1
00:00:00,160 --> 00:00:02,639
Hello. This is Francesca Matthews with the Becker's

2
00:00:02,639 --> 00:00:05,279
ASC review podcast. I'm thrilled to be joined

3
00:00:05,279 --> 00:00:08,160
today by doctor Randy Robbins, president of Valeo

4
00:00:08,160 --> 00:00:09,380
Anesthesia Associates.

5
00:00:09,839 --> 00:00:11,439
Randy, thank you so much for being here

6
00:00:11,439 --> 00:00:11,939
today.

7
00:00:12,799 --> 00:00:14,419
Thanks. It's an honor to be here.

8
00:00:15,254 --> 00:00:17,494
Great. To start us off, could you please

9
00:00:17,494 --> 00:00:19,175
introduce yourself and just tell us a little

10
00:00:19,175 --> 00:00:20,154
bit about your background?

11
00:00:21,254 --> 00:00:22,535
Sure. Like I said, my name is Randy

12
00:00:22,535 --> 00:00:24,634
Robbins. I'm a a board certified anesthesiologist

13
00:00:24,934 --> 00:00:26,394
in the Dallas Fort Worth Metroplex.

14
00:00:27,175 --> 00:00:29,515
I'm the founder and president of Valiant Anesthesia

15
00:00:29,814 --> 00:00:30,314
Associates.

16
00:00:30,989 --> 00:00:33,090
I founded this practice back in

17
00:00:33,549 --> 00:00:35,010
April 2013,

18
00:00:35,390 --> 00:00:37,310
here in Dallas, one of the most competitive

19
00:00:37,310 --> 00:00:39,549
markets in the country for anesthesia with two

20
00:00:39,549 --> 00:00:42,450
of us. And we're currently about 40 providers

21
00:00:42,590 --> 00:00:43,329
and do

22
00:00:44,030 --> 00:00:45,010
probably roughly

23
00:00:46,034 --> 00:00:48,214
15,000 cases a year or so now.

24
00:00:48,515 --> 00:00:50,994
I'm also the CEO of Vertex Medical Solutions

25
00:00:50,994 --> 00:00:54,914
and online scheduling and software scheduling software and,

26
00:00:55,314 --> 00:00:58,054
charge capture management system that we've got.

27
00:00:58,674 --> 00:01:01,320
Then I'm the medical director at Baylor Surgical

28
00:01:01,320 --> 00:01:03,240
Care Centennial. I'm the chief of staff at

29
00:01:03,240 --> 00:01:04,700
Methodist Southlake Hospital,

30
00:01:05,640 --> 00:01:08,120
and I'm also on city council in Southlake.

31
00:01:08,120 --> 00:01:09,959
So that's what I do in my spare

32
00:01:09,959 --> 00:01:10,459
time.

33
00:01:11,159 --> 00:01:12,859
Alright. Lots of experiences

34
00:01:13,239 --> 00:01:15,855
here to kinda inform inform your perspective.

35
00:01:16,975 --> 00:01:19,135
Yeah. We love when, you know, folks have

36
00:01:19,135 --> 00:01:20,115
an array of

37
00:01:20,655 --> 00:01:22,335
of experiences to be able to contribute to

38
00:01:22,335 --> 00:01:23,635
our conversations here.

39
00:01:24,255 --> 00:01:26,015
Kind of just jumping straight into it, what

40
00:01:26,015 --> 00:01:28,015
are the top three trends that you're following

41
00:01:28,015 --> 00:01:30,034
in health care and ASCs today?

