1 00:00:00,399 --> 00:00:03,120 Hello. This is Francesca Matthews with the Becker's 2 00:00:03,120 --> 00:00:04,339 ASC review podcast. 3 00:00:04,799 --> 00:00:06,639 I'm thrilled to be joined today by Michael 4 00:00:06,639 --> 00:00:09,699 Gale, administrative director at the Centara Ubichi 5 00:00:10,080 --> 00:00:10,580 Ambulatory 6 00:00:10,880 --> 00:00:13,199 Surgical Center. Michael, thank you so much for 7 00:00:13,199 --> 00:00:14,099 being here today. 8 00:00:14,684 --> 00:00:16,684 Thank you for having me. Alright. To start 9 00:00:16,684 --> 00:00:18,684 off, could you please introduce yourself and tell 10 00:00:18,684 --> 00:00:20,385 us a little bit about your background? 11 00:00:21,244 --> 00:00:23,744 Sure. I, well, I'm a health care executive. 12 00:00:23,804 --> 00:00:26,224 I was recruited here to Virginia from California 13 00:00:26,765 --> 00:00:27,984 about three years ago 14 00:00:28,649 --> 00:00:29,550 from endovascular. 15 00:00:30,170 --> 00:00:31,789 I ran endovascular 16 00:00:32,170 --> 00:00:33,630 ambulatory surgery corporation. 17 00:00:34,489 --> 00:00:34,989 And, 18 00:00:35,929 --> 00:00:36,429 Centerra 19 00:00:36,809 --> 00:00:37,309 Obici, 20 00:00:38,489 --> 00:00:41,149 is how it's pronounced. Centerra Obici Hospital 21 00:00:41,770 --> 00:00:44,384 is where our ASC is on the campus 22 00:00:44,945 --> 00:00:48,464 of. There are, eight other ASCs in my 23 00:00:48,464 --> 00:00:50,004 region, my Sentara region. 24 00:00:50,384 --> 00:00:51,664 It's a $13,000,000,000 25 00:00:51,664 --> 00:00:52,725 company and growing, 26 00:00:53,344 --> 00:00:53,744 and, 27 00:00:54,784 --> 00:00:56,004 it it's a multispecialty 28 00:00:56,545 --> 00:00:57,045 ASC. 29 00:00:57,424 --> 00:00:58,725 It's different from endovascular. 30 00:00:59,920 --> 00:01:01,600 I have a lot of expertise in that 31 00:01:01,600 --> 00:01:03,299 field. It's endovascular 32 00:01:03,840 --> 00:01:05,700 billing and coding can be quite complicated. 33 00:01:06,799 --> 00:01:08,259 So coming into a multispecialty 34 00:01:08,640 --> 00:01:09,140 environment 35 00:01:09,840 --> 00:01:11,619 was quite a variety of 36 00:01:12,344 --> 00:01:14,505 of of knowledge for me. So it's been 37 00:01:14,505 --> 00:01:16,584 very interesting. Before that, I, 38 00:01:17,385 --> 00:01:19,145 I've been at the c suite level at 39 00:01:19,145 --> 00:01:20,844 various, health care corporations, 40 00:01:21,944 --> 00:01:23,805 revenue cycle management hospitals, 41 00:01:24,105 --> 00:01:24,765 of course, 42 00:01:25,540 --> 00:01:27,000 various ambulatory care, 43 00:01:27,539 --> 00:01:28,039 environments, 44 00:01:28,340 --> 00:01:29,319 large practices, 45 00:01:30,500 --> 00:01:31,799 physician owned practices, 46 00:01:33,140 --> 00:01:33,640 regional, 47 00:01:34,340 --> 00:01:34,840 multistate. 48 00:01:35,700 --> 00:01:38,019 So, it's been varied. I I was even 49 00:01:38,019 --> 00:01:41,265 once a dialysis executive in Bakersfield, California. 50 00:01:42,204 --> 00:01:44,525 Yeah. Breath of experience there, and apologies for 51 00:01:44,525 --> 00:01:45,424 the mispronunciation 52 00:01:45,885 --> 00:01:47,905 or unnecessary Italian pronunciation 53 00:01:48,204 --> 00:01:48,704 there. 54 00:01:51,084 --> 00:01:53,885 But great. We'll keep it going then. What 55 00:01:53,885 --> 00:01:56,170 are the top three trends you're following in 56 00:01:56,170 --> 00:01:57,870 health care and ASCs today? 