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To learn 13 00:00:30,649 --> 00:00:32,929 more, visit carecredit.com 14 00:00:32,929 --> 00:00:34,789 forward slash beckerspodcast. 15 00:00:35,729 --> 00:00:37,729 This is Gracelyn Keller with the Becker's Healthcare 16 00:00:37,729 --> 00:00:39,649 Podcast, and we are recording live at the 17 00:00:39,649 --> 00:00:42,549 thirty first annual business and operations of ASCs. 18 00:00:43,175 --> 00:00:45,495 I'm currently joined by Greg Schuler, who is 19 00:00:45,495 --> 00:00:49,195 the chief operating officer at Cincinnati GI, CGI 20 00:00:49,335 --> 00:00:49,835 Anesthesia 21 00:00:50,135 --> 00:00:50,635 Associates, 22 00:00:51,015 --> 00:00:52,315 and Anderson Endoscopy 23 00:00:52,935 --> 00:00:55,175 Center. So thank you for being here, Greg. 24 00:00:55,414 --> 00:00:57,340 Let's have us start off by having you 25 00:00:57,340 --> 00:00:58,859 share a little bit more about yourself and 26 00:00:58,859 --> 00:01:00,320 your work in the ASC space. 27 00:01:00,700 --> 00:01:02,219 Okay. Well, I kinda go back to the 28 00:01:02,219 --> 00:01:02,719 dawn 29 00:01:03,100 --> 00:01:04,240 of, ASCs, 30 00:01:05,260 --> 00:01:05,659 and, 31 00:01:06,459 --> 00:01:07,680 I've worked for 32 00:01:07,980 --> 00:01:10,540 a number of companies including surgery center partners, 33 00:01:10,540 --> 00:01:12,995 endo center partners. So I built all kinds 34 00:01:12,995 --> 00:01:15,254 of different ASCs, whether it was eye centers, 35 00:01:15,635 --> 00:01:19,094 endoscopy centers, multi specialty centers, pain centers. 36 00:01:20,515 --> 00:01:21,094 I currently, 37 00:01:22,275 --> 00:01:24,295 we own a couple centers that I built, 38 00:01:25,234 --> 00:01:27,989 and we have an endoscopy center that right 39 00:01:27,989 --> 00:01:30,189 now did thirteen thousand cases last year. It's 40 00:01:30,189 --> 00:01:32,010 a real busy center, five rooms. 41 00:01:32,790 --> 00:01:34,489 I've also worked in private equity 42 00:01:35,590 --> 00:01:37,989 and helped roll up the largest nephrology practice 43 00:01:37,989 --> 00:01:40,329 in The United States. We had 63 nephrologists 44 00:01:40,469 --> 00:01:42,250 and 23 dialysis centers. 45 00:01:42,844 --> 00:01:44,204 Well, I've had a long career in a 46 00:01:44,204 --> 00:01:46,844 lot of different specialties, neurosurgery, you arrive run 47 00:01:46,844 --> 00:01:49,805 a urology practice. So long time, almost thirty 48 00:01:49,805 --> 00:01:51,825 five years in medicine, medical management. 49 00:01:52,444 --> 00:01:54,284 Wonderful. Well, thanks for taking the time to 50 00:01:54,284 --> 00:01:56,864 join me today, and let's start our conversation 51 00:01:57,244 --> 00:01:59,859 regarding the ASC market. In The US, this 52 00:01:59,859 --> 00:02:02,439 is projected to reach sixty point eight billion 53 00:02:02,500 --> 00:02:05,540 dollars by 2030 and continues to experience strong 54 00:02:05,540 --> 00:02:07,879 year over year growth. So from your perspective, 55 00:02:07,939 --> 00:02:10,020 what are the most significant trends and market 56 00:02:10,020 --> 00:02:12,500 forces driving this expansion, and how should ASC 57 00:02:12,500 --> 00:02:13,959 leaders be preparing today? 