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To learn 13 00:00:30,649 --> 00:00:33,009 more, visit carecredit.com 14 00:00:33,009 --> 00:00:34,789 forward slash beckerspodcast. 15 00:00:35,409 --> 00:00:37,409 This is Gracelyn Keller with the Becker's Healthcare 16 00:00:37,409 --> 00:00:39,329 Podcast, and we are recording live at the 17 00:00:39,329 --> 00:00:42,629 thirty first annual business and operations of ASCs. 18 00:00:43,155 --> 00:00:45,715 I'm currently join joined by doctor Nikhil Shetty, 19 00:00:45,715 --> 00:00:48,375 who is the chief operating officer at Midwest 20 00:00:48,435 --> 00:00:51,715 Interventional Spine Specialists. Doctor Shetty, thanks for being 21 00:00:51,715 --> 00:00:53,395 here. To kick us off, can you please 22 00:00:53,395 --> 00:00:55,155 share a little bit more about your work 23 00:00:55,155 --> 00:00:56,615 in the ASC space? 24 00:00:57,050 --> 00:00:59,789 Thank you for having me. Nikhil Shetty, interventional 25 00:00:59,850 --> 00:01:02,510 pain physician, Midwest interventional spine specialist, 26 00:01:02,969 --> 00:01:04,969 chief operating officer there, and I've been with 27 00:01:04,969 --> 00:01:06,650 that practice for the past eight and a 28 00:01:06,650 --> 00:01:08,270 half years in Northwest Indiana. 29 00:01:09,130 --> 00:01:11,954 We're single specialty interventional pain practice. I have 30 00:01:11,954 --> 00:01:13,974 a couple of partners, three nurse practitioners, 31 00:01:14,594 --> 00:01:16,515 and we've really been able to build and 32 00:01:16,515 --> 00:01:18,694 grow that area over the last twenty years. 33 00:01:18,915 --> 00:01:21,795 It's very satisfying treating patients in Northwest Indiana 34 00:01:21,795 --> 00:01:23,655 and also being able to live in Chicago, 35 00:01:24,070 --> 00:01:25,189 And it's good to be back on the 36 00:01:25,189 --> 00:01:25,689 podcast. 37 00:01:26,390 --> 00:01:29,350 Wonderful. Well, thanks for being here. And let's 38 00:01:29,350 --> 00:01:31,909 start with the ASC market, because in The 39 00:01:31,909 --> 00:01:33,689 US, this is projected to reach 40 00:01:34,070 --> 00:01:35,829 $60,800,000,000 41 00:01:35,829 --> 00:01:38,310 by 2030, and it continues to experience strong 42 00:01:38,310 --> 00:01:40,915 year over year growth. So from your perspective, 43 00:01:40,915 --> 00:01:42,754 what are the most significant trends in market 44 00:01:42,754 --> 00:01:45,474 forces driving this expansion, and how should ASC 45 00:01:45,474 --> 00:01:47,015 leaders be preparing today? 46 00:01:47,715 --> 00:01:49,395 Well, I think it's a very good question, 47 00:01:49,395 --> 00:01:52,275 and, that's an astounding figure, 60,800,000,000.0 48 00:01:52,275 --> 00:01:53,495 by the year 2030. 49 00:01:53,680 --> 00:01:55,840 I would say the ASC space continues to 50 00:01:55,840 --> 00:01:58,259 grow because it solves a very real problem. 51 00:01:58,799 --> 00:02:00,019 Hospitals are overburdened. 52 00:02:00,399 --> 00:02:02,659 Patients are demanding transparency and efficiency. 53 00:02:03,119 --> 00:02:04,959 The biggest trend I see is the migration 54 00:02:04,959 --> 00:02:07,299 of higher acuity cases into the ASCs 55 00:02:07,864 --> 00:02:10,685 supported by improvements in anesthesia, imaging, and technology. 56 00:02:11,384 --> 00:02:12,125 That's a personal, 57 00:02:13,305 --> 00:02:15,544 interest of mine being an interventional pain. We've 58 00:02:15,544 --> 00:02:17,324 been able to see how we're able to 59 00:02:17,465 --> 00:02:20,604 take certain cases, quicker turnover, faster turnaround, 60 00:02:21,129 --> 00:02:22,110 minimally invasive 61 00:02:23,050 --> 00:02:24,810 procedures that we're able to do in a 62 00:02:24,810 --> 00:02:28,009 safer controlled environment where we lower our infection 63 00:02:28,009 --> 00:02:30,030 risk, we improve our quality of outcomes, 64 00:02:30,330 --> 