57 00:01:59,129 --> 00:02:01,290 Well, you know, the migration of hospital based 58 00:02:01,290 --> 00:02:03,790 surgical procedures to ASC is a big deal. 59 00:02:04,090 --> 00:02:05,709 It's being pushed by CMS. 60 00:02:06,250 --> 00:02:08,669 Patients of a, of a low acuity 61 00:02:09,435 --> 00:02:11,215 level are are already here. 62 00:02:12,314 --> 00:02:14,235 So total joints are a good example of 63 00:02:14,235 --> 00:02:14,735 that. 64 00:02:15,594 --> 00:02:18,175 Higher acuity cases, like spine cases, 65 00:02:18,715 --> 00:02:20,175 are in the works right now. 66 00:02:20,555 --> 00:02:22,395 That that migration, I mean, is in the 67 00:02:22,395 --> 00:02:24,280 works right now. Some of the other things 68 00:02:24,280 --> 00:02:26,139 are the cost of anesthesia services, 69 00:02:26,599 --> 00:02:27,819 anesthesia contracts 70 00:02:28,439 --> 00:02:29,180 with anesthesia 71 00:02:30,360 --> 00:02:32,379 companies, contracts with them. 72 00:02:32,919 --> 00:02:35,159 And, of course, the the the total joints 73 00:02:35,159 --> 00:02:35,659 are 74 00:02:36,199 --> 00:02:36,699 speaking 75 00:02:37,474 --> 00:02:39,415 to total total joints as an opportunity, 76 00:02:40,835 --> 00:02:41,655 are a great, 77 00:02:43,635 --> 00:02:46,294 a great profit. They have great profit margins. 78 00:02:46,915 --> 00:02:48,435 You don't have to have a twenty three 79 00:02:48,435 --> 00:02:48,935 hour 80 00:02:49,889 --> 00:02:52,610 stay to be able to accommodate them. Right 81 00:02:52,610 --> 00:02:54,629 now, I do total joints, 82 00:02:55,330 --> 00:02:56,790 knees and shoulders, 83 00:02:57,169 --> 00:02:58,770 and I'm going to start to do hips 84 00:02:58,770 --> 00:03:01,270 this year. So that'll be exciting for us. 85 00:03:01,330 --> 00:03:02,995 There There are a lot of capital outlays, 86 00:03:03,455 --> 00:03:05,314 for that, capital equipment outlays. 87 00:03:06,094 --> 00:03:06,995 So it's, 88 00:03:08,495 --> 00:03:10,335 it can be a challenge, but it's it's, 89 00:03:10,814 --> 00:03:12,574 it's a good challenge to have since the 90 00:03:12,574 --> 00:03:13,794 margins are so good. 91 00:03:14,620 --> 00:03:16,939 Mhmm. Yeah. Absolutely. A lot of a lot 92 00:03:16,939 --> 00:03:18,379 of the new things going on there, especially 93 00:03:18,379 --> 00:03:21,180 with, yeah, CMS's recent announcement and, a lot 94 00:03:21,180 --> 00:03:23,419 of new procedures being added to the, a 95 00:03:23,419 --> 00:03:25,120 cover procedures list for ASCs. 96 00:03:26,694 --> 00:03:28,694 You know, I believe I read somewhere that, 97 00:03:28,855 --> 00:03:30,235 and I think it was on Becker's, 98 00:03:30,775 --> 00:03:33,415 that there was a three hundred percent increase 99 00:03:33,415 --> 00:03:34,395 in knee replacements 100 00:03:35,094 --> 00:03:37,194 in Mhmm. Outpatient surgery setting 101 00:03:37,574 --> 00:03:39,915 between 2019 and 2023. 102 00:03:40,135 --> 00:03:41,754 Now that's a huge increase. 103 00:03:42,449 --> 00:03:42,949 And 104 00:03:43,409 --> 00:03:44,289 I know that, 105 00:03:44,930 --> 00:03:47,009 this just occurred to me. I know that, 106 00:03:47,810 --> 00:03:49,009 you know, there has to be a a 107 00:03:49,009 --> 00:03:49,509 significant 108 00:03:50,930 --> 00:03:53,909 emphasis on postoperative care patient education, 109 00:03:54,289 --> 00:03:56,625 you you know, things like, home health and 110 00:03:56,625 --> 00:03:59,604 physical therapy afterwards. You know, immediate ambulation 111 00:04:00,625 --> 00:04:01,364 is important, 112 00:04:02,465 --> 00:04:03,364 to work into, 113 00:04:03,985 --> 00:04:06,004 discharge for total joint cases. 