1 00:00:00,160 --> 00:00:02,720 Hello, everyone. This is Erica Spicer Mason with 2 00:00:02,720 --> 00:00:04,799 Becker's Healthcare. Thank you so much for tuning 3 00:00:04,799 --> 00:00:07,379 into the Becker's Healthcare podcast series. 4 00:00:08,000 --> 00:00:10,400 Today, we're going to talk about breaking barriers 5 00:00:10,400 --> 00:00:12,500 and health system ASC development. 6 00:00:12,974 --> 00:00:14,654 And to talk us through this, we have 7 00:00:14,654 --> 00:00:18,195 two managing directors from VMG Health joining us. 8 00:00:18,335 --> 00:00:21,454 We have Aaron Mirsky and Cordell Mack. Aaron, 9 00:00:21,454 --> 00:00:23,774 Cordell, so thrilled to have you join Becker's 10 00:00:23,774 --> 00:00:25,294 today. Thank you so much for making the 11 00:00:25,294 --> 00:00:25,794 time. 12 00:00:26,254 --> 00:00:27,855 Yeah. I'm very glad to be here. Thank 13 00:00:27,855 --> 00:00:29,769 you. Thanks for having us, Erica. 14 00:00:30,469 --> 00:00:32,070 Yeah. So happy to have you both on 15 00:00:32,070 --> 00:00:33,829 the line. And before we get into the 16 00:00:33,829 --> 00:00:36,710 conversation on ASC development, I wanted to give 17 00:00:36,710 --> 00:00:38,469 you both the opportunity just to share a 18 00:00:38,469 --> 00:00:40,789 little bit more about yourselves and your work 19 00:00:40,789 --> 00:00:41,750 in health care. 20 00:00:42,070 --> 00:00:43,769 Cordell, would you mind getting us started? 21 00:00:44,515 --> 00:00:45,575 Yeah. Happy to. 22 00:00:46,434 --> 00:00:48,674 So I've been a a managing director. I've 23 00:00:48,674 --> 00:00:51,234 been in the consulting space for approaching twenty 24 00:00:51,234 --> 00:00:52,695 three years at this point, Erica. 25 00:00:53,234 --> 00:00:55,254 So I've seen, you know, a lot of 26 00:00:56,609 --> 00:00:58,789 trends, a lot of kind of future predictions, 27 00:00:59,170 --> 00:01:01,570 and, you know, probably batting about fifty fifty 28 00:01:01,570 --> 00:01:02,210 in terms of, 29 00:01:03,009 --> 00:01:05,409 what that may mean, you know, evidenced a 30 00:01:05,409 --> 00:01:07,090 little bit by what we're gonna talk about 31 00:01:07,090 --> 00:01:09,430 with some of the future on ASC development. 32 00:01:10,255 --> 00:01:12,334 My my former background is actually as a 33 00:01:12,334 --> 00:01:13,234 physical therapist, 34 00:01:13,614 --> 00:01:16,355 and so it's been interesting just to see 35 00:01:16,734 --> 00:01:18,995 some of the care model evolution in ASCs 36 00:01:19,375 --> 00:01:21,555 and, you know, how that is impacting, 37 00:01:22,255 --> 00:01:24,495 like, how our health system clients are kinda 38 00:01:24,495 --> 00:01:24,995 positioning 39 00:01:25,859 --> 00:01:28,260 for their future and, you know, their kind 40 00:01:28,260 --> 00:01:30,520 of subsequent investments inside of this sector. 41 00:01:31,219 --> 00:01:33,780 Yeah. Cordell, it's great to have your twenty 42 00:01:33,780 --> 00:01:36,500 three years of consulting experience here with us 43 00:01:36,500 --> 00:01:38,420 today, but also love that you have that 44 00:01:38,420 --> 00:01:40,704 background. As a physical therapist. You have that 45 00:01:40,704 --> 00:01:42,165 on the ground experience and, 46 00:01:42,545 --> 00:01:44,784 from a from a facilities perspective and patient 47 00:01:44,784 --> 00:01:47,505 perspective. So excited to learn more. Aaron, would 48 00:01:47,505 --> 00:01:49,204 you mind telling us about yourself next? 49 00:01:49,905 --> 00:01:50,704 Yeah. Great. 50 00:01:51,105 --> 00:01:54,489 I'm I'm a managing director that, sits in 51 00:01:54,489 --> 00:01:54,989 VMG's 52 00:01:55,450 --> 00:01:59,069 valuation transaction advisory services group, and I've been 53 00:01:59,209 --> 00:01:59,709 here 54 00:02:00,250 --> 00:02:01,789 for about twenty years now. 55 00:02:02,329 --> 00:02:05,390 I work typically with health systems operators, 56 00:02:05,984 --> 00:02:06,484 investors, 57 00:02:06,784 --> 00:02:08,944 and their advisers, so sort of a motley 58 00:02:08,944 --> 00:02:09,444 crew 59 00:02:09,824 --> 00:02:12,405 across many of the health care verticals, 60 00:02:13,985 --> 00:02:14,485 in 61 00:02:15,104 --> 00:02:15,604 services 62 00:02:15,905 --> 00:02:17,685 and insurance risk businesses. 63 00:02:18,064 --> 00:02:20,900 And a lot of my work focuses in 64 00:02:20,959 --> 00:02:24,879 business and asset valuation and consulting related to 65 00:02:24,879 --> 00:02:25,379 transactions, 66 00:02:26,719 --> 00:02:29,060 as well as intellectual property data and other 67 00:02:29,120 --> 00:02:31,379 novel kind of assets as that comes up. 68 00:02:31,745 --> 00:02:33,985 A lot of it's driven by, you know, 69 00:02:33,985 --> 00:02:36,965 just the regulatory compliance needs, but also transaction 70 00:02:37,104 --> 00:02:39,205 planning, accounting, and and strategy. 71 00:02:40,465 --> 00:02:44,145 So the ASC space is, you know, a 72 00:02:44,145 --> 00:02:47,080 very busy, very active market in a number 73 00:02:47,080 --> 00:02:47,819 of respects 74 00:02:48,280 --> 00:02:51,240 and its, you know, role over time. The 75 00:02:51,240 --> 00:02:54,219 the place that ASCs fit continues to 76 00:02:55,000 --> 00:02:57,259 evolve. And so it it just has made, 77 00:02:58,280 --> 00:03:00,645 so I've seen a lot of ASC transactions 78 00:03:00,705 --> 00:03:02,544 over time just by virtue of the fact 79 00:03:02,544 --> 00:03:04,885 it's a pretty pretty active, 80 00:03:05,825 --> 00:03:07,665 busy, and vibrant market. So 81 00:03:09,425 --> 00:03:11,105 Yeah. Erin, so great to have you with 82 00:03:11,105 --> 00:03:13,680 us. And, again, twenty years of experience, I 83 00:03:13,680 --> 00:03:14,959 I know you're going to add so much 84 00:03:14,959 --> 00:03:15,860 to this conversation. 