42
00:01:31,530 --> 00:01:32,729
So I think number one, you know, they

43
00:01:32,729 --> 00:01:34,569
all put the room for ASCs, especially right

44
00:01:34,569 --> 00:01:37,049
now, is anesthesia. It's it's crazy to have

45
00:01:37,049 --> 00:01:38,729
been a part of a of anesthesia for

46
00:01:38,729 --> 00:01:40,969
the last I finished my residency in o

47
00:01:40,969 --> 00:01:42,810
three and came straight into practice. And then

48
00:01:42,810 --> 00:01:43,869
having gone through,

49
00:01:44,250 --> 00:01:45,229
worked for

50
00:01:45,715 --> 00:01:47,875
a couple different groups and now having started

51
00:01:47,875 --> 00:01:49,875
my own practice, I think we've seen such

52
00:01:49,875 --> 00:01:51,814
a massive transition in anesthesia,

53
00:01:52,754 --> 00:01:55,715
especially since COVID. I think our specialty was

54
00:01:55,715 --> 00:01:58,834
hit especially hard with COVID, and I think

55
00:01:58,834 --> 00:02:00,454
we lost more providers,

56
00:02:01,239 --> 00:02:03,420
not necessarily from a, you know, a mortality

57
00:02:03,479 --> 00:02:05,099
standpoint, but I just think from

58
00:02:06,519 --> 00:02:08,699
a physicians choosing to exit the specialty

59
00:02:09,000 --> 00:02:11,879
standpoint than a lot of other specialties did.

60
00:02:11,879 --> 00:02:13,334
So I think it's changed the face of

61
00:02:13,334 --> 00:02:15,334
anesthesia when you look at it from a

62
00:02:15,334 --> 00:02:17,174
compensation standpoint, when you look at it from

63
00:02:17,174 --> 00:02:18,474
a labor force standpoint.

64
00:02:19,254 --> 00:02:20,955
And for the first time,

65
00:02:21,414 --> 00:02:23,834
honestly, I feel like in in

66
00:02:24,134 --> 00:02:26,155
in decades or maybe for forever,

67
00:02:26,560 --> 00:02:27,060
we're

68
00:02:27,599 --> 00:02:29,860
seeing ASCs really, really struggling

69
00:02:30,959 --> 00:02:32,879
to find coverage for anesthesia. So I think

70
00:02:32,879 --> 00:02:35,939
that's gonna be probably the single biggest piece

71
00:02:36,239 --> 00:02:36,900
of anesthesia

72
00:02:37,199 --> 00:02:40,079
of of ASC concern over the next, gosh,

73
00:02:40,079 --> 00:02:41,780
decade plus because I don't see

74
00:02:42,175 --> 00:02:43,935
I don't see that changing much from an

75
00:02:43,935 --> 00:02:45,395
anesthesia manpower standpoint.

76
00:02:46,414 --> 00:02:48,334
Secondly, I think you look at public policy

77
00:02:48,334 --> 00:02:49,575
and health care. You know, what is the

78
00:02:49,615 --> 00:02:51,294
what are the different bills gonna do? What

79
00:02:51,294 --> 00:02:52,574
are the different, you know,

80
00:02:52,974 --> 00:02:55,474
politicians gonna try to put forth that that

81
00:02:56,719 --> 00:02:59,840
put pressure on medicine in America. I think

82
00:02:59,840 --> 00:03:01,919
we do a great job with providing care

83
00:03:01,919 --> 00:03:02,579
to patients.

84
00:03:03,280 --> 00:03:04,639
I do think that there's a lot of

85
00:03:04,639 --> 00:03:06,719
pressure put on physicians and how they do

86
00:03:06,719 --> 00:03:09,199
that and where they cut those those costs

87
00:03:09,199 --> 00:03:09,699
for

88
00:03:10,564 --> 00:03:12,724
for savings standpoint. They seem to always come

89
00:03:12,724 --> 00:03:14,405
after the physicians, and I think that's going

90
00:03:14,405 --> 00:03:16,485
to continue to put more pressure on physicians.