58 00:02:14,465 --> 00:02:15,664 Well, as you know, there's a lot of 59 00:02:15,664 --> 00:02:17,444 new centers be still being built, 60 00:02:17,745 --> 00:02:19,985 and I think the insurance industry is driving 61 00:02:19,985 --> 00:02:22,224 some of that because they realize what a 62 00:02:22,224 --> 00:02:24,384 cost savings they have there, and the quality 63 00:02:24,384 --> 00:02:25,764 is equivalent or better. 64 00:02:26,144 --> 00:02:28,084 So, I mean, for example, UHC, 65 00:02:29,260 --> 00:02:31,760 when when we get a UHC patients, 66 00:02:32,139 --> 00:02:34,420 they will waive the pre cert and the 67 00:02:34,620 --> 00:02:36,319 or and or the prior authorization 68 00:02:37,099 --> 00:02:39,260 if they come to an ASC versus going 69 00:02:39,260 --> 00:02:40,000 to a hospital. 70 00:02:40,620 --> 00:02:43,340 Also, there's no, price parity right now, although 71 00:02:43,340 --> 00:02:45,925 that's probably gonna happen in the future. But 72 00:02:45,925 --> 00:02:47,685 right now, most of the hospitals, if they 73 00:02:47,685 --> 00:02:50,324 have an HOPD, for example, are probably bringing 74 00:02:50,324 --> 00:02:52,485 in two to three times the money that 75 00:02:52,485 --> 00:02:54,504 we get paid for the equivalent procedure. 76 00:02:55,444 --> 00:02:57,384 So I think it's a real positive trend 77 00:02:57,444 --> 00:02:57,944 for, 78 00:02:59,120 --> 00:02:59,620 ASCs, 79 00:03:00,080 --> 00:03:02,639 and I think the challenge for ASCs going 80 00:03:02,639 --> 00:03:04,900 down the road is to avoid being 81 00:03:05,199 --> 00:03:07,280 gobbled up, so to speak, by a hospital 82 00:03:07,280 --> 00:03:09,520 or by a private equity firm. And I 83 00:03:09,520 --> 00:03:11,039 just gave a talk this morning where I 84 00:03:11,039 --> 00:03:13,544 gave some really, I think, profound reasons for 85 00:03:13,544 --> 00:03:14,444 staying independent 86 00:03:14,824 --> 00:03:15,805 and some strategies 87 00:03:16,185 --> 00:03:17,805 for being able to do that. 88 00:03:18,745 --> 00:03:21,485 And from AI and robotic surgeries to advanced 89 00:03:21,544 --> 00:03:24,425 EHR systems, technology remains both a make or 90 00:03:24,425 --> 00:03:26,425 break factor and a critical driver of ASC 91 00:03:26,425 --> 00:03:27,645 operations at scale. 92 00:03:28,340 --> 00:03:30,740 How do you see deeper tech integration shaping 93 00:03:30,740 --> 00:03:32,979 the way ASCs deliver care and manage their 94 00:03:32,979 --> 00:03:34,680 business over the next few years? 95 00:03:35,139 --> 00:03:36,580 Well, we were one of the first to 96 00:03:36,580 --> 00:03:37,080 adopt 97 00:03:37,539 --> 00:03:38,680 AI enhanced colonoscopy. 98 00:03:39,539 --> 00:03:41,780 In the market we're in in Cincinnati, Greater 99 00:03:41,780 --> 00:03:42,280 Cincinnati, 100 00:03:43,194 --> 00:03:46,094 we were first to market with with, Medtronic 101 00:03:46,235 --> 00:03:48,875 system called GI Genius. And so we we 102 00:03:48,875 --> 00:03:51,675 did, institute that, implement that long before the 103 00:03:51,675 --> 00:03:52,175 hospital, 104 00:03:52,794 --> 00:03:53,534 the university, 105 00:03:54,314 --> 00:03:56,580 any of the other practices in town. We 106 00:03:56,580 --> 00:03:58,340 also are using AI now to do our 107 00:03:58,340 --> 00:03:58,840 charting, 108 00:03:59,219 --> 00:04:01,459 and it's a good augmentation to our charting. 109 00:04:01,459 --> 00:04:03,080 You can walk in the room with 110 00:04:03,459 --> 00:04:05,459 your phone or a laptop, talk to the 111 00:04:05,459 --> 00:04:05,959 patient. 