1 00:00:00,240 --> 00:00:02,960 Hello. This is Francesca Matthews with the Becker's 2 00:00:02,960 --> 00:00:04,179 ASC review podcast. 3 00:00:04,719 --> 00:00:06,319 I'm thrilled to be joined today by Brent 4 00:00:06,319 --> 00:00:06,819 Maxfield, 5 00:00:07,200 --> 00:00:07,700 CRNA, 6 00:00:08,080 --> 00:00:11,039 president and CEO of Maxfield Healthcare Solutions. Brett, 7 00:00:11,039 --> 00:00:12,644 thank you so much for being here today. 8 00:00:12,804 --> 00:00:14,905 Hey. My pleasure, Franchesca. Thanks for having me. 9 00:00:15,044 --> 00:00:16,964 Yeah. Of course. To start us off, could 10 00:00:16,964 --> 00:00:18,644 you please introduce yourself and tell us a 11 00:00:18,644 --> 00:00:19,864 little bit about your background? 12 00:00:20,245 --> 00:00:21,925 You bet. Yeah. Absolutely. So my name is 13 00:00:21,925 --> 00:00:22,664 Brett Maxfield. 14 00:00:23,445 --> 00:00:25,625 As you mentioned, I am a, by licensure, 15 00:00:25,765 --> 00:00:26,085 CRNA, 16 00:00:26,730 --> 00:00:28,089 but that's not really what I do anymore. 17 00:00:28,089 --> 00:00:29,769 So life has kind of evolved and changed 18 00:00:29,769 --> 00:00:30,829 a little bit. So, 19 00:00:31,529 --> 00:00:32,030 I, 20 00:00:32,409 --> 00:00:34,189 originally, that was the plan, was to be 21 00:00:34,409 --> 00:00:36,649 a a CRNA and do anesthesia, and life 22 00:00:36,649 --> 00:00:38,890 kinda changed a little bit. So about fifteen 23 00:00:38,890 --> 00:00:41,369 years ago, I had some pretty significant health 24 00:00:41,369 --> 00:00:41,869 issues 25 00:00:42,255 --> 00:00:43,475 and had to kinda 26 00:00:43,854 --> 00:00:44,914 transition careers. 27 00:00:45,454 --> 00:00:47,314 And so, out of that necessity, 28 00:00:48,414 --> 00:00:51,215 the consulting firm was born. And so I 29 00:00:51,215 --> 00:00:54,549 transitioned from doing bedside anesthesia to now I, 30 00:00:54,789 --> 00:00:56,229 I do a whole bunch of different things, 31 00:00:56,390 --> 00:00:57,989 kind of all under the umbrella of that 32 00:00:57,989 --> 00:00:58,969 health care solutions. 33 00:00:59,909 --> 00:01:02,009 So I guess kinda just naming things off. 34 00:01:03,030 --> 00:01:06,229 I own a multi specialty surgery center in 35 00:01:06,229 --> 00:01:07,290 Southeast Idaho. 36 00:01:07,754 --> 00:01:08,415 And then, 37 00:01:08,875 --> 00:01:10,814 with the consulting firm, 38 00:01:11,515 --> 00:01:15,215 I helped to supply, manage, direct, aid, train, 39 00:01:15,754 --> 00:01:18,555 multitude of different things with, about 400 to 40 00:01:18,555 --> 00:01:19,435 450, 41 00:01:19,674 --> 00:01:20,174 different 42 00:01:21,010 --> 00:01:23,590 surgery centers and office based surgical practices 43 00:01:23,969 --> 00:01:26,469 worldwide. So we're in all 50 states and 44 00:01:27,010 --> 00:01:28,069 expanded internationally. 45 00:01:29,090 --> 00:01:31,909 In addition to doing that, I also am 46 00:01:32,370 --> 00:01:33,969 one of the a member of the board 47 00:01:33,969 --> 00:01:35,670 of directors for Quad a. 48 00:01:36,435 --> 00:01:38,774 I'm also the president of the Idaho Ambulatory 49 00:01:38,834 --> 00:01:39,894 Surgery Center Association. 50 00:01:41,314 --> 00:01:43,974 I am an international surveyor for quad a. 51 00:01:44,354 --> 00:01:46,435 I'm the chair of the practice committee for 52 00:01:46,435 --> 00:01:48,534 the American Association of Nurse Anesthesiology. 53 00:01:49,680 --> 00:01:50,180 And, 54 00:01:51,680 --> 00:01:53,680 yeah. That kinda covers pretty much all my 55 00:01:53,680 --> 00:01:55,439 professional life. So I like to stay busy. 56 00:01:55,439 --> 00:01:55,680 I, 57 00:01:56,240 --> 00:01:57,520 I'm kind of all over the place and 58 00:01:57,520 --> 00:01:58,880 rarely home. So it's kind of a fun 59 00:01:58,880 --> 00:01:59,380 life. 60 00:02:00,000 --> 00:02:02,159 Yeah. I got the background there. Thanks for 61 00:02:02,159 --> 00:02:03,920 for sharing that. I always love to talk 62 00:02:03,920 --> 00:02:05,625 with people who have kind of a wide 63 00:02:05,625 --> 00:02:06,604 range of experiences. 64 00:02:07,224 --> 00:02:09,064 Yeah, I feel like it always it's always 65 00:02:09,064 --> 00:02:09,564 interesting. 66 00:02:10,824 --> 00:02:12,985 Jumping just right into questions here. What are 67 00:02:12,985 --> 00:02:14,745 the top three trends that you're following in 68 00:02:14,745 --> 00:02:16,525 health care and ASCs today? 69 00:02:17,064 --> 00:02:18,969 You know, there's a couple. Obviously, the thing 70 00:02:19,210 --> 00:02:20,889 when you talk about ASCs, the thing at 71 00:02:20,889 --> 00:02:23,290 everybody's forefront of their mind right now is 72 00:02:23,290 --> 00:02:25,370 the the cost involved and how it's just 73 00:02:25,370 --> 00:02:27,689 our reimbursements going down and our expenses are 74 00:02:27,689 --> 00:02:28,430 going up. 75 00:02:28,810 --> 00:02:30,675 You know, and when you stratify those costs 76 00:02:30,995 --> 00:02:32,835 post pandemic, the first thing that hit us 77 00:02:32,835 --> 00:02:33,335 was 78 00:02:34,275 --> 00:02:36,354 the the cost of supplies, you know, that 79 00:02:36,354 --> 00:02:37,574 supply chain got disrupted, 80 00:02:38,915 --> 00:02:41,415 supplies went up, and quite honestly, 81 00:02:41,794 --> 00:02:43,416 we were hoping that things would come back 82 00:02:43,416 --> 00:02:45,192 down, and I don't know if the the 83 00:02:45,192 --> 00:02:46,968 actual expense has stayed that high or if 84 00:02:46,968 --> 00:02:48,745 people just realized, like they often do, that, 85 00:02:48,745 --> 00:02:50,521 hey. You know, people will pay these prices 86 00:02:50,521 --> 00:02:52,298 and just kept things high. But, you