Hello everyone. This is Erica Spicer Mason with
Becker's Healthcare. Thank you so much for tuning
into the Becker's Healthcare podcast series today.
So today we're diving into one of the
most dynamic segments in healthcare, ambulatory surgery centers.
Rising costs, value based payment models and shifting
patient expectations
have pushed ambulatory growth from a nice to
have into the center of the C suite
playbook.
And ASCs continue to grow in both volume
and complexity, which is reshaping where and how
care is delivered.
So with all of that in mind, our
episode today is going to cover inside the
modern ASC. We'll cover innovation, partnerships, and performance
and explore the latest trends that are driving
ASC expansion,
as well as the importance of partnership and
the impact for patient experience.
So joining me for this important conversation is
Jimmy Descony, the senior director of healthcare administrator
relations at Arthrex
and Jonathan Kling, the COO of Naples Comprehensive
Health.
Jimmy, John, without further ado, welcome to the
podcast. Thank you so much for being here
today. Thank you, Erica. Thank you. Happy to
be here. Really great to have you both.
And before we get into our conversation and
talk all about ASCs, I'm wondering if you
can both just share a little bit more
about yourselves and the work that you do
in health care.
Jimmy, maybe you could or Jonathan,
feel free. Whoever would like to kick us
off. Jonathan, please. Yeah. Well, good morning.
Jonathan Kling. I'm the, chief operating officer of
NCH.
You you know, NCH is, Naples comprehensive health
here in Naples, Florida.
It's a two hospital system, 715
licensed beds.
But, really, one of the few not for
profit locally owned and government health systems left
in the state of Florida.
This
conversation today is really exciting to be a
part of. I think the strategy we're gonna
talk about here in the next few minutes
is gonna kind of outline what we have
done to remain that locally owned
and governed, not for profit health system that
serves our community while being innovative to the
best of our abilities and partner with the
best in class to achieve those goals.
Looking forward to learning about that. Thanks so
much, Jonathan.
And, Jimmy, tell us about you too. Yeah.
Sure. And thank you.
So like John, I'm a I'm a a
nurse by background. I need to mention it,
but I'm gonna mention it for him. So
we're we're both clinical leaders, and, we're we're
proud of that, background and and experience.
I also, was a hospital chief nursing officer
and hospital CEO, and I came to Arthrex
about eight years ago, so I I did
exit the the hospital and ASC industry,
to really just be be part of something
special here. And Arthrex was accelerating at the
time with with innovations, and,
I get the opportunity to work with, Jonathan
and leaders from around the world now on
a daily basis. So, very exciting to be
part of, the health care community in a
different way.
Oh, it's great to learn more about you
both and great to know as well that
you have this clinical experience that you're bringing
to the table and to your experience with
developing ASCs.
And, Jimmy, I'd like to start with you
for the first question. So
given all of the experience that you have
to date, from where you stand, what major
trends are you seeing shape the ASC landscape
right now? And how have teens adapted to
support this period of really rapid growth?
Yeah. Well, you you mentioned one of them
already. It's just the the increasing in, in
complexity. Is
a challenge in of itself. But
certainly can't go without saying, you know,
payers,
or steering cases, you know, out of hospital
inpatient to either outpatient or ASCs.
The margin pressures that that Jonathan and and
his team and others are facing.
I I would say that the increase in
joint ventures consolidation, there there's a there's a
ripple effect around that that Becker's has done
a nice job highlighting,
weekly,
and so I follow that very closely. The
CON laws change is another big one. You
know, North Carolina's next year,
on the docket with CON laws changing, and
so that that creates opportunity and and,
chaos in some ways,
but certainly, a competitive landscape.
Can't go without saying the potential regulatory changes
here, as CMS finalizes their rule,
here in November.
And and so a lot of discussion around
that at your recent conference that I attended
in Chicago.
And then, I I think for us, it's
how do you match up the innovation,
that's relevant to the changes that are happening
today and over the next, several years in
the ASC business? So I gave you a
handful there, but, certainly, each, we could go
on for an hour on each of those.
