Hello. This is Francesca Matthews with the Becker's
ASC review podcast.
I'm thrilled to be joined today by Michael
Gale, administrative director at the Centara Ubichi
Ambulatory
Surgical Center. Michael, thank you so much for
being here today.
Thank you for having me. Alright. To start
off, could you please introduce yourself and tell
us a little bit about your background?
Sure. I, well, I'm a health care executive.
I was recruited here to Virginia from California
about three years ago
from endovascular.
I ran endovascular
ambulatory surgery corporation.
And,
Centerra
Obici,
is how it's pronounced. Centerra Obici Hospital
is where our ASC is on the campus
of. There are, eight other ASCs in my
region, my Sentara region.
It's a $13,000,000,000
company and growing,
and,
it it's a multispecialty
ASC.
It's different from endovascular.
I have a lot of expertise in that
field. It's endovascular
billing and coding can be quite complicated.
So coming into a multispecialty
environment
was quite a variety of
of of knowledge for me. So it's been
very interesting. Before that, I,
I've been at the c suite level at
various, health care corporations,
revenue cycle management hospitals,
of course,
various ambulatory care,
environments,
large practices,
physician owned practices,
regional,
multistate.
So, it's been varied. I I was even
once a dialysis executive in Bakersfield, California.
Yeah. Breath of experience there, and apologies for
the mispronunciation
or unnecessary Italian pronunciation
there.
But great. We'll keep it going then. What
are the top three trends you're following in
health care and ASCs today?
Well, you know, the migration of hospital based
surgical procedures to ASC is a big deal.
It's being pushed by CMS.
Patients of a, of a low acuity
level are are already here.
So total joints are a good example of
that.
Higher acuity cases, like spine cases,
are in the works right now.
That that migration, I mean, is in the
works right now. Some of the other things
are the cost of anesthesia services,
anesthesia contracts
with anesthesia
companies, contracts with them.
And, of course, the the the total joints
are
speaking
to total total joints as an opportunity,
are a great,
a great profit. They have great profit margins.
You don't have to have a twenty three
hour
stay to be able to accommodate them. Right
now, I do total joints,
knees and shoulders,
and I'm going to start to do hips
this year. So that'll be exciting for us.
There There are a lot of capital outlays,
for that, capital equipment outlays.
So it's,
it can be a challenge, but it's it's,
it's a good challenge to have since the
margins are so good.
Mhmm. Yeah. Absolutely. A lot of a lot
of the new things going on there, especially
with, yeah, CMS's recent announcement and, a lot
of new procedures being added to the, a
cover procedures list for ASCs.
You know, I believe I read somewhere that,
and I think it was on Becker's,
that there was a three hundred percent increase
in knee replacements
in Mhmm. Outpatient surgery setting
between 2019 and 2023.
Now that's a huge increase.
And
I know that,
this just occurred to me. I know that,
you know, there has to be a a
significant
emphasis on postoperative care patient education,
you you know, things like, home health and
physical therapy afterwards. You know, immediate ambulation
is important,
to work into,
discharge for total joint cases.
So, some of some ASCs and I mentioned
this because, you know, some ASCs
have,
allow for overnight stays depending on the state
that they're in.
This state doesn't do that. This state doesn't
allow for that.
Your certificate of need has to be amended
for for that to happen. But in most
circumstances with total joints, that's that's actually not
necessary.
Mhmm. Mhmm.
Yeah. And kind of with all of these,
you know, these trends we're following, what are
you most excited about right now?
Well, I I'd have to I'd have to
go back to controlling cost of goods Mhmm.
To accommodate total joints. I think the hip
thing to say these days is AI,
but,
really not
they they need extremely large datasets,
the language large language models do,
and the,
the predictive analytics,
need exceptionally large datasets, patient,
datasets
to to accomplish what everybody's hoping that,
hoping for an impact on a positive impact
on
curative medicine, predictive analytics for
for that that can have a significant impact
on clinical outcomes.
But I think right now,
the the motivation of CMS to incentivize,
hospitals, out inpatient facilities,
to to move
higher acuity cases over to the ASC side
is,
is a very exciting environment to be involved
in right now.
You know, having backs done at a having
neurosurgery
and backs done at a surgery center,
just a few years ago used to be
a significant challenge. It used to be a
novel idea,
not anymore.
Mhmm. Yeah. Absolutely. And kind of with, kind
of still in this theme of, you know,
what's what's now possible
and sort of,
especially with the the recent CMS announcement.
How are you thinking about growth over the
next twelve months?
Well, there's a lot to talk about there.
You know, coming from endovascular,
I can tell you that,
you know, the treatment of peripheral arterial disease,
peripheral vascular disease, these chronic,
disease stasis, chronic conditions,
you know, they're not curable.
You can only manage them. So,
having,
getting into
endovascular and ASC,
is still a good prospect. Having interventional radiologists
and, vascular surgeons,
to accommodate those cases
is something that,
although, like I mentioned in the beginning, is
can be complex,
it it has a significant upside for the
patients.
Those are, you know, stenting,
balloon angioplasty,
atherectomy
procedures,
the placement of fistulas for dialysis patients, for
example. That's the upper extremity work that can
be done.
So and there's a lot of upside there
on reimbursement.
Some surgery centers
function as office based labs,
but the more profitable
aspect of that care in endovascular
is to function as a,
as an ASC, a full ASC, a place
of service 24.
I think,
as I mentioned, the migration of higher acuity
cases to ASCs is important.
