Hello. This is Franchesca Matthews with the Becker's
ASC review podcast.
I'm thrilled to be joined today by doctor
Nathan Merriman, the interim senior medical director of
the Surgical Specialties Digestive Health Clinical Program at
Intermountain Medical Center.
Doctor Merriman, thank you so much for being
here today.
Thank you for having me, Franchesca.
Absolutely. To start us off, could you please
introduce yourself and tell us a little bit
about your background?
Oh, sure.
So I won't go all the way back
to the beginning, but I would I will
say I grew up in
health care and medicine,
on the East Coast in academics.
Went to UNC Chapel Hill for medical school
and up to
Philadelphia at University of Pennsylvania for residency and
fellowship,
and then got a master's in clinical epidemiology
and with a focus on, clinical trial design
and had intended to stay in academics.
And then my wife and I decided to
go into private practice. She's maternal fetal medicine
and then,
for me in GI in Delaware and loved
our experience there for twelve years,
learned a ton,
about the business side of medicine.
Also, we had our own endoscopy center,
worked with
an AmSurge partner to help optimize
the clinical,
operational, and financial
health of the endoscopyAC and worked with the
health system ChristianaCare
as well
to understand
teamwork across,
health systems
and private practice partners.
And then,
also worked with start up companies on learning
about innovation and
how we can
actually work together across different,
partnerships in health care,
to be better because we can't all be
good at everything.
And then,
decided in 2020,
my wife and I decided that we would
leave our private practices and, join the Intermountain
Health team.
So we moved our four kids up to
Utah and have loved every minute of being
a part of Intermountain.
And
I'll just say candidly,
I see a lot of
collective strength
with an Intermountain system because we can
take some parts of academics,
some parts of,
private practice models of care,
and then,
center
on our mission focus,
on helping patients live their healthiest lives and
working together to prevent avoidable suffering across our
communities. So I can't say enough about how
happy I am to be with Intermountain.
Awesome. Yeah. That's that's great to hear. And
I love speaking with folks who have experience
in private practice. I write a lot on
the physician leadership side of our publication, and,
yeah, there's definitely I'm I'm kind of seeing
growing movement towards sort of hybrid models of
doing things just to kind of respond to
the very dynamic health care environment today,
which kind of transitions into our next question,
which I'm I'm curious. What are the top
three trends that you're following in health care
today?
Yes. I would start with,
understanding the the patient experience
and working toward patient centered design and improving
access to care.
What we're we're really trying to work on
and I'm following companies
both in startups as well as health systems
and private practices is how can we make
it easier
for our patients,
to get the right care they need at
the right time in the right venue.
And so by far, that's number one.
Human centered care design, I think, is something,
we need to all continue to work on
because
I've said this before. I've never done a
colonoscopy without a patient's help, and I know
that sounds basic, but
it is fundamentally true is if if we
leave our patients out of the design of
care,
we're gonna lose them.
And so I think really focusing on patient
centered care is number one.
Number two is a
a massive concern about the cost of health
care, which is
is unsustainable
and more and more,
awareness around this. And I know this has
come in waves before, but I think this
is one of the biggest waves that we're
seeing in
true unsustainability
if we keep doing what we're doing,
currently in terms of the cost of care.
And then the third
big trend is thinking about innovations
in team based care model
and technology. I I am of the opinion
that often
people use the word innovation
referring to technology, but there's so much more
to innovation.
As we're trying out new ways of working
together,
we're trying out,
at Intermountain, we're really focusing on proactive care,
which I believe is is
the right thing to do. How do we
get upstream,
working with patients on identifying,
health concerns,
conditions earlier
before they progress,
and get more costly and and more harmful
to patients. So
proactive care, I I believe, is a a
form of care innovation.
And so
using
team based care models to innovate with our
patients,
would be number three.
Mhmm. Absolutely. And what are you most excited
about right now?
I I think
I'm excited about competition.
And I don't I don't know if that's
a
popular response or what others say, but,
I think if we're competing on the right
things, we will all help our each other
to to get better faster.
And just in the the frame in GI,
I I think the way we're looking at
it is how do we compete against colon
cancer?
And then using that frame, then we start
to see each other across,
academic centers,
community health systems, and and,
larger groups as well as private practices and
start up companies is we're all teammates fighting
against colon cancer. And so I think I'm
very excited
about competition,
in and
how do we collaborate,
to compete on the right things,
High safety, high quality care,
lower cost of care for our patients,
and then human centered care, with a team
based approach with every patient as our teammate.
I I think
that's what I'm most excited about is,
competing on the right things to help make
care
better and more more affordable for our patients.