00:02:32,750 we restore function in a faster way. 65 00:02:33,405 --> 00:02:35,025 And, we're also seeing, 66 00:02:35,405 --> 00:02:38,125 this reflect in the landscape. The ASCs are 67 00:02:38,125 --> 00:02:40,844 growing. Hospitals have caught on to that. Major 68 00:02:40,844 --> 00:02:42,525 health players have caught on to that and 69 00:02:42,525 --> 00:02:43,745 are partnering with, 70 00:02:44,204 --> 00:02:46,364 other physicians in the area looking to build 71 00:02:46,364 --> 00:02:47,344 their own ASC. 72 00:02:47,949 --> 00:02:49,870 I would say that we're also seeing increasing 73 00:02:49,870 --> 00:02:51,969 payer consolidation and contract pressures. 74 00:02:52,269 --> 00:02:53,489 That's where independent 75 00:02:53,789 --> 00:02:56,209 ASCs like ours feel the squeeze. 76 00:02:56,590 --> 00:02:58,989 We're not just competing on outcomes anymore. We're 77 00:02:58,989 --> 00:03:02,134 navigating policy structures that were never designed with 78 00:03:02,134 --> 00:03:04,074 small physician owners in mind. 79 00:03:04,375 --> 00:03:05,275 It puts us 80 00:03:05,735 --> 00:03:07,894 sometimes at a disadvantage when we're playing the 81 00:03:07,894 --> 00:03:09,995 same game with the major hospital institutions 82 00:03:10,534 --> 00:03:13,354 that are spending, like you said, that 60,800,000,000.0 83 00:03:13,414 --> 00:03:14,614 by 2030. 84 00:03:14,614 --> 00:03:16,394 Though I think it's great for the country, 85 00:03:16,659 --> 00:03:17,159 ASCs 86 00:03:18,180 --> 00:03:19,080 are able to, 87 00:03:19,860 --> 00:03:22,840 service patients in a faster, safer, more efficient, 88 00:03:22,900 --> 00:03:23,639 and streamlined 89 00:03:24,259 --> 00:03:24,759 process. 90 00:03:25,219 --> 00:03:26,680 And with advance of technology, 91 00:03:27,060 --> 00:03:29,699 leveraging that technology into the ASC, we're able 92 00:03:29,699 --> 00:03:33,215 to do more sophisticated procedures that weren't otherwise 93 00:03:33,275 --> 00:03:33,935 or previously 94 00:03:34,555 --> 00:03:36,715 able to be done in a quick outpatient 95 00:03:36,715 --> 00:03:37,534 surgery center. 96 00:03:38,235 --> 00:03:41,055 And from AI and robotic surgeries to advanced 97 00:03:41,115 --> 00:03:43,754 EHR systems, technology remains both a make or 98 00:03:43,754 --> 00:03:46,075 break factor and a critical driver of ASC 99 00:03:46,075 --> 00:03:48,330 operations at scale. So how do you see 100 00:03:48,330 --> 00:03:51,370 deeper tech integration shaping the ways that ASCs 101 00:03:51,370 --> 00:03:53,769 deliver care and manage their business over the 102 00:03:53,769 --> 00:03:54,830 next few years? 103 00:03:55,370 --> 00:03:58,509 Well, I'd say technology is a massive enabler 104 00:03:58,569 --> 00:04:00,989 for physician independent physician centers. 105 00:04:01,585 --> 00:04:04,145 We're using AI driven tools in everything from 106 00:04:04,145 --> 00:04:06,324 patient education to workflow optimization. 107 00:04:06,944 --> 00:04:08,465 I'll just give you a quick example. I'm 108 00:04:08,465 --> 00:04:10,245 a big fan of the, 109 00:04:10,784 --> 00:04:12,944 application called Sora, where we're able to use 110 00:04:12,944 --> 00:04:13,444 video 111 00:04:13,905 --> 00:04:16,129 AI generation. And so I've been able to 112 00:04:16,129 --> 00:04:18,790 do that in my practice using my likeness 113 00:04:19,169 --> 00:04:19,910 to explain 114 00:04:20,769 --> 00:04:23,970 interventional pain procedures to the patients in a 115 00:04:23,970 --> 00:04:24,470 quick, 116 00:04:24,850 --> 00:04:28,529 shareable video form contact content that the patient 117 00:04:28,529 --> 00:04:31,384 can review before their procedure. So we hand 118 00:04:31,384 --> 00:04:32,824 that to them in a in a tablet 119 00:04:32,824 --> 00:04:34,425 while they're in the waiting room, and the 120 00:04:34,425 --> 00:04:35,644 patient's able to review 121 00:04:35,944 --> 00:04:38,264 my instructions on the procedures that they're about 122 00:04:38,264 --> 00:04:38,925 to get 123 00:04:39,544 --> 00:04:41,064 before they we bring them back into the 124 00:04:41,064 --> 00:04:42,925 pre op area. These are the same conversations 125 00:04:43,064 --> 00:04:44,204 I have with the patient 126 00:04:44,850 --> 00:04:47,410 in the clinic when I'm evaluating them. However, 127 00:04:47,410 --> 00:04:49,270 it's always good to have that refresher. 