85 00:03:16,400 --> 00:03:18,579 And I appreciate also how you teed up 86 00:03:18,719 --> 00:03:20,639 really where we're headed with this discussion, which 87 00:03:20,639 --> 00:03:22,400 is some of these trends that we're seeing 88 00:03:22,400 --> 00:03:24,239 in the ASC space. You noted it's a 89 00:03:24,239 --> 00:03:25,939 market that is growing quite rapidly, 90 00:03:26,775 --> 00:03:28,474 and we are seeing ASCs emerge 91 00:03:28,775 --> 00:03:30,854 really as a central pillar in many health 92 00:03:30,854 --> 00:03:31,354 systems' 93 00:03:31,735 --> 00:03:33,114 long term growth strategies. 94 00:03:33,735 --> 00:03:35,014 So I'd love to hear from both of 95 00:03:35,014 --> 00:03:37,414 you on what you see is driving this 96 00:03:37,414 --> 00:03:37,914 trend 97 00:03:38,419 --> 00:03:40,259 as well as the key barriers that systems 98 00:03:40,259 --> 00:03:42,919 are facing in developing ASCs that will actually 99 00:03:42,979 --> 00:03:46,180 deliver sustainable revenue and also expand access to 100 00:03:46,180 --> 00:03:46,680 care. 101 00:03:47,539 --> 00:03:49,560 Eric, I'm happy to happy to start. 102 00:03:50,099 --> 00:03:52,599 I think as as I kind of evaluate 103 00:03:52,659 --> 00:03:53,400 that question, 104 00:03:54,085 --> 00:03:55,305 certainly, it's probably, 105 00:03:56,004 --> 00:03:57,764 if not the number one, but maybe the 106 00:03:57,764 --> 00:04:00,324 number two, kinda inquiries that are kinda coming 107 00:04:00,324 --> 00:04:02,324 into our firm from health systems as they're 108 00:04:02,324 --> 00:04:04,025 trying to think through kind of their ambulatory 109 00:04:04,085 --> 00:04:05,865 strategy and what do they do with ASCs. 110 00:04:06,819 --> 00:04:08,340 And, you know, kinda your your question is 111 00:04:08,340 --> 00:04:09,699 why. Like like, what are the things that 112 00:04:09,699 --> 00:04:10,919 are driving towards that? 113 00:04:11,620 --> 00:04:12,439 You know, certainly, 114 00:04:13,219 --> 00:04:15,080 there's a, a technology 115 00:04:15,860 --> 00:04:18,814 and a comfort that has, you know, I 116 00:04:18,814 --> 00:04:21,794 think, really accelerated since COVID occurred where, 117 00:04:22,175 --> 00:04:24,414 you know, we are seeing probably patients that 118 00:04:24,414 --> 00:04:25,794 are a little higher acuity 119 00:04:26,334 --> 00:04:28,735 that previously were, you know, only only had 120 00:04:28,735 --> 00:04:31,074 surgeries inside, like, a hospital outpatient department. 121 00:04:31,949 --> 00:04:34,750 That's transcending to where now people are becoming 122 00:04:34,750 --> 00:04:37,310 more comfortable doing that care in maybe even 123 00:04:37,310 --> 00:04:39,410 off campus or on campus, you know, ASCs. 124 00:04:40,189 --> 00:04:42,029 And so that's, you know, you know, kinda 125 00:04:42,029 --> 00:04:42,529 driving, 126 00:04:43,069 --> 00:04:45,169 your health systems to have to kinda revisit, 127 00:04:45,254 --> 00:04:46,235 you know, some of this. 128 00:04:46,615 --> 00:04:48,074 From a policy perspective, 129 00:04:48,535 --> 00:04:50,855 like, we're in a totally different space. Right? 130 00:04:50,855 --> 00:04:51,495 We have 131 00:04:51,975 --> 00:04:53,514 policy is is continually 132 00:04:53,895 --> 00:04:56,134 pushing, you know, more cases outside of the 133 00:04:56,134 --> 00:04:58,935 hospital to ESCs. We've had the inpatient only 134 00:04:58,935 --> 00:04:59,819 rule. We've had, 135 00:05:00,699 --> 00:05:02,699 you know, kinda like, you know, pending site 136 00:05:02,699 --> 00:05:05,279 neutrality legislation, you know, that's out there. 137 00:05:05,580 --> 00:05:07,339 And it and it's all kinda pointing us, 138 00:05:07,339 --> 00:05:08,860 you know, you know, solely towards this one 139 00:05:08,860 --> 00:05:11,180 direction where we're gonna see kinda more more 140 00:05:11,180 --> 00:05:13,285 care outside the four walls of of of 141 00:05:13,285 --> 00:05:14,425 a hospital itself. 142 00:05:15,205 --> 00:05:17,705 Some payers in some markets have gotten 143 00:05:18,485 --> 00:05:20,824 more active and, like, in their preauthorization 144 00:05:21,365 --> 00:05:24,580 process of, you know, lower acuity work. You 145 00:05:24,580 --> 00:05:26,740 maybe think of, like, you know, colonoscopies or 146 00:05:26,740 --> 00:05:27,240 endoscopies 147 00:05:27,620 --> 00:05:30,020 where they're really kinda pushing that pre auth 148 00:05:30,020 --> 00:05:31,699 work for that that care to be delivered 149 00:05:31,699 --> 00:05:33,000 in ASCs only. 150 00:05:33,699 --> 00:05:35,379 And then I'd say, like, the last, like, 151 00:05:35,379 --> 00:05:38,740 kind of policy kinda directed maybe issue is 152 00:05:38,740 --> 00:05:41,105 we've seen some states, you know, Tennessee, North 153 00:05:41,105 --> 00:05:42,404 Carolina, South Carolina, 154 00:05:42,944 --> 00:05:45,185 where there's actually been, like, a relaxation of 155 00:05:45,185 --> 00:05:46,944 some of the state health plans or the 156 00:05:46,944 --> 00:05:48,324 certificate of need. 157 00:05:48,785 --> 00:05:49,524 And so 158 00:05:50,064 --> 00:05:52,144 ASC development is, you know, more on the 159 00:05:52,144 --> 00:05:54,225 forefront that we're seeing in health systems that 160 00:05:54,225 --> 00:05:55,365 weren't in this space, 161 00:05:55,729 --> 00:05:57,729 and maybe they had some quasi protection because 162 00:05:57,729 --> 00:05:59,509 of the state health plan rules. 163 00:05:59,970 --> 00:06:01,810 Now you'll kind of being focused in in 164 00:06:01,810 --> 00:06:03,029 in getting into that. 165 00:06:03,410 --> 00:06:05,009 And then just, you know, the last part 166 00:06:05,009 --> 00:06:07,009 of it is just maybe the actually at 167 00:06:07,009 --> 00:06:08,949 the physician or the patient level 168 00:06:09,544 --> 00:06:11,305 in that you know, there's a preference. Right? 