I really that's really interesting framing. I think
that sometimes, you know,
like, the you said is I don't know
if that's a popular response. And I think,
you know, most people kind of think about
competition in a different way. But what you
said of, you know, we're competing against colon
cancer, this is a collaborative
thing, and we're we're competing on the same
team. I think that's that's a really, you
know, poignant
note there.
How are you and your your center thinking
about growth over the next twelve months?
Oh, great great question. So and one thing
I should step back and share.
When I came to Intermountain in 2020, we
had no,
ambulatory endoscopy centers,
and
that was very surprising to me because I
was a physician investor and co owner and
co manager in one previously, and I I
knew about the value proposition
of,
ambulatory endoscopy centers. And so over the last
five years, we've worked together at Intermountain to
then,
initiate,
having ambulatory endoscopy centers, in Utah.
And
we've merged with SEL Health,
and so they also now we're we're one
big Intermountain team of teams.
They have three ambulatory endoscopy centers in the
Denver area,
that are joint ventures with
a very strong aligned private practice partner Gastroenterology
of the Rockies.
So now
I think as we started up the Altaview,
ASC, which is multi specialty with ENT, ophthalmology,
and GI,
and next week, actually, we have the ribbon
cutting,
for our first ever fully ambulatory endoscopy center
in Utah with Intermountain Health,
at Makady.
That's very exciting.
And,
as we then start up and and convert,
our HOPD
facility
at Riverton Hospital, and this is, to me,
fascinating, Franchesca, is
we are disrupting ourselves by saying we have
a hospital based facility,
and we're gonna convert that into,
an ASC in endoscopy at Riverton.
And so we're,
actually going to,
be making less money.
The cost of care for our patients is
gonna go down, as we make that disruption,
and and it's the right thing to do.
So going
from
the McKay Dee Ambulatory Endoscopy Center,
opening next week to Riverton,
Hospital,
HOPD conversion,
to an ambulatory endoscopy center
in in, I believe,
2026.
That is the big growth currently. And then
thinking ahead in,
early twenty twenty seven, we have a St.
George
ambulatory endoscopy center we're we're opening as well.
I I think
I'll I'll share, if it's okay,
the
excited about that growth and understand the challenge
in moving a lot of patients out of
the hospital based facilities in endoscopy we have
in Intermountain
into these lower cost of care settings,
is is going to be a challenge. And
I'm I'm really excited about that because we're
gonna be able
to work with our physician partners at each
center and then connect the centers to each
other to optimize
safety, quality,
efficiency,
in the patient experience at every center,
and that that's been a nice benefit of
working with surgery partners,
across our sites in Utah for the the
surgery ASCs as well as the endoscopy ASCs,
and they're connecting us,
on a shared platform of
who's doing things the best,
how can we learn from each other.
It's really the Intermountain way of
working together, to improve safety, quality,
operational
efficiency,
and the human experience for our patients.
Absolutely. And that is so interesting, the way
you kind of phrase, you know, the the
disrupting yourselves and moving out of the HOPD.
You know, I think that I I wonder
if that's something that we'll see
across more systems and, you know, ASC
organizations as,
you know, just kind of the the the
migration to outpatient kind of continues. And I
think that that,
the lower cost setting will just kind of
continue to prevail is sort of what I'm
hearing from sources. But that's definitely super interesting.
Anything else to add here that I haven't
asked about so far?
The one other thing
I'll share is traditionally
and and it's it had been said in
a meeting
several months ago too is, oh, Intermountain
doesn't really do,
ambulatory endoscopy centers, and and so we're changing
that. And that was the historic perspective.
It's really helped,
connect and align with our GI physician partners,
because they're also,
investing in the centers and and,
you know, part owners in the centers, and
and that's the the private practice model I
had experienced before. And,
to be open, that's helped with recruiting. It's
helped with,
also physicians being very
engaged and aligned on,
you know, operational efficiency, working together with our
anesthesia,
our nursing partners, our surgery partners team,
to bring out the best in each center.
And and I think
that's gonna be exciting to continue to do,
and and to be honest, it's a unique
value proposition I think we have as a
health system,
to have physicians being able to invest and
and buy into these,
both on the surgery ASC side as well
as the endoscopy ASC side.
Mhmm. Absolutely. And we'll have to continue to
follow-up with y'all to hear more about that,
because certainly it's very resonant over here as,
like I mentioned earlier, just as health care
kind of evolves, I feel like I'm hearing
more and more about just kind of new
and, you know, for lack of better term,
creative,
innovative ways that people are thinking about investment
and ownership. So,
yeah, that's that's all I have for you
today, though, doctor Merriman. Thank you so much
for joining us.
Thank you, Franchesca.
Absolutely. It's been a pleasure speaking with you,
and I look forward to connecting with you
again in the future.