Hello. This is Francesca Matthews with the Becker's
ASC review podcast. I'm thrilled to be joined
today by doctor Randy Robbins, president of Valeo
Anesthesia Associates.
Randy, thank you so much for being here
today.
Thanks. It's an honor to be here.
Great. To start us off, could you please
introduce yourself and just tell us a little
bit about your background?
Sure. Like I said, my name is Randy
Robbins. I'm a a board certified anesthesiologist
in the Dallas Fort Worth Metroplex.
I'm the founder and president of Valiant Anesthesia
Associates.
I founded this practice back in
April 2013,
here in Dallas, one of the most competitive
markets in the country for anesthesia with two
of us. And we're currently about 40 providers
and do
probably roughly
15,000 cases a year or so now.
I'm also the CEO of Vertex Medical Solutions
and online scheduling and software scheduling software and,
charge capture management system that we've got.
Then I'm the medical director at Baylor Surgical
Care Centennial. I'm the chief of staff at
Methodist Southlake Hospital,
and I'm also on city council in Southlake.
So that's what I do in my spare
time.
Alright. Lots of experiences
here to kinda inform inform your perspective.
Yeah. We love when, you know, folks have
an array of
of experiences to be able to contribute to
our conversations here.
Kind of just jumping straight into it, what
are the top three trends that you're following
in health care and ASCs today?
So I think number one, you know, they
all put the room for ASCs, especially right
now, is anesthesia. It's it's crazy to have
been a part of a of anesthesia for
the last I finished my residency in o
three and came straight into practice. And then
having gone through,
worked for
a couple different groups and now having started
my own practice, I think we've seen such
a massive transition in anesthesia,
especially since COVID. I think our specialty was
hit especially hard with COVID, and I think
we lost more providers,
not necessarily from a, you know, a mortality
standpoint, but I just think from
a physicians choosing to exit the specialty
standpoint than a lot of other specialties did.
So I think it's changed the face of
anesthesia when you look at it from a
compensation standpoint, when you look at it from
a labor force standpoint.
And for the first time,
honestly, I feel like in in
in decades or maybe for forever,
we're
seeing ASCs really, really struggling
to find coverage for anesthesia. So I think
that's gonna be probably the single biggest piece
of anesthesia
of of ASC concern over the next, gosh,
decade plus because I don't see
I don't see that changing much from an
anesthesia manpower standpoint.
Secondly, I think you look at public policy
and health care. You know, what is the
what are the different bills gonna do? What
are the different, you know,
politicians gonna try to put forth that that
put pressure on medicine in America. I think
we do a great job with providing care
to patients.
I do think that there's a lot of
pressure put on physicians and how they do
that and where they cut those those costs
for
for savings standpoint. They seem to always come
after the physicians, and I think that's going
to continue to put more pressure on physicians.
And I think you have to start worrying
about physician burnout
and what it's gonna do and how that's
going to affect
kinda overall, not just ASC
anesthesia specifically, but but, you know, surgeons and
primary care and everything across the board. They
just can't keep making less, working harder. You
know, I I heard a physician today quote
that she said, you know, we always have
a desire to do more with less, and
I kinda challenged that a little bit. I
said, I don't know that it's a desire
to do more with less. I think, unfortunately,
we're just being demanded to do more with
less on an almost day to day basis.
I think the other thing for me that
is a huge piece
of just overall success
for physicians
and for facilities and for ASCs and for
everyone in industry and across the board
is just kind of physician communication. I think
there are very, very few people that speak
communicate that speak physician that are not physicians,
and I don't think physicians do a very
good job speaking
anything but physician half the time. And I
think that we really are gonna have to
cultivate some leaders that can stand in the
gap and and really help
communicate
what the needs of a physician group are
or a physician specialty
and communicate to those physicians what the needs
of a facility are or what industry are
or just kind of what payers need or
or just really stand in the gap from
a communication standpoint.
Then when you look at the number of
physicians that are becoming employed by either
hospital systems
or especially, you know, private equity or different
different pieces
that have
oftentimes,
you know, a very
dichotomous desire in their goals
versus what a a position does. It may
not always be
patient care that they're most concerned about unless
that patient care can generate a better bottom
bottom line for them. So I think that
that's a very, very concerning trend in in
medicine that we're seeing is is private equity
in different places stepping in and and maybe
causing some concern with
with what we do from a quality standpoint
overall. I do think like I said, I
think quality
of care across the board is pretty strong.
I think it's very, very rare that you
see
dips in quality without red flags that that
should have been caught before.
But those are three, three, or four things
that I think are really gonna be challenging
in the ASC marketplace
in the next Absolutely.
Yeah. Those things definitely ring true just thinking
about, you know, the conversations I have here
at Becker's
every day. You know, that anesthesia component. I
think even, you know, even those who are
optimistic
can recognize that
you just can't really turn turn out that
many new graduates in a short amount of
time.
And so a lot of our conversations, I
think, are have been focused on kind of
what we're
doing in the meantime at the, you know,
kind of facility level. And on that note,
what what are you most excited about right
now on the other end of this conversation?
Well, you heard that, you know, I do
I wear a lot of different hats. So
I I think that, for me, an excitement
standpoint is is where anesthesia is. I think
for the first time ever in medicine,
anesthesia is at the table with a with
a real investment in the conversation.
You know? I think we've
anesthesia
historically been viewed almost as a commodity,
and I think that's changing immensely. And I
think people are now realizing that
that we are an important part of the
team. And and and that that piece makes
a difference for anesthesia providers
across the board. And so I'm excited about
finally getting to be a part of the
conversation
and trying to help
facilities understand that there's more to a procedure
than just,
you know, the the net rev that comes
off that case and and what we need
to do from an OR efficiency standpoint and
how we're how we're utilizing that and everything
across the board. So I'm excited about that.