169 00:06:11,305 --> 00:06:13,064 If you can if you can get your 170 00:06:13,064 --> 00:06:15,305 care, you know, maybe outside the four walls 171 00:06:15,305 --> 00:06:16,845 of of a hospital setting 172 00:06:17,305 --> 00:06:19,704 where, you know, you know, parking is is 173 00:06:19,704 --> 00:06:20,365 is potentially 174 00:06:20,665 --> 00:06:21,964 easier and better, 175 00:06:22,430 --> 00:06:24,189 You know, the the actual you know, the 176 00:06:24,189 --> 00:06:26,750 the peri op experience of kinda getting in, 177 00:06:26,750 --> 00:06:29,550 getting out, getting home, getting discharged is is 178 00:06:29,550 --> 00:06:30,529 potentially easier. 179 00:06:30,990 --> 00:06:32,589 And so there's just there's a lot of 180 00:06:32,589 --> 00:06:34,830 factors that are kinda driving, you know, why 181 00:06:34,830 --> 00:06:36,209 patients or why physicians 182 00:06:36,875 --> 00:06:39,355 also wanna kinda access care in ASC setting 183 00:06:39,355 --> 00:06:39,855 itself. 184 00:06:40,235 --> 00:06:42,555 Mhmm. Aaron, I'm I'm super interested in kinda, 185 00:06:42,555 --> 00:06:44,475 like, like, like, what you're seeing with your 186 00:06:44,475 --> 00:06:46,975 clients and and what's driving this emergence. 187 00:06:48,074 --> 00:06:50,610 Yeah. Yeah. No. I I I check all 188 00:06:50,610 --> 00:06:53,490 that up. That external environment, Cordell, is is 189 00:06:53,490 --> 00:06:55,029 really, I think, the big 190 00:06:55,330 --> 00:06:56,230 the big heading. 191 00:06:56,769 --> 00:06:58,370 And maybe it speaks to a little bit 192 00:06:58,370 --> 00:07:00,449 to the the last part of the question, 193 00:07:00,449 --> 00:07:03,384 Eric, around barriers. But, certainly, there's a you 194 00:07:03,384 --> 00:07:06,045 know, for for for a health system specifically, 195 00:07:07,225 --> 00:07:09,145 there's a lot of inertia and momentum in 196 00:07:09,145 --> 00:07:10,365 the external environment. 197 00:07:10,824 --> 00:07:14,045 So whether that be federal as Medicare 198 00:07:14,504 --> 00:07:15,404 kinda changes 199 00:07:16,024 --> 00:07:16,925 state based 200 00:07:17,319 --> 00:07:20,120 sort of relaxation, as Cordell mentioned, of of 201 00:07:20,120 --> 00:07:22,300 of things that provided some sort of barriers 202 00:07:22,360 --> 00:07:22,860 to 203 00:07:24,279 --> 00:07:26,379 to really having an ASC strategy, 204 00:07:26,920 --> 00:07:28,839 you know, run. I would also add to 205 00:07:28,839 --> 00:07:30,220 that, though, the 206 00:07:30,745 --> 00:07:33,464 who's who's involving themselves in the ASC space. 207 00:07:33,464 --> 00:07:35,084 And we continue to see 208 00:07:35,544 --> 00:07:36,925 private equity sponsored 209 00:07:37,625 --> 00:07:38,125 platforms, 210 00:07:38,584 --> 00:07:41,164 you know, of various sizes, shapes, and contours 211 00:07:41,384 --> 00:07:43,564 get into the ASC space, and 212 00:07:44,230 --> 00:07:45,770 the management company operators, 213 00:07:46,310 --> 00:07:47,529 you know, are still, 214 00:07:47,990 --> 00:07:50,949 very active and and pursuing their strategies. And 215 00:07:50,949 --> 00:07:53,430 so that you know, those you know, as 216 00:07:53,430 --> 00:07:56,629 the as the competitive landscape continues to evolve, 217 00:07:56,629 --> 00:07:57,689 I think it's it's 218 00:07:58,444 --> 00:08:00,845 reaching more of a fever pitch maybe, 219 00:08:01,245 --> 00:08:02,944 you know, more recently in 220 00:08:03,404 --> 00:08:05,024 needing to have a, 221 00:08:05,805 --> 00:08:07,985 a really viable ASC strategy. 222 00:08:08,524 --> 00:08:10,285 You know? And then and then probably lastly, 223 00:08:10,285 --> 00:08:11,504 their physician alignment. 224 00:08:12,120 --> 00:08:14,120 Sitting in one place and looking at how 225 00:08:14,120 --> 00:08:16,520 things evolve just over time. You know, there's 226 00:08:16,520 --> 00:08:18,360 this sort of ebb and flow of, you 227 00:08:18,360 --> 00:08:20,439 know, every five to ten years, you you 228 00:08:20,439 --> 00:08:23,240 sort of see both ASC life cycles as 229 00:08:23,240 --> 00:08:24,920 they sort of work their way through their 230 00:08:25,080 --> 00:08:25,740 the physician's 231 00:08:26,324 --> 00:08:27,544 practice life cycle. 232 00:08:28,084 --> 00:08:30,245 And then and then the the external market, 233 00:08:30,245 --> 00:08:32,404 it sort of follows some ebb and flow. 234 00:08:32,404 --> 00:08:34,245 And and this is certainly a period of 235 00:08:34,245 --> 00:08:37,605 time where where it's it's flowing more to 236 00:08:37,605 --> 00:08:40,480 the benefit of, you know, ASCs in general. 237 00:08:41,179 --> 00:08:43,820 But that physician alignment factor is really key. 238 00:08:43,980 --> 00:08:46,860 You know, the ASC models in general are 239 00:08:46,860 --> 00:08:50,240 really good at aligning interests of payers, patients, 240 00:08:51,115 --> 00:08:54,014 health systems, and physicians. So all the stakeholders, 241 00:08:54,634 --> 00:08:57,115 really win in the ASC environment, and and 242 00:08:57,115 --> 00:08:58,654 we're just seeing that play out. 243 00:08:59,115 --> 00:08:59,774 Mhmm. Yeah. 244 00:09:00,315 --> 00:09:02,955 It it's so interesting to hear the number 245 00:09:03,195 --> 00:09:05,274 the sheer number of factors that are shaping 246 00:09:05,274 --> 00:09:07,820 this trend. In just this short response, we've 247 00:09:07,820 --> 00:09:11,420 touched on policy changes, certificate of needs, patient 248 00:09:11,420 --> 00:09:13,580 preference, you know, what's going on in private 249 00:09:13,580 --> 00:09:14,960 equity sponsored platforms, 250 00:09:15,420 --> 00:09:16,960 competition, physician alignment. 