1
00:00:00,320 --> 00:00:02,319
This is Liz Hatton with the Becker's Healthcare

2
00:00:02,319 --> 00:00:02,819
podcast.

3
00:00:03,199 --> 00:00:05,519
I'm thrilled today to be joined by doctor

4
00:00:05,519 --> 00:00:06,419
Chris Nanson,

5
00:00:07,120 --> 00:00:10,480
program director of the Oregon Surgical Institute hip

6
00:00:10,480 --> 00:00:11,460
and knee arthroplasty

7
00:00:11,839 --> 00:00:12,339
program.

8
00:00:12,705 --> 00:00:14,785
For a fireside chat about the big trends

9
00:00:14,785 --> 00:00:16,085
and topics in orthopedics,

10
00:00:16,545 --> 00:00:18,324
spine, and surgery centers today.

11
00:00:18,785 --> 00:00:20,545
Doctor Nanson, thank you so much for being

12
00:00:20,545 --> 00:00:21,045
here.

13
00:00:22,064 --> 00:00:24,244
Well, thanks for having me. Pleasure to join.

14
00:00:25,839 --> 00:00:28,179
So before we dive into our discussion today,

15
00:00:28,559 --> 00:00:30,480
could you tell us just a little bit

16
00:00:30,480 --> 00:00:32,100
more about yourself and your background?

17
00:00:33,280 --> 00:00:34,100
Yeah. Absolutely.

18
00:00:34,960 --> 00:00:37,379
I, am a fellowship trained

19
00:00:37,954 --> 00:00:39,494
hip and knee replacement surgeon,

20
00:00:40,835 --> 00:00:41,814
native Oregonian,

21
00:00:42,195 --> 00:00:44,274
but trained all over the country. Did my

22
00:00:44,274 --> 00:00:46,295
fellowship at North Carolina and now,

23
00:00:47,475 --> 00:00:50,250
am part of a group. We developed a

24
00:00:50,329 --> 00:00:52,329
surgery center, really the first one in the

25
00:00:52,329 --> 00:00:55,310
region that was kinda specifically built for doing

26
00:00:55,609 --> 00:00:57,549
total joints in the ASC setting.

27
00:00:58,090 --> 00:01:00,409
We started this project about 02/2015.

28
00:01:00,409 --> 00:01:02,250
We opened in 02/2018,

29
00:01:02,250 --> 00:01:04,605
and now we're over four years in.

30
00:01:05,405 --> 00:01:07,484
And, so I've been serving as the program

31
00:01:07,484 --> 00:01:09,825
director for our outpatient arthroplasty program,

32
00:01:10,844 --> 00:01:11,344
and,

33
00:01:11,724 --> 00:01:13,484
proud to say that we were the highest

34
00:01:13,484 --> 00:01:16,125
volume total joint facility in the state, including

35
00:01:16,125 --> 00:01:17,724
all hospitals last year in the state of

36
00:01:17,724 --> 00:01:18,625
Oregon. So,

37
00:01:18,950 --> 00:01:20,549
that's kinda what we've been doing out west

38
00:01:20,549 --> 00:01:23,129
here, and, and things are going fairly well.

39
00:01:24,709 --> 00:01:26,329
Wow. That's so great to hear.

40
00:01:27,109 --> 00:01:30,229
So what trends are you currently following most

41
00:01:30,229 --> 00:01:31,849
closely today in health care?

42
00:01:33,834 --> 00:01:36,474
Really, it's, it seems to be particularly in

43
00:01:36,474 --> 00:01:36,974
orthopedics,

44
00:01:38,394 --> 00:01:40,474
a lot about consolidation. We've got a very

45
00:01:40,474 --> 00:01:42,954
fragmented market here, with a lot of small

46
00:01:42,954 --> 00:01:43,454
groups,

47
00:01:43,994 --> 00:01:44,894
kind of traditional,

48
00:01:45,834 --> 00:01:47,454
small fee for service practices.

