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Hello. This is Franchesca Matthews with the Becker's

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ASC review podcast.

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I'm thrilled to be joined today by doctor

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Nathan Merriman, the interim senior medical director of

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the Surgical Specialties Digestive Health Clinical Program at

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Intermountain Medical Center.

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Doctor Merriman, thank you so much for being

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here today.

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Thank you for having me, Franchesca.

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Absolutely. To start us off, could you please

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introduce yourself and tell us a little bit

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about your background?

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Oh, sure.

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So I won't go all the way back

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to the beginning, but I would I will

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say I grew up in

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health care and medicine,

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on the East Coast in academics.

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Went to UNC Chapel Hill for medical school

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and up to

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Philadelphia at University of Pennsylvania for residency and

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fellowship,

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and then got a master's in clinical epidemiology

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and with a focus on, clinical trial design

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and had intended to stay in academics.

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And then my wife and I decided to

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go into private practice. She's maternal fetal medicine

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and then,

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for me in GI in Delaware and loved

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our experience there for twelve years,

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learned a ton,

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about the business side of medicine.

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Also, we had our own endoscopy center,

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worked with

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an AmSurge partner to help optimize

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the clinical,

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operational, and financial

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health of the endoscopyAC and worked with the

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health system ChristianaCare

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as well

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to understand

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teamwork across,

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health systems

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and private practice partners.

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And then,

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also worked with start up companies on learning

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about innovation and

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how we can

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actually work together across different,

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partnerships in health care,

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to be better because we can't all be

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good at everything.

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And then,

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decided in 2020,

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my wife and I decided that we would

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leave our private practices and, join the Intermountain

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Health team.

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So we moved our four kids up to

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Utah and have loved every minute of being

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a part of Intermountain.

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And

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I'll just say candidly,

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I see a lot of

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collective strength

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with an Intermountain system because we can

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take some parts of academics,

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some parts of,

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private practice models of care,

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and then,

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center

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on our mission focus,

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on helping patients live their healthiest lives and

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working together to prevent avoidable suffering across our

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communities. So I can't say enough about how

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happy I am to be with Intermountain.

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Awesome. Yeah. That's that's great to hear. And

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I love speaking with folks who have experience

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in private practice. I write a lot on

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the physician leadership side of our publication, and,

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yeah, there's definitely I'm I'm kind of seeing

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growing movement towards sort of hybrid models of

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doing things just to kind of respond to

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the very dynamic health care environment today,

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which kind of transitions into our next question,

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which I'm I'm curious. What are the top

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three trends that you're following in health care

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today?

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Yes. I would start with,

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understanding the the patient experience

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and working toward patient centered design and improving

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access to care.

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What we're we're really trying to work on

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and I'm following companies

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both in startups as well as health systems

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and private practices is how can we make

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it easier

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for our patients,

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to get the right care they need at

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the right time in the right venue.

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And so by far, that's number one.

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Human centered care design, I think, is something,

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we need to all continue to work on

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because

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I've said this before. I've never done a

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colonoscopy without a patient's help, and I know

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that sounds basic, but

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it is fundamentally true is if if we

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leave our patients out of the design of

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care,

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we're gonna lose them.

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And so I think really focusing on patient

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centered care is number one.

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Number two is a

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a massive concern about the cost of health

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care, which is

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is unsustainable

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and more and more,

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awareness around this. And I know this has

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come in waves before, but I think this

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is one of the biggest waves that we're

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seeing in

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true unsustainability

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if we keep doing what we're doing,

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currently in terms of the cost of care.

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And then the third

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big trend is thinking about innovations

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in team based care model

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and technology. I I am of the opinion

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that often

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people use the word innovation

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referring to technology, but there's so much more

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to innovation.

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As we're trying out new ways of working

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together,

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we're trying out,

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at Intermountain, we're really focusing on proactive care,

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which I believe is is

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the right thing to do. How do we

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get upstream,

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working with patients on identifying,

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health concerns,

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conditions earlier

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before they progress,

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and get more costly and and more harmful

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to patients. So

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proactive care, I I believe, is a a

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form of care innovation.

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And so

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using

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team based care models to innovate with our

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patients,

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would be number three.

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Mhmm. Absolutely. And what are you most excited

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about right now?

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I I think

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I'm excited about competition.

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And I don't I don't know if that's

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a

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popular response or what others say, but,

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I think if we're competing on the right

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things, we will all help our each other

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to to get better faster.

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And just in the the frame in GI,

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I I think the way we're looking at

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it is how do we compete against colon

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cancer?

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And then using that frame, then we start

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to see each other across,

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academic centers,

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community health systems, and and,

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larger groups as well as private practices and

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start up companies is we're all teammates fighting

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against colon cancer. And so I think I'm

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very excited

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about competition,

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in and

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how do we collaborate,

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to compete on the right things,

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High safety, high quality care,

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lower cost of care for our patients,

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and then human centered care, with a team

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based approach with every patient as our teammate.

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I I think

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that's what I'm most excited about is,

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competing on the right things to help make

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care

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better and more more affordable for our patients.