251 00:09:17,340 --> 00:09:20,615 It's certainly a dynamic space, that ASCs are 252 00:09:20,615 --> 00:09:21,754 operating in right now. 253 00:09:22,695 --> 00:09:24,794 And so I'm sure it's something that is 254 00:09:25,014 --> 00:09:27,174 difficult for for those health systems that are 255 00:09:27,174 --> 00:09:30,534 just starting to consider or navigate an ASC 256 00:09:30,534 --> 00:09:33,595 strategy. I'm sure getting started is quite challenging. 257 00:09:34,300 --> 00:09:36,399 So for those leaders who are just starting 258 00:09:36,779 --> 00:09:39,360 this journey, what guidance would you offer around 259 00:09:39,820 --> 00:09:43,580 evaluating and structuring strategic joint ventures, acquisitions, or 260 00:09:43,580 --> 00:09:44,399 even partnerships? 261 00:09:45,580 --> 00:09:47,279 Aaron, I'll kick it to you first. 262 00:09:47,815 --> 00:09:50,215 Yeah. Great. You know, I'd say number one, 263 00:09:50,215 --> 00:09:51,835 it's it's understanding 264 00:09:52,295 --> 00:09:54,134 you know, it's it's just getting back to 265 00:09:54,134 --> 00:09:55,754 the fundamentals of objectives 266 00:09:56,215 --> 00:09:57,514 and and sort of 267 00:09:58,455 --> 00:10:01,514 the size, shape, contours of of what 268 00:10:01,870 --> 00:10:04,850 the ASC strategy is going to accomplish. 269 00:10:05,550 --> 00:10:07,090 Meaning, is the opportunity 270 00:10:07,629 --> 00:10:10,509 around one, two, or three ASCs, or is 271 00:10:10,509 --> 00:10:12,450 it a a more dynamic market 272 00:10:12,830 --> 00:10:13,330 where, 273 00:10:13,914 --> 00:10:15,294 you know, a health system 274 00:10:15,674 --> 00:10:17,514 may be trying to set up a a 275 00:10:17,514 --> 00:10:20,875 structure that can accommodate or respond to, you 276 00:10:20,875 --> 00:10:24,075 know, working with different parties and operators and 277 00:10:24,075 --> 00:10:26,715 and cover multiple states? And so I think, 278 00:10:26,715 --> 00:10:28,014 you know, just getting 279 00:10:28,639 --> 00:10:30,100 getting those things 280 00:10:30,879 --> 00:10:32,720 defined and some clarity around them is a 281 00:10:32,720 --> 00:10:34,100 really good first step 282 00:10:34,639 --> 00:10:36,720 to figuring out exactly what you need and 283 00:10:36,720 --> 00:10:37,539 what structure 284 00:10:38,000 --> 00:10:40,100 and what strategy would really support 285 00:10:40,554 --> 00:10:42,634 that the, you know, that vision, that that 286 00:10:42,634 --> 00:10:43,535 sort of objective. 287 00:10:44,075 --> 00:10:46,575 You know, you could you could not contemplate 288 00:10:47,115 --> 00:10:49,615 an ASC strategy needing to make acquisitions. 289 00:10:50,955 --> 00:10:52,875 And so that would sort of lead you, 290 00:10:52,875 --> 00:10:55,195 you know, to to sort of prioritize maybe 291 00:10:55,195 --> 00:10:57,110 certain other structural aspects 292 00:10:57,730 --> 00:10:59,730 versus having you know, knowing that you'll need 293 00:10:59,730 --> 00:11:01,730 to sort of have a a structure that 294 00:11:01,730 --> 00:11:05,169 can accommodate acquisitions and just different things. And 295 00:11:05,169 --> 00:11:08,210 so you really wanna have a design that 296 00:11:08,210 --> 00:11:09,269 supports the 297 00:11:09,684 --> 00:11:10,425 the initiative. 298 00:11:11,045 --> 00:11:13,144 And and I think a lack of clarity 299 00:11:13,205 --> 00:11:15,065 around that is it just as a first 300 00:11:15,285 --> 00:11:16,184 step often 301 00:11:16,965 --> 00:11:19,524 maybe it makes it introduces some friction and 302 00:11:19,524 --> 00:11:21,205 and makes things take a little bit longer 303 00:11:21,205 --> 00:11:23,125 because there's sort of a, you know, inability 304 00:11:23,125 --> 00:11:26,080 to articulate exactly what all might happen 305 00:11:26,460 --> 00:11:28,159 or what the needs of the strategy, 306 00:11:28,539 --> 00:11:30,620 might require. I don't know. Cordell, what do 307 00:11:30,620 --> 00:11:32,879 you think? You know, when we start this, 308 00:11:33,019 --> 00:11:35,419 I tend to like, you know, systems or 309 00:11:35,419 --> 00:11:35,919 hospitals 310 00:11:36,379 --> 00:11:38,559 to, you know, kinda take a step back 311 00:11:39,444 --> 00:11:40,964 and really look at their entire kind of 312 00:11:40,964 --> 00:11:43,204 book of their ambulatory surgery business or their 313 00:11:43,204 --> 00:11:44,264 procedural business, 314 00:11:45,365 --> 00:11:47,284 you know, work with their clinicians, you know, 315 00:11:47,284 --> 00:11:49,684 really try to identify, like, those cases that 316 00:11:49,684 --> 00:11:51,684 have, like, a, you know, like, a low 317 00:11:51,684 --> 00:11:52,184 anesthesia 318 00:11:52,565 --> 00:11:53,384 kinda ranking 319 00:11:53,764 --> 00:11:56,590 or, you know, the the cases that really 320 00:11:56,590 --> 00:11:58,830 are likely in a site kinda new, you 321 00:11:58,830 --> 00:12:02,190 know, neutral environment to be potentially pushed outside 322 00:12:02,190 --> 00:12:03,649 the four walls of a hospital, 323 00:12:04,029 --> 00:12:06,129 they really kinda know what that universe is. 324 00:12:06,375 --> 00:12:08,154 I think it's a good way to just 325 00:12:08,215 --> 00:12:10,294 kind of immediately kinda put up a a 326 00:12:10,294 --> 00:12:10,794 framing 327 00:12:11,174 --> 00:12:11,995 around that. 328 00:12:13,414 --> 00:12:15,254 And then, Aaron, I agree with you in 329 00:12:15,735 --> 00:12:15,894 you 330 00:12:16,615 --> 00:12:17,914 when you're evaluating, 331 00:12:18,455 --> 00:12:19,754 there's a myriad of options. 332 00:12:20,289 --> 00:12:22,049 And the myriad of options and and how 333 00:12:22,049 --> 00:12:23,570 do you kinda get started, how do you 334 00:12:23,570 --> 00:12:24,629 get to first base, 335 00:12:25,570 --> 00:12:27,090 you know, how do you kinda overcome some 336 00:12:27,090 --> 00:12:28,769 inertia? But if you can if you can 337 00:12:28,769 --> 00:12:29,269 understand 338 00:12:30,289 --> 00:12:31,990 what carrier you're already delivering 339 00:12:32,450 --> 00:12:34,549 and what part of that carrier delivery potentially 340 00:12:34,610 --> 00:12:35,830 could migrate to an, 341 00:12:36,605 --> 00:12:38,445 it gives you at least a a kind 342 00:12:38,445 --> 00:12:39,825 of a rudder in the water. 