49
00:01:48,810 --> 00:01:50,109
Not a lot of big groups,

50
00:01:51,209 --> 00:01:52,030
no Rothmans

51
00:01:52,569 --> 00:01:53,069
or

52
00:01:53,609 --> 00:01:54,829
core type

53
00:01:55,689 --> 00:01:58,650
mega groups out here. And so really following

54
00:01:58,650 --> 00:02:00,909
a lot of the consolidation trends

55
00:02:02,409 --> 00:02:03,149
and the

56
00:02:04,545 --> 00:02:05,765
ability to utilize

57
00:02:06,784 --> 00:02:08,084
technology and AI,

58
00:02:08,544 --> 00:02:10,084
to manage more population,

59
00:02:10,944 --> 00:02:14,064
size level health, and and, that's, that's kinda

60
00:02:14,064 --> 00:02:15,925
got a lot of my attention right now.

61
00:02:18,349 --> 00:02:21,389
Interesting. So how do you see orthopedic spine

62
00:02:21,389 --> 00:02:22,849
and ASCs evolving,

63
00:02:23,229 --> 00:02:24,530
in the next two years?

64
00:02:25,870 --> 00:02:28,449
Well, I think, we're gonna see in in

65
00:02:28,784 --> 00:02:30,305
smaller markets like ours,

66
00:02:31,025 --> 00:02:32,724
that increased trend for consolidation,

67
00:02:33,185 --> 00:02:34,724
our formation of bigger groups.

68
00:02:35,185 --> 00:02:35,844
I think

69
00:02:36,305 --> 00:02:38,164
in certain places, you're going to see,

70
00:02:39,185 --> 00:02:41,125
larger organizations moving in.

71
00:02:41,584 --> 00:02:43,044
We're seeing Rothman

72
00:02:43,360 --> 00:02:46,340
Institute, you know, expanding its footprint into Seattle.

73
00:02:48,159 --> 00:02:50,719
You have, you're gonna have a lot of,

74
00:02:52,080 --> 00:02:54,959
a lot of groups trying to engage more

75
00:02:54,959 --> 00:02:56,419
in population level

76
00:02:57,085 --> 00:02:58,944
management of orthopedic issues.

77
00:02:59,405 --> 00:03:02,545
I think payers are are interested primarily in

78
00:03:02,685 --> 00:03:04,305
in managing everything musculoskeletal

79
00:03:04,765 --> 00:03:07,004
rather than just trying to manage the one

80
00:03:07,004 --> 00:03:08,465
small piece of musculoskeletal

81
00:03:09,004 --> 00:03:11,510
surgery. And so, I think being able to

82
00:03:11,510 --> 00:03:13,530
create an organization that's responsive

83
00:03:14,069 --> 00:03:16,950
and, has a good technology base and and

84
00:03:16,950 --> 00:03:17,689
good partnerships,

85
00:03:18,870 --> 00:03:20,010
so that you can manage

86
00:03:20,469 --> 00:03:22,710
not only the the surgical piece through your

87
00:03:22,710 --> 00:03:23,210
ASC,

88
00:03:23,510 --> 00:03:24,730
which I think is vital,

89
00:03:25,694 --> 00:03:27,395
but, but also the nonoperative

90
00:03:27,694 --> 00:03:28,175
piece,

91
00:03:28,574 --> 00:03:31,215
through your office, and and managing that with,

92
00:03:32,254 --> 00:03:35,155
your ancillary providers such as physician assistants,

93
00:03:35,935 --> 00:03:38,835
nurse practitioners, other other folks to kinda help,

94
00:03:39,419 --> 00:03:41,580
see those patients and and manage that care.

95
00:03:41,819 --> 00:03:43,740
So I think you've you've really gotta build

96
00:03:43,740 --> 00:03:44,800
a robust organization,

97
00:03:45,340 --> 00:03:47,040
not only with orthopedic surgeons,

98
00:03:47,580 --> 00:03:49,979
but with, with other providers that can, that

99
00:03:49,979 --> 00:03:52,080
can help manage the patient burden,

100
00:03:52,764 --> 00:03:54,685
as well as the technology to keep things

101
00:03:54,685 --> 00:03:56,705
consistent and maintain high quality outcomes,

102
00:03:57,245 --> 00:03:58,305
in addition to,

103
00:03:58,764 --> 00:04:01,104
ensuring that you've got a robust ASC program

104
00:04:01,164 --> 00:04:02,764
so that you can get these surgeries done

105
00:04:02,764 --> 00:04:05,085
because we're seeing the stress on the hospital

