1 00:00:00,240 --> 00:00:03,220 This is Alan Condon with the Becker's ASC 2 00:00:03,520 --> 00:00:06,240 podcast. And I'm delighted to be joined today 3 00:00:06,240 --> 00:00:08,019 by Doctor. Sharyn Tofai, 4 00:00:08,400 --> 00:00:09,619 hernia and laparoscopic 5 00:00:09,919 --> 00:00:10,980 surgery specialist 6 00:00:11,359 --> 00:00:13,539 at Beverly Hills hernia center. 7 00:00:13,884 --> 00:00:14,705 Doctor. Tofai, 8 00:00:15,005 --> 00:00:17,005 pleasure to make your debut appearance with us 9 00:00:17,005 --> 00:00:18,864 on the Beckers ASC podcast. 10 00:00:20,524 --> 00:00:22,125 He is familiar with you the work that 11 00:00:22,125 --> 00:00:23,885 you do at your surgery centre. Do you 12 00:00:23,885 --> 00:00:25,164 mind giving us a little bit more insight 13 00:00:25,164 --> 00:00:26,065 into your background? 14 00:00:26,489 --> 00:00:28,089 Yeah. Sure. Thank you very much. 15 00:00:29,050 --> 00:00:31,690 I am a board certified general surgeon, and 16 00:00:31,690 --> 00:00:32,989 I do a lot of, 17 00:00:33,770 --> 00:00:35,789 minimally invasive surgery, including 18 00:00:36,250 --> 00:00:38,189 laparoscopic and robotic surgery. 19 00:00:39,054 --> 00:00:41,054 And I'm an active member of our own 20 00:00:41,054 --> 00:00:42,034 surgical center, 21 00:00:42,814 --> 00:00:46,515 which was a great venture that started by 22 00:00:46,975 --> 00:00:49,635 physicians and now is partially hospital owned. 23 00:00:50,335 --> 00:00:50,835 And 24 00:00:51,429 --> 00:00:52,409 it's been a great, 25 00:00:53,590 --> 00:00:56,229 experience seeing how a surgery center can ex 26 00:00:56,710 --> 00:00:57,850 to multiple specialties 27 00:00:58,310 --> 00:00:59,369 and then be 28 00:01:00,070 --> 00:01:00,570 involved 29 00:01:01,030 --> 00:01:04,409 in helping the hospital offload during COVID pandemic 30 00:01:04,629 --> 00:01:05,129 times 31 00:01:05,965 --> 00:01:07,665 and now start to be 32 00:01:08,605 --> 00:01:10,385 kind of, one of the premier 33 00:01:11,084 --> 00:01:13,004 surgical centers in the nation. I believe we 34 00:01:13,004 --> 00:01:15,084 were voted number one in the nation by 35 00:01:15,084 --> 00:01:16,145 Newsweek recently. 36 00:01:17,004 --> 00:01:19,405 Honestly. Wow. What an accomplishment by both of 37 00:01:19,405 --> 00:01:21,424 your colleagues at your surgery center. 38 00:01:22,560 --> 00:01:24,799 So huge accomplishment. Thank you, Converse. Send a 39 00:01:24,799 --> 00:01:26,719 little bit more insight to yourself, your background, 40 00:01:26,719 --> 00:01:29,920 your surgery center there. General surgeon, laparoscopic and 41 00:01:29,920 --> 00:01:32,400 robotic surgeries, a couple of minimally invasive areas 42 00:01:32,400 --> 00:01:34,019 that you're really focusing on. 43 00:01:34,399 --> 00:01:36,640 But more broadly, I guess, two or three 44 00:01:36,640 --> 00:01:37,459 kinda key 45 00:01:37,814 --> 00:01:39,974 big health care trends that you're paying close 46 00:01:39,974 --> 00:01:41,914 attention to today. What's on your radar? 47 00:01:42,935 --> 00:01:45,274 Yes. Absolutely. I would say that 48 00:01:45,894 --> 00:01:47,994 there's definitely a push to 49 00:01:48,375 --> 00:01:50,215 which which has been going on for decades 50 00:01:50,215 --> 00:01:52,634 now to move as much surgical care 51 00:01:53,189 --> 00:01:55,349 outside of the main hospital as possible to 52 00:01:55,349 --> 00:01:56,250 put it into 53 00:01:56,629 --> 00:01:59,269 surgical centers, and that's put the onus on 54 00:01:59,269 --> 00:02:00,729 surgical centers to 55 00:02:01,109 --> 00:02:03,590 be able to provide hospital level care in 56 00:02:03,590 --> 00:02:04,569 terms of technology. 