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Hello. This is Francesca Matthews with the Becker's

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ASC review podcast.

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I'm thrilled to be joined today by Mark

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Mayo, CASC,

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the administrator of Associated Surgical Center. Mark, thank

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you so much for being here today.

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Good morning. I'm good. Awesome. Great. So just

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to start us off, could you please introduce

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yourself and tell us a little bit about

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your background?

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I've been involved in,

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surgery centers for a long time. I actually

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helped a group of doctors,

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create

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a truly

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fifty fifty joint venture

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surgery center with a hospital in 1984,

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and

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it's still working

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that way. And then I went on to

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work with about 10 other surgery centers since

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then. You're truly a pioneer there?

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No. There were a lot of people before

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me. So I I we always,

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build on top of that.

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I have the privilege of serving on,

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two national surgery center association,

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boards,

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one that

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merged with a group called FAFSA to become

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the

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ASCA,

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and the other one was the board of,

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the CAS credential.

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I,

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helped,

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edit

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the a a national,

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ASC newsletter

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and

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helped develop,

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a state surgery center association.

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I've been involved with,

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Associated Surgical Center,

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since before we opened in 02/2016.

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They're located in Arlington Heights, Illinois,

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and have been working with them since, and

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we're now focused on preparing for reaccreditation.

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K. Excellent. Thank you for for the little

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summary of, your breadth of experience there.

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Given all of that, what are the top

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three trends you're following in health care and

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ASCs today?

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I I think the the the the first

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one is is pretty common to everybody, and

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that's the

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pressure

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of,

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revenue versus

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our increase in inflationary

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costs

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and how do we keep up with that.

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Particularly for a center like ours that's now

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involved in orthopedics,

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it's

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a careful control of implant costs.

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I think the third one would be a

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better awareness.

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This is a positive one, better awareness of

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the value

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and the

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positive,

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patient experience for surgery centers.

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Some of that came out of the, COVID

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nineteen

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issues a few years ago, and surgery centers

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have certainly become recognized,

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as part of

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a health care system

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as as opposed to fighting our way in

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the door.

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Mhmm.

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And what are you most excited about right

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now?

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The the the thing that excites me the

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most is the possibility

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for some type of cooperative networking,

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that needs to be explored

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among the some of the 70%

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of, surgery centers that are still physician owned.

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I I believe there's,

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inroads that can be made,

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without

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those independent surgery centers selling to

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hospital joint ventures or,

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becoming part of a national surgery center management

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company.

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Yeah. And and that definitely echoes,

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some things I've been hearing about just kind

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of in my reporting here at Becker's. And

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I think that folks in the industry are

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starting to get a little bit more creative

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with,

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how, you know, physician owned facilities can sort

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of align themselves,

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in order to maintain that independence,

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but, you know, kind of move forward in

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the industry and adapt as well.

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There's a there's a

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an independent

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streak,

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despite

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the twenty years that that

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we

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we always talk about a trend of

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joint venturing or or affiliating with a management

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company.

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While those management companies have grown,

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the numbers are still approximately

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the same.

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You know,

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25%

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of all surgery centers are

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are point centered in in some manner,

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but 75%

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of those centers still remain independent physician owned.

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Fueling that, I think, is gonna be,

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we now have groups of younger physicians

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who

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went to the employment model at a hospital,

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and

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they're now maturing

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and finding out that,

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there there's,

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there's some benefit

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to being more independent from the hospital,

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as as they they grow their practice and

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and their ability to

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perform surgery in an outpatient setting.

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And if the hospital's not providing

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that opportunity

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for them in a joint venture,

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some of these physicians are gonna start to

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migrate back to the independent surgery centers.

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Absolutely. Yeah. But, again, just definitely

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falls in line with things I've been seeing

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here at Becker's.

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And how are you thinking about growth over

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the next twelve months?

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Growth over the next twelve months and over

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the next few years is is, I think,

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gonna be, pretty significant.

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There are several factors that have come into

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play.

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One is the one that we just talked

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about, and and that's the recognition of surgery

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centers as a part of the health care

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system.

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Again, part of that grew out of the

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experience of surgery centers being able to be

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more flexible than the hospitals were during the

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the COVID shutdown period.

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Two, hospitals are starting to recognize that certain

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cases,

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if they move out of the main OR,

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even at a lower reimbursement

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rate, allows the hospital to

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fill that, scheduling

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space with, more acute cases,

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either,

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inpatient

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added surgeries

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or,

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elective cases that are are are larger

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orthopedic, cardiac,

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neuro, cases.