106
00:04:05,085 --> 00:04:05,585
systems

107
00:04:06,000 --> 00:04:08,560
really nationwide has has kinda proven too much

108
00:04:08,560 --> 00:04:11,379
for for the hospitals, particularly in our area,

109
00:04:11,759 --> 00:04:13,360
to handle the volume of patient care they

110
00:04:13,360 --> 00:04:14,159
need to. They just,

111
00:04:14,639 --> 00:04:16,800
they haven't been able to to kinda come

112
00:04:16,800 --> 00:04:18,979
back from the COVID and the staffing hit.

113
00:04:21,694 --> 00:04:23,454
Interesting. And and I see you kinda you

114
00:04:23,454 --> 00:04:25,774
kinda touched on touched on, the next question

115
00:04:25,774 --> 00:04:28,035
towards the end with, I was wondering

116
00:04:28,415 --> 00:04:29,235
what challenges,

117
00:04:30,095 --> 00:04:31,475
do you believe are ahead?

118
00:04:32,889 --> 00:04:34,490
So, you know, I think,

119
00:04:35,210 --> 00:04:36,670
you you have to

120
00:04:37,370 --> 00:04:40,330
you have to deal with, with, obviously, the

121
00:04:40,330 --> 00:04:43,490
the current challenges of of staffing issues, maintaining,

122
00:04:43,850 --> 00:04:46,490
you know, a a happy staff, maintaining a

123
00:04:46,490 --> 00:04:49,205
consistent staff so that, you know, you can

124
00:04:49,365 --> 00:04:51,705
you have good quality, consistent outcomes.

125
00:04:53,365 --> 00:04:55,365
I think that's that's kind of something that

126
00:04:55,365 --> 00:04:57,605
we're all living in right now. Certainly, the

127
00:04:57,605 --> 00:04:59,625
hospitals are struggling more than we are.

128
00:05:00,245 --> 00:05:00,725
But,

129
00:05:01,750 --> 00:05:03,509
as we kinda move beyond that, I think,

130
00:05:03,509 --> 00:05:05,769
you know, the biggest challenge is gonna be

131
00:05:07,910 --> 00:05:08,410
maintaining

132
00:05:08,870 --> 00:05:10,470
the driver's seat in health care,

133
00:05:10,949 --> 00:05:11,269
as,

134
00:05:11,829 --> 00:05:12,310
as,

135
00:05:12,709 --> 00:05:14,569
physicians and physician led organizations.

136
00:05:15,525 --> 00:05:16,185
I think,

137
00:05:16,884 --> 00:05:17,285
it's,

138
00:05:17,845 --> 00:05:19,285
you know, it's a little bit of an

139
00:05:19,285 --> 00:05:20,745
adapt or die strategy,

140
00:05:21,205 --> 00:05:22,805
and and you do need to have some

141
00:05:22,805 --> 00:05:24,324
size, and you would need to have some

142
00:05:24,324 --> 00:05:26,105
some robust measures in place.

143
00:05:26,564 --> 00:05:28,310
I think a lot of physicians,

144
00:05:29,330 --> 00:05:31,089
wanna be physicians, and they and they they

145
00:05:31,089 --> 00:05:32,790
they don't wanna necessarily manage,

146
00:05:33,250 --> 00:05:34,930
a large organization. I think that's,

147
00:05:35,490 --> 00:05:37,810
it's challenging to, ensure that you've got the

148
00:05:37,810 --> 00:05:40,230
the right leaders in position, so that

149
00:05:40,654 --> 00:05:42,335
the docs can be docs and and take

150
00:05:42,335 --> 00:05:43,835
care of patients.