57 00:02:05,590 --> 00:02:07,609 I think the next step is having 58 00:02:08,025 --> 00:02:09,004 a broader 59 00:02:10,424 --> 00:02:10,924 availability 60 00:02:11,224 --> 00:02:12,525 of robotic surgery 61 00:02:12,905 --> 00:02:15,485 at surgical centers. It's been something that 62 00:02:16,025 --> 00:02:17,864 we really haven't been able to do from 63 00:02:17,864 --> 00:02:18,525 a financial 64 00:02:19,384 --> 00:02:19,884 standpoint, 65 00:02:21,064 --> 00:02:22,685 but that seems to be 66 00:02:23,520 --> 00:02:25,060 moving in a direction where 67 00:02:26,000 --> 00:02:28,719 collaborating with industry is making it so that 68 00:02:28,719 --> 00:02:29,219 we're 69 00:02:29,599 --> 00:02:31,599 more likely to be able to offer robotic 70 00:02:31,599 --> 00:02:33,919 surgery in the surgical center. And as you 71 00:02:33,919 --> 00:02:34,580 may know, 72 00:02:35,039 --> 00:02:37,860 the more you offer minimally invasive or robotic 73 00:02:37,919 --> 00:02:38,775 surgery, the more 74 00:02:39,414 --> 00:02:41,114 likely you are to be able to provide 75 00:02:41,254 --> 00:02:42,954 care to patients as an outpatient 76 00:02:43,334 --> 00:02:46,074 and not require hospitalization because the pain 77 00:02:46,534 --> 00:02:48,614 the pain is pretty well tolerated with those 78 00:02:48,614 --> 00:02:49,114 operations. 79 00:02:49,894 --> 00:02:52,710 That's number one. I would also say that 80 00:02:52,710 --> 00:02:54,010 this idea of, 81 00:02:54,469 --> 00:02:56,169 you know, multi specialty 82 00:02:56,790 --> 00:02:58,409 surgical centers is becoming 83 00:02:59,030 --> 00:03:00,710 better. It used to be, at least I 84 00:03:00,710 --> 00:03:03,270 know I'm in Los Angeles, Beverly Hills. Most 85 00:03:03,270 --> 00:03:05,210 of our surgical centers are 86 00:03:05,655 --> 00:03:06,155 cash 87 00:03:06,534 --> 00:03:09,034 based for cosmetic and plastic surgery, 88 00:03:09,655 --> 00:03:11,034 and that's really changing, 89 00:03:12,614 --> 00:03:13,674 where we're seeing 90 00:03:14,614 --> 00:03:15,674 serious operations, 91 00:03:15,974 --> 00:03:17,594 whether it's hysterectomies 92 00:03:18,134 --> 00:03:19,034 or prostatectomies 93 00:03:20,300 --> 00:03:22,719 being performed at an outpatient setting as well. 94 00:03:23,259 --> 00:03:25,280 And nurses and surgeons and anesthesiologists 95 00:03:25,740 --> 00:03:27,040 are becoming more comfortable 96 00:03:27,740 --> 00:03:30,219 offering higher level of care at a surgical 97 00:03:30,219 --> 00:03:30,719 center. 98 00:03:31,580 --> 00:03:33,280 I would say those are the top two. 99 00:03:33,685 --> 00:03:36,185 Got it. So I'm I'm fascinated by 100 00:03:36,564 --> 00:03:38,164 both both of those trends, but I think 101 00:03:38,164 --> 00:03:40,564 particularly the first one. I think, as it 102 00:03:40,564 --> 00:03:43,044 relates to robotic surgery, like you said, one 103 00:03:43,044 --> 00:03:45,284 of those key minimally invasive techniques is that's 104 00:03:45,284 --> 00:03:47,099 really the onus for a lot of these, 105 00:03:47,739 --> 00:03:50,219 complex surgeries being driven away from the hospitals 106 00:03:50,219 --> 00:03:52,560 to outpatient settings, ASCs. 107 00:03:52,860 --> 00:03:54,699 He did mention we we hear so often 108 00:03:54,699 --> 00:03:56,699 that the barriers to ASCs for some of 109 00:03:56,699 --> 00:03:57,919 these robots was 110 00:03:58,219 --> 00:03:59,739 number one. So we are so often hear 111 00:03:59,739 --> 00:04:02,155 about the cost, the size. Seems like those 112 00:04:02,155 --> 00:04:04,155 two barriers are are coming down a little 113 00:04:04,155 --> 00:04:06,715 bit now. To your point, collaborating with industry 114 00:04:06,715 --> 00:04:07,614 is a big thing. 