112 00:04:06,500 --> 00:04:07,959 It'll take all that information 113 00:04:08,500 --> 00:04:11,239 and what's been collected by the medical assistant 114 00:04:11,379 --> 00:04:11,879 or 115 00:04:12,235 --> 00:04:13,294 at the front desk, 116 00:04:13,914 --> 00:04:16,314 integrate all that into a chart note, which 117 00:04:16,314 --> 00:04:18,555 obviously you have editorial control over, but it 118 00:04:18,555 --> 00:04:20,394 really saves a lot of time because it 119 00:04:20,394 --> 00:04:21,834 does a very good job of doing that, 120 00:04:21,834 --> 00:04:23,194 and it helps you pick out your e 121 00:04:23,194 --> 00:04:25,560 and m code, the ICD 10 code, and 122 00:04:25,560 --> 00:04:27,079 what level of e and m code you 123 00:04:27,079 --> 00:04:29,319 select. So it really helps you also kinda 124 00:04:29,319 --> 00:04:31,399 get your billing down right, which I find 125 00:04:31,399 --> 00:04:32,759 is kind of a problem for some of 126 00:04:32,759 --> 00:04:35,160 our mid level providers for our NPs or 127 00:04:35,160 --> 00:04:35,660 PAs. 128 00:04:36,279 --> 00:04:37,720 So those are the things I see in 129 00:04:37,720 --> 00:04:38,459 terms of 130 00:04:38,839 --> 00:04:40,895 AI. And then, you know, in terms of 131 00:04:40,895 --> 00:04:42,915 technological innovations, I mean, 132 00:04:43,375 --> 00:04:46,014 the in GI, the the quality of the 133 00:04:46,014 --> 00:04:47,314 scopes, the imaging, 134 00:04:48,175 --> 00:04:50,014 the drivability of the scopes. I mean, there 135 00:04:50,014 --> 00:04:51,694 is just a ton of things that are 136 00:04:51,694 --> 00:04:53,889 improving over the years. So I I see 137 00:04:53,889 --> 00:04:56,389 a pretty rosy future for technological innovation. 138 00:04:57,250 --> 00:04:59,410 Wonderful. And I guess follow-up to that, is 139 00:04:59,410 --> 00:05:01,730 there one technology or innovation in specific that 140 00:05:01,730 --> 00:05:03,589 stands out to you as especially transformative? 141 00:05:04,370 --> 00:05:05,889 Well, I think AI is. I mean, you 142 00:05:05,889 --> 00:05:07,089 know, we're tracking the, 143 00:05:08,084 --> 00:05:11,045 ADR rate. They call it, adenoma detection rate. 144 00:05:11,045 --> 00:05:12,964 And that we're not finding a huge bump. 145 00:05:12,964 --> 00:05:15,225 If you're a good endoscopist, you're not gonna 146 00:05:15,685 --> 00:05:16,985 increase that terribly. 147 00:05:17,444 --> 00:05:19,464 But if you're a younger guy in training 148 00:05:19,605 --> 00:05:22,504 or somebody who's maybe a less skilled provider, 149 00:05:22,979 --> 00:05:26,099 it's wonderful. I mean, doctor Rex at IU 150 00:05:26,099 --> 00:05:26,500 is, 151 00:05:27,779 --> 00:05:28,279 extremely, 152 00:05:29,620 --> 00:05:30,819 strong on this, and he's one of the 153 00:05:30,819 --> 00:05:34,019 guys that frankly invented endoscopy. You know? Doug 154 00:05:34,019 --> 00:05:36,675 Rex is somebody that almost any GI doctor 155 00:05:36,675 --> 00:05:38,615 would say, oh, yeah. I know doctor Rex. 156 00:05:38,834 --> 00:05:39,154 So, 157 00:05:39,634 --> 00:05:41,314 so I I really think that's probably gonna 158 00:05:41,314 --> 00:05:42,915 be the biggest driver, which it is in 159 00:05:42,915 --> 00:05:43,814 a lot of areas. 