128 00:04:49,810 --> 00:04:52,290 AI has made that process so much easier, 129 00:04:52,290 --> 00:04:56,209 and applications video applications like Sora, for example, 130 00:04:56,209 --> 00:04:57,990 make that so much more streamlined. 131 00:04:58,290 --> 00:05:00,495 They're able from the patient perspective, it makes 132 00:05:00,495 --> 00:05:03,154 them feel comfortable because they're seeing the physician 133 00:05:03,214 --> 00:05:04,995 that's about to perform the procedure 134 00:05:05,694 --> 00:05:08,175 go through once again explaining to the patient 135 00:05:08,175 --> 00:05:10,414 what exactly is gonna be done, answering some 136 00:05:10,414 --> 00:05:12,990 of those last minute questions that sometimes can 137 00:05:13,069 --> 00:05:15,229 cause log jams or slow up the throughput 138 00:05:15,229 --> 00:05:16,990 of the ASC. I think that's a very 139 00:05:16,990 --> 00:05:19,470 good tech that we're now starting to leverage 140 00:05:19,470 --> 00:05:20,370 in our ASC. 141 00:05:21,229 --> 00:05:21,729 And 142 00:05:22,110 --> 00:05:25,629 with 60% of health systems considering ASC joint 143 00:05:25,629 --> 00:05:26,129 ventures, 144 00:05:26,704 --> 00:05:29,105 many ASCs are already partnering with systems in 145 00:05:29,105 --> 00:05:29,845 their communities. 146 00:05:30,225 --> 00:05:32,644 So what opportunities do you see for collaboration, 147 00:05:32,704 --> 00:05:35,185 whether with other providers or vendors, to strengthen 148 00:05:35,185 --> 00:05:36,884 patient care and operational efficiency? 149 00:05:38,064 --> 00:05:40,324 Yeah. I think collaboration can be powerful, 150 00:05:40,680 --> 00:05:41,819 but it has to be equitable. 151 00:05:42,439 --> 00:05:45,899 Independent ambulatory surgery centers bring agility, flexibility, 152 00:05:46,279 --> 00:05:49,740 local insight, and hospitals bring scale and infrastructure. 153 00:05:50,199 --> 00:05:53,079 The challenging is ensuring these partnerships don't erode 154 00:05:53,079 --> 00:05:54,699 physician autonomy or innovation. 155 00:05:55,444 --> 00:05:57,384 I've seen great models where hospitals 156 00:05:57,925 --> 00:06:00,664 offload their lower acuity cases to the ASCs, 157 00:06:01,044 --> 00:06:03,444 improving throughput on both sides, but that only 158 00:06:03,444 --> 00:06:06,425 works of reimbursement and governance are structured fairly. 159 00:06:06,724 --> 00:06:07,685 I'll say this, 160 00:06:08,324 --> 00:06:10,185 using the example of the pandemic. 161 00:06:10,589 --> 00:06:12,350 During the pandemic, about five and a half 162 00:06:12,350 --> 00:06:14,610 years ago now, when everything was shut down, 163 00:06:14,750 --> 00:06:17,709 hospital outpatient departments were completely shut down, everybody 164 00:06:17,709 --> 00:06:19,889 was under these government mandated 165 00:06:20,270 --> 00:06:22,830 shutdowns, including our own practice, and we were 166 00:06:22,830 --> 00:06:24,449 abiding by the CDC guidelines. 