know, 87 00:02:52,298 --> 00:02:54,074 that was the first wave to hit us. 88 00:02:54,074 --> 00:02:55,850 The next wave to hit us was the 89 00:02:55,850 --> 00:02:56,875 anesthesia shortage. So, 90 00:02:57,735 --> 00:02:58,955 I think that 91 00:02:59,735 --> 00:03:01,574 doing what I do, working in the consulting 92 00:03:01,574 --> 00:03:02,074 field, 93 00:03:02,375 --> 00:03:04,614 I saw a big, big, big uptick in 94 00:03:04,614 --> 00:03:05,754 demand for my services 95 00:03:06,375 --> 00:03:07,114 post pandemic 96 00:03:07,735 --> 00:03:09,254 because a lot of the people who were 97 00:03:09,254 --> 00:03:10,155 deemed nonessential 98 00:03:10,969 --> 00:03:12,729 decided that they weren't gonna let the hospitals 99 00:03:12,729 --> 00:03:13,229 determine, 100 00:03:13,769 --> 00:03:15,530 their livelihood. And so they said, you know, 101 00:03:15,530 --> 00:03:16,810 we're taking this out of your hands. And 102 00:03:16,810 --> 00:03:18,729 they they started reaching out to people like 103 00:03:18,729 --> 00:03:22,169 me and creating office based surgical practices, ambulatory 104 00:03:22,169 --> 00:03:23,709 surgery centers, things like that, 105 00:03:24,064 --> 00:03:25,664 which most of the hospitals didn't care because 106 00:03:25,664 --> 00:03:26,944 it was, you know, again the ones they 107 00:03:26,944 --> 00:03:28,965 deemed non essential. So this was the plastics, 108 00:03:29,025 --> 00:03:29,764 the podiatry, 109 00:03:30,064 --> 00:03:32,164 things like that, you know, pediatric dentistry. 110 00:03:32,544 --> 00:03:35,205 I think what they failed to realize though 111 00:03:35,264 --> 00:03:37,604 was that when those people left the hospital, 112 00:03:37,849 --> 00:03:39,930 it also meant they're going to take anesthesia 113 00:03:39,930 --> 00:03:41,370 with them. And then a lot of these 114 00:03:41,370 --> 00:03:43,770 things, you know, especially for CRNAs, you know, 115 00:03:43,770 --> 00:03:44,430 my background, 116 00:03:45,290 --> 00:03:47,050 the opportunity to leave and do your own 117 00:03:47,050 --> 00:03:49,129 thing was significantly more lucrative with a better 118 00:03:49,129 --> 00:03:50,750 lifestyle than staying in the hospital. 119 00:03:51,064 --> 00:03:53,085 And so I think that was an unforeseen, 120 00:03:54,025 --> 00:03:54,525 result 121 00:03:55,064 --> 00:03:55,805 of that 122 00:03:56,425 --> 00:03:57,564 kind of push to, 123 00:03:58,025 --> 00:03:58,685 you know, 124 00:03:59,224 --> 00:03:59,724 deprioritize 125 00:04:00,264 --> 00:04:00,925 the nonessential, 126 00:04:02,025 --> 00:04:04,185 providers, was the hospitals didn't realize they're gonna 127 00:04:04,185 --> 00:04:05,909 lose a big chunk of their anesthesia. So, 128 00:04:05,990 --> 00:04:07,750 obviously, that's another big one that we're watching 129 00:04:07,750 --> 00:04:08,389 right now. 130 00:04:08,790 --> 00:04:10,790 And then the newest latest entry into the 131 00:04:10,790 --> 00:04:11,449 the mix 132 00:04:12,150 --> 00:04:14,550 is, AI. You know, AI is definitely something 133 00:04:14,550 --> 00:04:15,050 that 134 00:04:15,430 --> 00:04:16,089 as we 135 00:04:16,709 --> 00:04:19,290 integrate it more, see it more in play, 136 00:04:19,474 --> 00:04:21,735 it's definitely gonna change things within the ASC 137 00:04:23,074 --> 00:04:23,574 realm. 138 00:04:23,875 --> 00:04:24,995 And so those those are kind of the 139 00:04:24,995 --> 00:04:27,074 big things we're watching right now, as those 140 00:04:27,074 --> 00:04:29,634 those different trends kinda seeing what's happening. You 141 00:04:29,634 --> 00:04:31,154 know, we're kinda watching a little bit to 142 00:04:31,154 --> 00:04:34,050 see what's still coming out. Again, you know, 143 00:04:34,050 --> 00:04:34,550 being 144 00:04:34,930 --> 00:04:37,170 kind of on a a 30,000 145 00:04:37,170 --> 00:04:39,750 foot view of things with what I do, 146 00:04:39,889 --> 00:04:41,750 it's been interesting to see which specialties 147 00:04:42,129 --> 00:04:44,209 have also kinda taken off in that ASC 148 00:04:44,209 --> 00:04:46,395 world. So, you know, the last five years, 149 00:04:46,395 --> 00:04:47,855 we've seen a huge uptick. 150 00:04:48,314 --> 00:04:49,435 And a lot of stuff that used to 151 00:04:49,435 --> 00:04:51,274 be mainly just hospital based, you know, the 152 00:04:51,274 --> 00:04:51,774 vascular, 153 00:04:52,875 --> 00:04:55,995 areas, the, you know, as things come off 154 00:04:55,995 --> 00:04:58,329 the inpatient only list, we're seeing more of 155 00:04:58,329 --> 00:05:00,509 those GYN specialties leave again. 156 00:05:00,970 --> 00:05:03,129 And, you know, it it'll be interesting. I'm 157 00:05:03,209 --> 00:05:05,209 we've got a health care crisis right now. 158 00:05:05,209 --> 00:05:07,069 We've got an affordability crisis. 159 00:05:07,930 --> 00:05:08,430 This 160 00:05:09,464 --> 00:05:11,785 government shutdown really kind of brought that to 161 00:05:11,785 --> 00:05:12,285 light 162 00:05:12,824 --> 00:05:15,345 and kind of brought to light how ridiculous 163 00:05:15,345 --> 00:05:17,165 a lot of this stuff is, you know. 164 00:05:17,944 --> 00:05:20,125 For an example, my family of five, 165 00:05:21,475 --> 00:05:21,975 pre 166 00:05:22,330 --> 00:05:24,970 Affordable Care Act, paid about $800 a month 167 00:05:24,970 --> 00:05:25,629 in premiums 168 00:05:25,930 --> 00:05:28,350 to for our insurance, you know, for a 169 00:05:28,410 --> 00:05:30,490 a barely moderate plan, like a silver level 170 00:05:30,490 --> 00:05:31,150 type plan. 171 00:05:31,529 --> 00:05:33,050 And as soon as the Affordable Care Act, 172 00:05:33,050 --> 00:05:35,050 it did anything passed. It did anything but 173 00:05:35,050 --> 00:05:37,375 make things affordable. Like, for my family, it 174 00:05:37,375 --> 00:05:40,535 jumped from $800 a month to $2,500 175 00:05:40,535 --> 00:05:42,014 a month to where now we're sitting close 176 00:05:42,014 --> 00:05:44,435 to, I think, $4,000 a month 177 00:05:44,814 --> 00:05:47,134 for that same silver type plan. So so, 178 00:05:47,134 --> 00:05:49,055 anyway, we're watching all those different things. I 179 00:05:49,055 --> 00:05:51,180 think you're gonna see some big changes coming. 