343 00:12:40,524 --> 00:12:43,084 Yeah. But then most, you know, most health 344 00:12:43,084 --> 00:12:45,164 systems and most hospitals, I mean, they tend 345 00:12:45,164 --> 00:12:48,784 to run, like, a, you know, joint commission 346 00:12:49,084 --> 00:12:51,420 or kind of a, you know, kinda highly 347 00:12:51,420 --> 00:12:51,920 regulated, 348 00:12:52,860 --> 00:12:54,320 you know, kind of business entity. 349 00:12:55,179 --> 00:12:56,860 And, you know, there needs to be a 350 00:12:56,860 --> 00:12:58,460 recognition that as you look at, like, your 351 00:12:58,460 --> 00:12:58,960 competencies, 352 00:13:00,220 --> 00:13:02,399 being being successful in the inventory 353 00:13:02,955 --> 00:13:05,675 surgical environment, it it requires some things that 354 00:13:05,675 --> 00:13:07,535 are a little bit different. Right? It requires 355 00:13:08,715 --> 00:13:11,535 a viewpoint that maybe is, you know, enterprise 356 00:13:11,675 --> 00:13:13,915 wide. And so you're you're getting you're using 357 00:13:13,915 --> 00:13:17,110 the ASC in, an opportunity to maybe go 358 00:13:17,110 --> 00:13:19,990 into noncore markets that you you don't otherwise 359 00:13:19,990 --> 00:13:20,490 have, 360 00:13:21,670 --> 00:13:24,170 your inpatient, you know, and and bed capacity 361 00:13:24,470 --> 00:13:26,870 already in. Or it requires you to think 362 00:13:26,870 --> 00:13:28,250 about, you know, competencies 363 00:13:29,485 --> 00:13:31,085 in terms of, like, you know, how do 364 00:13:31,085 --> 00:13:33,485 we make decisions, how responsive can we be, 365 00:13:33,485 --> 00:13:35,644 can we be really a good, you know, 366 00:13:35,644 --> 00:13:38,044 active partner with, you know, other stakeholders and 367 00:13:38,044 --> 00:13:39,804 shareholders, you know, in type of this type 368 00:13:39,804 --> 00:13:41,004 of, you know, kind of, you know, your 369 00:13:41,004 --> 00:13:41,825 business model. 370 00:13:42,860 --> 00:13:44,779 And then, you know, it it was said 371 00:13:44,779 --> 00:13:45,279 earlier, 372 00:13:45,980 --> 00:13:47,980 and and agree a 100%, you know, with 373 00:13:47,980 --> 00:13:49,519 with Aaron in that 374 00:13:50,379 --> 00:13:52,700 so much of our provider and our physician 375 00:13:52,700 --> 00:13:54,560 workforce is already in employment. 376 00:13:55,845 --> 00:13:58,165 And it is a great ASCs can be 377 00:13:58,165 --> 00:14:00,745 a great physician alignment, you know, opportunity. 378 00:14:01,524 --> 00:14:04,325 But but because so many health systems employ 379 00:14:04,325 --> 00:14:06,725 so many doctors, including, you know, surgeons and 380 00:14:06,725 --> 00:14:07,225 proceduralists, 381 00:14:08,200 --> 00:14:10,120 you also really have to think your way 382 00:14:10,120 --> 00:14:10,620 through 383 00:14:11,399 --> 00:14:13,799 what is what is, you know, ASC development 384 00:14:13,799 --> 00:14:15,480 really mean in context to the fact that 385 00:14:15,480 --> 00:14:18,220 I already have a financial relationship through employment 386 00:14:18,360 --> 00:14:20,679 or a contract relationship with with this group 387 00:14:20,679 --> 00:14:21,259 of doctors. 388 00:14:22,034 --> 00:14:23,315 And so I think, you know, kind of 389 00:14:23,315 --> 00:14:24,454 taking a step back, 390 00:14:24,914 --> 00:14:27,154 you know, organizing all the deck chairs to 391 00:14:27,154 --> 00:14:29,654 really, really kind of know your market, 392 00:14:30,034 --> 00:14:30,534 understand, 393 00:14:31,794 --> 00:14:33,394 you know, the volumes that are at play, 394 00:14:33,394 --> 00:14:35,975 understand the growth opportunities that are out there, 395 00:14:36,115 --> 00:14:38,740 and then being really honest with yourself about 396 00:14:38,740 --> 00:14:41,320 what competencies do you have or don't have, 397 00:14:41,620 --> 00:14:43,460 I think then you'll start to inform the 398 00:14:43,460 --> 00:14:44,899 way in which you would start to think 399 00:14:44,899 --> 00:14:46,839 about, you know, partnerships or 400 00:14:47,299 --> 00:14:49,539 joint ventures or, you know, the need for 401 00:14:49,539 --> 00:14:51,460 a strategic partner to, you know, kind of 402 00:14:51,460 --> 00:14:52,360 fill your development. 403 00:14:54,605 --> 00:14:57,264 Yeah. I appreciate the advice from you both. 404 00:14:57,404 --> 00:14:59,324 From what I can tell, it sounds like 405 00:14:59,324 --> 00:15:02,044 there's really, in those initial steps, a a 406 00:15:02,044 --> 00:15:05,264 great need for clarity in general, whether that's, 407 00:15:05,589 --> 00:15:07,110 you know, I think what goes into that, 408 00:15:07,110 --> 00:15:09,029 it sounds like is assessing the current state, 409 00:15:09,029 --> 00:15:09,850 getting honest, 410 00:15:10,470 --> 00:15:12,649 with yourselves as Cordell, as you mentioned, 411 00:15:13,190 --> 00:15:16,409 whether that's assessing the market services, competencies, 412 00:15:17,029 --> 00:15:17,929 business opportunities, 413 00:15:19,269 --> 00:15:20,809 really helpful first steps. 414 00:15:21,184 --> 00:15:23,845 And I'm curious if you both think about 415 00:15:23,985 --> 00:15:26,865 whether we're talking about ASC development strategy in 416 00:15:26,865 --> 00:15:30,065 general, or even taking those first first steps 417 00:15:30,065 --> 00:15:30,884 toward that. 418 00:15:31,264 --> 00:15:33,105 It does an example of a health system 419 00:15:33,105 --> 00:15:35,340 come to mind who really got this right? 