115 00:04:08,394 --> 00:04:10,394 I'd love to hear your insight kind of 116 00:04:10,394 --> 00:04:11,754 how do you see kind of the future 117 00:04:11,754 --> 00:04:13,979 of robotics at ASCs And and and to 118 00:04:13,979 --> 00:04:16,139 your point, collaborating with industry, how does that 119 00:04:16,139 --> 00:04:18,139 kinda relate to this whole, movement to the 120 00:04:18,139 --> 00:04:19,919 ASC outpatient setting with those robots? 121 00:04:20,779 --> 00:04:22,300 Sure. I have a great story to share 122 00:04:22,300 --> 00:04:23,360 for you. So 123 00:04:23,819 --> 00:04:25,579 when I first got involved with the surgery 124 00:04:25,579 --> 00:04:27,279 center back in 2013, 125 00:04:28,535 --> 00:04:31,355 robotics for general surgery was just becoming 126 00:04:32,055 --> 00:04:34,714 something of interest and mostly it was urology. 127 00:04:34,855 --> 00:04:37,355 You know, prostatectomies were pretty commonly performed 128 00:04:37,975 --> 00:04:38,475 robotically. 129 00:04:38,855 --> 00:04:39,355 And 130 00:04:40,710 --> 00:04:43,850 my hope was to bring the robotic technology 131 00:04:44,230 --> 00:04:46,069 into the surgical center, but at that time, 132 00:04:46,069 --> 00:04:47,990 you had to spend $2,000,000 to buy a 133 00:04:47,990 --> 00:04:48,490 robot. 134 00:04:49,110 --> 00:04:51,290 And the insurance will never 135 00:04:52,150 --> 00:04:53,610 provide you payments 136 00:04:54,144 --> 00:04:55,745 any differently if you use a robot or 137 00:04:55,745 --> 00:04:57,985 didn't use a robot. So there was no 138 00:04:57,985 --> 00:05:00,404 way financially to make sense of that. 139 00:05:00,865 --> 00:05:03,444 And at that time, industry was also not 140 00:05:03,904 --> 00:05:05,604 eager to bring down their pricing, 141 00:05:06,224 --> 00:05:08,324 to accommodate for a larger 142 00:05:09,220 --> 00:05:11,560 volume of surgeons in the surgical centers, 143 00:05:11,860 --> 00:05:13,779 they were still expanding out in the the 144 00:05:13,779 --> 00:05:14,600 main hospitals. 145 00:05:15,939 --> 00:05:18,339 I must say over time and partially that's 146 00:05:18,339 --> 00:05:19,240 because of, 147 00:05:20,580 --> 00:05:23,745 interest of industry to penetrate more, and, also, 148 00:05:23,745 --> 00:05:24,805 there's more competition, 149 00:05:25,985 --> 00:05:27,285 in the robotic field. 150 00:05:27,745 --> 00:05:29,044 The price of 151 00:05:30,144 --> 00:05:32,785 of robotic surgery has reduced, and they've come 152 00:05:32,785 --> 00:05:34,564 up with a bit more interesting, 153 00:05:35,824 --> 00:05:37,604 ways. You don't have to buy the 154 00:05:38,160 --> 00:05:39,939 robot outright anymore, for example. 155 00:05:40,720 --> 00:05:42,480 You can lease it. You can do these, 156 00:05:42,480 --> 00:05:43,300 what we call, 157 00:05:44,080 --> 00:05:46,319 pay pay per click. It's basically you pay 158 00:05:46,319 --> 00:05:48,720 each time you use the the the robot. 159 00:05:48,720 --> 00:05:49,220 So 160 00:05:49,520 --> 00:05:52,004 it's like leasing a a luxury car, right, 161 00:05:52,004 --> 00:05:54,485 as opposed to buying your luxury car. It's 162 00:05:54,485 --> 00:05:55,865 a little bit more manageable. 