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This is Chanel Banger with the Becker's 17 00:00:37,859 --> 00:00:40,420 Healthcare podcast, and I'm recording live at the 18 00:00:40,420 --> 00:00:44,020 21st annual Spine Orthopedic and Pain Management Driven 19 00:00:44,020 --> 00:00:46,575 ASC plus the Future of Spine Conference in 20 00:00:46,575 --> 00:00:49,375 Chicago. Right now, I'm sitting with Tracy Young, 21 00:00:49,375 --> 00:00:52,274 the co founder and COO of Essential Anesthesia 22 00:00:52,575 --> 00:00:53,075 Management. 23 00:00:53,829 --> 00:00:55,189 Tracy, thank you so much for joining me 24 00:00:55,189 --> 00:00:57,449 today. Hi, Chanel. Thank you for having me. 25 00:00:57,509 --> 00:00:59,269 Perfect. Well, to get us started, could you 26 00:00:59,269 --> 00:01:00,710 please tell us a little bit about your 27 00:01:00,710 --> 00:01:01,689 background and organization? 28 00:01:02,234 --> 00:01:04,635 Sure. Absolutely. I'm a I'm a certified registered 29 00:01:04,635 --> 00:01:07,674 nurse in Essentys, which is, advanced practice registered 30 00:01:07,674 --> 00:01:08,174 nurse, 31 00:01:08,555 --> 00:01:11,060 for 24 years now. And the last 20 32 00:01:11,060 --> 00:01:13,159 years, I've been involved in anesthesia management, 33 00:01:13,540 --> 00:01:16,259 groups. I founded a anesthesia management company back 34 00:01:16,259 --> 00:01:17,000 in 2003. 35 00:01:18,234 --> 00:01:18,894 And currently, 36 00:01:19,194 --> 00:01:21,994 we're called Essential Anesthesia Management, and we we 37 00:01:21,994 --> 00:01:24,814 provide outsource anesthesia services to about a 138 38 00:01:25,034 --> 00:01:28,780 ambulatory surgery centers and hospitals across six states 39 00:01:28,780 --> 00:01:29,260 with, 40 00:01:29,739 --> 00:01:30,719 roughly 1400 41 00:01:31,180 --> 00:01:33,819 anesthesia professionals working for us. Got it. Thank 42 00:01:33,819 --> 00:01:35,200 you so much for that introduction. 43 00:01:35,500 --> 00:01:37,019 Now to get us into the meat of 44 00:01:37,019 --> 00:01:37,599 the podcast, 45 00:01:37,984 --> 00:01:39,905 based on your experience, how has the patient 46 00:01:39,905 --> 00:01:41,844 provider dynamic changed over time? 47 00:01:42,145 --> 00:01:43,984 Yeah. This is a interesting question from an 48 00:01:43,984 --> 00:01:46,885 anesthesia standpoint. I I think the biggest change, 49 00:01:47,585 --> 00:01:50,370 in anesthesia and the patient provider relationship is 50 00:01:50,370 --> 00:01:52,150 what we're seeing is more and more production 51 00:01:52,210 --> 00:01:52,710 pressures 52 00:01:53,329 --> 00:01:55,329 where we have less time to spend with 53 00:01:55,329 --> 00:01:57,295 patients than we ever have before, and we 54 00:01:57,295 --> 00:01:59,694 have to really spend that time building up 55 00:01:59,694 --> 00:02:02,575 a trust relationship and and making sure that 56 00:02:02,575 --> 00:02:04,415 patients feel comfortable with the care that we're 57 00:02:04,415 --> 00:02:05,234 gonna provide, 58 00:02:06,180 --> 00:02:07,700 all at the same time while doing an 59 00:02:07,700 --> 00:02:09,319 anesthesia preoperative evaluation 60 00:02:09,780 --> 00:02:11,460 to make sure that we know their their 61 00:02:11,460 --> 00:02:11,960 comorbidities 62 00:02:12,419 --> 00:02:15,139 and