114 00:04:06,810 --> 00:04:09,610 So, some of some ASCs and I mentioned 115 00:04:09,610 --> 00:04:11,550 this because, you know, some ASCs 116 00:04:12,409 --> 00:04:12,909 have, 117 00:04:13,849 --> 00:04:16,250 allow for overnight stays depending on the state 118 00:04:16,250 --> 00:04:17,149 that they're in. 119 00:04:17,850 --> 00:04:19,930 This state doesn't do that. This state doesn't 120 00:04:19,930 --> 00:04:20,830 allow for that. 121 00:04:21,475 --> 00:04:23,235 Your certificate of need has to be amended 122 00:04:23,235 --> 00:04:25,074 for for that to happen. But in most 123 00:04:25,074 --> 00:04:27,714 circumstances with total joints, that's that's actually not 124 00:04:27,714 --> 00:04:28,214 necessary. 125 00:04:29,314 --> 00:04:30,454 Mhmm. Mhmm. 126 00:04:30,834 --> 00:04:32,675 Yeah. And kind of with all of these, 127 00:04:33,074 --> 00:04:34,754 you know, these trends we're following, what are 128 00:04:34,754 --> 00:04:36,560 you most excited about right now? 129 00:04:37,660 --> 00:04:39,580 Well, I I'd have to I'd have to 130 00:04:39,580 --> 00:04:41,819 go back to controlling cost of goods Mhmm. 131 00:04:41,899 --> 00:04:43,899 To accommodate total joints. I think the hip 132 00:04:43,899 --> 00:04:45,680 thing to say these days is AI, 133 00:04:46,139 --> 00:04:46,460 but, 134 00:04:47,259 --> 00:04:47,819 really not 135 00:04:48,460 --> 00:04:50,639 they they need extremely large datasets, 136 00:04:51,975 --> 00:04:54,235 the language large language models do, 137 00:04:54,615 --> 00:04:55,495 and the, 138 00:04:55,894 --> 00:04:57,274 the predictive analytics, 139 00:04:58,294 --> 00:05:00,794 need exceptionally large datasets, patient, 140 00:05:01,175 --> 00:05:01,675 datasets 141 00:05:02,375 --> 00:05:05,595 to to accomplish what everybody's hoping that, 142 00:05:06,330 --> 00:05:08,730 hoping for an impact on a positive impact 143 00:05:08,730 --> 00:05:09,230 on 144 00:05:09,610 --> 00:05:12,270 curative medicine, predictive analytics for 145 00:05:12,649 --> 00:05:14,730 for that that can have a significant impact 146 00:05:14,730 --> 00:05:15,949 on clinical outcomes. 147 00:05:16,410 --> 00:05:17,629 But I think right now, 148 00:05:19,275 --> 00:05:22,254 the the motivation of CMS to incentivize, 149 00:05:23,595 --> 00:05:25,935 hospitals, out inpatient facilities, 150 00:05:27,275 --> 00:05:28,495 to to move 151 00:05:29,115 --> 00:05:32,654 higher acuity cases over to the ASC side 152 00:05:33,120 --> 00:05:33,620 is, 153 00:05:34,319 --> 00:05:36,319 is a very exciting environment to be involved 154 00:05:36,319 --> 00:05:37,220 in right now. 155 00:05:37,520 --> 00:05:40,000 You know, having backs done at a having 156 00:05:40,000 --> 00:05:40,500 neurosurgery 157 00:05:40,800 --> 00:05:42,580 and backs done at a surgery center, 158 00:05:43,199 --> 00:05:45,139 just a few years ago used to be 159 00:05:46,214 --> 00:05:47,974 a significant challenge. It used to be a 160 00:05:47,974 --> 00:05:48,875 novel idea, 161 00:05:49,974 --> 00:05:50,714 not anymore. 162 00:05:52,375 --> 00:05:56,294 Mhmm. Yeah. Absolutely. And kind of with, kind 163 00:05:56,294 --> 00:05:57,574 of still in this theme of, you know, 164 00:05:57,574 --> 00:05:58,875 what's what's now possible 165 00:05:59,254 --> 00:05:59,974 and sort of, 166 00:06:00,680 --> 00:06:02,860 especially with the the recent CMS announcement. 