420 00:15:35,340 --> 00:15:37,040 And if so, what do you think contributed 421 00:15:37,100 --> 00:15:38,480 most to their success? 422 00:15:39,580 --> 00:15:41,420 Yeah. I can I can take a crack 423 00:15:41,420 --> 00:15:43,500 at that one, Erica? I think I won't 424 00:15:43,500 --> 00:15:44,160 I won't 425 00:15:44,540 --> 00:15:46,379 call I won't name any names or call 426 00:15:46,379 --> 00:15:48,620 anyone out, but I think it's it's along 427 00:15:48,620 --> 00:15:51,225 the lines of what what we've said in 428 00:15:51,225 --> 00:15:52,044 terms of 429 00:15:52,664 --> 00:15:53,164 prioritization 430 00:15:53,865 --> 00:15:54,365 and 431 00:15:54,745 --> 00:15:55,245 understanding 432 00:15:55,704 --> 00:15:58,605 that, you know, to Cordell's point, 433 00:15:58,985 --> 00:16:00,524 in in their core 434 00:16:00,904 --> 00:16:02,524 for a for a small, 435 00:16:03,304 --> 00:16:04,204 smaller regional 436 00:16:04,899 --> 00:16:06,120 health system presence, 437 00:16:06,659 --> 00:16:09,120 you have sort of, you know, 438 00:16:09,779 --> 00:16:12,839 an employed physician group with a compensation 439 00:16:13,139 --> 00:16:16,360 model and and and operating rooms that have, 440 00:16:16,580 --> 00:16:18,679 you know, set surgery schedules. 441 00:16:19,059 --> 00:16:21,934 And and so that that's one part of 442 00:16:21,934 --> 00:16:24,654 an ASC opportunity is is sort of impacting 443 00:16:24,654 --> 00:16:26,195 or disrupting that flow. 444 00:16:26,815 --> 00:16:29,375 But the priority really was and and over 445 00:16:29,375 --> 00:16:31,934 time, certainly, with all the external factors, sir, 446 00:16:31,934 --> 00:16:33,154 you know, that would be, 447 00:16:33,490 --> 00:16:35,590 you know, part of the strategy is impacting 448 00:16:35,649 --> 00:16:38,370 sort of, you know, the core core market. 449 00:16:38,370 --> 00:16:39,350 But as the 450 00:16:39,730 --> 00:16:41,190 health system expanded, 451 00:16:41,730 --> 00:16:44,790 their ASC strategy really led with or prioritized 452 00:16:47,264 --> 00:16:50,064 new and getting into, you know, sort of 453 00:16:50,064 --> 00:16:50,564 adjacent 454 00:16:50,865 --> 00:16:51,365 geographies, 455 00:16:52,464 --> 00:16:55,024 such that it was minimally disruptive to the 456 00:16:55,024 --> 00:16:55,924 core legacy, 457 00:16:56,704 --> 00:16:59,504 you know, operations and really provided a way 458 00:16:59,504 --> 00:17:00,884 to move into markets, 459 00:17:01,559 --> 00:17:02,779 align with physicians, 460 00:17:03,879 --> 00:17:04,380 and, 461 00:17:05,160 --> 00:17:07,339 demonstrate some the model, 462 00:17:08,039 --> 00:17:10,059 and and really stand it up effectively. 463 00:17:11,000 --> 00:17:11,500 Because 464 00:17:12,279 --> 00:17:14,839 while the ASC strategy really affected all of 465 00:17:14,839 --> 00:17:15,579 their markets 466 00:17:15,960 --> 00:17:16,779 over time, 467 00:17:17,174 --> 00:17:20,215 Getting some some wins and starting these new 468 00:17:20,215 --> 00:17:20,715 businesses, 469 00:17:21,495 --> 00:17:23,735 was really important in building trust with the 470 00:17:23,735 --> 00:17:26,634 physicians. And so when it came time to, 471 00:17:26,934 --> 00:17:29,755 you know, discuss with, you know, the employed 472 00:17:29,815 --> 00:17:33,390 physicians and sort of more entrenched legacy operations. 473 00:17:33,390 --> 00:17:35,089 There was some good trust built. 474 00:17:35,710 --> 00:17:37,789 There were already physicians in the community that 475 00:17:37,789 --> 00:17:39,089 had good things to say. 476 00:17:39,869 --> 00:17:41,630 And so, really, I'd say, you know, getting 477 00:17:41,630 --> 00:17:44,269 it right is goes into that that planning 478 00:17:44,269 --> 00:17:46,750 and and that clarity and honesty about where 479 00:17:46,750 --> 00:17:50,005 the where the friction might be and and 480 00:17:50,005 --> 00:17:52,964 where the opportunity really might sit and just 481 00:17:52,964 --> 00:17:54,264 prioritizing accordingly 482 00:17:54,884 --> 00:17:55,384 to, 483 00:17:55,764 --> 00:17:57,784 to to you know, it's all sort of 484 00:17:58,085 --> 00:17:59,044 gonna get there, 485 00:17:59,365 --> 00:18:01,065 but in, you know, in what order, 486 00:18:01,605 --> 00:18:03,144 is is critically important. 487 00:18:03,900 --> 00:18:06,059 Yeah. Aaron, thanks so much for the example. 488 00:18:06,059 --> 00:18:07,740 It's really helpful to hear how this is 489 00:18:07,740 --> 00:18:09,200 working for other systems, 490 00:18:09,980 --> 00:18:10,799 on the ground. 491 00:18:11,259 --> 00:18:13,019 I just wanna check-in with you, Cordell. Before 492 00:18:13,019 --> 00:18:14,779 we get to closing thoughts, anything that you'd 493 00:18:14,779 --> 00:18:15,519 add there? 494 00:18:16,404 --> 00:18:17,765 I would just say, like, you know, health 495 00:18:17,765 --> 00:18:20,424 care remains local. Right? I think ASC 496 00:18:21,045 --> 00:18:21,545 distribution 497 00:18:21,924 --> 00:18:23,144 or, you know, ASC 498 00:18:23,525 --> 00:18:25,305 development, it is very uneven. 499 00:18:26,644 --> 00:18:29,365 You know, what works potentially in in one 500 00:18:29,365 --> 00:18:32,340 market is not potentially gonna be successful in 501 00:18:32,340 --> 00:18:34,680 another market. Maybe it's because of, 502 00:18:34,980 --> 00:18:36,519 you know, state level issues. 503 00:18:36,820 --> 00:18:38,440 Maybe it's because of, 504 00:18:39,059 --> 00:18:41,460 you know, just the the local kind of 505 00:18:41,460 --> 00:18:44,279 payer community, you know, how they've kinda organized 506 00:18:44,340 --> 00:18:44,840 themselves. 507 00:18:45,775 --> 00:18:46,595 It could be 508 00:18:47,134 --> 00:18:49,454 the market dynamics of what you're in is, 509 00:18:49,454 --> 00:18:51,694 you know, your market's not growing. It's maybe, 510 00:18:51,694 --> 00:18:53,535 you know, aging, and maybe you have a 511 00:18:53,535 --> 00:18:55,555 deteriorating payer mix that's there. 