But, I'll turn it over to you and
Jonathan, for some follow-up.
Sure.
Yeah. I mean, I appreciate you highlighting
the many areas where ASCs are are seeing
a lot of significant shifts. So you've touched
on complexity,
steering patients out of inpatient toward the outpatient
space, consolidation, CUN laws, regulatory changes. I mean,
there's a lot happening here.
And John, I know where where you sit
with your organization
at NCH, you've mentioned that there's been some
growth. And I know building a new ASC
was actually a cornerstone of your expansion strategy
for your organization. So can you say a
little bit about what really drove that decision
and how it aligns with the kind of
broader goals for access as well as growth?
Yes. Yes. Jimmy, they're really a lot of
key factors. One of those was, you know,
the the payer and access puck was going
that way on the ice already.
So but what and so we set we
had about four and a half years ago,
we had a board strategic session, and the
ASC strategy was one of the top agenda
items.
At that time, we did not have any
ASCs in our health system, but with the
way the payers were kinda pushing those more
complex cases that are traditionally done in acute
care hospital,
it kind of it it it forced our
hand to go a little quicker than we
thought we were going to.
You know, fast forward four years, here we
are. We're talking about this beautiful ASC we
built, but it's more than just beautiful brick
and mortar. I think the driving strategy was
our board said, be the best, partner with
the best.
We we don't want just a good ASC.
We want the world's best ASC.
And that's when we partner with the hospital
for special surgery in New York to drive
some of our strategies around their quality. They
have a the world's best orthopedic hospital for
many years running. And then, you know, being
right across the street from Arthrogs here, the
natural synergies are on innovation,
clinical integration, physician led decision making,
and integrating technology into, ASC
that really drives education,
research, and quality.
That was our foundational principles for this project,
and it's been highly successful. It was a
great process throughout, and we'll talk more about
it the rest of this podcast, but very
exciting times here in Naples.
Yeah. Oh, absolutely. I appreciate you sharing those
exciting developments, John. And this partnership with Hospital
for Special Surgery, I mean, sounds like it
was a very intentional partnership. I think you
mentioned how your board wanted this to be
the world's best new ASC. So what a
goal to aim toward. And can you just
say a little bit more about how that
partnership with hospital for for special surgery has
really helped from a business and a patient
care standpoint?
Yes. I think if you look at the,
their best in class policies and procedures and
how they take care of the patients and
the whole continuum of that patient journey,
It's really it's really best practice. And he
so what we try to do here was
integrate our culture here at Naples Comprehensive Health
with best practices from our partners up in
New York and look at the how the
process works. For example,
this is not your traditional ASC that has
generalist
for orthopedics, for example.
Our orthopedic surgeons, they specialize in one area.
So when when you have somebody comes in
that only does shoulders, only does knees, only
does hips, only does hands, that kind of
specialized care
is really, what we were looking for. We
wanted to differentiate ourselves in this market, in
The States, in the country, actually,
that, you know, attritional ASCs, in my experience,
in my knowledge, you have a lot of
generalists, and that's not a bad thing. But
we chose to invest a little bit more
heavily
in, the number of surgeons and focus them
on one subset of their work, and that
was it. And finally, we wanted to make
sure that they were all fellowship trained in
that subspecialty.
And so there isn't one like that in
our market to my knowledge. And so I
think that really from a patient perspective,
if you know you're going to, a surgeon
that he or she only does one thing
every single day,
all week, all year for their career,
quality is the driving force behind that decision.
So that's exciting as a clinician myself to
be able to bring that to a community
and offer that world class care right here
in Southwest Florida. More of that factory mentality?
Yes. Yes.
Yeah. Yeah. And I know quality has come
up a number of times, John. And based
on what you just described, I can see
how that that's been a driving force in
that area.
And really this idea of partnerships,
Jimmy, we're seeing partnerships play a growing role
in modern ASC operations.