180 00:05:51,740 --> 00:05:53,259 I think we're gonna have to see some 181 00:05:53,259 --> 00:05:55,199 big changes coming there because 182 00:05:56,060 --> 00:05:58,779 the average person making $46,000 183 00:05:58,779 --> 00:05:59,439 a year 184 00:05:59,819 --> 00:06:03,180 cannot afford to make a $48,000 185 00:06:03,180 --> 00:06:05,985 a year health insurance payment. It's ridiculous. So 186 00:06:06,044 --> 00:06:07,884 there's gonna be some changes coming and there 187 00:06:07,884 --> 00:06:09,004 have to be. So those are kind of 188 00:06:09,004 --> 00:06:10,604 things we're keeping our eye on, watching what's 189 00:06:10,604 --> 00:06:12,845 happening, and a lot of it circles around 190 00:06:12,845 --> 00:06:13,985 that finance component. 191 00:06:14,925 --> 00:06:17,850 Yeah. Absolutely. I think I think the shutdown 192 00:06:17,850 --> 00:06:19,290 and a a number of things in the 193 00:06:19,290 --> 00:06:20,410 last year, so I have kind of done 194 00:06:20,410 --> 00:06:21,149 that, like, 195 00:06:21,529 --> 00:06:22,509 behind the curtain 196 00:06:22,970 --> 00:06:23,470 effect. 197 00:06:24,569 --> 00:06:27,209 So, yeah, all totally relevant topics there. What 198 00:06:27,209 --> 00:06:29,444 are you most excited about right now? You 199 00:06:29,605 --> 00:06:31,285 know, honestly, the thing I am most excited 200 00:06:31,285 --> 00:06:33,125 about has to do with that AI. I 201 00:06:33,125 --> 00:06:33,365 think, 202 00:06:34,085 --> 00:06:37,064 I think it's a tool that, you know, 203 00:06:37,444 --> 00:06:38,884 like, we wanna be a little bit doomsday. 204 00:06:38,884 --> 00:06:39,925 We have to be a little bit careful 205 00:06:39,925 --> 00:06:42,425 and not not trust too much in AI 206 00:06:42,750 --> 00:06:43,250 because 207 00:06:43,550 --> 00:06:45,230 we, you know, we don't want things to 208 00:06:45,230 --> 00:06:46,910 suddenly end up that we have no idea 209 00:06:46,910 --> 00:06:49,069 how to do things without AI. But on 210 00:06:49,069 --> 00:06:49,970 the flip side, 211 00:06:50,509 --> 00:06:53,230 you know, there's some really cool opportunities there. 212 00:06:53,230 --> 00:06:54,029 There's some, 213 00:06:55,069 --> 00:06:57,310 real opportunity, especially on the revenue cycle side 214 00:06:57,310 --> 00:06:57,764 of things, 215 00:06:58,245 --> 00:06:58,985 to see 216 00:06:59,764 --> 00:07:01,925 where a lot of this inefficiency that happens, 217 00:07:01,925 --> 00:07:03,764 this back and forth, the stupidity of we're 218 00:07:03,764 --> 00:07:05,764 gonna deny, deny, deny, and then approve with 219 00:07:05,764 --> 00:07:07,764 no changes. You know, just that stupidity that 220 00:07:07,764 --> 00:07:10,725 happens there. The ability to control costs a 221 00:07:10,725 --> 00:07:12,345 little bit better within your systems. 222 00:07:12,959 --> 00:07:16,160 The ability to, really, honestly, with AI, have 223 00:07:16,160 --> 00:07:19,279 almost immediate input from your quality assurance programs. 224 00:07:19,519 --> 00:07:21,600 You know, looking at things like, hey. Let's 225 00:07:21,600 --> 00:07:23,839 plug in all this surgeon's data. We've got 226 00:07:23,839 --> 00:07:25,415 a guy who claims that he takes two 227 00:07:25,415 --> 00:07:25,915 hours, 228 00:07:26,375 --> 00:07:28,795 to do this particular surgery, but survey says 229 00:07:29,095 --> 00:07:29,595 AI 230 00:07:30,055 --> 00:07:31,654 tells us you're three and a half hours. 231 00:07:31,654 --> 00:07:33,175 So guess what, buddy? You're not scheduling for 232 00:07:33,175 --> 00:07:35,095 two hours anymore. Your cases are scheduled for 233 00:07:35,095 --> 00:07:37,675 three and a half. You know, increasing efficiency, 234 00:07:38,610 --> 00:07:41,169 decreasing patient satisfaction with wait times, things like 235 00:07:41,169 --> 00:07:42,870 that. I just I think there's a lot 236 00:07:43,329 --> 00:07:44,310 of potential 237 00:07:45,089 --> 00:07:47,750 with AI application within the ASC field. 238 00:07:49,009 --> 00:07:51,649 Mhmm. Yeah. Absolutely. And it's something that's interesting 239 00:07:51,649 --> 00:07:53,475 to me just I know that, like, within 240 00:07:53,475 --> 00:07:56,055 the ASC field, the use of technology 241 00:07:56,995 --> 00:07:58,595 is kind of fragmented or I noticed there's 242 00:07:58,595 --> 00:07:59,954 some large gaps. You know, a lot there 243 00:07:59,954 --> 00:08:01,654 are plenty of ASCs that are still, 244 00:08:02,514 --> 00:08:04,675 you know, don't have EMR systems. And then 245 00:08:04,675 --> 00:08:06,194 there's I just wrote an article not too 246 00:08:06,194 --> 00:08:08,689 long ago about a totally AI powered ASC, 247 00:08:09,470 --> 00:08:10,750 going up on the East Coast. So I 248 00:08:10,750 --> 00:08:13,149 think that's something really kind of being reconciled 249 00:08:13,149 --> 00:08:15,310 within the industry right now. Yeah. Well, I 250 00:08:15,310 --> 00:08:17,169 think for ASCs and especially, 251 00:08:17,629 --> 00:08:19,250 the office based surgical practices, 252 00:08:19,709 --> 00:08:22,209 a lot of times these EMRs are just 253 00:08:23,285 --> 00:08:26,245 priced so high that they price themselves out 254 00:08:26,245 --> 00:08:27,845 of a client. And so I think that's 255 00:08:27,845 --> 00:08:29,444 something we're gonna have to see kind of, 256 00:08:29,444 --> 00:08:32,024 you know, balancing itself out and reconciling itself. 