167 00:06:24,764 --> 00:06:26,944 With time, we were able to open up, 168 00:06:27,084 --> 00:06:29,564 and those lower acuity cases that were getting 169 00:06:29,564 --> 00:06:31,264 pushed back by the big hospitals 170 00:06:31,884 --> 00:06:34,044 big hospital or health care systems, we were 171 00:06:34,044 --> 00:06:36,285 now able to open up our doors for 172 00:06:36,285 --> 00:06:38,384 them. We take that same 173 00:06:38,870 --> 00:06:41,589 mindset into 2025 now where we're able to 174 00:06:41,589 --> 00:06:44,470 transition these higher acuity cases into the surgery 175 00:06:44,470 --> 00:06:46,470 center. And when the patient checks in with 176 00:06:46,470 --> 00:06:48,949 us, it's a quick and easy process. I 177 00:06:48,949 --> 00:06:51,189 explained to you already how the pre op 178 00:06:51,189 --> 00:06:53,714 area works. The patient's reviewing a tablet that 179 00:06:53,714 --> 00:06:56,435 has, once again, my instructions on the procedures 180 00:06:56,435 --> 00:06:58,274 that the patient's about to get. They get 181 00:06:58,274 --> 00:07:00,274 brought back to the preop area. And by 182 00:07:00,274 --> 00:07:01,495 the time they're in the PACU, 183 00:07:01,875 --> 00:07:04,595 everybody knows their name. We're familiar. We're able 184 00:07:04,595 --> 00:07:07,334 to control that environment and streamline that process, 185 00:07:07,550 --> 00:07:09,149 making it so much more comfortable for the 186 00:07:09,149 --> 00:07:11,310 patient. My number one comment that I hear 187 00:07:11,310 --> 00:07:12,209 is patients 188 00:07:12,589 --> 00:07:14,930 that previously were done at bigger health systems 189 00:07:14,990 --> 00:07:17,389 transition to the ASCs as well. You guys 190 00:07:17,389 --> 00:07:19,410 really know my name. You remember I like 191 00:07:19,550 --> 00:07:21,810 one cream, one sugar in my coffee. And 192 00:07:21,904 --> 00:07:23,345 when I came back for my second procedure, 193 00:07:23,345 --> 00:07:24,785 it was ready waiting for me after my 194 00:07:24,785 --> 00:07:25,285 procedure. 195 00:07:25,745 --> 00:07:28,404 This level of touch points, this level of 196 00:07:28,785 --> 00:07:30,324 patient interaction and patient, 197 00:07:30,865 --> 00:07:33,264 care is something that's unique in a in 198 00:07:33,264 --> 00:07:33,845 a system 199 00:07:34,145 --> 00:07:35,985 like our surgery center where we're able to 200 00:07:35,985 --> 00:07:37,285 streamline that flow. 201 00:07:37,730 --> 00:07:40,069 We're able to work in a lean fashion, 202 00:07:40,449 --> 00:07:42,629 and we're able to be flexible to accommodate 203 00:07:42,689 --> 00:07:44,069 the needs of the patient. Whereas 204 00:07:44,689 --> 00:07:45,970 if you wanna add on a case at 205 00:07:45,970 --> 00:07:47,569 the hospital, it'll take you a week or 206 00:07:47,569 --> 00:07:49,410 two before they give you OR time. Whereas 207 00:07:49,410 --> 00:07:51,410 with us, we'll open up. I'll open up 208 00:07:51,410 --> 00:07:53,615 early. Like I did, for example, this morning 209 00:07:53,675 --> 00:07:55,355 before coming to the conference. We opened up 210 00:07:55,355 --> 00:07:57,455 our surgery center early this morning to accommodate 211 00:07:57,514 --> 00:07:59,754 some patients to come in sooner. That level 212 00:07:59,754 --> 00:08:02,175 of flexibility is just something that's not achievable. 213 00:08:02,795 --> 00:08:04,634 Too many moving parts in a major health 214 00:08:04,634 --> 00:08:05,134 system. 215 00:08:05,720 --> 00:08:07,340 And so this flexibility, 216 00:08:07,720 --> 00:08:11,580 this lean operating structure makes it very convenient 217 00:08:12,040 --> 00:08:13,720 for the patients to come in and get 218 00:08:13,720 --> 00:08:15,960 their procedures done. That's the number one comment 219 00:08:15,960 --> 00:08:17,800 I hear from patients who have had the 220 00:08:17,800 --> 00:08:20,644 same procedure done at two different institutions, one 221 00:08:20,644 --> 00:08:22,404 of them being our ASC. That's our number 222 00:08:22,404 --> 00:08:24,245 one comment. And then if we're gonna go 223 00:08:24,245 --> 00:08:26,084 deeper into this, one of the my biggest 224 00:08:26,084 --> 00:08:27,865 passions is price transparency. 