So I'd love to hear from your perspective
why you think partnerships are really necessary to
help address the complexities that ASCs face today.
And, really, how is your team working to
help ASCs enhance performance and also efficiency?
Yeah. Erica, I I think the first thing
that comes to to my mind is
somebody has to innovate. And and and I
can tell you because I've spent twenty five
years in the hospital and ASC world that
it's the most complex enterprise that exists. And
whether it's a lack of resources, a focused
effort,
you know, the the talent and the expertise
to innovate, and a lot of health systems
can do it. It's certainly difficult for ASCs.
And I I I think the bottom line
is
health systems, hospitals, ASCs, ASC management companies, they
can't go at it alone.
You you have to have industry partners,
you know, like Arthrex. And and and, certainly,
if if anyone knows about Arthrex, right, we're,
we're a pioneer in the ASC space with
our minimally invasive technologies for for decades now,
almost over forty years. And so
I I think of
not going at it alone is is what,
you know, I think drives a lot of
my thought process. But we also believe that
every patient deserves access to innovation.
So John mentioned, you know, patient centric, physician
centric mentality here, and and this focus factory
model is is important.
And so we're anticipating the needs. We're already
inventing technologies,
that'll come out in the next three to
five years
that'll be relevant,
with with this migration of cases and and
what what the ASCs and and hospital joint
venture partners as well, you know, or even
the management companies for that matter. And so
we we feel a responsibility
to be, the innovative partner,
and we're really hyper focused on growth and
efficiency. So, you know, John mentioned this new
project,
super exciting.
We feel it's one of the most advanced
and efficient
ASCs in the world at this point, and
there's lots of different reasons for that. And
the technology can enable
different levels of efficiencies.
And we know, Erica, that that time is
is a big driver. So if we can
help reduce time or surgical steps,
and we can train the whole team
to know the procedures,
the whole team is more efficient. The the
pull through that John and his team will
see, the increase in patient experience scores, the
outcomes,
you know, all those things will happen if
we can be more efficient. Think of it
this way. And and John and I are
both clinicians by background.
If we're reducing time under general anesthesia, you
know, what happens? Right? We're reducing risk. Or
no anesthesia or locals only. Right? Yeah. Great
point. So we've invented
some new technologies, a nano needle scope, where
we can actually move procedures out to procedure
rooms and use the main ORs for more
complex,
you know, cases,
higher margin cases,
and and increase utilization of how John and
his team are using ORs and procedure rooms,
so that whole throughput equation. And, ultimately, it
helps the patient experience
and, and and things like that. So for
us,
a big driver was we need to stand
up a a program and a platform. So
we stood up what's called the Arthrex Surgery
Center Innovation Program or ASCX.
So we opened up our planning and design
studio here on our global headquarters in Naples,
Florida. It's for hospitals, ASCs,
and ASC management companies, but you're gonna hear
us promote more around the ASCX,
brand.
And we have a group of trusted partners
can help with design, planning, construction management, whatever
the customer needs. We're flexible there.
And John and his team were one of
the the early adopters here of this, platform,
and I'll certainly let him speak to how
that worked for him and his team. But
we we just feel like
the competitive environment
is heating up,
and we we find customers turning to us
as as the innovator to find ways to
help them be become more competitive because we
all know
growth is about, you know, efficiencies. It's about
quality. It's about adding real value. That's what
true partnerships do. It's just not transactional at
this point. So I'll pause there for John's
feedback. Yeah. That's that's well said, Jimmy. I
think to add a little more color from
my perspective or my lens here is,
you know, partnering with, Hospital for Special Surgery
and Arthrex,
not only is best in class in both
clinical and innovation and technology,
But when we wanna differentiate ourselves here for
this ASC, I mentioned a few things already
around the education component, the research.
But to have a type of surgeon that
wants to do those things, it's not really
easy to find. And having the ability to
participate in clinical trials,
with the hospital special surgery for being able
to do intellectual property things to to to
research and development,
those are the kind of surgeons that want
to be a part of something special.