163 00:05:57,604 --> 00:05:59,925 So kudos to industry for doing that because 164 00:05:59,925 --> 00:06:02,425 when we first spoke to their leadership, 165 00:06:03,259 --> 00:06:05,579 now it's, what, twelve years ago, there was 166 00:06:05,579 --> 00:06:07,740 zero interest. And now there's a lot of 167 00:06:07,740 --> 00:06:08,240 interest 168 00:06:08,860 --> 00:06:10,160 to work with surgical 169 00:06:10,699 --> 00:06:13,360 centers to go in to to enter surgical 170 00:06:13,419 --> 00:06:15,259 surgical centers because they've pretty much done a 171 00:06:15,259 --> 00:06:16,240 good job of 172 00:06:17,035 --> 00:06:19,854 of saturating the market on the hospital side. 173 00:06:20,314 --> 00:06:21,535 The problem is 174 00:06:22,074 --> 00:06:24,875 the other arm of the finances here, which 175 00:06:24,875 --> 00:06:25,615 is insurance, 176 00:06:26,235 --> 00:06:28,254 has not kicked in. So 177 00:06:29,539 --> 00:06:32,660 as your viewers probably know, there's three tiers 178 00:06:32,660 --> 00:06:34,979 of payment by insurance for the same exact 179 00:06:34,979 --> 00:06:35,479 operation. 180 00:06:36,099 --> 00:06:37,720 If instead of the main hospital, 181 00:06:38,419 --> 00:06:39,939 you get a large amount of money for 182 00:06:39,939 --> 00:06:40,439 it. 183 00:06:40,834 --> 00:06:42,694 If the same operation is performed 184 00:06:43,395 --> 00:06:47,314 at a hospital based outpatient surgery center, you 185 00:06:47,314 --> 00:06:48,535 get a lesser amount, 186 00:06:48,915 --> 00:06:51,415 and the least amount is paid to a 187 00:06:51,634 --> 00:06:53,254 freestanding surgical center. 188 00:06:53,714 --> 00:06:54,214 So 189 00:06:54,740 --> 00:06:57,060 it makes no sense financially to do a 190 00:06:57,060 --> 00:06:59,319 robotic operation, which is expensive, 191 00:07:00,580 --> 00:07:03,139 in a in a environment such as a 192 00:07:03,139 --> 00:07:05,080 freestanding outpatient surgery center 193 00:07:05,540 --> 00:07:06,040 that 194 00:07:06,580 --> 00:07:09,384 gives you the lowest reimbursement for that operation. 195 00:07:09,605 --> 00:07:11,525 So even though industry has kicked in to 196 00:07:11,525 --> 00:07:12,025 help 197 00:07:12,564 --> 00:07:13,545 on their side, 198 00:07:14,004 --> 00:07:15,625 insurance really has not, 199 00:07:16,404 --> 00:07:19,285 done their job of of allowing that to 200 00:07:19,285 --> 00:07:22,569 be a feasible financial situation. So that's a 201 00:07:22,569 --> 00:07:25,710 major roadblock right now, which is what operations 202 00:07:26,250 --> 00:07:27,689 does it make sense to do in an 203 00:07:27,689 --> 00:07:30,490 outpatient surgery center if you're the, let's say, 204 00:07:30,490 --> 00:07:32,189 the hospital or health care system. 205 00:07:32,685 --> 00:07:35,324 Mhmm. And how do you make that, in 206 00:07:35,324 --> 00:07:37,165 your own surgery center? How do you make 207 00:07:37,165 --> 00:07:39,085 those decisions, those choices, if you don't mind 208 00:07:39,085 --> 00:07:40,925 me asking? A little bit of perspective from 209 00:07:40,925 --> 00:07:42,605 from your ASC in terms of, is this 210 00:07:42,605 --> 00:07:44,685 a procedure I'm gonna do robotically? Is this 211 00:07:44,685 --> 00:07:47,229 something I'm gonna do a traditional method? Just 212 00:07:47,229 --> 00:07:48,849 curious to hear your thoughts on that. 213 00:07:49,470 --> 00:07:51,550 I mean, we're we're very lucky. We're in 214 00:07:51,550 --> 00:07:55,149 a very robust outpatient freestanding surgical center. We're 215 00:07:55,149 --> 00:07:57,009 partnered with our major hospital. 