AI enhancements
to,
things like administrative workflow,
you know, that aggregation of data,
the integration of AI into various EMR platforms
is is something to be
excited about to to help accommodate growth here.
I Mhmm. I think the, some of the
best margins that I have right now are
neuro
what we refer to as neuro, but they're
actually spine cases
where we put the neurostimulators
in the back. Technically, I I think they're
but they they're classified as ortho cases. We
call them spine here.
OBGYN and podiatry cases, the growth there is
important,
to maintain and to seek out.
Those are low cost,
low overhead procedures, low cost of goods,
cases,
OB and podiatry,
and they're easily managed, and they have good,
reimbursement,
markers for them. I think there are also
obstacles to growth that should be mentioned. You
know, the I I came from a state
I came from a state on the West
Coast
that,
you know, had no certificate of need. It's
a very mercenary
environment out there, and there there weren't a
lot of hospital affiliations with ASCs.
And because of the extreme population debts density,
you
you could manage,
with three or four ASCs,
in a relatively short
short area a small area rather.
So so I think having being in a
certificate of need state, and I don't know
the number of states that have certificate of
need requirements,
but having to, get acquainted with it is
a significant obstacle
to growth.
You have to have I I have, two
ORs and two procedure rooms, for example,
and,
I I have, two other ORs that are
built out, that are framed out, and just
have to be constructed.
And, you know, there's some technicalities there where
you could call it a procedure room versus
an OR,
and, the state will accept it. But just
speaking in generalities,
all of these things need permission,
And it can take us an extremely long
time
to go before the various
city and state committees,
to satisfy that commute that,
community need assessment.
And if and there there are competing hospitals
that also own ASCs, like in my case,
you know, they're all fighting for that number
of,
approved
ORs
in that space.
And so it can it can be quite,
political too.
Mhmm. Yeah. I think it is good and
very important that you mentioned that. You know?
I think,
you know, this conversation has kind of covered
a range of subjects, but people there's a
lot of excitement around AI and kind of
like you said, these sort of lofty things
that are will be possible in the future,
but it sounds
like a lot of ASCs are still grounded
in these realities of what state regulations permit
and that that kind of being where a
lot of people are at still.
Yes, ma'am.
Yeah. And I think, I think I would
like also like to mention as a growth
obstacle
or as something that can be a challenge,
that more physician surgeons are joining hospital systems.
And, you know, there's meaning
that there are a limited number of independent
physician surgeons
to become owners,
to feed a surgery center.
And,
you know, sometimes there are legal barriers to
employed physicians
that work at in a hospital assist system
to joining an ASC as owners.
Sometimes that is that is the case. So
that that that can be an obstacle to
growth. But if you're if you're constantly involved
and seeking out that that new participation
amongst younger physician surgeons,
and you know the the lay of the
land, you know what that challenge is gonna
look like, it it's that that recruitment effort
is still very important to maintain.
It's just that it's,
here here on the East Coast, I've noticed.
These hospital affiliations
and the purchase of
of large physician groups,
especially those that have,
that have physician surgeons within them,
is is far more common
and and more accelerated here
than it is, on the West Coast, at
least in my experience.
That's that's definitely very interesting.
Again, certainly dynamic that
is shaping shaping things in the state that
you're in. And it sounds like the region
is something that,
I'll be interested to look into a little
more. Anything else to add here, Michael?
No. I I think,
you know, things like
minor things, I would call them, you know,
things like, zero day stays.
You know, the ASCs
reduce the number or increase the number of
zero day stays, which is a good thing
for patients,
when they come to an area.
So I just think there's a lot of
there there are a lot of details
about
the convenience factor for patients
that ASC growth, wherever they are, wherever it
happens in the country,
drives for the for the benefit of patients.
And I I think that
the the drivers within our industry
are interesting to talk about, but these
these these tangible benefits to the patients
are are, you know,
very tangible too. So we have a lot
of especially if you
if you're
on the ball cooperating with your referral sources
as an ASC
with pre and post patient education.
If you have a dedicated program, you have
a a sort of
a concierge
attentiveness
to patients, for example, that come through,
a total joint program
at the ASC
where people are sort of people going through
that process, going through those surgeries are sort
of segregated
and,
have a have a different
track
so that,
we can attend to them.
The physician can consult with them
in a in a more
polished environment.
That that's something that
I I think deserves a lot more attention
from ASCs
that that because of the nature of some
of these
higher acuity cases that come to surgery centers,
and the track of patient education,
it it can be a very intimidating experience.
And sometimes
it's necessary
to to have those patients as they process
through the facility
at the ASC.
Once we get our hands on them, that
they feel
that we're where we we have a different
kind of accommodation,
for for what they're going through and need,
because it can feel overwhelming. The all of
the information you get, all of the aftercare
instructions that you get, all of the things
you have to adapt to, you know, it's
just an intimidating experience to begin with even
for modest,
cases that are of,
of low complexity,
cases that are,
less
involved.
Even that's an an intimidating process. People have
to get off from work. You know, they
have,
their financial obligations on their side, the high
deductibles in a lot of cases. So there's
a lot to worry about, and I think,
we have to keep up
with,
our customer service
at an ASC
and not not treat it like it's a
an assembly line where all patients, no matter
what what they're coming for, you know, get
the same kind of
treatment. It's it just
it's not a cookie cutter environment anymore.
Mhmm. Yeah. That personalization is is key there,
it sounds like.
Alright.
Well, that is all I have for you
today, Michael. Thank you so much for joining
us. It has been a pleasure speaking with
you, and I look forward to connecting with
you again in the future.
I hope you have a good day.