But most important, what that leads to is
innovation first in human types of procedures.
We fully anticipate with our relationships that we've
established here for this world class ASC that
there'll be many first in human things in
the MSK realm.
You know, we've already done a few things
already that, we're proud to offer.
And, really, the whole ASC design is meant
to to be
an enabler of research, education, and training.
And so as as a as a nurse
and myself and seeing patients for the last
twenty five years in health care, I heard
so many patients say, I came here because
I knew that you were doing clinical research.
I came here because you have the best
technology.
And so and we never we didn't have
that in the AC. Attrition of the AC
is very low margin, you know, volume, volume,
volume, and we're taking an approach where
the quality will drive high volume that drives
a different margin. And and, eventually, the payers
will recognize that this is not your traditional
ASC.
But the way it's re the way it's
set up for quality and outcomes,
reputation,
it's it should drive higher payer contracts down
the road. And that's, you know, the the
mission's coming before the margin, so to speak.
Mhmm. But I think, we're starting with the
the quality mission always, and I think good
things will follow because we have good partners.
Yeah. And, John, I appreciate you elaborating a
bit more on your partnerships and especially the
ASCX program. It sounds like it's really been
a differentiator
for NCH, and it's been something that's
enabled your organization to attract
potentially other members of the workforce who you're
looking for, you know, especially those,
specialized surgeons that you've mentioned. So aside from
staffing, are there other
favorable outcomes that you'd wanna highlight or or
anything else that you'd like to share in
terms of, you know, benefits you've seen from
joining this program?
Yeah. I think, one of the things that
really has surprised us is that how fast
the word got out about what we've built
here.
That's obviously because of our partners, but, HSS
and Orthorex,
so we're blessed to have that relationship.
But at least 10 organizations come across the
country to take a tour of our facility,
understand, hey. Why'd you guys do this? How
did you all do this?
Can we check out how you did your
planning session because it was so fast? We
built a very large facility and, that is
very unique. It actually is one of the
few, if only the one, in South in
Southeast United States that has a five o
r ASC that also has an inpatient
hospital units, inpatient ORs,
clinic, inpatient physical therapy, outpatient physical therapy, all
under one umbrella. And we did that in
about seventeen months because we took advantage of
our relationship with Arthrex
and the, CDOx and them, and they're able
to do the the design process
really quickly, but most importantly, with our physicians
involved in the in the process.
We're we're a clinically driven organization. I know
most of us are. We all are or
we should be.
But having the surgeons in the holodeck, so
to speak, we'll talk a bit more about
that in a second. But having them walk
through the designs,
it really dramatically changed the change order number
volume of change orders
and the ability to do it really quickly,
but also with the highest quality, facility that
really, it's and it's it's exceeding our performer
expectations already at three months in. So
Erica, for for the listeners, John mentioned a
room on our campus here called the Holodeck.
So I'll just add a clarifying comment or
two here. Thank you. So we, essentially, we've
built an LED room. So we have the
ability to bring blueprints to life. We can
render
fly throughs of the spaces,
live edits to to blueprints and plans.
And and so it's really an exceptional room,
to our knowledge. We're the only med tech
company in the world that possesses this technology,
and it helped enable efficiencies. It helped
cost avoidance. John mentioned change orders. Right? That's
that's usually a 6 figure item.
And to get get a consensus sooner, the
the power of deploying our technology and our
expertise,
certainly paid off because, seventeen months is fast,
and time matters. Right? When you go through
licensing accreditation, you can open sooner, things like
that. And so,
delighted to to have John and
and his team at NCH,
and others, involved in this, this project. And
and it it is a destination. And I
think John said something important in the beginning
here.
They made the decision
to build something different.