257 00:08:32,085 --> 00:08:34,164 But as we drift to the technology driven 258 00:08:34,164 --> 00:08:35,845 side, you're gonna have to see some of 259 00:08:35,845 --> 00:08:38,019 these disruptors enter into the market to bring 260 00:08:38,019 --> 00:08:39,960 things that offer the same quality 261 00:08:40,740 --> 00:08:42,120 at a an affordability 262 00:08:42,500 --> 00:08:44,500 price point where a lot of these places 263 00:08:44,500 --> 00:08:46,019 can get in. You know? I I know 264 00:08:46,019 --> 00:08:47,720 speaking from from experience, 265 00:08:48,419 --> 00:08:49,940 a lot of the practices that I work 266 00:08:49,940 --> 00:08:51,865 with have that issue where they would like 267 00:08:51,865 --> 00:08:52,904 to have that. They would like to have 268 00:08:52,904 --> 00:08:54,605 that gathering ability at their fingertips, 269 00:08:55,065 --> 00:08:57,084 but it's just so cost prohibitive 270 00:08:57,704 --> 00:09:00,424 that it's it really makes it difficult. And, 271 00:09:00,424 --> 00:09:01,324 you know, again, 272 00:09:01,784 --> 00:09:03,784 coming from the anesthesia background, I can tell 273 00:09:03,784 --> 00:09:06,044 you as an anesthesia provider, I hated EMRs. 274 00:09:06,184 --> 00:09:07,330 You know, you wanna slow me down and 275 00:09:07,330 --> 00:09:08,929 make me inefficient, give me an EMR. That's 276 00:09:08,929 --> 00:09:10,690 a great way to do it. So I'm 277 00:09:10,690 --> 00:09:12,370 kind of a dinosaur. You know, technology is 278 00:09:12,370 --> 00:09:14,769 not my best friend. I'm not, you know, 279 00:09:14,769 --> 00:09:17,170 a 20 who's grown up with an iPad 280 00:09:17,170 --> 00:09:18,610 or an iPhone in their hand their whole 281 00:09:18,610 --> 00:09:20,054 life. So that could be part of my 282 00:09:20,054 --> 00:09:22,774 problem. I readily, you know, acknowledge that could 283 00:09:22,774 --> 00:09:24,774 be one of my limitations. But, you know, 284 00:09:24,774 --> 00:09:26,214 at the same time, we'll we'll see how 285 00:09:26,214 --> 00:09:27,834 that all plays out and if we can 286 00:09:28,214 --> 00:09:30,954 eliminate some of those inefficiencies that make practitioners 287 00:09:31,014 --> 00:09:32,314 not want to use those. 288 00:09:33,250 --> 00:09:35,750 Absolutely. Yeah. No. I hear you there on 289 00:09:35,889 --> 00:09:38,289 the the the dinosaur aspect. I'm I'm honestly 290 00:09:38,289 --> 00:09:40,129 in my twenties and sometimes still feel like 291 00:09:40,129 --> 00:09:41,970 I'm not really with with it as far 292 00:09:41,970 --> 00:09:44,389 as all the technology, like, the way that 293 00:09:44,529 --> 00:09:46,610 some of these kids are. But how are 294 00:09:46,610 --> 00:09:48,585 you thinking about growth over the next twelve 295 00:09:49,545 --> 00:09:51,404 months? You know, as far as growth goes, 296 00:09:52,024 --> 00:09:54,585 it's an interesting time for growth. A lot 297 00:09:54,585 --> 00:09:56,504 of it I'm seeing a little bit of 298 00:09:56,504 --> 00:09:57,004 hesitation 299 00:09:57,465 --> 00:09:59,965 in the kind of in that ASC market, 300 00:10:00,504 --> 00:10:02,024 kind of waiting to see what happens with 301 00:10:02,024 --> 00:10:04,205 our economy. You know, there's been so much 302 00:10:04,259 --> 00:10:06,580 there's been so much partisan politicking that it 303 00:10:06,580 --> 00:10:08,179 just makes me wanna vomit when it comes 304 00:10:08,179 --> 00:10:09,059 to that kind of stuff. They 305 00:10:09,779 --> 00:10:10,980 you know, if people would just do what's 306 00:10:10,980 --> 00:10:12,259 best for the country instead of what's best 307 00:10:12,259 --> 00:10:14,580 for themselves, that would be amazing. But that's 308 00:10:14,580 --> 00:10:15,160 an aside. 309 00:10:16,259 --> 00:10:18,279 Because of a lot of what's going on, 310 00:10:18,705 --> 00:10:21,264 I've seen people either going headfirst into the, 311 00:10:21,264 --> 00:10:22,945 hey. It's good now. We've got to go. 312 00:10:22,945 --> 00:10:24,384 Let's do this as quick as we can 313 00:10:24,384 --> 00:10:26,865 before it goes away. And I've also seen 314 00:10:26,865 --> 00:10:28,384 even more to the other side where it's, 315 00:10:28,384 --> 00:10:30,304 hey. I'm not sure how certain the future 316 00:10:30,304 --> 00:10:30,804 looks. 317 00:10:31,105 --> 00:10:33,105 Let's be cautious. Let's kind of hold off 318 00:10:33,105 --> 00:10:34,245 on some of these projects. 319 00:10:34,919 --> 00:10:36,839 But really, honestly, where a lot of the 320 00:10:36,839 --> 00:10:39,480 growth that I see coming is we've had 321 00:10:39,480 --> 00:10:41,019 this exodus. Right? So 322 00:10:41,559 --> 00:10:42,379 we've had 323 00:10:42,839 --> 00:10:45,580 all these people redeemed non essential, 324 00:10:46,440 --> 00:10:47,419 during the pandemic 325 00:10:48,274 --> 00:10:51,235 step out and take their services to other 326 00:10:51,235 --> 00:10:51,735 locations. 327 00:10:52,995 --> 00:10:55,394 They have been in turn seen the benefit 328 00:10:55,394 --> 00:10:57,475 of, dang. You know what? It's kinda nice 329 00:10:57,475 --> 00:10:58,914 to collect a facility fee when I own 330 00:10:58,914 --> 00:11:01,794 an ASC as a podiatrist, as a plastic 331 00:11:01,794 --> 00:11:02,294 surgeon, 332 00:11:02,750 --> 00:11:04,830 as a reproductive specialist, you know, whatever it 333 00:11:04,830 --> 00:11:05,490 may be. 334 00:11:06,429 --> 00:11:08,669 And they're seeing that as an an additional 335 00:11:08,669 --> 00:11:09,649 revenue stream. 