167 00:06:03,319 --> 00:06:05,160 How are you thinking about growth over the 168 00:06:05,160 --> 00:06:06,139 next twelve months? 169 00:06:07,240 --> 00:06:09,560 Well, there's a lot to talk about there. 170 00:06:09,959 --> 00:06:11,420 You know, coming from endovascular, 171 00:06:11,800 --> 00:06:13,020 I can tell you that, 172 00:06:13,725 --> 00:06:16,305 you know, the treatment of peripheral arterial disease, 173 00:06:16,685 --> 00:06:19,185 peripheral vascular disease, these chronic, 174 00:06:19,564 --> 00:06:21,264 disease stasis, chronic conditions, 175 00:06:21,645 --> 00:06:22,785 you know, they're not curable. 176 00:06:23,324 --> 00:06:25,745 You can only manage them. So, 177 00:06:26,045 --> 00:06:26,545 having, 178 00:06:27,004 --> 00:06:27,824 getting into 179 00:06:28,990 --> 00:06:30,449 endovascular and ASC, 180 00:06:31,789 --> 00:06:34,610 is still a good prospect. Having interventional radiologists 181 00:06:35,389 --> 00:06:37,169 and, vascular surgeons, 182 00:06:38,349 --> 00:06:39,889 to accommodate those cases 183 00:06:40,589 --> 00:06:41,649 is something that, 184 00:06:42,704 --> 00:06:44,384 although, like I mentioned in the beginning, is 185 00:06:44,464 --> 00:06:45,285 can be complex, 186 00:06:45,824 --> 00:06:47,824 it it has a significant upside for the 187 00:06:47,824 --> 00:06:48,324 patients. 188 00:06:48,944 --> 00:06:50,324 Those are, you know, stenting, 189 00:06:50,625 --> 00:06:51,524 balloon angioplasty, 190 00:06:52,625 --> 00:06:53,125 atherectomy 191 00:06:53,584 --> 00:06:54,084 procedures, 192 00:06:55,250 --> 00:06:57,889 the placement of fistulas for dialysis patients, for 193 00:06:57,889 --> 00:07:00,610 example. That's the upper extremity work that can 194 00:07:00,610 --> 00:07:01,269 be done. 195 00:07:01,730 --> 00:07:03,889 So and there's a lot of upside there 196 00:07:03,889 --> 00:07:04,629 on reimbursement. 197 00:07:05,970 --> 00:07:07,110 Some surgery centers 198 00:07:07,649 --> 00:07:09,430 function as office based labs, 199 00:07:10,125 --> 00:07:11,345 but the more profitable 200 00:07:11,964 --> 00:07:13,904 aspect of that care in endovascular 201 00:07:14,205 --> 00:07:15,665 is to function as a, 202 00:07:16,365 --> 00:07:18,444 as an ASC, a full ASC, a place 203 00:07:18,444 --> 00:07:19,745 of service 24. 204 00:07:20,605 --> 00:07:21,264 I think, 205 00:07:21,884 --> 00:07:23,805 as I mentioned, the migration of higher acuity 206 00:07:23,805 --> 00:07:25,585 cases to ASCs is important. 207 00:07:26,279 --> 00:07:27,180 AI enhancements 208 00:07:28,199 --> 00:07:28,680 to, 209 00:07:29,000 --> 00:07:30,779 things like administrative workflow, 210 00:07:31,879 --> 00:07:33,899 you know, that aggregation of data, 211 00:07:34,279 --> 00:07:37,579 the integration of AI into various EMR platforms 212 00:07:38,199 --> 00:07:39,740 is is something to be 213 00:07:40,555 --> 00:07:43,214 excited about to to help accommodate growth here. 214 00:07:43,754 --> 00:07:46,394 I Mhmm. I think the, some of the 215 00:07:46,394 --> 00:07:48,235 best margins that I have right now are 216 00:07:48,235 --> 00:07:48,735 neuro 217 00:07:49,274 --> 00:07:51,034 what we refer to as neuro, but they're 218 00:07:51,034 --> 00:07:52,574 actually spine cases 219 00:07:53,069 --> 00:07:54,210 where we put the neurostimulators 