160 00:05:44,754 --> 00:05:46,454 You know, really nothing in instrumentation 161 00:05:46,754 --> 00:05:47,894 change in our specialty. 162 00:05:49,180 --> 00:05:51,899 But, I mean, there's always innovations. My, ex 163 00:05:51,899 --> 00:05:53,740 wife is a neurosurgeon, and some of the 164 00:05:53,740 --> 00:05:55,579 things I've seen happen in neurosurgery over the 165 00:05:55,579 --> 00:05:58,240 years are amazing. You know, frameless stereo taxi 166 00:05:58,300 --> 00:05:58,800 and, 167 00:05:59,259 --> 00:06:01,180 some of the new gamma knife stuff. So 168 00:06:01,180 --> 00:06:02,079 I you know, 169 00:06:03,034 --> 00:06:04,634 as long as they fund the research, we're 170 00:06:04,634 --> 00:06:06,414 gonna continue to improve the technology. 171 00:06:07,514 --> 00:06:08,014 Absolutely. 172 00:06:08,555 --> 00:06:11,675 And with 60% of health systems considering ASC 173 00:06:11,675 --> 00:06:14,474 joint ventures and many ASCs already partnering with 174 00:06:14,474 --> 00:06:15,694 systems in their communities, 175 00:06:16,199 --> 00:06:18,600 What opportunities do you see for collaboration whether 176 00:06:18,600 --> 00:06:22,039 with other providers or vendors, to strengthen patient 177 00:06:22,039 --> 00:06:23,419 care and operational efficiency? 178 00:06:24,120 --> 00:06:25,579 Well, I'm not a fan of collaboration 179 00:06:25,959 --> 00:06:26,459 actually, 180 00:06:27,000 --> 00:06:27,800 to be blunt. 181 00:06:28,120 --> 00:06:29,665 I think there's a lot of lot to 182 00:06:29,665 --> 00:06:32,225 be severed being an independent practice because when 183 00:06:32,225 --> 00:06:33,824 you look at the studies and they look 184 00:06:33,824 --> 00:06:35,444 at market penetration of 185 00:06:35,745 --> 00:06:37,665 private equity and they look at market penetration 186 00:06:37,665 --> 00:06:39,205 of employed hospital physicians, 187 00:06:40,305 --> 00:06:40,865 it really, 188 00:06:41,264 --> 00:06:43,985 the per capita cost for health care is 189 00:06:43,985 --> 00:06:45,240 higher when there's a higher 190 00:06:45,800 --> 00:06:49,259 market penetration of PE or hospital ownership. 191 00:06:49,639 --> 00:06:51,319 So I think that's rule one from my 192 00:06:51,319 --> 00:06:53,000 point of view for why it's important to 193 00:06:53,000 --> 00:06:55,240 try and stay independent if you already are. 194 00:06:55,560 --> 00:06:57,160 There are reasons you might wanna sell your 195 00:06:57,160 --> 00:06:59,319 practice if you have an aging physician population, 196 00:06:59,319 --> 00:07:01,134 you have a very busy senate center and 197 00:07:01,134 --> 00:07:03,454 you wanna monetize that? Well, I'm okay with 198 00:07:03,454 --> 00:07:04,814 that. But I think if you have a 199 00:07:04,814 --> 00:07:07,935 center with, with a profile of physicians throughout 200 00:07:07,935 --> 00:07:10,034 their career, where they're at in their careers, 201 00:07:10,175 --> 00:07:11,935 and you're doing a healthy volume, I think 202 00:07:11,935 --> 00:07:13,454 there's plenty of things you can do to 203 00:07:13,454 --> 00:07:14,754 keep that center independent. 