and understand and develop an anesthesia plan 63 00:02:15,139 --> 00:02:15,925 of care 64 00:02:16,224 --> 00:02:18,625 that that's gonna be tailored specifically for that 65 00:02:18,625 --> 00:02:21,025 surgery and for that patient. So doing that 66 00:02:21,025 --> 00:02:22,865 in a very brief period of time while 67 00:02:22,865 --> 00:02:25,360 developing trust with the with the patient and 68 00:02:25,360 --> 00:02:27,280 making sure they're comfortable that they know that 69 00:02:27,280 --> 00:02:29,360 they'll be taken care of safely and that 70 00:02:29,360 --> 00:02:31,360 we'll we'll take care of their postoperative pain 71 00:02:31,360 --> 00:02:33,379 effectively as well too is really critical. 72 00:02:33,925 --> 00:02:35,544 Absolutely. And from an organizational 73 00:02:36,084 --> 00:02:38,185 standpoint, do you have any strategies 74 00:02:38,485 --> 00:02:41,205 in place aimed at helping bring in patients 75 00:02:41,205 --> 00:02:42,584 and retaining those patients? 76 00:02:43,550 --> 00:02:45,469 Yeah. This this is a nuanced answer to 77 00:02:45,469 --> 00:02:47,310 you as from an anesthesia standpoint. If we're 78 00:02:47,310 --> 00:02:50,849 truly providing anesthesia services, we're an ancillary service. 79 00:02:51,094 --> 00:02:52,694 So the majority of patients that come into 80 00:02:52,694 --> 00:02:55,094 the ambulatory service centers aren't coming in because 81 00:02:55,094 --> 00:02:57,014 of us. They're coming in because of their 82 00:02:57,014 --> 00:02:57,995 surgeon relationship. 83 00:02:58,540 --> 00:03:00,540 So for for us, it's all about keeping 84 00:03:00,540 --> 00:03:03,260 the surgeon happy and making sure that their 85 00:03:03,260 --> 00:03:05,340 patients have a really great experience because it 86 00:03:05,340 --> 00:03:07,034 reflects back on the surgeon. And, 87 00:03:07,435 --> 00:03:10,254 we're an invited guest quite frequently into ambulatory 88 00:03:10,314 --> 00:03:11,775 surgery centers, and, 89 00:03:12,155 --> 00:03:13,835 making sure that we understand that we're in 90 00:03:13,835 --> 00:03:15,835 a service industry and that patients don't come 91 00:03:15,835 --> 00:03:17,680 for us is is really critical. 92 00:03:17,980 --> 00:03:19,819 From a retention standpoint, the things that we've 93 00:03:19,819 --> 00:03:22,540 been focused on mostly mostly lately is is 94 00:03:22,540 --> 00:03:23,760 retention of providers. 95 00:03:24,625 --> 00:03:26,724 Severe shortage of anesthesia providers, 96 00:03:27,185 --> 00:03:29,745 currently in the United States, and everybody's talking 97 00:03:29,745 --> 00:03:31,525 about recruitment, recruitment, recruitment. 98 00:03:32,479 --> 00:03:34,639 We're we're focused on retention. We wanna make 99 00:03:34,639 --> 00:03:36,639 sure that we we keep the providers that 100 00:03:36,639 --> 00:03:38,239 we have. We keep them happy, and we 101 00:03:38,239 --> 00:03:39,459 we develop a culture, 102 00:03:39,974 --> 00:03:41,735 where they serve those surgeons and their patients 103 00:03:41,735 --> 00:03:42,955 to the best of their ability. 104 00:03:43,334 --> 00:03:45,675 Absolutely. And why is that retention so important? 105 00:03:46,055 --> 00:03:48,830 Well, every turnover of an anesthesia professional, 1, 106 00:03:48,909 --> 00:03:51,330 is disruptive, and 2, it's very costly. 