91
00:03:16,485 --> 00:03:17,685
And I think you have to start worrying

92
00:03:17,685 --> 00:03:18,905
about physician burnout

93
00:03:20,164 --> 00:03:22,004
and what it's gonna do and how that's

94
00:03:22,004 --> 00:03:22,985
going to affect

95
00:03:23,790 --> 00:03:25,569
kinda overall, not just ASC

96
00:03:26,110 --> 00:03:29,729
anesthesia specifically, but but, you know, surgeons and

97
00:03:30,430 --> 00:03:32,510
primary care and everything across the board. They

98
00:03:32,510 --> 00:03:35,150
just can't keep making less, working harder. You

99
00:03:35,150 --> 00:03:37,150
know, I I heard a physician today quote

100
00:03:37,150 --> 00:03:39,215
that she said, you know, we always have

101
00:03:39,215 --> 00:03:40,814
a desire to do more with less, and

102
00:03:40,814 --> 00:03:42,094
I kinda challenged that a little bit. I

103
00:03:42,094 --> 00:03:43,615
said, I don't know that it's a desire

104
00:03:43,615 --> 00:03:45,395
to do more with less. I think, unfortunately,

105
00:03:45,455 --> 00:03:47,855
we're just being demanded to do more with

106
00:03:47,855 --> 00:03:50,034
less on an almost day to day basis.

107
00:03:51,389 --> 00:03:53,629
I think the other thing for me that

108
00:03:53,629 --> 00:03:55,090
is a huge piece

109
00:03:55,629 --> 00:03:57,490
of just overall success

110
00:03:58,349 --> 00:03:59,490
for physicians

111
00:03:59,790 --> 00:04:02,349
and for facilities and for ASCs and for

112
00:04:02,349 --> 00:04:05,010
everyone in industry and across the board

113
00:04:05,365 --> 00:04:07,685
is just kind of physician communication. I think

114
00:04:07,685 --> 00:04:09,925
there are very, very few people that speak

115
00:04:09,925 --> 00:04:12,724
communicate that speak physician that are not physicians,

116
00:04:12,724 --> 00:04:14,485
and I don't think physicians do a very

117
00:04:14,485 --> 00:04:15,544
good job speaking

118
00:04:16,324 --> 00:04:18,324
anything but physician half the time. And I

119
00:04:18,324 --> 00:04:20,139
think that we really are gonna have to

120
00:04:20,139 --> 00:04:22,139
cultivate some leaders that can stand in the

121
00:04:22,139 --> 00:04:23,920
gap and and really help

122
00:04:24,540 --> 00:04:25,040
communicate

123
00:04:25,579 --> 00:04:28,139
what the needs of a physician group are

124
00:04:28,139 --> 00:04:29,600
or a physician specialty

125
00:04:30,699 --> 00:04:33,180
and communicate to those physicians what the needs

126
00:04:33,180 --> 00:04:35,475
of a facility are or what industry are

127
00:04:35,555 --> 00:04:37,314
or just kind of what payers need or

128
00:04:37,314 --> 00:04:38,915
or just really stand in the gap from

129
00:04:38,915 --> 00:04:40,214
a communication standpoint.

130
00:04:40,675 --> 00:04:42,915
Then when you look at the number of

131
00:04:42,915 --> 00:04:45,334
physicians that are becoming employed by either

132
00:04:45,795 --> 00:04:46,855
hospital systems

133
00:04:47,235 --> 00:04:50,194
or especially, you know, private equity or different

134
00:04:50,194 --> 00:04:51,175
different pieces

135
00:04:51,790 --> 00:04:52,610
that have

136
00:04:53,230 --> 00:04:53,730
oftentimes,

137
00:04:54,030 --> 00:04:55,410
you know, a very

138
00:04:56,189 --> 00:04:58,770
dichotomous desire in their goals

139
00:04:59,389 --> 00:05:02,189
versus what a a position does. It may

140
00:05:02,189 --> 00:05:03,330
not always be

141
00:05:04,814 --> 00:05:07,855
patient care that they're most concerned about unless

142
00:05:07,855 --> 00:05:10,335
that patient care can generate a better bottom

143
00:05:10,335 --> 00:05:12,095
bottom line for them. So I think that

144
00:05:12,095 --> 00:05:14,415
that's a very, very concerning trend in in

145
00:05:14,415 --> 00:05:17,375
medicine that we're seeing is is private equity

146
00:05:17,375 --> 00:05:19,579
in different places stepping in and and maybe

147
00:05:19,579 --> 00:05:21,360
causing some concern with

148
00:05:21,899 --> 00:05:23,740
with what we do from a quality standpoint

149
00:05:23,740 --> 00:05:25,099
overall. I do think like I said, I

150
00:05:25,099 --> 00:05:25,839
think quality

151
00:05:27,019 --> 00:05:29,180
of care across the board is pretty strong.