216 00:07:57,789 --> 00:08:00,370 We're very high volumes. So based on that, 217 00:08:00,754 --> 00:08:04,115 we're a bit, stronger financially than maybe your 218 00:08:04,115 --> 00:08:04,615 standard 219 00:08:05,074 --> 00:08:07,014 privately owned surgical center. 220 00:08:07,714 --> 00:08:09,314 So we're very lucky with that, and our 221 00:08:09,314 --> 00:08:11,314 partnership with the hospital has made it so 222 00:08:11,314 --> 00:08:11,814 that, 223 00:08:12,435 --> 00:08:15,319 there's some efficiencies we can we can build 224 00:08:15,379 --> 00:08:15,879 into, 225 00:08:16,339 --> 00:08:17,720 running the surgical center. 226 00:08:18,579 --> 00:08:20,500 Our hope is that within the next year, 227 00:08:20,500 --> 00:08:21,800 we will have a robot 228 00:08:22,180 --> 00:08:24,600 as we're expanding our surgical center. And, 229 00:08:24,979 --> 00:08:25,479 honestly, 230 00:08:26,819 --> 00:08:29,459 if it were completely up to the business 231 00:08:29,459 --> 00:08:29,959 people, 232 00:08:30,475 --> 00:08:31,995 it would probably not be a good good 233 00:08:31,995 --> 00:08:33,215 idea to have a robot. 234 00:08:33,914 --> 00:08:36,475 But the demand for robotic surgery is so 235 00:08:36,475 --> 00:08:37,855 high. In order to maintain 236 00:08:38,475 --> 00:08:39,215 high quality, 237 00:08:40,075 --> 00:08:40,575 surgeons, 238 00:08:41,115 --> 00:08:42,414 you kind of have to 239 00:08:42,950 --> 00:08:46,149 offer the technology that's out there. So that's 240 00:08:46,149 --> 00:08:46,970 really what's 241 00:08:47,509 --> 00:08:48,970 I think that's my impression. 242 00:08:49,350 --> 00:08:51,269 I'm not, like, the CEO of the hospital. 243 00:08:51,269 --> 00:08:53,110 I'm one of the surgeons. I'm part of 244 00:08:53,110 --> 00:08:55,750 their leadership, but I would say that my 245 00:08:55,750 --> 00:08:57,049 impression is that, 246 00:08:57,824 --> 00:08:58,485 the demands 247 00:08:59,424 --> 00:09:01,204 of the per of the surgeons 248 00:09:02,144 --> 00:09:03,824 is one that's making it so that we 249 00:09:03,824 --> 00:09:05,605 are moving towards getting a robot. 250 00:09:06,064 --> 00:09:08,704 But it's now twelve years after I've I've 251 00:09:08,704 --> 00:09:11,910 initially requested a robot. So it's a slow 252 00:09:11,910 --> 00:09:13,129 process, and, 253 00:09:13,990 --> 00:09:15,450 hopefully, will not be 254 00:09:15,990 --> 00:09:17,450 a financially detrimental 255 00:09:18,070 --> 00:09:18,570 decision. 256 00:09:19,190 --> 00:09:21,190 Mhmm. No. It's fascinating to kinda get your 257 00:09:21,190 --> 00:09:23,110 thoughts or insight there kinda more broadly and 258 00:09:23,110 --> 00:09:24,790 then also as it affects and relates to 259 00:09:24,790 --> 00:09:25,450 your center. 260 00:09:25,915 --> 00:09:27,595 Really, really excited to kinda hear the developments 261 00:09:27,595 --> 00:09:29,595 there. Many meaning based tech technology as it 262 00:09:29,595 --> 00:09:30,894 relates to general surgery. 263 00:09:31,514 --> 00:09:33,514 I'd love to get your perspective kind of, 264 00:09:34,075 --> 00:09:37,195 fantastic surgery center, number one ranked on Newsweek, 265 00:09:37,195 --> 00:09:38,610 like you've mentioned at the top. 266 00:09:39,169 --> 00:09:41,409 How are you thinking about growth over the 267 00:09:41,409 --> 00:09:43,970 next twelve, twenty four months or so? Like 268 00:09:43,970 --> 00:09:45,649 you said, you've got a partnership with a 269 00:09:45,649 --> 00:09:48,529 hospital, high, high volume center. Is growth them 270 00:09:48,529 --> 00:09:51,329 adding more physicians, more surgeons, tacking on new 271 00:09:51,329 --> 00:09:53,329 specialties? Kind of what what are your thoughts 272 00:09:53,329 --> 00:09:53,829 there? 