512 00:18:56,015 --> 00:18:56,674 And so 513 00:18:57,214 --> 00:19:00,194 kinda, you know, taking a step back and 514 00:19:00,829 --> 00:19:02,690 really, you just, you know, organizing 515 00:19:03,230 --> 00:19:03,730 what's 516 00:19:04,430 --> 00:19:07,390 best for your community and, you know, your 517 00:19:07,390 --> 00:19:09,089 system and your kind of stakeholders 518 00:19:10,190 --> 00:19:12,670 is this is, you know, a 100% of 519 00:19:12,670 --> 00:19:14,509 space where there is really not a one 520 00:19:14,509 --> 00:19:15,650 size fits all. 521 00:19:16,365 --> 00:19:16,865 And, 522 00:19:17,644 --> 00:19:18,144 being 523 00:19:19,325 --> 00:19:20,224 very intentional 524 00:19:20,924 --> 00:19:23,644 about your approach, I think, will will pay 525 00:19:23,644 --> 00:19:25,744 off in the in in the long run 526 00:19:26,444 --> 00:19:27,744 as compared to, 527 00:19:28,204 --> 00:19:29,664 you're making more, 528 00:19:30,140 --> 00:19:32,000 you know, short term, you know, opportunistic 529 00:19:32,299 --> 00:19:35,019 type decisions that, you know, could, you know, 530 00:19:35,019 --> 00:19:37,019 go against really what's in the best interest 531 00:19:37,019 --> 00:19:39,279 of your, community over the long haul. 532 00:19:40,860 --> 00:19:43,039 Yeah. Really important to highlight, Cordell, 533 00:19:43,500 --> 00:19:45,944 the uniqueness of each market that health systems 534 00:19:45,944 --> 00:19:47,964 are operating in and how that will inevitably 535 00:19:48,184 --> 00:19:48,684 change 536 00:19:49,065 --> 00:19:50,045 ASC strategy. 537 00:19:50,904 --> 00:19:52,585 Well, it's been great talking to you both, 538 00:19:52,585 --> 00:19:54,444 and I I wanted to end our conversation 539 00:19:54,585 --> 00:19:56,365 on kind of a forward looking note. 540 00:19:56,664 --> 00:19:58,125 I'm curious if you could share 541 00:19:58,529 --> 00:20:01,350 any shifts or emerging trends that you anticipate 542 00:20:01,570 --> 00:20:03,809 shaping the ASC landscape in the next few 543 00:20:03,809 --> 00:20:04,309 years 544 00:20:04,690 --> 00:20:06,769 and one step that health systems can take 545 00:20:06,769 --> 00:20:07,670 now to prepare 546 00:20:08,049 --> 00:20:08,950 for what's coming. 547 00:20:10,210 --> 00:20:10,710 Sure. 548 00:20:11,055 --> 00:20:12,494 I'll jump in, Eric. I'll I'll just give 549 00:20:12,494 --> 00:20:14,275 you a couple things. One, 550 00:20:14,894 --> 00:20:16,975 just maybe in the way that, like, society 551 00:20:16,975 --> 00:20:18,894 is moving in general. I I do think 552 00:20:18,894 --> 00:20:20,755 we're gonna continue to see more 553 00:20:21,295 --> 00:20:21,795 subspecialty 554 00:20:22,095 --> 00:20:24,195 focus inside the ASC space. 555 00:20:24,575 --> 00:20:25,315 And so, 556 00:20:25,970 --> 00:20:27,910 you know, whether we're talking about your musculoskeletal 557 00:20:28,289 --> 00:20:29,269 and it's musculoskeletal 558 00:20:29,970 --> 00:20:32,150 focused on total joints or, 559 00:20:32,450 --> 00:20:34,549 you know, spine related or, 560 00:20:34,930 --> 00:20:37,009 you know, cardiac, and now a subset of 561 00:20:37,009 --> 00:20:38,470 cardiac is really electrophysiology. 562 00:20:39,694 --> 00:20:41,295 So I do think you're gonna continue to 563 00:20:41,295 --> 00:20:43,214 see, you know, more and more interest in 564 00:20:43,214 --> 00:20:44,035 in finding, 565 00:20:44,734 --> 00:20:46,515 you know, kind of, you know, single specialty, 566 00:20:47,454 --> 00:20:49,134 centers. That has been a trend, but I 567 00:20:49,134 --> 00:20:50,494 think that's only going to kind of, you 568 00:20:50,494 --> 00:20:51,954 know, potentially accelerate. 569 00:20:53,029 --> 00:20:55,669 I I think we're we're gonna see health 570 00:20:55,669 --> 00:20:56,169 systems 571 00:20:56,549 --> 00:20:59,589 that have to start thinking differently about their 572 00:20:59,589 --> 00:21:01,849 entire managed care strategy as a result. 573 00:21:02,789 --> 00:21:05,750 And it it just intuitively, it doesn't make 574 00:21:05,750 --> 00:21:07,049 sense to me that 575 00:21:07,394 --> 00:21:08,855 I can have the same procedure 576 00:21:09,634 --> 00:21:11,015 in a hospital setting 577 00:21:11,795 --> 00:21:14,115 as compared to an ASC setting, and the 578 00:21:14,115 --> 00:21:16,295 ASC setting is getting paid, 579 00:21:16,674 --> 00:21:18,674 you know, 50ยข on the dollar of what 580 00:21:18,674 --> 00:21:21,575 you'd get reimbursed inside of a hospital setting. 581 00:21:22,595 --> 00:21:25,740 And the connection to that is, well, 582 00:21:26,200 --> 00:21:28,920 if hospitals and health systems were getting, you 583 00:21:28,920 --> 00:21:29,820 know, remunerated 584 00:21:30,440 --> 00:21:33,099 adequately for, you know, the excess capacity 585 00:21:34,279 --> 00:21:37,099 that they have to have and being a 586 00:21:37,924 --> 00:21:38,744 being a hospital, 587 00:21:39,845 --> 00:21:42,825 maybe, like, the idea of site neutrality 588 00:21:43,125 --> 00:21:44,105 for these procedures 589 00:21:45,125 --> 00:21:47,684 are appropriately gonna push, you know, things that 590 00:21:47,684 --> 00:21:49,865 can be, you know, off the hospital campus, 591 00:21:49,924 --> 00:21:52,105 into the community, into an ASC. 592 00:21:52,710 --> 00:21:54,869 It's gonna potentially make, you know, all of 593 00:21:54,869 --> 00:21:55,369 that, 594 00:21:56,230 --> 00:21:58,309 a lot a lot easier a lot easier 595 00:21:58,309 --> 00:21:58,970 to accept. 596 00:21:59,269 --> 00:22:01,130 So I think really progressive 597 00:22:01,669 --> 00:22:03,450 health systems are going to 598 00:22:03,750 --> 00:22:06,585 look at, you know, long range financial planning. 