336 00:11:10,110 --> 00:11:11,549 So what we're now starting to see on 337 00:11:11,549 --> 00:11:13,330 the growth side is that hospitals 338 00:11:13,950 --> 00:11:16,029 have gotten smart and said, oh, shoot. We 339 00:11:16,029 --> 00:11:18,424 kind of messed up there. And so 340 00:11:19,205 --> 00:11:21,945 I've had several opportunities recently where 341 00:11:23,205 --> 00:11:25,384 an an opportunity has presented itself 342 00:11:26,004 --> 00:11:26,504 to 343 00:11:26,884 --> 00:11:29,044 kind of incorporate these surgery centers back into 344 00:11:29,044 --> 00:11:29,544 hospitals. 345 00:11:29,940 --> 00:11:31,700 And the hospitals, especially some of the larger 346 00:11:31,700 --> 00:11:33,700 hospital systems, have gotten smart and realized that, 347 00:11:33,700 --> 00:11:34,440 hey. You know, 348 00:11:34,899 --> 00:11:36,580 here's an example. We've got one that's close 349 00:11:36,580 --> 00:11:37,720 enough to be an HOPD. 350 00:11:38,500 --> 00:11:39,860 They started out that path and go, hey. 351 00:11:39,860 --> 00:11:42,019 Yeah. We can make HOPD. We could generate 352 00:11:42,019 --> 00:11:42,679 these hospital 353 00:11:43,940 --> 00:11:46,065 rates. We could, you know, have that extra 354 00:11:46,065 --> 00:11:47,205 revenue coming in. 355 00:11:47,585 --> 00:11:48,785 But then they take a pause and they 356 00:11:48,785 --> 00:11:49,985 go, okay. But what are we gonna do? 357 00:11:49,985 --> 00:11:51,985 We're gonna alienate these surgeons again that we've 358 00:11:51,985 --> 00:11:54,065 just worked hard to come get back in. 359 00:11:54,065 --> 00:11:56,465 So I've actually seen an interesting trend in 360 00:11:56,465 --> 00:11:58,804 the growth where a lot of these hospital 361 00:11:58,865 --> 00:11:59,365 systems 362 00:12:00,069 --> 00:12:01,049 are actually purchasing 363 00:12:01,909 --> 00:12:02,409 ASCs 364 00:12:03,110 --> 00:12:04,889 with the intent of keeping 365 00:12:05,750 --> 00:12:07,929 them just an ASC, not an HOPD, 366 00:12:09,110 --> 00:12:10,709 for the purpose of being able to have 367 00:12:10,709 --> 00:12:11,929 an investment mechanism 368 00:12:12,549 --> 00:12:13,129 to get 369 00:12:13,875 --> 00:12:15,975 surgeons, primary care physicians, things like 370 00:12:16,514 --> 00:12:18,674 that incorporated into the hospital system and buying 371 00:12:18,674 --> 00:12:20,535 into the hospital system, kind of essentially 372 00:12:20,915 --> 00:12:21,894 allowing them 373 00:12:22,915 --> 00:12:25,634 some legal loyalty there. Who knows how long 374 00:12:25,634 --> 00:12:27,634 it'll be before somebody in the government decides 375 00:12:27,634 --> 00:12:29,409 that, you know, while they can take kickbacks 376 00:12:29,409 --> 00:12:32,289 and bribes, again, we can't let the can't 377 00:12:32,289 --> 00:12:33,970 let the physicians do that, so let's ban 378 00:12:33,970 --> 00:12:36,470 it. But for now, that's looking like possibly 379 00:12:38,610 --> 00:12:40,850 an avenue for growth for quite a few, 380 00:12:41,089 --> 00:12:43,029 of the smaller ASCs and no BSs. 381 00:12:44,195 --> 00:12:47,235 Yeah. Definitely the laughing at your bribe comment 382 00:12:47,235 --> 00:12:49,075 because yeah. Oh, let's be honest. But, you 383 00:12:49,075 --> 00:12:51,075 know, like Yeah. No. For sure. Hold back 384 00:12:51,075 --> 00:12:53,075 the curtain there and just say the truth. 385 00:12:53,075 --> 00:12:53,654 I mean, 386 00:12:54,035 --> 00:12:56,035 the ASCs were originally 387 00:12:56,799 --> 00:12:58,820 you know, when they first started coming around, 388 00:12:59,040 --> 00:13:00,720 everybody had to have a certificate of need. 389 00:13:00,720 --> 00:13:02,879 And basically, the intent there was, hey. The 390 00:13:02,879 --> 00:13:04,740 American Hospital Association is afraid. 391 00:13:05,200 --> 00:13:06,720 You know, these are gonna come in. The 392 00:13:06,720 --> 00:13:08,080 OR is the only place where a hospital 393 00:13:08,080 --> 00:13:10,320 really generates any money. These ASCs are gonna 394 00:13:10,320 --> 00:13:12,000 pop up everywhere in every corner and cripple 395 00:13:12,000 --> 00:13:12,465 everybody. 396 00:13:12,945 --> 00:13:13,925 That didn't happen. 397 00:13:14,305 --> 00:13:14,805 So 398 00:13:15,425 --> 00:13:16,945 as the states have gotten smart to that 399 00:13:16,945 --> 00:13:19,345 and realized that they've gone through and kind 400 00:13:19,345 --> 00:13:21,105 of a lot of the states have started 401 00:13:21,105 --> 00:13:22,165 removing these, 402 00:13:22,945 --> 00:13:24,485 certificate of need areas. 403 00:13:25,649 --> 00:13:27,250 So there's a couple things happening with this, 404 00:13:27,250 --> 00:13:28,769 and and I wanna address this one a 405 00:13:28,769 --> 00:13:30,309 little bit. You know, you've still got 406 00:13:30,929 --> 00:13:33,889 some of these places where, quite honestly, it's 407 00:13:33,889 --> 00:13:36,129 it's a bribe. You know, like, I let's 408 00:13:36,129 --> 00:13:38,129 call a spade a spade. You know, in 409 00:13:38,129 --> 00:13:40,209 Chicagoland area, when you build an ASC, you 410 00:13:40,209 --> 00:13:41,384 have to find the right person, you have 411 00:13:41,384 --> 00:13:42,745 paying the right amount, and then suddenly you 412 00:13:42,745 --> 00:13:43,965 get a certificate of need. 413 00:13:44,985 --> 00:13:45,884 It's not 414 00:13:46,345 --> 00:13:47,804 it's not an honest process. 