273 00:09:54,534 --> 00:09:56,554 Oh, well, we are very excited, 274 00:09:57,735 --> 00:10:00,455 about growth. We were the first surgical center 275 00:10:00,455 --> 00:10:01,835 for our hospital to 276 00:10:02,375 --> 00:10:04,615 to partner up with. I believe now they 277 00:10:04,615 --> 00:10:05,115 have 278 00:10:05,575 --> 00:10:07,274 upwards of 12 or more, 279 00:10:08,039 --> 00:10:10,460 in the Greater Los Angeles County area. 280 00:10:11,320 --> 00:10:12,299 And it's 281 00:10:12,840 --> 00:10:13,340 been 282 00:10:13,799 --> 00:10:15,500 because we were such a successful 283 00:10:16,440 --> 00:10:19,000 endeavor that they continue to do that. And 284 00:10:19,000 --> 00:10:19,879 the key is 285 00:10:20,360 --> 00:10:22,784 and I'll add to you, we are adding 286 00:10:22,784 --> 00:10:24,965 a third surgical center in our own 287 00:10:25,345 --> 00:10:26,085 in our, 288 00:10:26,625 --> 00:10:29,105 the same facility as the original surgical center 289 00:10:29,105 --> 00:10:31,105 that was opened. So we went up to 290 00:10:31,105 --> 00:10:32,164 two during the pandemic, 291 00:10:33,105 --> 00:10:35,184 and then now we're up to three by 292 00:10:35,184 --> 00:10:36,325 next year. So 293 00:10:36,720 --> 00:10:38,000 the volume is there. 294 00:10:38,399 --> 00:10:40,659 The interest is there. My patients prefer 295 00:10:41,360 --> 00:10:43,299 to be operated on at the surgical center. 296 00:10:44,000 --> 00:10:46,159 I have my own team at the surgical 297 00:10:46,159 --> 00:10:47,539 centers to the same 298 00:10:48,079 --> 00:10:51,535 circulating nurse and and so on. So it's 299 00:10:51,535 --> 00:10:52,514 much more efficient 300 00:10:52,894 --> 00:10:54,754 and much more likely to 301 00:10:55,134 --> 00:10:57,955 get standardized care for my specific patients. 302 00:10:58,654 --> 00:11:00,654 So I love working at the surgical center, 303 00:11:00,654 --> 00:11:03,054 and the more surgeons we recruit to come 304 00:11:03,054 --> 00:11:05,054 to the surgical center and bring their cases 305 00:11:05,054 --> 00:11:06,035 as opposed to 306 00:11:06,470 --> 00:11:09,129 the bulkier, less efficient time wise 307 00:11:09,590 --> 00:11:11,190 hospital, the more they like to be in 308 00:11:11,190 --> 00:11:13,590 the surgical center too. So I would say 309 00:11:13,590 --> 00:11:15,750 it's like going to a a big box 310 00:11:15,750 --> 00:11:18,090 hotel versus to, like, a boutique y hotel. 311 00:11:18,470 --> 00:11:21,370 You get better service and potentially nicer 312 00:11:22,034 --> 00:11:23,014 nicer options. 313 00:11:23,794 --> 00:11:26,434 Mhmm. And that kinda ties into just the 314 00:11:26,434 --> 00:11:28,034 last question I have here. I think it'd 315 00:11:28,034 --> 00:11:29,714 be a crime for me not to ask. 316 00:11:29,714 --> 00:11:32,914 I mean, such a fantastic surgeon, fantastic leadership, 317 00:11:32,914 --> 00:11:35,894 it sounds like, Beverly Hills hernia center. 318 00:11:36,830 --> 00:11:40,509 For for ASC physician owners, ASC administrators listen 319 00:11:40,509 --> 00:11:41,250 to this podcast, 320 00:11:41,550 --> 00:11:44,029 obviously, it's so so highly rated, fantastic achievement 321 00:11:44,029 --> 00:11:44,769 by Newsweek. 322 00:11:45,230 --> 00:11:47,009 One or two maybe key tips, 323 00:11:48,110 --> 00:11:50,350 to to really kind of elevate that patient 324 00:11:50,350 --> 00:11:51,554 experience care 325 00:11:51,875 --> 00:11:54,034 for for surgery centers who really look at 326 00:11:54,034 --> 00:11:54,615 the booster, 327 00:11:55,875 --> 00:11:57,414 their position and their markets. 