599 00:22:06,644 --> 00:22:08,244 They're gonna build all of that in. And 600 00:22:08,244 --> 00:22:09,684 I think they're gonna take a really hard 601 00:22:09,684 --> 00:22:11,444 look at just their overall kind of managed 602 00:22:11,444 --> 00:22:12,184 care strategy, 603 00:22:12,724 --> 00:22:15,464 specifically for their, you know, their ED business, 604 00:22:15,525 --> 00:22:17,525 for their inpatient business where they really need 605 00:22:17,525 --> 00:22:18,029 to have 606 00:22:19,150 --> 00:22:20,509 capacity. Then the last thing I'd say, and 607 00:22:20,509 --> 00:22:22,690 it's, you know, something that Aaron kinda started 608 00:22:23,070 --> 00:22:25,009 with, we're in this perpetual, 609 00:22:25,309 --> 00:22:27,309 like, cycle right now where no matter kind 610 00:22:27,309 --> 00:22:28,369 of what we do, 611 00:22:28,670 --> 00:22:30,769 the hardest part of this is access, 612 00:22:31,605 --> 00:22:32,585 workforce shortages, 613 00:22:33,525 --> 00:22:36,805 actually finding, you know, high quality, high value 614 00:22:36,805 --> 00:22:38,825 doctors to be able to deliver care. 615 00:22:39,285 --> 00:22:41,285 And so I do think that you're also 616 00:22:41,285 --> 00:22:43,785 gonna see, like, a an increasing 617 00:22:44,440 --> 00:22:47,080 preponderance of health systems are gonna open up 618 00:22:47,080 --> 00:22:48,299 syndication opportunities 619 00:22:49,320 --> 00:22:52,200 for employed physicians. Some already do. A lot 620 00:22:52,200 --> 00:22:53,099 already do, 621 00:22:53,400 --> 00:22:55,880 but some have been resistant to that. I 622 00:22:55,880 --> 00:22:57,900 think just in trying to solve their workforce 623 00:22:57,960 --> 00:23:00,515 issues, I think they're gonna use ASCs as 624 00:23:00,515 --> 00:23:02,674 another tool and another vehicle to be able 625 00:23:02,674 --> 00:23:03,734 to kind of attract 626 00:23:04,275 --> 00:23:06,934 high level talent to their respective communities themselves. 627 00:23:08,194 --> 00:23:10,755 Such great notes, Cordell. Thank you so much. 628 00:23:10,755 --> 00:23:12,674 Aaron, anything that you'd add as you look 629 00:23:12,674 --> 00:23:13,734 to the future here? 630 00:23:14,220 --> 00:23:16,779 No. I you know, just one one thing 631 00:23:16,779 --> 00:23:19,339 to to to add, and that's, you know, 632 00:23:19,339 --> 00:23:20,640 the the continued 633 00:23:21,339 --> 00:23:22,720 migration of procedures, 634 00:23:23,579 --> 00:23:24,079 surgeries 635 00:23:24,380 --> 00:23:26,240 being right for the ASC setting, 636 00:23:26,835 --> 00:23:28,775 aging population and utilizers, 637 00:23:29,154 --> 00:23:32,775 you know, patient needs requiring more access points, 638 00:23:33,394 --> 00:23:36,355 the regulatory and reimbursement environment. All those things 639 00:23:36,355 --> 00:23:38,454 for for some time now have been very 640 00:23:38,849 --> 00:23:41,569 positive tailwinds for ASC. It's a it's a 641 00:23:41,569 --> 00:23:45,089 growing market. And really, to Cordell's point, when 642 00:23:45,089 --> 00:23:46,369 I look at that and I say, okay. 643 00:23:46,369 --> 00:23:48,470 Well, what's the what's the headwind? 644 00:23:49,170 --> 00:23:50,869 I think it's really how quick 645 00:23:51,384 --> 00:23:53,724 can you move because in some markets, 646 00:23:54,025 --> 00:23:56,285 more ASCs may be disruptive to 647 00:23:57,065 --> 00:23:58,365 sort of legacy operations. 648 00:23:59,065 --> 00:23:59,565 And 649 00:24:00,424 --> 00:24:01,884 is is there a physician 650 00:24:03,599 --> 00:24:05,839 supply issue? Is there sort of a having 651 00:24:05,839 --> 00:24:07,059 the right high quality 652 00:24:07,599 --> 00:24:10,240 physician partners is is you can't have an 653 00:24:10,240 --> 00:24:13,460 ASC without that. And so there's there's certainly 654 00:24:13,519 --> 00:24:15,494 a lot of tailwinds as we as we 655 00:24:15,654 --> 00:24:18,055 look forward, things sort of blowing wind in 656 00:24:18,055 --> 00:24:20,694 the sales of the the ASC market. And 657 00:24:20,694 --> 00:24:22,775 it's really gonna come down to to, I 658 00:24:22,775 --> 00:24:25,575 think, execution on how do you align with 659 00:24:25,575 --> 00:24:27,894 the right, you know, physician partners and the 660 00:24:27,894 --> 00:24:30,555 and the and the right institutional partners to 661 00:24:30,710 --> 00:24:33,289 to sort of deliver on an ASC strategy. 662 00:24:34,390 --> 00:24:34,890 Absolutely. 663 00:24:35,670 --> 00:24:37,509 It's been such a great conversation with you 664 00:24:37,509 --> 00:24:39,670 both. I appreciate you walking me and our 665 00:24:39,670 --> 00:24:43,005 listeners through this landscape that it sounds very 666 00:24:43,005 --> 00:24:45,005 exciting and challenging at the same time, a 667 00:24:45,005 --> 00:24:47,184 lot of opportunities ahead, but also, 668 00:24:47,964 --> 00:24:49,244 the need to keep an eye on some 669 00:24:49,244 --> 00:24:50,305 shifts in policy, 670 00:24:51,244 --> 00:24:53,825 payer procedures and policies as well. 671 00:24:54,444 --> 00:24:56,444 But just wanna thank you both for making 672 00:24:56,444 --> 00:24:58,365 the time for Becker's today and for sharing 673 00:24:58,365 --> 00:24:59,880 your expertise with our listeners. 674 00:25:00,579 --> 00:25:02,599 Thanks for having us, Erica. Thanks, Erica. 675 00:25:02,980 --> 00:25:04,500 It's been great having you both. And, of 676 00:25:04,500 --> 00:25:06,339 course, we'd also like to thank our podcast 677 00:25:06,339 --> 00:25:08,200 sponsor today, VMG Health. 678 00:25:08,627 --> 00:25:10,147 Listeners, be sure to tune in to more 679 00:25:10,147 --> 00:25:12,947 podcasts from Becker's by visiting our podcast page 680 00:25:12,947 --> 00:25:15,367 at beckershospitalreview.com.