415 00:13:48,264 --> 00:13:51,225 And it's it's not just Chicago. It's New 416 00:13:51,225 --> 00:13:53,850 York. It's, you know, even Alaska. I mean, 417 00:13:54,250 --> 00:13:57,370 I had an opportunity present where literally a 418 00:13:57,370 --> 00:13:58,750 converted Jiffy Lube 419 00:13:59,209 --> 00:14:00,889 was being offered as a, 420 00:14:01,289 --> 00:14:03,709 surgery center because it had a certificate. 421 00:14:04,169 --> 00:14:06,169 The building itself was in a horrible area. 422 00:14:06,169 --> 00:14:07,995 It was a trashy building. But because they 423 00:14:07,995 --> 00:14:09,595 had this certificate of need, they were asking 424 00:14:09,595 --> 00:14:11,915 a ridiculous amount for it because, again, you 425 00:14:11,915 --> 00:14:13,035 know, you have to pay off the right 426 00:14:13,035 --> 00:14:14,975 people, grease the right wheels, which is wrong. 427 00:14:15,434 --> 00:14:17,915 So we've now you know, the pendulum swings 428 00:14:17,915 --> 00:14:18,634 each way. 429 00:14:19,035 --> 00:14:20,815 It can't swing too far the other way. 430 00:14:21,035 --> 00:14:22,095 I think the 431 00:14:22,790 --> 00:14:24,649 the thing that will prevent 432 00:14:25,990 --> 00:14:27,910 kind of that fear, that original fear and, 433 00:14:27,910 --> 00:14:29,509 honestly, the the original fear was that if 434 00:14:29,509 --> 00:14:31,269 these pop up everywhere, they're gonna be unregulated. 435 00:14:31,269 --> 00:14:32,710 They're gonna be unsafe. We're gonna have patients 436 00:14:32,710 --> 00:14:34,490 dying all over the place. That's a legitimate 437 00:14:34,629 --> 00:14:35,129 fear. 438 00:14:35,590 --> 00:14:38,565 You know, The United Arab Emirates is an 439 00:14:38,565 --> 00:14:40,404 example I'll use. Right now, they've got a 440 00:14:40,404 --> 00:14:41,625 huge growth happening. 441 00:14:42,165 --> 00:14:43,705 And so rather than 442 00:14:44,165 --> 00:14:47,125 creating this false bribery system that we have 443 00:14:47,125 --> 00:14:49,445 going on, they basically just said, hey. You 444 00:14:49,445 --> 00:14:49,945 know, 445 00:14:50,389 --> 00:14:52,070 fine. Go out and do your thing. Set 446 00:14:52,070 --> 00:14:53,590 up. But you have to be able to 447 00:14:53,590 --> 00:14:55,750 get accredited. And so that kinda covers both, 448 00:14:55,750 --> 00:14:57,590 hey. It fills the need, and, hey. We 449 00:14:57,590 --> 00:14:59,450 also are assuring that it's safe because 450 00:14:59,830 --> 00:15:02,149 you have to go through a an approved 451 00:15:02,149 --> 00:15:03,210 accrediting agency 452 00:15:03,590 --> 00:15:04,389 to make sure that your 453 00:15:05,174 --> 00:15:07,014 you know, what you're doing there is legit. 454 00:15:07,014 --> 00:15:08,855 It's safe. We're not gonna have, you know, 455 00:15:08,855 --> 00:15:12,134 somebody's garage in Miami with silicone being injected 456 00:15:12,134 --> 00:15:14,394 into a buttocks from Home Depot. Right? 457 00:15:14,855 --> 00:15:17,254 So, anyway, again, I'm a little biased. I'm 458 00:15:17,254 --> 00:15:18,235 I'm with QuadE, 459 00:15:19,070 --> 00:15:20,909 so there is some bias. I I see 460 00:15:20,909 --> 00:15:24,209 the value in accreditation or, agencies and organizations, 461 00:15:24,909 --> 00:15:26,429 but the data is there too. You know? 462 00:15:26,429 --> 00:15:27,570 When you look at accreditation, 463 00:15:28,350 --> 00:15:30,209 accredited versus nonaccredited facilities, 464 00:15:30,830 --> 00:15:32,049 your morbidity 465 00:15:32,429 --> 00:15:33,649 morbidity and mortality 466 00:15:34,184 --> 00:15:35,485 drop off pretty significantly 467 00:15:36,184 --> 00:15:38,745 from the random pop ups that are just, 468 00:15:38,745 --> 00:15:39,325 you know, 469 00:15:39,945 --> 00:15:41,625 by the seat of your parents type thing 470 00:15:41,625 --> 00:15:43,625 versus the ones that are doing things right. 471 00:15:43,625 --> 00:15:45,865 So, anyway, there you go. There's my little 472 00:15:45,865 --> 00:15:48,000 soapbox for a minute there. No. We love 473 00:15:48,000 --> 00:15:49,360 we love a soapbox here. 474 00:15:49,920 --> 00:15:51,440 Is there anything else that I haven't touched 475 00:15:51,440 --> 00:15:52,879 on that you think is important in this 476 00:15:52,879 --> 00:15:53,379 conversation? 477 00:15:54,480 --> 00:15:55,700 You know, that's a good question. 478 00:15:56,720 --> 00:15:57,620 There's a lot 479 00:15:58,560 --> 00:16:00,639 you know, as we're talking about growth, I 480 00:16:00,639 --> 00:16:03,415 think there's more opportunity for growth. I think 481 00:16:03,415 --> 00:16:04,695 that's a really important thing for people to 482 00:16:04,695 --> 00:16:05,835 understand is that 483 00:16:06,215 --> 00:16:08,774 health care is in need of disruptors right 484 00:16:08,774 --> 00:16:09,274 now. 485 00:16:09,654 --> 00:16:12,215 I think that the trend to ASCs, as 486 00:16:12,215 --> 00:16:13,595 long as it's done the right way, 487 00:16:14,054 --> 00:16:16,730 is definitely that pop potential disruptor. 488 00:16:18,149 --> 00:16:19,990 I had an opportunity to speak, and I 489 00:16:19,990 --> 00:16:21,669 I won't say the state, but I was 490 00:16:21,669 --> 00:16:23,250 meeting with the, 491 00:16:23,830 --> 00:16:24,330 the, 492 00:16:25,750 --> 00:16:27,990 basically, the health care panel within the state 493 00:16:27,990 --> 00:16:28,490 government. 494 00:16:29,125 --> 00:16:30,504 So senators and representatives, 495 00:16:32,165 --> 00:16:33,845 had a discussion with them, had a good 496 00:16:33,845 --> 00:16:36,644 lunch. We were talking about how ASCs get 497 00:16:36,644 --> 00:16:39,465 reimbursed versus hospitals and HOPDs. 