152
00:05:29,180 --> 00:05:30,860
I think it's very, very rare that you

153
00:05:30,860 --> 00:05:31,360
see

154
00:05:31,935 --> 00:05:34,495
dips in quality without red flags that that

155
00:05:34,495 --> 00:05:35,875
should have been caught before.

156
00:05:36,735 --> 00:05:38,175
But those are three, three, or four things

157
00:05:38,175 --> 00:05:39,694
that I think are really gonna be challenging

158
00:05:39,694 --> 00:05:40,995
in the ASC marketplace

159
00:05:41,855 --> 00:05:43,074
in the next Absolutely.

160
00:05:44,199 --> 00:05:46,600
Yeah. Those things definitely ring true just thinking

161
00:05:46,600 --> 00:05:48,080
about, you know, the conversations I have here

162
00:05:48,080 --> 00:05:48,699
at Becker's

163
00:05:49,160 --> 00:05:51,480
every day. You know, that anesthesia component. I

164
00:05:51,480 --> 00:05:53,399
think even, you know, even those who are

165
00:05:53,399 --> 00:05:53,899
optimistic

166
00:05:54,199 --> 00:05:55,420
can recognize that

167
00:05:55,879 --> 00:05:57,720
you just can't really turn turn out that

168
00:05:57,720 --> 00:06:00,074
many new graduates in a short amount of

169
00:06:00,074 --> 00:06:00,555
time.

170
00:06:01,194 --> 00:06:02,475
And so a lot of our conversations, I

171
00:06:02,475 --> 00:06:03,754
think, are have been focused on kind of

172
00:06:03,754 --> 00:06:04,495
what we're

173
00:06:04,954 --> 00:06:07,035
doing in the meantime at the, you know,

174
00:06:07,035 --> 00:06:09,535
kind of facility level. And on that note,

175
00:06:09,595 --> 00:06:11,595
what what are you most excited about right

176
00:06:11,595 --> 00:06:13,295
now on the other end of this conversation?

177
00:06:15,019 --> 00:06:16,300
Well, you heard that, you know, I do

178
00:06:16,779 --> 00:06:18,779
I wear a lot of different hats. So

179
00:06:18,779 --> 00:06:21,120
I I think that, for me, an excitement

180
00:06:21,180 --> 00:06:23,740
standpoint is is where anesthesia is. I think

181
00:06:23,740 --> 00:06:25,759
for the first time ever in medicine,

182
00:06:26,634 --> 00:06:28,475
anesthesia is at the table with a with

183
00:06:28,475 --> 00:06:30,735
a real investment in the conversation.

184
00:06:31,274 --> 00:06:32,235
You know? I think we've

185
00:06:32,714 --> 00:06:33,214
anesthesia

186
00:06:33,514 --> 00:06:36,334
historically been viewed almost as a commodity,

187
00:06:36,714 --> 00:06:38,875
and I think that's changing immensely. And I

188
00:06:38,875 --> 00:06:41,055
think people are now realizing that

189
00:06:41,479 --> 00:06:42,919
that we are an important part of the

190
00:06:42,919 --> 00:06:45,800
team. And and and that that piece makes

191
00:06:45,800 --> 00:06:47,660
a difference for anesthesia providers

192
00:06:48,360 --> 00:06:50,620
across the board. And so I'm excited about

193
00:06:50,680 --> 00:06:52,199
finally getting to be a part of the

194
00:06:52,199 --> 00:06:52,699
conversation

195
00:06:53,495 --> 00:06:54,634
and trying to help

196
00:06:55,415 --> 00:06:58,714
facilities understand that there's more to a procedure

197
00:06:58,774 --> 00:06:59,435
than just,

198
00:06:59,735 --> 00:07:01,415
you know, the the net rev that comes

199
00:07:01,415 --> 00:07:03,495
off that case and and what we need

200
00:07:03,495 --> 00:07:05,814
to do from an OR efficiency standpoint and

201
00:07:05,814 --> 00:07:08,055
how we're how we're utilizing that and everything

202
00:07:08,055 --> 00:07:10,589
across the board. So I'm excited about that.

