Looking for a solution that helps alleviate administrative
tasks for your staff and also helps your
patients cover their out of pocket health care
expenses?
Find what you're looking for from CareCredit because
CareCredit is a credit card and more. It's
a helping hand for staff and a flexible
payment solution for patients. For over thirty years,
CareCredit, a Synchrony solution, has offered patients a
credit card with promotional financing options to get
the care they want while helping staff do
what they do best, provide care. To learn
more, visit carecredit.com
forward slash beckerspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are recording live at the
thirty first annual business and operations of ASCs.
I'm currently joined by Greg Schuler, who is
the chief operating officer at Cincinnati GI, CGI
Anesthesia
Associates,
and Anderson Endoscopy
Center. So thank you for being here, Greg.
Let's have us start off by having you
share a little bit more about yourself and
your work in the ASC space.
Okay. Well, I kinda go back to the
dawn
of, ASCs,
and,
I've worked for
a number of companies including surgery center partners,
endo center partners. So I built all kinds
of different ASCs, whether it was eye centers,
endoscopy centers, multi specialty centers, pain centers.
I currently,
we own a couple centers that I built,
and we have an endoscopy center that right
now did thirteen thousand cases last year. It's
a real busy center, five rooms.
I've also worked in private equity
and helped roll up the largest nephrology practice
in The United States. We had 63 nephrologists
and 23 dialysis centers.
Well, I've had a long career in a
lot of different specialties, neurosurgery, you arrive run
a urology practice. So long time, almost thirty
five years in medicine, medical management.
Wonderful. Well, thanks for taking the time to
join me today, and let's start our conversation
regarding the ASC market. In The US, this
is projected to reach sixty point eight billion
dollars by 2030 and continues to experience strong
year over year growth. So from your perspective,
what are the most significant trends and market
forces driving this expansion, and how should ASC
leaders be preparing today?
Well, as you know, there's a lot of
new centers be still being built,
and I think the insurance industry is driving
some of that because they realize what a
cost savings they have there, and the quality
is equivalent or better.
So, I mean, for example, UHC,
when when we get a UHC patients,
they will waive the pre cert and the
or and or the prior authorization
if they come to an ASC versus going
to a hospital.
Also, there's no, price parity right now, although
that's probably gonna happen in the future. But
right now, most of the hospitals, if they
have an HOPD, for example, are probably bringing
in two to three times the money that
we get paid for the equivalent procedure.
So I think it's a real positive trend
for,
ASCs,
and I think the challenge for ASCs going
down the road is to avoid being
gobbled up, so to speak, by a hospital
or by a private equity firm. And I
just gave a talk this morning where I
gave some really, I think, profound reasons for
staying independent
and some strategies
for being able to do that.
And from AI and robotic surgeries to advanced
EHR systems, technology remains both a make or
break factor and a critical driver of ASC
operations at scale.
How do you see deeper tech integration shaping
the way ASCs deliver care and manage their
business over the next few years?
Well, we were one of the first to
adopt
AI enhanced colonoscopy.
In the market we're in in Cincinnati, Greater
Cincinnati,
we were first to market with with, Medtronic
system called GI Genius. And so we we
did, institute that, implement that long before the
hospital,
the university,
any of the other practices in town. We
also are using AI now to do our
charting,
and it's a good augmentation to our charting.
You can walk in the room with
your phone or a laptop, talk to the
patient.
It'll take all that information
and what's been collected by the medical assistant
or
at the front desk,
integrate all that into a chart note, which
obviously you have editorial control over, but it
really saves a lot of time because it
does a very good job of doing that,
and it helps you pick out your e
and m code, the ICD 10 code, and
what level of e and m code you
select. So it really helps you also kinda
get your billing down right, which I find
is kind of a problem for some of
our mid level providers for our NPs or
PAs.
So those are the things I see in
terms of
AI. And then, you know, in terms of
technological innovations, I mean,
the in GI, the the quality of the
scopes, the imaging,
the drivability of the scopes. I mean, there
is just a ton of things that are
improving over the years. So I I see
a pretty rosy future for technological innovation.
Wonderful. And I guess follow-up to that, is
there one technology or innovation in specific that
stands out to you as especially transformative?
Well, I think AI is. I mean, you
know, we're tracking the,
ADR rate. They call it, adenoma detection rate.
And that we're not finding a huge bump.
If you're a good endoscopist, you're not gonna
increase that terribly.
But if you're a younger guy in training
or somebody who's maybe a less skilled provider,
it's wonderful. I mean, doctor Rex at IU
is,
extremely,
strong on this, and he's one of the
guys that frankly invented endoscopy. You know? Doug
Rex is somebody that almost any GI doctor
would say, oh, yeah. I know doctor Rex.