151
00:05:44,335 --> 00:05:46,814
And, I think that's gonna be a a

152
00:05:46,814 --> 00:05:48,415
real kind of paradigm shift,

153
00:05:48,735 --> 00:05:51,295
in in medicine is, you know, moving away

154
00:05:51,295 --> 00:05:53,634
from the the, small practice,

155
00:05:54,095 --> 00:05:56,949
kinda country doc mentality to, you know, we

156
00:05:56,949 --> 00:05:58,569
really need to be a health care organization,

157
00:05:59,750 --> 00:06:00,629
and and,

158
00:06:01,189 --> 00:06:02,789
and do it better than the hospitals have

159
00:06:02,789 --> 00:06:05,430
traditionally done. Because, like I said, they're part

160
00:06:05,430 --> 00:06:07,589
of their struggles, I think, are are due

161
00:06:07,589 --> 00:06:08,089
to

162
00:06:08,834 --> 00:06:10,834
their difficulty in in managing their staff and

163
00:06:10,834 --> 00:06:11,555
keeping their staff,

164
00:06:12,194 --> 00:06:13,254
happy and engaged,

165
00:06:13,714 --> 00:06:15,235
and and that's why they're having a lot

166
00:06:15,235 --> 00:06:16,615
of staffing issues right now.

167
00:06:18,834 --> 00:06:19,334
Interesting.

168
00:06:19,954 --> 00:06:21,795
Is there anything else that you'd like to

169
00:06:21,795 --> 00:06:22,829
share with us today?

170
00:06:24,909 --> 00:06:26,829
You know, it's, I I think there's a

171
00:06:26,829 --> 00:06:28,750
lot of opportunity, and, you know, I don't

172
00:06:28,750 --> 00:06:30,509
wanna sound too pessimistic. I think there's a

173
00:06:30,509 --> 00:06:32,110
lot of opportunity. I think there's room for

174
00:06:32,110 --> 00:06:34,029
growth. I think there's room for positive change.

175
00:06:34,029 --> 00:06:34,669
And and,

176
00:06:35,389 --> 00:06:38,485
and, personally, I'm excited to to kinda move

177
00:06:38,485 --> 00:06:38,985
on

178
00:06:39,365 --> 00:06:42,324
to to the next, generation health care, as

179
00:06:42,324 --> 00:06:44,805
we as we move through the post COVID

180
00:06:44,805 --> 00:06:47,044
era or the the living with COVID area

181
00:06:47,285 --> 00:06:48,504
era, I should say.

182
00:06:49,524 --> 00:06:52,164
And, you know, I think there's, there's just

183
00:06:52,164 --> 00:06:54,060
a lot of, a lot of space for

184
00:06:54,139 --> 00:06:55,199
for smart motivated,

185
00:06:55,899 --> 00:06:57,899
you know, driven people to to be in

186
00:06:57,899 --> 00:06:59,980
the health care space and and, create some

187
00:06:59,980 --> 00:07:01,660
innovation and some change for the betterment of

188
00:07:01,660 --> 00:07:02,480
patient care,

189
00:07:02,860 --> 00:07:04,240
and, really to improve,

190
00:07:04,779 --> 00:07:07,259
how we interact. And and, it's very exciting

191
00:07:07,259 --> 00:07:09,519
to be in the ASC space, and

192
00:07:09,935 --> 00:07:11,154
and seeing all of

193
00:07:11,775 --> 00:07:14,194
this come down and, being provided the opportunity

194
00:07:14,254 --> 00:07:16,415
to to actually maybe contribute to to some

195
00:07:16,415 --> 00:07:18,175
of the change and and making America's health

196
00:07:18,175 --> 00:07:19,555
care system better. So,

197
00:07:20,175 --> 00:07:22,014
it's a it's a daunting task, but,

198
00:07:22,654 --> 00:07:24,095
I think, I think there's a lot of

199
00:07:24,095 --> 00:07:25,154
reasons to be optimistic.

200
00:07:27,660 --> 00:07:28,939
Well, thank you so much,

201
00:07:29,339 --> 00:07:32,300
doctor Nansen for that fascinating discussion. I look

202
00:07:32,300 --> 00:07:33,899
forward to connecting with you again in the

203
00:07:33,899 --> 00:07:34,399
future.

204
00:07:35,259 --> 00:07:36,699
Alright. Well, thanks for having me. It was

205
00:07:36,699 --> 00:07:37,919
a pleasure talking today.