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I really that's really interesting framing. I think

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that sometimes, you know,

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like, the you said is I don't know

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if that's a popular response. And I think,

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you know, most people kind of think about

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competition in a different way. But what you

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said of, you know, we're competing against colon

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cancer, this is a collaborative

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thing, and we're we're competing on the same

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team. I think that's that's a really, you

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know, poignant

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note there.

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How are you and your your center thinking

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about growth over the next twelve months?

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Oh, great great question. So and one thing

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I should step back and share.

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When I came to Intermountain in 2020, we

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had no,

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ambulatory endoscopy centers,

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and

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that was very surprising to me because I

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was a physician investor and co owner and

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co manager in one previously, and I I

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knew about the value proposition

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of,

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ambulatory endoscopy centers. And so over the last

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five years, we've worked together at Intermountain to

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then,

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initiate,

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having ambulatory endoscopy centers, in Utah.

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And

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we've merged with SEL Health,

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and so they also now we're we're one

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big Intermountain team of teams.

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They have three ambulatory endoscopy centers in the

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Denver area,

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that are joint ventures with

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a very strong aligned private practice partner Gastroenterology

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of the Rockies.

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So now

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I think as we started up the Altaview,

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ASC, which is multi specialty with ENT, ophthalmology,

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and GI,

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and next week, actually, we have the ribbon

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cutting,

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for our first ever fully ambulatory endoscopy center

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in Utah with Intermountain Health,

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at Makady.

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That's very exciting.

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And,

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as we then start up and and convert,

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our HOPD

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facility

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at Riverton Hospital, and this is, to me,

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fascinating, Franchesca, is

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we are disrupting ourselves by saying we have

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a hospital based facility,

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and we're gonna convert that into,

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an ASC in endoscopy at Riverton.

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And so we're,

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actually going to,

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be making less money.

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The cost of care for our patients is

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gonna go down, as we make that disruption,

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and and it's the right thing to do.

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So going

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from

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the McKay Dee Ambulatory Endoscopy Center,

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opening next week to Riverton,

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Hospital,

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HOPD conversion,

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to an ambulatory endoscopy center

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in in, I believe,

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2026.

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That is the big growth currently. And then

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thinking ahead in,

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early twenty twenty seven, we have a St.

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George

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ambulatory endoscopy center we're we're opening as well.

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I I think

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I'll I'll share, if it's okay,

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the

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excited about that growth and understand the challenge

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in moving a lot of patients out of

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the hospital based facilities in endoscopy we have

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in Intermountain

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into these lower cost of care settings,

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is is going to be a challenge. And

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I'm I'm really excited about that because we're

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gonna be able

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to work with our physician partners at each

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center and then connect the centers to each

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other to optimize

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safety, quality,

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efficiency,

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in the patient experience at every center,

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and that that's been a nice benefit of

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working with surgery partners,

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across our sites in Utah for the the

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surgery ASCs as well as the endoscopy ASCs,

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and they're connecting us,

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on a shared platform of

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who's doing things the best,

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how can we learn from each other.

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It's really the Intermountain way of

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working together, to improve safety, quality,

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operational

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efficiency,

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and the human experience for our patients.

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Absolutely. And that is so interesting, the way

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you kind of phrase, you know, the the

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disrupting yourselves and moving out of the HOPD.

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You know, I think that I I wonder

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if that's something that we'll see

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across more systems and, you know, ASC

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organizations as,

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you know, just kind of the the the

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migration to outpatient kind of continues. And I

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think that that,

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the lower cost setting will just kind of

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continue to prevail is sort of what I'm

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hearing from sources. But that's definitely super interesting.

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Anything else to add here that I haven't

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asked about so far?

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The one other thing

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I'll share is traditionally

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and and it's it had been said in

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a meeting

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several months ago too is, oh, Intermountain

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doesn't really do,

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ambulatory endoscopy centers, and and so we're changing

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that. And that was the historic perspective.

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It's really helped,

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connect and align with our GI physician partners,

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because they're also,

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investing in the centers and and,

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you know, part owners in the centers, and

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and that's the the private practice model I

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had experienced before. And,

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to be open, that's helped with recruiting. It's

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helped with,

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also physicians being very

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engaged and aligned on,

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you know, operational efficiency, working together with our

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anesthesia,

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our nursing partners, our surgery partners team,

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to bring out the best in each center.

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And and I think

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that's gonna be exciting to continue to do,

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and and to be honest, it's a unique

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value proposition I think we have as a

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health system,

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to have physicians being able to invest and

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and buy into these,

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both on the surgery ASC side as well

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as the endoscopy ASC side.

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Mhmm. Absolutely. And we'll have to continue to

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follow-up with y'all to hear more about that,

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because certainly it's very resonant over here as,

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like I mentioned earlier, just as health care

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kind of evolves, I feel like I'm hearing

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more and more about just kind of new

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and, you know, for lack of better term,

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creative,

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innovative ways that people are thinking about investment

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and ownership. So,

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yeah, that's that's all I have for you

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today, though, doctor Merriman. Thank you so much

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for joining us.

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Thank you, Franchesca.

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Absolutely. It's been a pleasure speaking with you,

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and I look forward to connecting with you

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again in the future.