220 00:07:55,069 --> 00:07:57,629 in the back. Technically, I I think they're 221 00:07:57,710 --> 00:07:59,949 but they they're classified as ortho cases. We 222 00:07:59,949 --> 00:08:01,250 call them spine here. 223 00:08:02,110 --> 00:08:05,230 OBGYN and podiatry cases, the growth there is 224 00:08:05,230 --> 00:08:05,730 important, 225 00:08:06,430 --> 00:08:08,290 to maintain and to seek out. 226 00:08:09,245 --> 00:08:10,625 Those are low cost, 227 00:08:11,085 --> 00:08:13,425 low overhead procedures, low cost of goods, 228 00:08:14,125 --> 00:08:14,625 cases, 229 00:08:15,725 --> 00:08:16,865 OB and podiatry, 230 00:08:17,725 --> 00:08:19,725 and they're easily managed, and they have good, 231 00:08:20,205 --> 00:08:20,705 reimbursement, 232 00:08:21,699 --> 00:08:24,120 markers for them. I think there are also 233 00:08:24,339 --> 00:08:26,579 obstacles to growth that should be mentioned. You 234 00:08:26,579 --> 00:08:28,500 know, the I I came from a state 235 00:08:28,500 --> 00:08:30,019 I came from a state on the West 236 00:08:30,019 --> 00:08:30,519 Coast 237 00:08:31,060 --> 00:08:31,560 that, 238 00:08:32,340 --> 00:08:34,179 you know, had no certificate of need. It's 239 00:08:34,179 --> 00:08:35,080 a very mercenary 240 00:08:35,745 --> 00:08:37,345 environment out there, and there there weren't a 241 00:08:37,345 --> 00:08:39,365 lot of hospital affiliations with ASCs. 242 00:08:40,304 --> 00:08:43,024 And because of the extreme population debts density, 243 00:08:43,024 --> 00:08:43,524 you 244 00:08:44,225 --> 00:08:45,125 you could manage, 245 00:08:45,825 --> 00:08:47,285 with three or four ASCs, 246 00:08:48,144 --> 00:08:49,605 in a relatively short 247 00:08:50,000 --> 00:08:52,259 short area a small area rather. 248 00:08:52,799 --> 00:08:55,200 So so I think having being in a 249 00:08:55,200 --> 00:08:57,360 certificate of need state, and I don't know 250 00:08:57,360 --> 00:08:59,279 the number of states that have certificate of 251 00:08:59,279 --> 00:09:00,100 need requirements, 252 00:09:00,639 --> 00:09:03,679 but having to, get acquainted with it is 253 00:09:03,679 --> 00:09:05,059 a significant obstacle 254 00:09:05,404 --> 00:09:06,065 to growth. 255 00:09:06,524 --> 00:09:09,165 You have to have I I have, two 256 00:09:09,165 --> 00:09:11,504 ORs and two procedure rooms, for example, 257 00:09:11,884 --> 00:09:12,365 and, 258 00:09:12,764 --> 00:09:15,404 I I have, two other ORs that are 259 00:09:15,404 --> 00:09:18,139 built out, that are framed out, and just 260 00:09:18,139 --> 00:09:19,039 have to be constructed. 261 00:09:19,340 --> 00:09:21,259 And, you know, there's some technicalities there where 262 00:09:21,259 --> 00:09:23,660 you could call it a procedure room versus 263 00:09:23,660 --> 00:09:24,320 an OR, 264 00:09:24,860 --> 00:09:27,660 and, the state will accept it. But just 265 00:09:27,660 --> 00:09:28,720 speaking in generalities, 266 00:09:30,059 --> 00:09:31,600 all of these things need permission, 267 00:09:32,325 --> 00:09:34,804 And it can take us an extremely long 268 00:09:34,804 --> 00:09:35,304 time 269 00:09:35,764 --> 00:09:37,065 to go before the various 270 00:09:37,365 --> 00:09:38,665 city and state committees, 271 00:09:39,605 --> 00:09:41,524 to satisfy that commute that, 272 00:09:42,004 --> 00:09:43,384 community need assessment. 