204 00:07:15,509 --> 00:07:16,949 I talked about some of those this morning 205 00:07:16,949 --> 00:07:18,949 at a talk I gave. But I think 206 00:07:18,949 --> 00:07:20,389 one of the things you can do and 207 00:07:20,389 --> 00:07:21,290 I do enjoy, 208 00:07:21,829 --> 00:07:24,230 relationships with hospitals in the Cincinnati market. We're 209 00:07:24,230 --> 00:07:26,490 in the PHO for one and an ACO 210 00:07:26,550 --> 00:07:27,209 for another, 211 00:07:28,035 --> 00:07:30,355 and that brings in patients. The PHO brings 212 00:07:30,355 --> 00:07:32,915 in an additional 243,000 213 00:07:32,915 --> 00:07:33,814 covered lives 214 00:07:34,115 --> 00:07:36,514 that we we take care of. So, the 215 00:07:36,514 --> 00:07:38,514 ACO that we belong to in that hospital 216 00:07:38,514 --> 00:07:40,295 system does all our MIPS MACRA, 217 00:07:41,199 --> 00:07:43,040 which saves us at least a full time 218 00:07:43,040 --> 00:07:45,060 employee because it's an awful lot of work. 219 00:07:45,439 --> 00:07:47,439 So I think there's a lot of opportunity 220 00:07:47,439 --> 00:07:50,500 for collaboration. But in terms of actual, selling, 221 00:07:50,879 --> 00:07:52,879 I think, you know, if you sell 51%, 222 00:07:52,879 --> 00:07:54,800 there's a governance issue. If you sell less 223 00:07:54,800 --> 00:07:56,865 than that, you know, you still have a 224 00:07:56,865 --> 00:07:58,964 cultural mismatch there necessarily. 225 00:08:00,144 --> 00:08:02,224 I can recall one time I brought some 226 00:08:02,224 --> 00:08:04,464 nurses from a hospital system that wanted us 227 00:08:04,464 --> 00:08:07,104 to manage their center, which was an hospital 228 00:08:07,104 --> 00:08:09,985 outpatient department center. And I brought the nurses 229 00:08:09,985 --> 00:08:11,044 down to our center, 230 00:08:11,560 --> 00:08:12,060 and, 231 00:08:12,600 --> 00:08:14,519 I had to tell them frankly, it was 232 00:08:14,519 --> 00:08:16,600 a busy Monday. Monday and Friday are the 233 00:08:16,600 --> 00:08:18,919 busiest days in a a east in, endo 234 00:08:18,919 --> 00:08:20,919 center. I said, please don't stand in one 235 00:08:20,919 --> 00:08:22,519 place too long or you're gonna get run 236 00:08:22,519 --> 00:08:23,019 over. 237 00:08:23,720 --> 00:08:25,785 And they were I their jaws were open 238 00:08:25,865 --> 00:08:27,865 because everybody was moving around so fast, and 239 00:08:27,865 --> 00:08:29,944 I find that in the hospital, there's not 240 00:08:29,944 --> 00:08:30,444 that 241 00:08:31,225 --> 00:08:33,865 morale maybe or or concern for how fast 242 00:08:33,865 --> 00:08:35,965 you get things done, but our efficiency is 243 00:08:36,024 --> 00:08:38,024 pretty amazing in a private center. So I 244 00:08:38,024 --> 00:08:39,465 see a lot of reasons. The care is 245 00:08:39,465 --> 00:08:42,129 great. Our center, four years running, has been, 246 00:08:42,289 --> 00:08:43,590 the Newsweek Statista, 247 00:08:44,289 --> 00:08:46,769 highest ranked quality wise, and they use publicly 248 00:08:46,769 --> 00:08:49,570 available data like CMS in the whole state 249 00:08:49,570 --> 00:08:51,409 of Ohio. So, I mean, doing a lot 250 00:08:51,409 --> 00:08:53,409 of cases is also a a key. The 251 00:08:53,409 --> 00:08:55,174 more you do, the better you do. That's 252 00:08:55,174 --> 00:08:56,634 true in almost any specialty. 253 00:08:57,334 --> 00:08:57,834 So 254 00:08:58,214 --> 00:09:00,855 I I really think, you know, efficiency is 255 00:09:00,855 --> 00:09:01,355 important. 256 00:09:02,375 --> 00:09:04,375 Good care is more important, but you can 257 00:09:04,375 --> 00:09:05,514 do both those things. 