So,
so I I really think that's probably gonna
be the biggest driver, which it is in
a lot of areas.
You know, really nothing in instrumentation
change in our specialty.
But, I mean, there's always innovations. My, ex
wife is a neurosurgeon, and some of the
things I've seen happen in neurosurgery over the
years are amazing. You know, frameless stereo taxi
and,
some of the new gamma knife stuff. So
I you know,
as long as they fund the research, we're
gonna continue to improve the technology.
Absolutely.
And with 60% of health systems considering ASC
joint ventures and many ASCs already partnering with
systems in their communities,
What opportunities do you see for collaboration whether
with other providers or vendors, to strengthen patient
care and operational efficiency?
Well, I'm not a fan of collaboration
actually,
to be blunt.
I think there's a lot of lot to
be severed being an independent practice because when
you look at the studies and they look
at market penetration of
private equity and they look at market penetration
of employed hospital physicians,
it really,
the per capita cost for health care is
higher when there's a higher
market penetration of PE or hospital ownership.
So I think that's rule one from my
point of view for why it's important to
try and stay independent if you already are.
There are reasons you might wanna sell your
practice if you have an aging physician population,
you have a very busy senate center and
you wanna monetize that? Well, I'm okay with
that. But I think if you have a
center with, with a profile of physicians throughout
their career, where they're at in their careers,
and you're doing a healthy volume, I think
there's plenty of things you can do to
keep that center independent.
I talked about some of those this morning
at a talk I gave. But I think
one of the things you can do and
I do enjoy,
relationships with hospitals in the Cincinnati market. We're
in the PHO for one and an ACO
for another,
and that brings in patients. The PHO brings
in an additional 243,000
covered lives
that we we take care of. So, the
ACO that we belong to in that hospital
system does all our MIPS MACRA,
which saves us at least a full time
employee because it's an awful lot of work.
So I think there's a lot of opportunity
for collaboration. But in terms of actual, selling,
I think, you know, if you sell 51%,
there's a governance issue. If you sell less
than that, you know, you still have a
cultural mismatch there necessarily.
I can recall one time I brought some
nurses from a hospital system that wanted us
to manage their center, which was an hospital
outpatient department center. And I brought the nurses
down to our center,
and,
I had to tell them frankly, it was
a busy Monday. Monday and Friday are the
busiest days in a a east in, endo
center. I said, please don't stand in one
place too long or you're gonna get run
over.
And they were I their jaws were open
because everybody was moving around so fast, and
I find that in the hospital, there's not
that
morale maybe or or concern for how fast
you get things done, but our efficiency is
pretty amazing in a private center. So I
see a lot of reasons. The care is
great. Our center, four years running, has been,
the Newsweek Statista,
highest ranked quality wise, and they use publicly
available data like CMS in the whole state
of Ohio. So, I mean, doing a lot
of cases is also a a key. The
more you do, the better you do. That's
true in almost any specialty.
So
I I really think, you know, efficiency is
important.
Good care is more important, but you can
do both those things.
Is there anything else we didn't touch on
or any final thoughts you'd like to share
as we wrap up our conversation today?
Well, I I gotta say, I think the
I mean, I've been doing this a long
time, and I think the key
to all the success you have with any
center, I don't care if it's an eye
center or
a endo center or a ortho center or
a pain center or whatever it is is
the employees you have working there, your nurses,
your anesthetists. We use a lot of CRNAs.
We have our own anesthesia company.
That is the key. You know, I I
was once offered a center and I can't
remember which one of the big guys it
was, USPI,
SCA, whoever it was. They literally offered me
a center for nothing.
And I went and looked at it. It
was a four room center. It was really
nice. It was in a real nice office
building. I they left they said you can
have all the OR equipment. I looked through
all that. It was all great. I needed
some new OR lights. That was about it.
The furniture, and we'll give you $300,000.
And I said no. You know why? Because
I didn't have any doctors to put there.
That center is worth nothing, literally. They were
just getting rid of their low hanging fruit,
you know. And if somebody would take it
under one condition and that was signed the
long term lease,
they just wanted it off their books. So,
I mean, that's just one simple example of
what I'm saying. You know, the key to
success is having great employees and creating an
environment so those people will be recruited and
retained.
Absolutely.
Well, thanks so much for joining me today
on the Becker's Healthcare Podcast to share these
insights. Again, we are recording live at the
thirty first annual business and operations of ASCs.
Thank you very much.