107 00:03:51,629 --> 00:03:53,790 So if, we use a cRNA, for example, 108 00:03:53,790 --> 00:03:56,030 if a cRNA gives their notice, call it 109 00:03:56,030 --> 00:03:57,090 a 60 day notice, 110 00:03:57,495 --> 00:03:59,655 more likely than that, there's gonna be an 111 00:03:59,655 --> 00:04:01,814 interim locum CRNA that's gonna have to fill 112 00:04:01,814 --> 00:04:04,135 a gap for 2, 3 months while we 113 00:04:04,135 --> 00:04:07,115 recruit and be able to, refill that spot. 114 00:04:07,360 --> 00:04:09,759 The premium on locums versus full time CRNA 115 00:04:09,759 --> 00:04:12,259 is just 30, 40, sometimes up to 50% 116 00:04:12,799 --> 00:04:15,060 increased premium it pays. So it is costly, 117 00:04:15,294 --> 00:04:17,394 and it's disruptive to surgeons. Surgeons, 118 00:04:17,855 --> 00:04:19,294 they wanna know who's at the head of 119 00:04:19,294 --> 00:04:21,855 the bed. They like seeing familiar faces, especially 120 00:04:21,855 --> 00:04:23,939 in ambulatory surgery centers. So, 121 00:04:24,500 --> 00:04:26,660 retention is really critical for the success of, 122 00:04:27,060 --> 00:04:28,199 anesthesia currently. 123 00:04:28,580 --> 00:04:30,980 Absolutely. And kinda looking ahead a bit, if 124 00:04:30,980 --> 00:04:31,639 the macroeconomic 125 00:04:32,019 --> 00:04:34,574 challenges of care do not change, how do 126 00:04:34,574 --> 00:04:37,214 you anticipate the industry will evolve? And will 127 00:04:37,214 --> 00:04:39,214 care shift to more of a consumer based 128 00:04:39,214 --> 00:04:41,529 service than a personal one? And how might 129 00:04:41,529 --> 00:04:44,910 that impact care groups versus individual practices? 130 00:04:45,850 --> 00:04:46,910 Look. The the macroeconomic 131 00:04:47,290 --> 00:04:50,185 challenges are pretty clear. The the provider shortage 132 00:04:50,185 --> 00:04:52,764 we're seeing in anesthesia is driving up compensation 133 00:04:52,824 --> 00:04:54,985 of providers. And on the opposite side of 134 00:04:54,985 --> 00:04:58,329 the equation, we're seeing decreased reimbursement. Medicare, cut 135 00:04:58,409 --> 00:05:00,810 cut anesthesia reimbursement every year for the past 136 00:05:00,810 --> 00:05:01,470 3 years, 137 00:05:02,089 --> 00:05:04,970 and commercial payers are not really keen on 138 00:05:04,970 --> 00:05:05,470 renegotiating 139 00:05:05,849 --> 00:05:07,241 anesthesia anesthesia rates with the no surprise act 140 00:05:07,241 --> 00:05:08,288 and the inability to be able to go 141 00:05:08,288 --> 00:05:09,524 out of network and balance bill, which is 142 00:05:09,524 --> 00:05:12,084 a whole separate topic. However, what it's done 143 00:05:12,084 --> 00:05:13,225 is it's really 144 00:05:15,120 --> 00:05:16,019 shifted the leverage away 145 00:05:16,319 --> 00:05:19,040 from anesthesia groups, from payers, and it's it's 146 00:05:19,040 --> 00:05:22,419 essentially pushing anesthesia to almost becoming a commodity 147 00:05:22,735 --> 00:05:25,154 in the, in the AAC, in the hospital 148 00:05:25,214 --> 00:05:25,714 marketplace. 