258 00:09:05,975 --> 00:09:07,654 Is there anything else we didn't touch on 259 00:09:07,654 --> 00:09:09,174 or any final thoughts you'd like to share 260 00:09:09,174 --> 00:09:10,799 as we wrap up our conversation today? 261 00:09:11,759 --> 00:09:13,120 Well, I I gotta say, I think the 262 00:09:13,279 --> 00:09:14,399 I mean, I've been doing this a long 263 00:09:14,399 --> 00:09:15,779 time, and I think the key 264 00:09:16,559 --> 00:09:18,080 to all the success you have with any 265 00:09:18,080 --> 00:09:19,360 center, I don't care if it's an eye 266 00:09:19,360 --> 00:09:20,179 center or 267 00:09:21,039 --> 00:09:23,600 a endo center or a ortho center or 268 00:09:23,600 --> 00:09:25,355 a pain center or whatever it is is 269 00:09:25,355 --> 00:09:27,514 the employees you have working there, your nurses, 270 00:09:27,514 --> 00:09:29,534 your anesthetists. We use a lot of CRNAs. 271 00:09:29,595 --> 00:09:31,214 We have our own anesthesia company. 272 00:09:31,595 --> 00:09:32,875 That is the key. You know, I I 273 00:09:32,875 --> 00:09:34,794 was once offered a center and I can't 274 00:09:34,794 --> 00:09:37,115 remember which one of the big guys it 275 00:09:37,115 --> 00:09:38,014 was, USPI, 276 00:09:38,634 --> 00:09:41,259 SCA, whoever it was. They literally offered me 277 00:09:41,259 --> 00:09:42,320 a center for nothing. 278 00:09:43,100 --> 00:09:44,620 And I went and looked at it. It 279 00:09:44,620 --> 00:09:45,980 was a four room center. It was really 280 00:09:45,980 --> 00:09:47,420 nice. It was in a real nice office 281 00:09:47,420 --> 00:09:49,660 building. I they left they said you can 282 00:09:49,660 --> 00:09:51,340 have all the OR equipment. I looked through 283 00:09:51,340 --> 00:09:53,235 all that. It was all great. I needed 284 00:09:53,235 --> 00:09:55,154 some new OR lights. That was about it. 285 00:09:55,154 --> 00:09:57,794 The furniture, and we'll give you $300,000. 286 00:09:57,794 --> 00:09:59,794 And I said no. You know why? Because 287 00:09:59,794 --> 00:10:01,475 I didn't have any doctors to put there. 288 00:10:01,475 --> 00:10:04,274 That center is worth nothing, literally. They were 289 00:10:04,274 --> 00:10:06,195 just getting rid of their low hanging fruit, 290 00:10:06,195 --> 00:10:08,319 you know. And if somebody would take it 291 00:10:08,319 --> 00:10:10,000 under one condition and that was signed the 292 00:10:10,000 --> 00:10:10,899 long term lease, 293 00:10:11,279 --> 00:10:13,439 they just wanted it off their books. So, 294 00:10:13,439 --> 00:10:15,600 I mean, that's just one simple example of 295 00:10:15,600 --> 00:10:17,279 what I'm saying. You know, the key to 296 00:10:17,279 --> 00:10:19,679 success is having great employees and creating an 297 00:10:19,679 --> 00:10:22,665 environment so those people will be recruited and 298 00:10:22,665 --> 00:10:23,165 retained. 299 00:10:23,945 --> 00:10:24,445 Absolutely. 300 00:10:25,065 --> 00:10:26,904 Well, thanks so much for joining me today 301 00:10:26,904 --> 00:10:28,904 on the Becker's Healthcare Podcast to share these 302 00:10:28,904 --> 00:10:30,985 insights. Again, we are recording live at the 303 00:10:30,985 --> 00:10:33,644 thirty first annual business and operations of ASCs. 304 00:10:34,345 --> 00:10:35,472 Thank you very much.