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forward slash beckers podcast.

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This is Gracelyn Keller with the Becker's Healthcare

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Podcast, and we are recording live at the

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twenty second annual Spine Orthopedic and Pain Management

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Conference.

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I'm currently joined by Mahur Rai, who is

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the CEO and medical director at Kansas Surgery

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Center. Thank you for being here. And let's

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start off by having you share a little

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bit more about yourself, your role, and your

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organization.

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Good afternoon, everybody. Beautiful day in Chicago here.

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We are at the Riverside,

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at the Suze Hotel in Chicago.

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So my name is Mahua Ray. I am

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a anesthesiologist

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and a pain physician that was initially,

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out working in the VA and with academia

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and then returned to private practice in about

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2015.

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I've been,

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instrumental in,

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getting set up as a surgery center just

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ground up. We built a building ground up,

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set up our own pain ASC

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about four or five years ago. I'm currently

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the medical director.

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I'm involved in all aspects from staffing

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to being on top of the service lines,

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such

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as credentialing, anesthesiology

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services, inventory,

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nursing, and staffing.

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And I have learned a lot from Becker's,

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and I hope that I can contribute through

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this podcast.

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Wonderful. Well, thank you for being here.

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And let's start the conversation

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with what trends and shifts you're seeing right

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now in the industry that you think are

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most important for leaders to pay attention to.

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So there are certain trends that all of

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us know about, including

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that a lot of the procedures that were

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traditionally done in the hospital setting have moved

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to the ASC. For example, knee, hip, shoulder

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replacements,

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minimally invasive spine.

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In pain management, that's a big field.

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So that is really good news for ASC

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owners because they sent very easy negotiate negotiation

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point

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for getting contracts set up because, you know,

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you can save a lot of money for

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it to be done in an outpatient setting.

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It does come with a lot of, you

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know, accreditation

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and compliance that you have to follow, especially

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with regards to sterilization.

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You know, because of our profit margins going

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down, we also have to look into the

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future to see what procedures

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or surgeries

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are are lucrative to do in the ASC

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because some of them might not feel make

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any sense given the reimbursements.

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So we just have to make sure that

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every procedure, the health care economics has worked

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out. The second thing is that the cost

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transparency.

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I think the patients

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have to be well informed ahead of time

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about the cost transparency as more and more

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patients

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move towards high deductible plans,

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and we don't want any surprises at the

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end. When patients were used to going to

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the hospitals,

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that was something that physicians and ASC owners

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were not used to dealing with.

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But I see there are a lot of

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bad patient reviews

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based on billing, you know, and not having

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transparency.

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So that is something we are focusing on

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in the future.

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The third thing in the shift is that

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the population the baby boomers have become a

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lot older. The population has gotten sicker and

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older. So there's a critical role of having

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MD anesthesiologists

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who can review charts in order to prevent

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cancellation of anesthesia cases.

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So that's the third one.

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Absolutely.

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And let's also touch on staffing and workforce

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challenges as these continue to be concerns across

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health care.

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So how is your organization navigating these pressures,

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and what strategies have you seen work well?

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So there are two main parts of ASC

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staffing that is a problem all through the

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country. One is the anesthesiology

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or anesthesia staffing, and the second is RN

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staffing.

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RN staffing

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was really difficult during ASC. It has gotten

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better.

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A whole lot of, small business has have

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opened for RN staffing. So we use, like,

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a few companies out there that are able

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to supply us RN on last minute. You

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have to make sure you have relationship with

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them with the understanding that

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you might be in need of an RN

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at last minute notice.

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For the for the anesthesiology

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shortage, there's not much you can do. Most

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CRNAs are now doing locum work. So what

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we do is since we have pain and

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anesthesia both, we have some of our anesthesiologists

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help out in the Operating Room.

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The other thing that we have done for

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for RN shorting is we have tried to

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hire more LPNs and medical assistants that can

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at least help

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expedite what an RN does. We have also

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tried to be good with our preoperative process

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so that the RN time is reduced in

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the pre op. Everything is printed out for

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her. She has all the med list and

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everything available. So just utilizing the staff that

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we have, giving them a lot of help

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so we can get by with fewer staff.

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And as outpatient care continues to grow, how

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do you see the role of orthopedics,

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spine, and ASCs evolving with the broader health

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care ecosystem?

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So I think the future looks bright here

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because of more and more procedures that are

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moving from the hospital to the ASC.

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I think if I was speaking in a

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hospital space, I wouldn't be happy at this

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time.

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It is coming with growing pains.

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I don't think ASCs were ready to handle

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all this orthopedic spine and pain volume.

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And,

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you know, places like Becker helped for us

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to network and find new technologies and AI

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to help. So I think the future looks

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bright.

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Absolutely.

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And as we wrap our conversation,

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I'd love to touch on how you train

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your teams. So whether that's clinical or front

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office,

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how do you train your teams to have

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conversations around healthcare costs, insurance coverage, and financial

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responsibility in a way that feels clear and

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supported for patients? And why do you see

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this as important?

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So that's a really good question and something

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that has we struggled as a surgery center

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in the last few years. You know, you

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bill the patient and then after a few

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statements, you send them to collections and the

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patients are upset.

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So we actually had to hire an up

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patient account manager.

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We also had to hire an additional billing

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person in house that, first of all, understands

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the the difference between co pays and deductibles

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and out of pocket expenses.

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We are using,

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a software that has helped us. It's also

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a billing software

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that will help us, do a good faith

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estimate.

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I think that's very, very important.

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It's not ideal. Sometimes the estimate is a

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little bit off and patients might be surprised,

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but it's within 10% of what is we

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are going to ask the patient to pay.

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Every once a month, all the front office

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are trained,

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retrained on how to collect

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a head, how to collect an estimate, how

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to collect a balance,

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what softwares we can use to help the

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patients do payment plans.

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Very difficult topic, actually, because as more and

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more patients are moving to high deductible plans,

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a surgery center that's dependent on in network,

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has to make sure that proper information is

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given.

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The lastly, also, what we're doing in the

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training sessions is that we are recording some

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of these training sessions, and we are allotting

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free time to our employees

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to retrain on these, things,

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because it's become extremely hard to find front

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office with billing backgrounds.

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We are also looking into AI software, which

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we have not yet purchased,

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if that could help and maybe automatically calculate

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the estimates. Until then, we are doing it

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through the help of a software.

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Yes. Wonderful. Well, thank you so much for

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joining me today on the Becker's Healthcare Podcast.

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Again, we are recording live at the twenty

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second annual Spine Orthopedic and Pain Management Conference.

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Thank you.