203
00:07:10,589 --> 00:07:12,910
I'm excited about physician engagement across the board.

204
00:07:12,910 --> 00:07:14,829
I think we have a I think we

205
00:07:14,829 --> 00:07:15,729
have a real

206
00:07:16,350 --> 00:07:16,850
vacuum

207
00:07:17,229 --> 00:07:19,629
in physician leadership that's kinda led us to

208
00:07:19,629 --> 00:07:20,529
where we are

209
00:07:20,990 --> 00:07:22,990
in medicine across the board in America. And

210
00:07:22,990 --> 00:07:25,014
I think it's it's gonna take some really,

211
00:07:25,014 --> 00:07:27,735
really strong leaders to step up and stand

212
00:07:27,735 --> 00:07:29,995
in the gap and start having some really

213
00:07:30,134 --> 00:07:32,154
difficult conversations potentially,

214
00:07:33,735 --> 00:07:35,355
with a lot of different folks

215
00:07:35,860 --> 00:07:37,480
to really turn the tide

216
00:07:37,860 --> 00:07:39,540
in medicine and make a difference in the

217
00:07:39,540 --> 00:07:40,040
future.

218
00:07:41,300 --> 00:07:43,379
Absolutely. Yeah. I I also write for our

219
00:07:43,379 --> 00:07:46,040
physician leadership line, and there's definitely,

220
00:07:46,420 --> 00:07:48,040
you know, I think kind of a

221
00:07:48,894 --> 00:07:51,134
a younger generation of physicians that are starting

222
00:07:51,134 --> 00:07:52,654
to come in. And a lot of those

223
00:07:52,654 --> 00:07:54,894
conversations, I think, are kind of starting to

224
00:07:54,894 --> 00:07:56,974
happen about how can we, you know, sort

225
00:07:56,974 --> 00:07:59,294
of close the gap between where physician leadership

226
00:07:59,294 --> 00:08:00,894
maybe is now and where we want it

227
00:08:00,894 --> 00:08:02,834
to be in the next ten years given

228
00:08:03,419 --> 00:08:05,919
the very rapid changes in health care, AI,

229
00:08:05,979 --> 00:08:06,720
all of that.

230
00:08:08,060 --> 00:08:09,979
But, yeah, how are you I think a

231
00:08:09,979 --> 00:08:11,819
lot of times you see that younger that

232
00:08:11,819 --> 00:08:14,300
younger generation of positions that are coming out

233
00:08:14,300 --> 00:08:14,959
of training.

234
00:08:15,819 --> 00:08:16,319
Like,

235
00:08:17,604 --> 00:08:19,464
they're one of the biggest voids in leadership

236
00:08:19,604 --> 00:08:21,365
because of the fact that, you know, you've

237
00:08:21,365 --> 00:08:23,064
had the eighty hour work week limitation.

238
00:08:23,365 --> 00:08:24,344
They're so

239
00:08:24,964 --> 00:08:28,164
they're so focused on, you know, this work

240
00:08:28,164 --> 00:08:30,404
life balance that sometimes they forget that, hey.

241
00:08:30,404 --> 00:08:32,910
Not everything can be balanced for leaders

242
00:08:33,290 --> 00:08:33,790
because

243
00:08:34,169 --> 00:08:35,629
leadership is a sacrifice,

244
00:08:36,169 --> 00:08:36,669
period.

245
00:08:37,769 --> 00:08:40,350
And Mhmm. A lot of times, you know,

246
00:08:40,490 --> 00:08:42,350
they they just don't they don't

247
00:08:43,129 --> 00:08:44,669
the willingness to sacrifice

248
00:08:45,144 --> 00:08:47,325
is is becoming less and less, I think,

249
00:08:47,464 --> 00:08:49,964
in in in each generation, it seems like.