498 00:16:40,404 --> 00:16:40,904 And 499 00:16:41,620 --> 00:16:43,540 these people who are making the decisions about 500 00:16:43,540 --> 00:16:45,160 things like Medicaid reimbursement 501 00:16:45,540 --> 00:16:48,340 and, you know, hospital policy, health care policy 502 00:16:48,340 --> 00:16:49,080 for the state, 503 00:16:49,460 --> 00:16:51,460 as we got talking with them, it became 504 00:16:51,460 --> 00:16:52,920 very clear that they 505 00:16:53,904 --> 00:16:55,924 didn't really know how any of that works. 506 00:16:56,065 --> 00:16:57,904 You know, one of the specific examples we 507 00:16:57,904 --> 00:16:59,264 use was we talked about how in an 508 00:16:59,264 --> 00:17:00,804 ASC, a true ASC, 509 00:17:01,585 --> 00:17:03,605 your CPT code is kind of the ceiling. 510 00:17:03,745 --> 00:17:06,724 So if you're having code, you know, whatever 511 00:17:07,640 --> 00:17:09,799 for a bunion correction, you know, 512 00:17:11,080 --> 00:17:12,200 I can't think of the code off the 513 00:17:12,200 --> 00:17:14,039 top of my head. But, anyway, with that 514 00:17:14,039 --> 00:17:15,720 code, if they say, hey. For this code, 515 00:17:15,720 --> 00:17:17,740 we reimburse you $6,000. 516 00:17:18,360 --> 00:17:19,960 That's it. Period. That's the end of the 517 00:17:19,960 --> 00:17:22,279 statement. So you get $6,000, and that's what 518 00:17:22,279 --> 00:17:25,184 you get reimbursed for any hardware, any facility 519 00:17:25,184 --> 00:17:27,904 fees, paying your staff, paying for, medications, paying 520 00:17:27,904 --> 00:17:28,565 for anesthesia. 521 00:17:29,025 --> 00:17:31,025 You know, all that kind of stuff outside 522 00:17:31,025 --> 00:17:33,265 of the the anesthesia professional fees are paid 523 00:17:33,265 --> 00:17:35,345 with that facility fee, with that one CPT 524 00:17:35,345 --> 00:17:35,845 code 525 00:17:36,419 --> 00:17:38,259 versus in the hospital where that's kind of 526 00:17:38,259 --> 00:17:40,099 your floor instead of your ceiling. So you 527 00:17:40,099 --> 00:17:41,379 start with that, then you get to charge 528 00:17:41,379 --> 00:17:43,639 for nursing fees and facility fees and, 529 00:17:44,259 --> 00:17:46,740 you know, medication administration fees and all kinds 530 00:17:46,740 --> 00:17:48,019 of, you know, your DME, all that kind 531 00:17:48,019 --> 00:17:49,399 of stuff gets added on top. 532 00:17:50,355 --> 00:17:52,295 So when we started talking about that, 533 00:17:52,835 --> 00:17:54,755 it became very clear that they had no 534 00:17:54,755 --> 00:17:56,434 idea that's how it worked. They had no 535 00:17:56,434 --> 00:17:58,275 idea why it was that ASCs were cheaper. 536 00:17:58,275 --> 00:17:59,634 They just thought maybe we charge less, you 537 00:17:59,634 --> 00:18:00,835 know, on the goodness of our heart or 538 00:18:00,835 --> 00:18:01,650 something. Right? 539 00:18:01,970 --> 00:18:04,529 So as we discussed this, about fifteen minutes 540 00:18:04,529 --> 00:18:06,549 into the conversation, one of the state senators 541 00:18:07,330 --> 00:18:09,809 says, hey, can we regulate can we can 542 00:18:09,809 --> 00:18:11,330 we mandate that anything that can be done 543 00:18:11,330 --> 00:18:12,950 in ASC is done in ASC? 544 00:18:13,330 --> 00:18:14,210 I kind of just looked at him and 545 00:18:14,210 --> 00:18:15,490 laughed at him and said, hey, you're the 546 00:18:15,490 --> 00:18:17,144 government. Do whatever you want, you know? You 547 00:18:17,144 --> 00:18:19,644 guys can do whatever you wanna do. And, 548 00:18:20,424 --> 00:18:22,345 they kinda discussed that quite a bit about, 549 00:18:22,345 --> 00:18:23,865 hey. How do we how do we require 550 00:18:23,865 --> 00:18:25,965 that, you know, if this is an ASC, 551 00:18:27,625 --> 00:18:28,125 potential 552 00:18:28,585 --> 00:18:29,945 that we send that they have to at 553 00:18:29,945 --> 00:18:32,410 least evaluate that as a spot first before 554 00:18:32,410 --> 00:18:33,609 they go to the hospital to have it 555 00:18:33,609 --> 00:18:34,109 done. 556 00:18:35,769 --> 00:18:38,029 So theoretically, one fifteen minute conversation 557 00:18:38,650 --> 00:18:41,289 with the right people within the government could 558 00:18:41,289 --> 00:18:43,690 have saved this particular state literally hundreds of 559 00:18:43,690 --> 00:18:46,029 millions of dollars in Medicaid fees 560 00:18:46,674 --> 00:18:49,875 and could have generated additional revenue for these 561 00:18:49,875 --> 00:18:50,375 ASCs. 562 00:18:50,914 --> 00:18:53,154 You know, it just, you know, all the 563 00:18:53,154 --> 00:18:53,974 while saving 564 00:18:54,355 --> 00:18:57,174 taxpayers money and saving patients money 565 00:18:57,634 --> 00:18:58,134 and 566 00:18:58,595 --> 00:19:00,434 throwing things into a system that's, you know, 567 00:19:00,434 --> 00:19:01,494 a little bit more 568 00:19:02,490 --> 00:19:03,849 efficient, I guess, would be the best way 569 00:19:03,849 --> 00:19:04,809 of putting it. You know? 570 00:19:05,609 --> 00:19:07,130 I use the example. This is this has 571 00:19:07,130 --> 00:19:08,269 been quite a few years ago, 572 00:19:08,650 --> 00:19:09,869 but I was doing anesthesia 573 00:19:10,569 --> 00:19:11,309 for a, 574 00:19:11,769 --> 00:19:12,990 OBGYN surgeon. 575 00:19:13,609 --> 00:19:15,224 He came in, and he did a robotic 576 00:19:15,224 --> 00:19:18,105 hysterectomy. And then he, he left and came 577 00:19:18,105 --> 00:19:20,345 back to do, something small, like a bladder 578 00:19:20,345 --> 00:19:22,285 sling or something like that. But anyway, 579 00:19:23,224 --> 00:19:24,505 got it done, took him out, hit, said 580 00:19:24,505 --> 00:19:25,404 hi to the patient, 581 00:19:26,505 --> 00:19:28,664 rolled the patient to the the hysterectomy patient 582 00:19:28,664 --> 00:19:30,569 out to the Recovery Room, went out. I 583 00:19:30,569 --> 00:19:31,849 saw the patient, brought him back, got him 584 00:19:31,849 --> 00:19:33,049 up, got him hooked up. We were ready 585 00:19:33,049 --> 00:19:34,409 for surgery. I called the surgeon and said, 586 00:19:34,409 --> 00:19:36,009 hey. We're ready. Come on in. You know, 587 00:19:36,009 --> 00:19:38,009 we're good to go. And he's like, hey. 588 00:19:38,169 --> 00:19:39,369 What do you mean you're good to go? 589 00:19:39,369 --> 00:19:40,589 I'm I'm at lunch. 