273 00:09:44,565 --> 00:09:46,904 And if and there there are competing hospitals 274 00:09:47,360 --> 00:09:50,180 that also own ASCs, like in my case, 275 00:09:51,200 --> 00:09:53,600 you know, they're all fighting for that number 276 00:09:53,600 --> 00:09:54,100 of, 277 00:09:55,200 --> 00:09:55,700 approved 278 00:09:56,160 --> 00:09:56,660 ORs 279 00:09:57,360 --> 00:09:58,420 in that space. 280 00:09:59,120 --> 00:10:00,720 And so it can it can be quite, 281 00:10:01,120 --> 00:10:02,180 political too. 282 00:10:03,174 --> 00:10:05,174 Mhmm. Yeah. I think it is good and 283 00:10:05,174 --> 00:10:06,615 very important that you mentioned that. You know? 284 00:10:06,615 --> 00:10:07,194 I think, 285 00:10:07,654 --> 00:10:09,334 you know, this conversation has kind of covered 286 00:10:09,334 --> 00:10:11,334 a range of subjects, but people there's a 287 00:10:11,334 --> 00:10:13,014 lot of excitement around AI and kind of 288 00:10:13,014 --> 00:10:15,174 like you said, these sort of lofty things 289 00:10:15,174 --> 00:10:16,615 that are will be possible in the future, 290 00:10:16,615 --> 00:10:17,279 but it sounds 291 00:10:18,000 --> 00:10:18,800 like a lot of ASCs are still grounded 292 00:10:18,800 --> 00:10:21,840 in these realities of what state regulations permit 293 00:10:21,840 --> 00:10:23,519 and that that kind of being where a 294 00:10:23,519 --> 00:10:24,899 lot of people are at still. 295 00:10:25,920 --> 00:10:26,740 Yes, ma'am. 296 00:10:27,360 --> 00:10:29,120 Yeah. And I think, I think I would 297 00:10:29,120 --> 00:10:31,200 like also like to mention as a growth 298 00:10:31,200 --> 00:10:31,700 obstacle 299 00:10:32,134 --> 00:10:34,315 or as something that can be a challenge, 300 00:10:35,654 --> 00:10:38,394 that more physician surgeons are joining hospital systems. 301 00:10:39,254 --> 00:10:41,274 And, you know, there's meaning 302 00:10:41,575 --> 00:10:43,995 that there are a limited number of independent 303 00:10:44,294 --> 00:10:45,274 physician surgeons 304 00:10:46,129 --> 00:10:47,409 to become owners, 305 00:10:48,370 --> 00:10:49,830 to feed a surgery center. 306 00:10:50,289 --> 00:10:50,769 And, 307 00:10:51,169 --> 00:10:53,330 you know, sometimes there are legal barriers to 308 00:10:53,330 --> 00:10:54,389 employed physicians 309 00:10:55,250 --> 00:10:58,070 that work at in a hospital assist system 310 00:10:58,370 --> 00:11:00,549 to joining an ASC as owners. 311 00:11:01,164 --> 00:11:03,985 Sometimes that is that is the case. So 312 00:11:04,285 --> 00:11:06,285 that that that can be an obstacle to 313 00:11:06,285 --> 00:11:09,745 growth. But if you're if you're constantly involved 314 00:11:09,965 --> 00:11:12,465 and seeking out that that new participation 315 00:11:13,245 --> 00:11:15,264 amongst younger physician surgeons, 316 00:11:16,169 --> 00:11:17,610 and you know the the lay of the 317 00:11:17,610 --> 00:11:19,129 land, you know what that challenge is gonna 318 00:11:19,129 --> 00:11:22,090 look like, it it's that that recruitment effort 319 00:11:22,090 --> 00:11:23,789 is still very important to maintain. 320 00:11:24,330 --> 00:11:25,210 It's just that it's, 321 00:11:26,090 --> 00:11:28,190 here here on the East Coast, I've noticed. 322 00:11:28,735 --> 00:11:30,115 These hospital affiliations 323 00:11:30,975 --> 00:11:32,274 and the purchase of 324 00:11:32,654 --> 00:11:34,274 of large physician groups, 325 00:11:34,654 --> 00:11:35,855 especially those that have, 326 00:11:36,575 --> 00:11:38,595 that have physician surgeons within them, 327 00:11:39,615 --> 00:11:41,235 is is far more common 328 00:11:41,799 --> 00:11:43,740 and and more accelerated here 329 00:11:44,120 --> 00:11:46,040 than it is, on the West Coast, at 330 00:11:46,040 --> 00:11:47,019 least in my experience. 