,529 just thinking about all of the potential possibilities 278 00:10:12,990 --> 00:10:13,789 of case, 279 00:10:14,190 --> 00:10:16,990 cases and just the different specialties that might 280 00:10:16,990 --> 00:10:19,764 be able to be present within our new 281 00:10:19,764 --> 00:10:20,664 surgery center, 282 00:10:21,044 --> 00:10:22,184 in the coming years. 283 00:10:22,725 --> 00:10:25,205 Yeah. Yeah. And that ties nicely into to 284 00:10:25,205 --> 00:10:27,524 my next question as well, Alex. So four 285 00:10:27,524 --> 00:10:29,684 ORs in the in the second surgery center 286 00:10:29,684 --> 00:10:30,965 that you're going to be open up, your 287 00:10:30,965 --> 00:10:32,585 current ASC is two ORs. 288 00:10:33,669 --> 00:10:35,870 How are you thinking about growth when the 289 00:10:35,990 --> 00:10:38,230 when that second surgery center opens up? Is 290 00:10:38,230 --> 00:10:41,429 it potentially adding more providers, expanding some of 291 00:10:41,429 --> 00:10:43,589 your specialties, or or anything else that you're 292 00:10:43,589 --> 00:10:45,589 considering, or maybe just case volume? I'd love 293 00:10:45,589 --> 00:10:46,970 to hear a little bit more on that. 294 00:10:47,165 --> 00:10:49,085 Yeah. It'll be a combination of all three. 295 00:10:49,085 --> 00:10:50,764 Of course, case volume is one of those 296 00:10:50,764 --> 00:10:53,404 things that you always wanna focus on within 297 00:10:53,404 --> 00:10:55,485 your your current spaces, but then also in 298 00:10:55,485 --> 00:10:58,304 our future spaces. But adding new providers, 299 00:10:58,605 --> 00:11:00,545 we have an interest in, like I said, 300 00:11:00,870 --> 00:11:02,169 being multi specialty. 301 00:11:02,470 --> 00:11:05,110 So we wanna make sure that, one, our 302 00:11:05,110 --> 00:11:06,950 facility is set up in a way that 303 00:11:06,950 --> 00:11:08,970 we are attractive to other, physicians. 304 00:11:09,350 --> 00:11:11,509 I think that being in Houston, Texas, we 305 00:11:11,509 --> 00:11:15,029 have a a good setup where there is 306 00:11:15,029 --> 00:11:16,570 some appetite for, 307 00:11:17,245 --> 00:11:19,804 a lot more independent physicians to be able 308 00:11:19,804 --> 00:11:21,565 to come to a surgery center and do 309 00:11:21,565 --> 00:11:23,565 some of that work versus being at a 310 00:11:23,565 --> 00:11:25,964 hospital. So we're really excited about that. And 311 00:11:25,964 --> 00:11:27,485 then the last thing is really, 312 00:11:27,884 --> 00:11:31,004 expanding though those procedures that we're doing. One 313 00:11:31,004 --> 00:11:32,580 of the things that I'm actually going to 314 00:11:32,660 --> 00:11:35,139 be discussing when I'm at backers is adding 315 00:11:35,139 --> 00:11:37,940 those, additional service lines. There's a lot of 316 00:11:37,940 --> 00:11:40,820 things sometimes our physicians are able to do, 317 00:11:40,820 --> 00:11:42,100 but they've only been, 318 00:11:42,660 --> 00:11:44,759 allocated to being done at the hospital. 