328 00:11:57,794 --> 00:11:59,235 What what what advice would you have for 329 00:11:59,235 --> 00:11:59,735 them? 330 00:12:00,595 --> 00:12:02,754 I would say proceed with caution. I have 331 00:12:02,754 --> 00:12:04,779 a feeling there there are many, 332 00:12:05,420 --> 00:12:08,059 doctors and surgeons who are interested in opening 333 00:12:08,059 --> 00:12:10,000 up a surgical center because the 334 00:12:10,379 --> 00:12:12,000 the payment that you see 335 00:12:12,540 --> 00:12:14,940 to a facility is so much more than 336 00:12:14,940 --> 00:12:16,639 the typical payment for 337 00:12:17,014 --> 00:12:18,554 the, surgeon provider. 338 00:12:19,095 --> 00:12:21,434 And so from a financial standpoint, 339 00:12:21,815 --> 00:12:23,595 they feel that that 340 00:12:23,894 --> 00:12:25,495 it just makes sense to open up your 341 00:12:25,495 --> 00:12:26,475 own surgery center. 342 00:12:26,774 --> 00:12:28,475 But it's highly regulated. 343 00:12:28,855 --> 00:12:30,634 It's a very serious business. 344 00:12:31,335 --> 00:12:32,554 Staffing is critical, 345 00:12:34,110 --> 00:12:36,129 and it it really 346 00:12:36,509 --> 00:12:38,110 needs to be done with a lot of 347 00:12:38,110 --> 00:12:39,970 thought and not just be a reflex 348 00:12:40,669 --> 00:12:42,429 of, oh, I can have a one or 349 00:12:42,429 --> 00:12:44,909 two bed surgery center and make a lot 350 00:12:44,909 --> 00:12:46,049 of money off of it. 351 00:12:46,664 --> 00:12:49,004 There's so many surgical centers that fail 352 00:12:49,625 --> 00:12:52,205 and so many that are end up in 353 00:12:52,264 --> 00:12:54,524 some type of poor outcome for patients 354 00:12:54,985 --> 00:12:55,485 because 355 00:12:56,424 --> 00:12:58,205 there have been situations where 356 00:12:58,919 --> 00:13:01,240 corners are cut and maybe you don't really 357 00:13:01,240 --> 00:13:04,360 have a qualified nurse doing this or you 358 00:13:04,360 --> 00:13:05,419 don't have an anesthesiologist. 359 00:13:05,960 --> 00:13:08,839 You're it's you you can't cut corners with 360 00:13:08,839 --> 00:13:09,659 patient care. 361 00:13:10,200 --> 00:13:10,940 And so 362 00:13:11,480 --> 00:13:13,639 if you're just looking at it as a 363 00:13:13,639 --> 00:13:15,555 way to make money, that's just not appropriate 364 00:13:16,175 --> 00:13:18,435 because you're you've got patient's lives at hand. 365 00:13:18,894 --> 00:13:20,835 So I would say proceed with caution, 366 00:13:21,455 --> 00:13:22,754 surround yourself with 367 00:13:23,295 --> 00:13:25,075 really smart, experienced 368 00:13:26,014 --> 00:13:26,514 people, 369 00:13:27,509 --> 00:13:28,009 and, 370 00:13:28,870 --> 00:13:30,009 make sure you're doing it 371 00:13:30,310 --> 00:13:32,410 with, good intentions in mind. 372 00:13:33,110 --> 00:13:35,670 I think two fantastic kind of tips and 373 00:13:35,670 --> 00:13:38,550 takeaways to round out our podcast today. Doctor 374 00:13:38,550 --> 00:13:40,550 Tofai, an absolute pleasure speaking to you and 375 00:13:40,550 --> 00:13:42,295 catching up here in a lot about your 376 00:13:42,295 --> 00:13:44,075 surgery center. Sounds like a ton of excitement, 377 00:13:44,134 --> 00:13:46,134 a ton of growth ahead. Thank you so 378 00:13:46,134 --> 00:13:47,654 much for taking the time, and look forward 379 00:13:47,654 --> 00:13:49,095 to catching up with you down the line. 380 00:13:49,095 --> 00:13:50,875 I appreciate it. Thanks so much.