331 00:11:48,120 --> 00:11:50,059 That's that's definitely very interesting. 332 00:11:50,840 --> 00:11:52,620 Again, certainly dynamic that 333 00:11:52,920 --> 00:11:54,679 is shaping shaping things in the state that 334 00:11:54,679 --> 00:11:56,200 you're in. And it sounds like the region 335 00:11:56,200 --> 00:11:57,179 is something that, 336 00:11:57,944 --> 00:11:59,544 I'll be interested to look into a little 337 00:11:59,544 --> 00:12:02,125 more. Anything else to add here, Michael? 338 00:12:03,464 --> 00:12:04,584 No. I I think, 339 00:12:05,065 --> 00:12:06,365 you know, things like 340 00:12:07,704 --> 00:12:09,704 minor things, I would call them, you know, 341 00:12:09,704 --> 00:12:11,565 things like, zero day stays. 342 00:12:12,360 --> 00:12:14,539 You know, the ASCs 343 00:12:15,320 --> 00:12:17,720 reduce the number or increase the number of 344 00:12:17,720 --> 00:12:19,399 zero day stays, which is a good thing 345 00:12:19,399 --> 00:12:20,059 for patients, 346 00:12:20,759 --> 00:12:22,139 when they come to an area. 347 00:12:23,000 --> 00:12:24,860 So I just think there's a lot of 348 00:12:26,284 --> 00:12:27,504 there there are a lot of details 349 00:12:28,125 --> 00:12:28,625 about 350 00:12:29,245 --> 00:12:31,424 the convenience factor for patients 351 00:12:32,205 --> 00:12:35,644 that ASC growth, wherever they are, wherever it 352 00:12:35,644 --> 00:12:36,705 happens in the country, 353 00:12:37,565 --> 00:12:39,825 drives for the for the benefit of patients. 354 00:12:40,919 --> 00:12:42,059 And I I think that 355 00:12:42,759 --> 00:12:44,860 the the drivers within our industry 356 00:12:45,639 --> 00:12:47,740 are interesting to talk about, but these 357 00:12:48,120 --> 00:12:50,299 these these tangible benefits to the patients 358 00:12:51,000 --> 00:12:52,059 are are, you know, 359 00:12:52,865 --> 00:12:55,024 very tangible too. So we have a lot 360 00:12:55,024 --> 00:12:56,725 of especially if you 361 00:12:57,304 --> 00:12:58,164 if you're 362 00:12:58,625 --> 00:13:01,365 on the ball cooperating with your referral sources 363 00:13:01,504 --> 00:13:02,325 as an ASC 364 00:13:02,705 --> 00:13:04,404 with pre and post patient education. 365 00:13:04,705 --> 00:13:06,705 If you have a dedicated program, you have 366 00:13:06,705 --> 00:13:07,924 a a sort of 367 00:13:09,049 --> 00:13:09,710 a concierge 368 00:13:11,210 --> 00:13:11,710 attentiveness 369 00:13:12,649 --> 00:13:14,909 to patients, for example, that come through, 370 00:13:15,370 --> 00:13:16,669 a total joint program 371 00:13:17,129 --> 00:13:18,190 at the ASC 372 00:13:18,570 --> 00:13:20,490 where people are sort of people going through 373 00:13:20,490 --> 00:13:22,649 that process, going through those surgeries are sort 374 00:13:22,649 --> 00:13:23,389 of segregated 375 00:13:24,115 --> 00:13:24,615 and, 376 00:13:25,394 --> 00:13:26,774 have a have a different 377 00:13:27,394 --> 00:13:27,894 track 378 00:13:28,514 --> 00:13:29,174 so that, 379 00:13:30,274 --> 00:13:31,654 we can attend to them. 380 00:13:32,274 --> 00:13:34,535 The physician can consult with them 381 00:13:34,915 --> 00:13:36,375 in a in a more 382 00:13:37,870 --> 00:13:38,929 polished environment. 