319 00:11:45,065 --> 00:11:46,904 So what kind of things can we do 320 00:11:46,904 --> 00:11:48,445 within our surgery center 321 00:11:48,825 --> 00:11:49,884 to make it easy 322 00:11:50,264 --> 00:11:52,985 for our providers to transition some of those 323 00:11:52,985 --> 00:11:55,225 procedures to outpatient? You know, some stuff, of 324 00:11:55,225 --> 00:11:56,745 course, we need to be mindful and make 325 00:11:56,745 --> 00:11:58,919 sure it's still safe for the patient depending 326 00:11:58,919 --> 00:12:01,559 on, the acuity level of the patients that 327 00:12:01,559 --> 00:12:04,200 we're seeing. But there's plenty of procedures that, 328 00:12:04,440 --> 00:12:06,299 our vascular surgeon right now, 329 00:12:06,840 --> 00:12:08,759 does that might be able to be outpatient 330 00:12:08,759 --> 00:12:10,200 that he's doing at the hospital that we 331 00:12:10,200 --> 00:12:13,335 can transition and do in that outpatient setting. 332 00:12:13,335 --> 00:12:15,815 So there we're we're doing a combination of 333 00:12:15,815 --> 00:12:17,975 all those things that you listed, to try 334 00:12:17,975 --> 00:12:19,835 to make sure that we're focused on growth 335 00:12:20,054 --> 00:12:20,554 for, 336 00:12:21,014 --> 00:12:23,414 not only our new surgery center, but also 337 00:12:23,414 --> 00:12:25,230 our current surgery center to make sure that 338 00:12:25,230 --> 00:12:27,309 we're make being efficient and making the best 339 00:12:27,309 --> 00:12:29,389 out of, you know, our operational function that 340 00:12:29,389 --> 00:12:30,769 we have already. 341 00:12:31,950 --> 00:12:34,509 So, Alex, really appreciate the the great level 342 00:12:34,509 --> 00:12:36,830 of insight. A lot of exciting things happen 343 00:12:36,830 --> 00:12:39,464 at your surgery center. Something that's popped up 344 00:12:39,464 --> 00:12:42,204 time and time again in my conversations recently 345 00:12:42,264 --> 00:12:46,184 with, ASC physician owners, ASC administrators, director of 346 00:12:46,184 --> 00:12:48,825 operations like yourselves is that challenge or not 347 00:12:48,825 --> 00:12:52,845 that that migrating those higher acuity complex procedures 348 00:12:53,339 --> 00:12:54,559 safely and effectively 349 00:12:54,940 --> 00:12:56,879 to the ASC, the outpatient setting. 350 00:12:57,259 --> 00:12:59,819 In your opinion, what do some folks, some 351 00:12:59,819 --> 00:13:01,600 centers potentially get wrong, 352 00:13:02,139 --> 00:13:03,500 or or some of the watch outs, the 353 00:13:03,500 --> 00:13:04,940 red flags that they really have to be 354 00:13:04,940 --> 00:13:07,819 careful about when safely and effectively migrating some 355 00:13:07,819 --> 00:13:10,144 of those higher complex procedures to the ASC 356 00:13:10,144 --> 00:13:10,644 setting? 357 00:13:11,184 --> 00:13:13,584 Yes. So there's a couple different things that 358 00:13:13,584 --> 00:13:16,705 sometimes people will use as oversight when adding 359 00:13:16,705 --> 00:13:19,024 some of these complex procedures. One of the 360 00:13:19,024 --> 00:13:21,605 things is definitely going to be, the supplies 361 00:13:21,825 --> 00:13:23,985 and the cost associated with some of these 362 00:13:23,985 --> 00:13:24,485 procedures. 