590 00:19:41,210 --> 00:19:43,289 I'm like, yeah, dude. It's been fifteen minutes. 591 00:19:43,289 --> 00:19:44,730 Get your butt in here. It's time to 592 00:19:44,730 --> 00:19:45,164 go. 593 00:19:45,725 --> 00:19:47,565 And he's like, hey. I'm I'm used to 594 00:19:47,565 --> 00:19:49,085 this hospital. He's like, I I thought I 595 00:19:49,085 --> 00:19:50,525 had time to go eat. I'm actually at 596 00:19:50,525 --> 00:19:53,325 a restaurant. I, and we're like, dude, you 597 00:19:53,325 --> 00:19:55,005 saw this patient. You signed off. You said 598 00:19:55,005 --> 00:19:57,164 it was ready. We're in the OR. And 599 00:19:57,164 --> 00:19:58,545 so just that kind of that 600 00:19:59,009 --> 00:20:01,730 that inefficiency, you know, eliminating things like that, 601 00:20:01,730 --> 00:20:02,789 you know, just 602 00:20:03,250 --> 00:20:05,089 I've got all kind of anecdotal stories from 603 00:20:05,089 --> 00:20:07,970 that from my previous anesthesia career where there's 604 00:20:07,970 --> 00:20:09,410 just a lot of inefficiency that can be 605 00:20:09,410 --> 00:20:12,484 eliminated and where we can, you know, through 606 00:20:12,484 --> 00:20:14,484 some of these other methods. Again, looking at 607 00:20:14,484 --> 00:20:17,044 AI at ways to eliminate, hey. This particular 608 00:20:17,044 --> 00:20:18,884 anesthesia provider is able to get a patient 609 00:20:18,884 --> 00:20:19,845 in and get them to sleep in this 610 00:20:19,845 --> 00:20:21,544 amount of time. Hey. This particular surgeon 611 00:20:22,244 --> 00:20:22,724 can, 612 00:20:23,204 --> 00:20:25,605 get this exact same procedure done in one 613 00:20:25,605 --> 00:20:27,490 third the amount of time that the other 614 00:20:27,490 --> 00:20:29,490 partners there at the surgery center can. What's 615 00:20:29,490 --> 00:20:31,250 he doing differently? Let's bring him in and 616 00:20:31,250 --> 00:20:33,009 have him maybe train with the others, you 617 00:20:33,009 --> 00:20:35,009 know. So I just I see a lot 618 00:20:35,009 --> 00:20:37,809 of potential for growth, for efficiency, for progress 619 00:20:37,809 --> 00:20:38,309 there. 620 00:20:38,690 --> 00:20:39,190 And, 621 00:20:39,650 --> 00:20:41,409 I think as we do that, as we 622 00:20:41,409 --> 00:20:42,390 become more efficient, 623 00:20:42,974 --> 00:20:44,355 it'll have ripple effects 624 00:20:44,894 --> 00:20:45,954 as long as 625 00:20:47,134 --> 00:20:47,634 administration 626 00:20:48,575 --> 00:20:50,994 treats things ethically. So that's a whole other, 627 00:20:51,694 --> 00:20:54,974 like, a whole whole different side side quest 628 00:20:54,974 --> 00:20:55,954 here, if you will. 629 00:20:56,335 --> 00:20:58,035 I just look at it as, you know, 630 00:20:58,720 --> 00:20:59,779 treat your people right, 631 00:21:00,160 --> 00:21:02,100 and they're gonna do their best for you. 632 00:21:02,799 --> 00:21:04,420 I I've always tried to live, 633 00:21:04,960 --> 00:21:06,880 with that as far as the areas where 634 00:21:06,880 --> 00:21:08,880 I've been director and manager, and it really 635 00:21:08,880 --> 00:21:10,240 has paid off. You know, I've had some 636 00:21:10,240 --> 00:21:11,059 just incredible 637 00:21:12,160 --> 00:21:12,660 employees 638 00:21:13,345 --> 00:21:15,025 who are just willing to absolutely go to 639 00:21:15,025 --> 00:21:15,505 bat for me. 640 00:21:16,545 --> 00:21:17,985 And it's because they know that on the 641 00:21:17,985 --> 00:21:19,904 flip side, I am a 100% on board 642 00:21:19,904 --> 00:21:21,424 to do the same for them. That, 643 00:21:22,065 --> 00:21:24,225 you know, if it doesn't seem fair to 644 00:21:24,225 --> 00:21:25,825 them, if it doesn't seem fair to me, 645 00:21:25,825 --> 00:21:27,170 then it probably isn't fair. We need to 646 00:21:27,170 --> 00:21:28,769 make a change type thing. And I just 647 00:21:28,849 --> 00:21:30,049 I wish that we had a little bit 648 00:21:30,049 --> 00:21:30,789 more of that 649 00:21:31,329 --> 00:21:33,329 in this world of kinda corruption and greed, 650 00:21:33,329 --> 00:21:34,130 you know, who 651 00:21:35,170 --> 00:21:35,670 what 652 00:21:36,210 --> 00:21:38,609 health insurance CEO really needs to be taking 653 00:21:38,609 --> 00:21:39,970 in 350,000,000 654 00:21:39,970 --> 00:21:42,554 a year, you know, while I don't know. 655 00:21:42,694 --> 00:21:44,774 Another soapbox. We yeah. I was like, well, 656 00:21:44,774 --> 00:21:46,934 we've got many. We can get a whole 657 00:21:46,934 --> 00:21:48,534 series of podcasts about that. I don't even 658 00:21:48,534 --> 00:21:49,835 get this started. But, 659 00:21:50,375 --> 00:21:50,875 absolutely. 660 00:21:51,414 --> 00:21:52,855 Well, that is all I have for you 661 00:21:52,855 --> 00:21:54,934 today, Brett. Thank you so much for joining 662 00:21:54,934 --> 00:21:57,059 us today. It has been a pleasure speaking 663 00:21:57,059 --> 00:21:58,660 with you, and I look forward to connecting 664 00:21:58,660 --> 00:21:59,880 with you again in the future. 665 00:22:00,180 --> 00:22:01,700 Hey. My pleasure's all mine. Thank you so 666 00:22:01,700 --> 00:22:03,559 much, Francesca. Good to hear from you again. 667 00:22:03,700 --> 00:22:04,519 Yeah. Absolutely.