383 00:13:39,789 --> 00:13:41,169 That that's something that 384 00:13:41,549 --> 00:13:43,549 I I think deserves a lot more attention 385 00:13:43,549 --> 00:13:44,370 from ASCs 386 00:13:44,750 --> 00:13:46,909 that that because of the nature of some 387 00:13:46,909 --> 00:13:47,649 of these 388 00:13:48,110 --> 00:13:50,690 higher acuity cases that come to surgery centers, 389 00:13:51,565 --> 00:13:53,985 and the track of patient education, 390 00:13:54,845 --> 00:13:57,105 it it can be a very intimidating experience. 391 00:13:57,164 --> 00:13:57,904 And sometimes 392 00:13:58,284 --> 00:13:59,105 it's necessary 393 00:14:00,044 --> 00:14:02,284 to to have those patients as they process 394 00:14:02,284 --> 00:14:03,264 through the facility 395 00:14:03,725 --> 00:14:04,544 at the ASC. 396 00:14:05,620 --> 00:14:07,139 Once we get our hands on them, that 397 00:14:07,139 --> 00:14:07,799 they feel 398 00:14:08,820 --> 00:14:11,539 that we're where we we have a different 399 00:14:11,539 --> 00:14:12,600 kind of accommodation, 400 00:14:13,779 --> 00:14:15,860 for for what they're going through and need, 401 00:14:16,100 --> 00:14:18,019 because it can feel overwhelming. The all of 402 00:14:18,019 --> 00:14:20,445 the information you get, all of the aftercare 403 00:14:20,585 --> 00:14:22,264 instructions that you get, all of the things 404 00:14:22,264 --> 00:14:23,945 you have to adapt to, you know, it's 405 00:14:23,945 --> 00:14:26,184 just an intimidating experience to begin with even 406 00:14:26,184 --> 00:14:26,845 for modest, 407 00:14:27,544 --> 00:14:28,504 cases that are of, 408 00:14:29,625 --> 00:14:30,524 of low complexity, 409 00:14:31,144 --> 00:14:32,105 cases that are, 410 00:14:32,664 --> 00:14:33,164 less 411 00:14:33,860 --> 00:14:34,360 involved. 412 00:14:35,220 --> 00:14:37,699 Even that's an an intimidating process. People have 413 00:14:37,699 --> 00:14:38,820 to get off from work. You know, they 414 00:14:38,820 --> 00:14:39,320 have, 415 00:14:39,860 --> 00:14:42,500 their financial obligations on their side, the high 416 00:14:42,500 --> 00:14:44,579 deductibles in a lot of cases. So there's 417 00:14:44,579 --> 00:14:46,579 a lot to worry about, and I think, 418 00:14:46,980 --> 00:14:48,279 we have to keep up 419 00:14:48,914 --> 00:14:49,414 with, 420 00:14:49,875 --> 00:14:51,174 our customer service 421 00:14:51,554 --> 00:14:52,375 at an ASC 422 00:14:52,914 --> 00:14:54,995 and not not treat it like it's a 423 00:14:55,075 --> 00:14:57,315 an assembly line where all patients, no matter 424 00:14:57,315 --> 00:15:00,115 what what they're coming for, you know, get 425 00:15:00,115 --> 00:15:01,174 the same kind of 426 00:15:01,875 --> 00:15:02,995 treatment. It's it just 427 00:15:03,559 --> 00:15:05,579 it's not a cookie cutter environment anymore. 428 00:15:06,839 --> 00:15:09,480 Mhmm. Yeah. That personalization is is key there, 429 00:15:09,480 --> 00:15:10,379 it sounds like. 430 00:15:11,159 --> 00:15:11,659 Alright. 431 00:15:12,120 --> 00:15:13,559 Well, that is all I have for you 432 00:15:13,559 --> 00:15:15,959 today, Michael. Thank you so much for joining 433 00:15:15,959 --> 00:15:18,284 us. It has been a pleasure speaking with 434 00:15:18,284 --> 00:15:20,204 you, and I look forward to connecting with 435 00:15:20,204 --> 00:15:21,424 you again in the future. 436 00:15:21,884 --> 00:15:23,264 I hope you have a good day.