Anyone can choose to build an ASC like
any other ASC in the corner, but this
not only gives them competitive advantage, this will
draw patients and staff and and others that
wanna be a part of something special. So
I think that was a really key point
you hit on there, John. Yeah. And one
of the things that we talked about, Jimmy
hit on this earlier as well, about minimally
invasive,
no anesthesia, or little anesthesia. I think we've
also,
partnered with Arthrex,
some nanoarthroscopy
suites, and those are not behind the red
line, the sterile line.
And as you look at the way technology
is with, minimally invasive cameras and scopes and
and procedures,
things that were always done in the traditional
OR are now are now being done under
local. Right? And so and, you know, hand
surgeon can do twenty, twenty five cases and
not ever have to go into the OR.
You know you know, foot and ankle surgeons
can do a lot of things out there
and many, many more. I think
we went into the design process
with our thorax as our as our design
partners and their technology
with zero nanoarthroscopy
suites and plan. We came out with four
Because, you know, after talking with our surgeons,
like, hey. You know, I can do this
and not not need general anesthesia. Wow. How
much more efficient can I be as a
surgeon? I I I wanna be home and
see my family at 5PM, not 10PM.
Those are, you know, work life balance matters.
When you have a happy surgeon, that equates
to happy patients, and that's the most important
thing inefficiencies because the, you know, the margin
is getting smaller and smaller in health care.
Everybody knows that. That's I'm not saying anything
new. But how do you
change your model, change your mindset, and be
disruptive in the minimally invasive space was a
a big strategy for us during this process.
You have the challenges to ask well. Yeah.
Yeah. Well, Jimmy, Jonathan, this has been such
a a great conversation. I think one that's
really highlighted,
what's possible with deeply intentional partnerships,
a really strong vision for a best in
class ASC, and how that drives some really
significant gains in efficiency, physician satisfaction, and more.
I just can't thank you both enough for
joining Becker's today. Before we close, is there
anything else that you wanted to share with
our listeners? Any final takeaways?
Yeah. I think the takeaway, if you hear
one thing from me today, it's
that be disruptive around quality and everything else
follows.
Take a chance.
I know that, most health systems don't have
a lot of capital to do this, and
we didn't either.
But we took that investment. Our board support
it because the board vision was bringing the
best, be the best no matter what it
costs,
and the margin will follow. So if you
focus on that, being the best, be disruptive,
have your mindset to be the you wanna
be different in your market, I think you
you can't
lose. Yeah. That's great, John. And, you know,
you've also been early adopters on the endoscopic
spine. So there are, you know, these technologies
that that you're all interested in, and and
we appreciate that that true partnership.
And I love what you said. You know,
lead in with quality and everything else follows.
Invest in your people,
and, of course, the technology that's enabling.
So, you know, really, my final comments for
the listeners would be
encourage you to work with the local Arthrex
agency partners.
Go to arthrex.com,
find more information, follow our ASCX
LinkedIn channel.
You'll see recent visits from customers from around
the world.
You'll learn about some of the newer technologies
that are being deployed and,
encourage a visit to our campus here in
Naples, Florida
because it's hard to emulate this in the
field. So, you have to be here to
experience it. And,
maybe John would allow some some tours at
his facility as well. I would absolutely love
to do that. Listen to Jimmy talk. Kinda
motivated me. I have one more comment. We're
also getting involved with arthritis in the carathoracic
space. Why can't vascular and carathoracic be in
the ASC setting for specific
procedures and surgeries? So we're looking to be
disruptive in our multi specialty ASC, not just
the orthopedic one. So it's, it's that's been
a really great opportunity for us too with
the arthritis. I want to thank you guys
for that partnership as minimally invasive carotidactic is
really coming into vogue too. So a lot
of opportunity. We're in it together, John.
Well, again, John, Jimmy, this has been such
a great conversation. Appreciate the passion that you
brought to it as well that really came
through throughout the episode. So thank you again
for making the time for Becker's today. And
of course, we'd also like to thank our
podcast sponsor, Arthrex.
Listeners, be sure to tune into more podcasts
from Becker's by visiting our podcast page at
beckershospitalreview.com.