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So they see some benefit to

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allowing cases, and it it's no longer a

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competitive

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environment, and the ASCs are no longer accused

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of cherry picking,

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the easy cases to to, you know, to

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take from the hospital.

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There's a collaborative

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atmosphere now

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that recognizes

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the value of of surgery centers. And, certainly,

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the the numbers are showing that the shift

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to

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outpatient surgery

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is gonna continue.

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The growth of surgery centers, I'm seeing,

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you know, more

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individual

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surgery centers being created.

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So there's growth opportunity there.

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The growth opportunity

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per surgery center is pretty much dependent, I

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think, on geography

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and

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the age of your medical staff.

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So

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succession planning is is important to,

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to realize when some of your physicians might

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be retiring.

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And and,

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are they bringing junior partners along

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that

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that can replace them,

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in volume? And

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the the other part of it is that,

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we're there's more public awareness of surgery centers.

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Patients have

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found that that that, you know, what we

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advertise is what we deliver with. We have,

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quality care, low infection rates,

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patient centered care that,

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the patients appreciate

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the the opportunity. And,

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it's easier to schedule cases at a surgery

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center than it is to get elective cases,

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particularly

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orthopedic cases where where sometimes the the orthopod

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is

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is telling the patient that, you know, a

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hospital case is maybe two months out from

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now.

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So those factors are all coming to

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to play now in

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growth

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potential for for surgery centers.

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Mhmm. Mhmm. Absolutely. I like the way you

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kind of illustrated that there. There are, like,

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a number of these sort of larger factors

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playing into,

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the future of every

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individual center there. Anything else to add today

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here, Mark?

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It it depends on, again, on on each

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center.

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Two two things that are that are I

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I hear constantly

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that are important.

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Keeping up on the regulatory

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environment changes,

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it could be state regulation. It could be

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changes in Medicare.

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It could be thinking about what Medicare is

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looking at. For example,

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cataract surgery is the number one procedure performed

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in the country,

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and we all know that reimbursement

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rates have, have not changed very much in

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in the last five years for

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for cataract surgery. At at surgery centers, we

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still have the site of service differential

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that's

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a tremendous factor,

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but

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Medicare

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may be leading the way to move

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cataract surgery

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in particular

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to the office space setting. And some surgery

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centers are gonna have to adjust to that,

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if if that

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trend

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and I know it's I I know they've

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been exploring it, but if that trend continues,

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then then people are gonna have to start

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to rethink some other line of service.

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Mhmm. So that's a that's a big issue.

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Absolutely. Absolutely. And and, again, just totally echoes

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things I'm I'm hearing here on our end.

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So

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all great insights.

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That's actually all I have for you today,

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Mark. Oh, do you have anything else to

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add? The other part the other part that

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I wanted to add to that is is

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not a solicitous

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plug for for Becker's ASC,

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but people need to be plugged into,

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networks where they can exchange information.

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It's Becker's. It's AORN.

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It's outpatient

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surgery magazine.

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It's,

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all sorts of resources.

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So somebody in your center needs to be

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allowed

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and given the time to

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do some of that online. It it's so

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much easier now that that that we can

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clearly communicate online and exchange information.

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But it's not just receiving the information. It's

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taking it to your governing body,

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and having a discussion with the doctors there

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about

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what the implications are of these changes.

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And, also,

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making sure that staff are aware so that

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they understand what they're doing and why they're

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doing it is more important.

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And that pays off both in in,

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the attitude of staff, but certainly when you

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go through accreditation,

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the more the staff

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are informed and know,

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the better they shine

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when when a surveyor comes in and asks,

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well, why are you doing this? Do you

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do you understand

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what's behind the what's the theory behind it?

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So having having somebody that's, involved,

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I think, is very important, and the resources

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are certainly out there.

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Most of them are free. Webinars

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are all over the place, and and you

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have to pick and choose, but I think

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it's worth the time,

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to spend to do that and to educate

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ourselves.

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Mhmm. Mhmm. I'm I'm really glad you added

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that because I think that that's sort of,

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you know again, not to not to bring

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it back to us, but our belief here

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at Becker's is that, you know, everybody can

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do better work if we're all communicating more,

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if people have access to that information. And

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I can only see that making an even

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even bigger difference,

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as, you know, the industry progresses. So thank

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you for adding that. Absolutely.

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Okay. You're welcome.

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Yeah.

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And, yeah, again, just thank you so much

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for joining us.

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It has been a pleasure speaking with you,

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and I look forward to connecting with you

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again in the future.

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Francisca, thank you again for doing this, and

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have a good day. Yep. You too.