250
00:08:50,664 --> 00:08:52,605
Super interesting you say that. Yeah.

251
00:08:53,784 --> 00:08:55,945
Yeah. Definitely. We'll we'll kinda keep that in

252
00:08:55,945 --> 00:08:57,644
mind going forward in those conversations

253
00:08:58,024 --> 00:09:00,070
just for that part of the publication. Cause

254
00:09:00,070 --> 00:09:02,389
it's definitely something that, you know, I've talked

255
00:09:02,389 --> 00:09:03,509
to when I talk to people, I feel

256
00:09:03,509 --> 00:09:04,870
like everybody's at a little bit of a

257
00:09:04,870 --> 00:09:07,050
different point in the, the

258
00:09:07,429 --> 00:09:08,410
larger picture.

259
00:09:08,790 --> 00:09:10,870
So, yeah, just super interesting to hear you

260
00:09:10,870 --> 00:09:11,269
say that.

261
00:09:12,304 --> 00:09:14,304
Pivoting a little bit, how are you thinking

262
00:09:14,304 --> 00:09:16,245
about growth over the next twelve months?

263
00:09:18,144 --> 00:09:21,924
Well, it's it's it's intriguing. Anesthesia growth is

264
00:09:22,544 --> 00:09:24,625
is for the is for the first time

265
00:09:24,625 --> 00:09:26,304
in a long time, it's it's really easy

266
00:09:26,304 --> 00:09:28,379
to grow if you can find people. You

267
00:09:28,379 --> 00:09:30,960
know? I I literally have probably got

268
00:09:31,740 --> 00:09:34,620
no less than five different facilities currently that

269
00:09:34,620 --> 00:09:36,399
would love for me to,

270
00:09:36,860 --> 00:09:38,620
you know, put in a bid for their

271
00:09:38,620 --> 00:09:39,519
for their coverage.

272
00:09:40,644 --> 00:09:42,804
The problem's not growth. The problem is finding

273
00:09:42,804 --> 00:09:44,985
the manpower to cover the growth. And and

274
00:09:45,044 --> 00:09:46,504
that so I think for us,

275
00:09:48,004 --> 00:09:49,764
the piece we're looking at is how do

276
00:09:49,764 --> 00:09:51,764
we find the right people to partner with?

277
00:09:51,764 --> 00:09:53,945
And I think we have to go beyond

278
00:09:54,644 --> 00:09:55,704
looking at

279
00:09:56,529 --> 00:09:59,830
that commodity provision of anesthesia and start looking

280
00:09:59,889 --> 00:10:02,230
at how do we partner with facilities

281
00:10:02,850 --> 00:10:03,909
and really

282
00:10:04,529 --> 00:10:05,830
make a value add.

283
00:10:06,690 --> 00:10:09,824
We always hear talk about, you know, clinical

284
00:10:09,824 --> 00:10:12,225
quality. But, again, I think clinical quality, especially

285
00:10:12,225 --> 00:10:13,904
in anesthesia, when you look at it, it's

286
00:10:13,904 --> 00:10:16,304
pretty strong across the board. We've got we've

287
00:10:16,304 --> 00:10:18,464
made such advances from a monitoring and from

288
00:10:18,464 --> 00:10:21,105
a perioperative pain control and post op nausea

289
00:10:21,105 --> 00:10:23,184
and everything. We we've got so many options

290
00:10:23,184 --> 00:10:25,389
now that we're doing such a great job

291
00:10:25,389 --> 00:10:26,690
from a clinical standpoint.

292
00:10:27,070 --> 00:10:28,610
It really starts to become,

293
00:10:28,990 --> 00:10:31,309
okay. How can we partner with with a

294
00:10:31,309 --> 00:10:31,809
facility

295
00:10:32,829 --> 00:10:35,549
and start making a dent on the revenue

296
00:10:35,549 --> 00:10:37,149
piece of this? You know, how do we

297
00:10:37,149 --> 00:10:39,434
how do we step in instead of always

298
00:10:39,434 --> 00:10:41,434
saying, okay. You just need to write more

299
00:10:41,434 --> 00:10:42,415
checks to me.