363 00:13:24,959 --> 00:13:26,319 A lot of times when you're working in 364 00:13:26,319 --> 00:13:29,759 an ASC space, you're pretty accustomed to the 365 00:13:29,759 --> 00:13:32,000 specific cases that you're used to doing. You 366 00:13:32,000 --> 00:13:32,480 know what, 367 00:13:33,199 --> 00:13:35,039 you have a kind of a plan of 368 00:13:35,039 --> 00:13:36,959 what you usually order, how you order it, 369 00:13:36,959 --> 00:13:38,634 how much it's gonna be. But a lot 370 00:13:38,634 --> 00:13:40,894 of times, that's an oversight, and there's sometimes 371 00:13:41,274 --> 00:13:44,095 people will cut corners in what they're ordering 372 00:13:44,154 --> 00:13:46,735 for supplies associated with some of those cases, 373 00:13:47,034 --> 00:13:49,595 which could be a detriment depending on, the 374 00:13:49,595 --> 00:13:51,615 type of procedure that you are transitioning 375 00:13:52,235 --> 00:13:55,019 to your surgery center. Another thing that I 376 00:13:55,019 --> 00:13:57,820 would say is your patient population. Who are 377 00:13:57,820 --> 00:13:58,559 you treating, 378 00:13:59,179 --> 00:14:01,519 at your surgery center for these complex, 379 00:14:01,980 --> 00:14:02,480 cases? 380 00:14:02,860 --> 00:14:05,820 So as things get more complex, you also 381 00:14:05,820 --> 00:14:07,995 have to be mindful of anesthesia times, how 382 00:14:08,075 --> 00:14:10,634 long your patient's gonna be down. Is this 383 00:14:10,634 --> 00:14:13,294 gonna be effective for your patient population? 384 00:14:14,154 --> 00:14:16,634 Is it something where these patients maybe have, 385 00:14:16,875 --> 00:14:18,554 a different acuity level and need to be 386 00:14:18,554 --> 00:14:20,399 done at the hospital because of, 387 00:14:21,040 --> 00:14:22,259 some of those comorbidities 388 00:14:23,040 --> 00:14:23,540 versus, 389 00:14:24,240 --> 00:14:26,160 a very healthy person that might be able 390 00:14:26,160 --> 00:14:28,899 to endure those complex cases within an ASC. 391 00:14:29,279 --> 00:14:31,519 I do think that there's plenty of space 392 00:14:31,519 --> 00:14:32,340 for procedures 393 00:14:32,800 --> 00:14:34,639 to be done within the ASC that are 394 00:14:34,639 --> 00:14:35,940 still being considered 395 00:14:36,294 --> 00:14:38,054 super complex and only being done at the 396 00:14:38,054 --> 00:14:38,554 hospital. 397 00:14:39,335 --> 00:14:41,254 But I do think that we do have 398 00:14:41,254 --> 00:14:43,415 to take the time to really dig deep 399 00:14:43,415 --> 00:14:46,875 and make sure that we are looking into 400 00:14:46,934 --> 00:14:49,014 all the cost cost associated, all of the 401 00:14:49,014 --> 00:14:49,995 risk associated 402 00:14:50,389 --> 00:14:51,289 with these procedures? 403 00:14:51,669 --> 00:14:53,990 And do we have the means to be 404 00:14:53,990 --> 00:14:54,490 able 405 00:14:55,029 --> 00:14:57,750 to transition this patient if there were something 406 00:14:57,750 --> 00:14:59,769 that goes wrong during that procedure? 407 00:15:00,950 --> 00:15:02,804 Mhmm. Yeah. I think so. It's so very 408 00:15:02,884 --> 00:15:04,245 very important to kinda keep in mind. So 409 00:15:04,245 --> 00:15:06,085 next and takeaways and insights there for any 410 00:15:06,085 --> 00:15:07,225 other ASC administrators, 411 00:15:07,605 --> 00:15:10,585 physician physician owners on the call today. 412 00:15:11,284 --> 00:15:13,924 Alex, so greatly appreciate your perspective. Really, really 413 00:15:13,924 --> 00:15:15,870 looking forward to meeting you and having you 414 00:15:15,870 --> 00:15:18,590 speak at our spine orthopedic and pain management 415 00:15:18,590 --> 00:15:21,470 driven ASC event next month. Thank you so 416 00:15:21,470 --> 00:15:23,309 much for taking the time. Yeah. No. Thank 417 00:15:23,309 --> 00:15:24,929 you. I appreciate the time today.