I'm excited about physician engagement across the board.
I think we have a I think we
have a real
vacuum
in physician leadership that's kinda led us to
where we are
in medicine across the board in America. And
I think it's it's gonna take some really,
really strong leaders to step up and stand
in the gap and start having some really
difficult conversations potentially,
with a lot of different folks
to really turn the tide
in medicine and make a difference in the
future.
Absolutely. Yeah. I I also write for our
physician leadership line, and there's definitely,
you know, I think kind of a
a younger generation of physicians that are starting
to come in. And a lot of those
conversations, I think, are kind of starting to
happen about how can we, you know, sort
of close the gap between where physician leadership
maybe is now and where we want it
to be in the next ten years given
the very rapid changes in health care, AI,
all of that.
But, yeah, how are you I think a
lot of times you see that younger that
younger generation of positions that are coming out
of training.
Like,
they're one of the biggest voids in leadership
because of the fact that, you know, you've
had the eighty hour work week limitation.
They're so
they're so focused on, you know, this work
life balance that sometimes they forget that, hey.
Not everything can be balanced for leaders
because
leadership is a sacrifice,
period.
And Mhmm. A lot of times, you know,
they they just don't they don't
the willingness to sacrifice
is is becoming less and less, I think,
in in in each generation, it seems like.
Super interesting you say that. Yeah.
Yeah. Definitely. We'll we'll kinda keep that in
mind going forward in those conversations
just for that part of the publication. Cause
it's definitely something that, you know, I've talked
to when I talk to people, I feel
like everybody's at a little bit of a
different point in the, the
larger picture.
So, yeah, just super interesting to hear you
say that.
Pivoting a little bit, how are you thinking
about growth over the next twelve months?
Well, it's it's it's intriguing. Anesthesia growth is
is for the is for the first time
in a long time, it's it's really easy
to grow if you can find people. You
know? I I literally have probably got
no less than five different facilities currently that
would love for me to,
you know, put in a bid for their
for their coverage.
The problem's not growth. The problem is finding
the manpower to cover the growth. And and
that so I think for us,
the piece we're looking at is how do
we find the right people to partner with?
And I think we have to go beyond
looking at
that commodity provision of anesthesia and start looking
at how do we partner with facilities
and really
make a value add.
We always hear talk about, you know, clinical
quality. But, again, I think clinical quality, especially
in anesthesia, when you look at it, it's
pretty strong across the board. We've got we've
made such advances from a monitoring and from
a perioperative pain control and post op nausea
and everything. We we've got so many options
now that we're doing such a great job
from a clinical standpoint.
It really starts to become,
okay. How can we partner with with a
facility
and start making a dent on the revenue
piece of this? You know, how do we
how do we step in instead of always
saying, okay. You just need to write more
checks to me.
What can we do to help offset that?
And a lot of times, like I said,
I think it's looking at OR efficiency
and looking at OR utilization
and partnering with the the leaders of the
facility and saying, hey.
Yeah. If you wanna run
flip rooms for six different surgeons and have
two hour gaps in each of those rooms,
you can do that. And maybe the net
rev on your side makes sense to just
pay for the anesthesia to do that. But
if we can consolidate and figure out how
to work these surgeons' cases the right way
where even if we are doing a flip
room, we've got something that goes in that
gap there that helps make a difference and
helps offset, you know, the expense of that.
So I think for us, growth is gonna
be a lot more about quality than quantity.
You know? I think, like I said, I
think if COVID hadn't happened, like I said,
we're a group of about 40 right now.
I think we'd have been, you know, close
to a 100 or more
because we were growing 40 to 60% year
over year for the first, gosh,
seven or eight years of our practice.
But COVID just put the brakes on all
of that. And and then you turn around
and, like I said, you see private equity
stepping in. And here in Dallas, you've got
probably 70 plus percent of the anesthetics provided
by an equity owned provider.
And we've seen the cost of coverage for
CRNAs and anesthesiologists,
you know, double and triple it in in
a lot of instances.
And that becomes a a a crippling
finance piece for private practice providers.
So I think it's gonna be really quality
over quantity for us and just really finding
the right partners to to work with over
the next ten years.
Absolutely.
For sure. That quality over quantity piece, I
think, is, yeah, again, very, very felt,
based on the other conversations
I have here at Becker's.
Is there anything else that I didn't ask
about that you wanna touch on in this
conversation?
No. I I think that what that
the ASC marketplace in general has is at
a real tipping point. We're seeing such a
move to the ASCs
that the pieces we used,
you know, five years ago to market ASC
lifestyle and jobs
really has changed. We're now seeing almost a
a competition from the hospitals
saying, well, we may be the better lifestyle
now. Yes. We have call, but, you know,
we're not doing as many cases because they've
all been pushed to the ASC. So I
I think that the ASCs are really
at a tipping point to find out how
are we gonna manage the volume of growth
and the volume of cases and stuff that
we're seeing
over the next decade, because I think it's
gonna be immense as payers continue to put
pressure on
patients to have their stuff done in ASC.
And we see, you know, an increase in
acuity
across the board with what kind of patients
we're seeing in an ASC environment.
But the problem is that increase in acuity
doesn't necessarily come with an increased compensation. So
it it costs more to care for a
sicker patient.
Without the provision of that revenue there, that's
gonna be a concern, and there's gonna become
a a squeeze that's gonna be untenable at
some point in time.
Absolutely. Yeah. Hear hearing you on the the
tipping point.
Well, that is actually all I have for
you today, Randy. Thank you so much for
joining us. Absolutely. Thank you. I appreciate it,
and look forward to talking again sometime.
Yeah. It's been a pleasure speaking with you,
and I look forward to it too. Alright.
Thanks. Yep. Have a good one.