300
00:10:42,795 --> 00:10:44,875
What can we do to help offset that?

301
00:10:44,875 --> 00:10:46,315
And a lot of times, like I said,

302
00:10:46,315 --> 00:10:48,575
I think it's looking at OR efficiency

303
00:10:49,274 --> 00:10:51,295
and looking at OR utilization

304
00:10:51,674 --> 00:10:54,049
and partnering with the the leaders of the

305
00:10:54,049 --> 00:10:55,750
facility and saying, hey.

306
00:10:56,449 --> 00:10:57,829
Yeah. If you wanna run

307
00:10:58,129 --> 00:11:00,850
flip rooms for six different surgeons and have

308
00:11:00,850 --> 00:11:02,370
two hour gaps in each of those rooms,

309
00:11:02,370 --> 00:11:04,690
you can do that. And maybe the net

310
00:11:04,690 --> 00:11:06,769
rev on your side makes sense to just

311
00:11:06,769 --> 00:11:09,029
pay for the anesthesia to do that. But

312
00:11:10,345 --> 00:11:12,585
if we can consolidate and figure out how

313
00:11:12,585 --> 00:11:15,144
to work these surgeons' cases the right way

314
00:11:15,144 --> 00:11:17,465
where even if we are doing a flip

315
00:11:17,465 --> 00:11:19,625
room, we've got something that goes in that

316
00:11:19,625 --> 00:11:21,545
gap there that helps make a difference and

317
00:11:21,545 --> 00:11:24,445
helps offset, you know, the expense of that.

318
00:11:24,889 --> 00:11:26,809
So I think for us, growth is gonna

319
00:11:26,809 --> 00:11:29,470
be a lot more about quality than quantity.

320
00:11:29,850 --> 00:11:31,289
You know? I think, like I said, I

321
00:11:31,289 --> 00:11:32,970
think if COVID hadn't happened, like I said,

322
00:11:32,970 --> 00:11:34,889
we're a group of about 40 right now.

323
00:11:34,889 --> 00:11:36,809
I think we'd have been, you know, close

324
00:11:36,809 --> 00:11:38,110
to a 100 or more

325
00:11:38,454 --> 00:11:41,014
because we were growing 40 to 60% year

326
00:11:41,014 --> 00:11:43,034
over year for the first, gosh,

327
00:11:44,054 --> 00:11:45,595
seven or eight years of our practice.

328
00:11:46,054 --> 00:11:47,735
But COVID just put the brakes on all

329
00:11:47,735 --> 00:11:49,575
of that. And and then you turn around

330
00:11:49,575 --> 00:11:51,414
and, like I said, you see private equity

331
00:11:51,414 --> 00:11:53,754
stepping in. And here in Dallas, you've got

332
00:11:54,149 --> 00:11:56,709
probably 70 plus percent of the anesthetics provided

333
00:11:56,709 --> 00:11:58,649
by an equity owned provider.

334
00:11:59,350 --> 00:12:01,850
And we've seen the cost of coverage for

335
00:12:02,230 --> 00:12:03,529
CRNAs and anesthesiologists,

336
00:12:04,069 --> 00:12:06,149
you know, double and triple it in in

337
00:12:06,149 --> 00:12:07,049
a lot of instances.

338
00:12:07,605 --> 00:12:09,784
And that becomes a a a crippling

339
00:12:11,365 --> 00:12:14,105
finance piece for private practice providers.

340
00:12:14,644 --> 00:12:16,245
So I think it's gonna be really quality

341
00:12:16,245 --> 00:12:18,964
over quantity for us and just really finding

342
00:12:18,964 --> 00:12:20,644
the right partners to to work with over

343
00:12:20,644 --> 00:12:22,184
the next ten years.

344
00:12:23,779 --> 00:12:24,279
Absolutely.

345
00:12:24,659 --> 00:12:26,740
For sure. That quality over quantity piece, I

346
00:12:26,740 --> 00:12:28,759
think, is, yeah, again, very, very felt,

347
00:12:29,379 --> 00:12:30,600
based on the other conversations

348
00:12:31,379 --> 00:12:32,820
I have here at Becker's.