225 00:08:28,564 --> 00:08:31,764 Make prices of procedures transparent across our surgery 226 00:08:31,764 --> 00:08:32,264 center, 227 00:08:33,049 --> 00:08:35,529 landscape as well as the overall major health 228 00:08:35,529 --> 00:08:38,490 system landscape. As patients start to see exactly 229 00:08:38,490 --> 00:08:41,129 what they're getting charged in major health care 230 00:08:41,129 --> 00:08:41,629 systems 231 00:08:42,250 --> 00:08:43,870 compared to what there are ASCs 232 00:08:44,330 --> 00:08:46,894 overall cost is, When we make those prices 233 00:08:46,894 --> 00:08:47,394 transparent, 234 00:08:47,855 --> 00:08:50,575 ASCs will win. And I think the country 235 00:08:50,575 --> 00:08:52,495 is seeing that, and that's where that 60,000,000,000 236 00:08:52,495 --> 00:08:54,514 figure is going by the year 2030. 237 00:08:54,975 --> 00:08:55,714 It saves, 238 00:08:56,414 --> 00:08:58,514 health care dollars across the country. 239 00:08:59,039 --> 00:09:01,839 Price transparency make sort of levels the playing 240 00:09:01,839 --> 00:09:04,959 field, and so that insurers can see that 241 00:09:04,959 --> 00:09:09,059 ASCs, these independently physician owned ASCs, are faster, 242 00:09:09,120 --> 00:09:09,860 more efficient, 243 00:09:10,240 --> 00:09:13,220 safer, number one, and our outcomes prove that 244 00:09:13,595 --> 00:09:15,774 more volume will be driven to the ASC, 245 00:09:15,835 --> 00:09:18,335 and I think which overall lowers cost 246 00:09:18,875 --> 00:09:19,375 and 247 00:09:19,754 --> 00:09:20,254 streamlines 248 00:09:20,715 --> 00:09:23,295 that health that health care efficiency throughput, 249 00:09:23,754 --> 00:09:27,055 especially for these lower acuity, minimally invasive procedures 250 00:09:27,115 --> 00:09:29,860 that don't need hospital OR time and can 251 00:09:29,860 --> 00:09:31,240 be done in the surgery center. 252 00:09:32,100 --> 00:09:34,259 Well, doctor Shetty, thanks so much for joining 253 00:09:34,259 --> 00:09:36,339 me today on the podcast. Is there anything 254 00:09:36,339 --> 00:09:37,860 we didn't touch on or any final thoughts 255 00:09:37,860 --> 00:09:39,720 you'd like to share before we wrap up? 256 00:09:40,375 --> 00:09:42,054 Thank you very much for having me. I 257 00:09:42,054 --> 00:09:44,554 I think Becker's is a very important conference 258 00:09:45,254 --> 00:09:45,754 for 259 00:09:46,214 --> 00:09:47,274 independent practices, 260 00:09:47,815 --> 00:09:50,075 ASC leaders to come together, 261 00:09:50,454 --> 00:09:51,274 talk policy, 262 00:09:51,735 --> 00:09:54,235 learn more about the environment that we're in, 263 00:09:54,379 --> 00:09:56,620 and learn how we can make our system 264 00:09:56,620 --> 00:09:57,120 better. 265 00:09:57,500 --> 00:10:00,459 We're always focused on focusing on how can 266 00:10:00,459 --> 00:10:02,620 I be, number one, a better physician, better 267 00:10:02,620 --> 00:10:03,360 for my patients, 268 00:10:03,740 --> 00:10:05,759 but also better for my employees, 269 00:10:06,139 --> 00:10:07,899 my staff that I work with? What are 270 00:10:07,899 --> 00:10:09,839 some of the trends out there 271 00:10:10,139 --> 00:10:11,175 in in a different ASC 272 00:10:11,555 --> 00:10:13,235 market that they are employing that I can 273 00:10:13,235 --> 00:10:15,394 now employ in our practice? I do appreciate 274 00:10:15,394 --> 00:10:17,495 Becker's for being a good host for that. 275 00:10:17,555 --> 00:10:18,995 I do appreciate the, 276 00:10:19,475 --> 00:10:21,154 the panels that we have and I've been 277 00:10:21,154 --> 00:10:23,175 a part of as well as this podcast. 278 00:10:23,394 --> 00:10:24,855 So thank you for having me. 279 00:10:25,347 --> 00:10:27,187 Wonderful. Well, thanks for being here. And again, 280 00:10:27,187 --> 00:10:29,028 we are recording live at the thirty first 281 00:10:29,028 --> 00:10:31,288 annual business and operations of ASCs.