149 00:05:26,334 --> 00:05:28,435 And when when services become commoditized, 150 00:05:29,615 --> 00:05:31,669 often you can lose that personal touch. So 151 00:05:31,669 --> 00:05:32,789 what we need to do is we need 152 00:05:32,789 --> 00:05:33,689 to fight back, 153 00:05:34,069 --> 00:05:35,350 1, to make sure that we get fair 154 00:05:35,350 --> 00:05:36,490 and equitable reimbursement, 155 00:05:37,029 --> 00:05:38,470 but, 2, to make sure that we don't 156 00:05:38,470 --> 00:05:41,235 lose that patient centered focus and that outcomes 157 00:05:41,235 --> 00:05:41,975 are important, 158 00:05:42,435 --> 00:05:45,895 but also especially in the ambulatory surgery environment, 159 00:05:45,955 --> 00:05:48,274 it's a boutique and it's a niche service 160 00:05:48,274 --> 00:05:50,520 where patients they they don't wanna feel like 161 00:05:50,520 --> 00:05:52,680 their cattle being rushed in and rushed out. 162 00:05:52,680 --> 00:05:54,680 They wanna have that unique touch, and anesthesia 163 00:05:54,680 --> 00:05:56,680 plays such an important role in that. It's 164 00:05:56,680 --> 00:05:58,824 important to, make sure that we don't lose 165 00:05:58,824 --> 00:06:00,425 that, and we still spend those extra couple 166 00:06:00,425 --> 00:06:02,185 of seconds to develop that trust and that 167 00:06:02,185 --> 00:06:03,485 relationship with the patient. 168 00:06:03,865 --> 00:06:05,544 Absolutely. Well, Tracy, I wanna thank you for 169 00:06:05,544 --> 00:06:06,920 your time today. But before I let you 170 00:06:06,920 --> 00:06:08,759 go, is there anything else that listeners should 171 00:06:08,759 --> 00:06:09,259 know? 172 00:06:10,520 --> 00:06:13,000 So I I think the the most important 173 00:06:13,000 --> 00:06:14,300 thing right now in anesthesia 174 00:06:14,805 --> 00:06:16,805 is making sure that your surgery centers and 175 00:06:16,805 --> 00:06:19,764 your anesthesia group management are really aligned and 176 00:06:19,764 --> 00:06:22,665 that there's honesty and transparency in those communications 177 00:06:23,319 --> 00:06:24,699 so that the partnership 178 00:06:25,079 --> 00:06:27,180 can strive as opposed to, 179 00:06:28,519 --> 00:06:31,375 becoming adversarial and and making sure that all 180 00:06:31,375 --> 00:06:33,795 the anesthesia providers are well taken care of. 181 00:06:34,254 --> 00:06:35,935 10 years ago, it it it almost didn't 182 00:06:35,935 --> 00:06:38,650 matter. Anesthesia was, there was a lot of 183 00:06:38,650 --> 00:06:40,350 CRNAs, there were a lot of anesthesiologists, 184 00:06:40,730 --> 00:06:43,290 ambulatory surgery centers were the desired place to 185 00:06:43,290 --> 00:06:45,944 work, and the trends are shifting. 186 00:06:46,245 --> 00:06:48,084 So I think the take home message for 187 00:06:48,084 --> 00:06:50,084 for your listeners today is to make sure 188 00:06:50,084 --> 00:06:51,704 that you have a partnership with anesthesia 189 00:06:52,050 --> 00:06:54,209 that is built on honesty, transparency, and that 190 00:06:54,209 --> 00:06:56,689 you're all aligned for the same goals to 191 00:06:56,689 --> 00:06:57,970 to make sure that the patients have a 192 00:06:57,970 --> 00:06:58,709 good experience. 193 00:06:59,305 --> 00:07:00,824 Absolutely. Well, Tracy, I want to thank you 194 00:07:00,824 --> 00:07:02,185 once again for your time today and for 195 00:07:02,185 --> 00:07:03,944 joining me on the Becker's Healthcare Podcast. Thank 196 00:07:03,944 --> 00:07:05,485 you. Thank you for having me.