349
00:12:33,139 --> 00:12:34,659
Is there anything else that I didn't ask

350
00:12:34,659 --> 00:12:36,339
about that you wanna touch on in this

351
00:12:36,339 --> 00:12:36,839
conversation?

352
00:12:38,445 --> 00:12:40,464
No. I I think that what that

353
00:12:41,084 --> 00:12:43,804
the ASC marketplace in general has is at

354
00:12:43,804 --> 00:12:46,764
a real tipping point. We're seeing such a

355
00:12:46,764 --> 00:12:47,985
move to the ASCs

356
00:12:48,524 --> 00:12:50,225
that the pieces we used,

357
00:12:50,649 --> 00:12:53,309
you know, five years ago to market ASC

358
00:12:54,009 --> 00:12:55,309
lifestyle and jobs

359
00:12:56,250 --> 00:12:58,490
really has changed. We're now seeing almost a

360
00:12:58,490 --> 00:13:00,589
a competition from the hospitals

361
00:13:01,529 --> 00:13:03,529
saying, well, we may be the better lifestyle

362
00:13:03,529 --> 00:13:05,924
now. Yes. We have call, but, you know,

363
00:13:06,004 --> 00:13:07,524
we're not doing as many cases because they've

364
00:13:07,524 --> 00:13:09,205
all been pushed to the ASC. So I

365
00:13:09,205 --> 00:13:11,144
I think that the ASCs are really

366
00:13:11,684 --> 00:13:14,084
at a tipping point to find out how

367
00:13:14,084 --> 00:13:16,644
are we gonna manage the volume of growth

368
00:13:16,644 --> 00:13:18,725
and the volume of cases and stuff that

369
00:13:18,725 --> 00:13:19,464
we're seeing

370
00:13:20,059 --> 00:13:21,820
over the next decade, because I think it's

371
00:13:21,820 --> 00:13:24,299
gonna be immense as payers continue to put

372
00:13:24,299 --> 00:13:25,279
pressure on

373
00:13:26,059 --> 00:13:28,299
patients to have their stuff done in ASC.

374
00:13:28,299 --> 00:13:29,899
And we see, you know, an increase in

375
00:13:29,899 --> 00:13:30,399
acuity

376
00:13:31,259 --> 00:13:33,259
across the board with what kind of patients

377
00:13:33,259 --> 00:13:34,959
we're seeing in an ASC environment.

378
00:13:35,834 --> 00:13:37,834
But the problem is that increase in acuity

379
00:13:37,834 --> 00:13:40,475
doesn't necessarily come with an increased compensation. So

380
00:13:40,475 --> 00:13:42,154
it it costs more to care for a

381
00:13:42,154 --> 00:13:43,054
sicker patient.

382
00:13:43,834 --> 00:13:45,995
Without the provision of that revenue there, that's

383
00:13:45,995 --> 00:13:47,995
gonna be a concern, and there's gonna become

384
00:13:47,995 --> 00:13:50,394
a a squeeze that's gonna be untenable at

385
00:13:50,394 --> 00:13:51,454
some point in time.

386
00:13:52,769 --> 00:13:54,850
Absolutely. Yeah. Hear hearing you on the the

387
00:13:54,850 --> 00:13:55,750
tipping point.

388
00:13:56,610 --> 00:13:58,210
Well, that is actually all I have for

389
00:13:58,210 --> 00:14:00,129
you today, Randy. Thank you so much for

390
00:14:00,129 --> 00:14:02,610
joining us. Absolutely. Thank you. I appreciate it,

391
00:14:02,610 --> 00:14:04,549
and look forward to talking again sometime.

392
00:14:05,075 --> 00:14:07,075
Yeah. It's been a pleasure speaking with you,

393
00:14:07,075 --> 00:14:08,995
and I look forward to it too. Alright.

394
00:14:08,995 --> 00:14:10,855
Thanks. Yep. Have a good one.