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events page. See you in Chicago.
This is Laura Dierda with the Becker's Healthcare
podcast.
I'm thrilled today to be joined by doctor
Brian Krenzel, chief quality and development officer at
OrthoCarolina
as well as board chair for Viewmont Surgery
Center, a multispecialty
ASC in Hickory, North Carolina. Doctor Krenzel, it's
a pleasure to have you on the podcast
today.
Thank you, Laura. I'm excited to be here,
excited to talk about Viewmont and our recent
growth as well
as all things, orthopedic value in nature.
Fantastic.
Well, I know we've got a lot to
talk about and certainly excited to learn more
about,
what you're doing at the surgery center. But
before we dive in, can you tell us
a little bit more about yourself and your
background?
Sure.
I am a fellowship trained adult reconstruction specialist.
I have, certainly focused the bulk of my,
professional practice career in the hip and knee
replacement realm.
I have,
evolved that into some
leadership roles within OrthoCarolina
as well
as outside of OrthoCarolina
and our surgery center venture here in Hickory.
Really evolved, I would say, over the past
dozen years or so
into the value space, really trying to figure
out a better way to deliver hip and
knee replacement,
through improvements in quality as well as, the
all important,
cost drivers
and trying to identify
those levers we can pull to to change,
the
incredibly high cost of health care throughout our
country and in our region. So, ultimately,
really spend a lot of time living in
that, value realm.
That's great to hear. Now first and foremost,
what are some of the biggest issues that
you're following in health care today? What's top
of mind for you?
In my
space, working in value and in my leadership
role, really, what we're
focusing on and seeing as a main driver
is is where can we find the cost
containment.
I think a lot of
a lot of the aspects of of health
care focusing on cost have really
ignored the value piece, however.
And what I mean by that is we
see a lot of
movement towards various side of service shifting,
potentially even out of the country with some
of our local employers here in Hickory.
But the patients aren't necessarily getting
the highest quality care out of that.
And when you
ignore one piece for the other, you're not
necessarily
driving value.
And,
that value equation quality divided by cost seems
to be one of the larger hot button
issues that is
on the talking points for the orthopedic
realm, especially with spine and joint replacement surgeries
being
as historically costly as they've been in the
hospital based settings.
We're seeing this conversation not just being driven
at the highest level from CMS,
but also all the way down to the
more granular level of local health care delivery
with small business and and how they're able
to
manage their health care spends through through,
population health tools,
and all the way to bundling,
the singular episodes of care. A lot of
lot of
spectrum there to discuss,
but, ultimately, one of the key pieces to
that and one of the biggest things that
we're seeing is
is a shift to some of these higher
cost surgeries like hip and knee replacement
into the ambulatory surgery space, and that's been
something
gaining a lot of traction
over the past decade, but certainly over the
past 5 years, and and COVID was a
big driver in that.
That makes a lot of sense. And, you
know, I I can really appreciate having those
procedures going to the outpatient setting. From your
perspective, have you seen,
you know,
patients as well as clinicians get on board
with being able to perform more of these
higher acuity cases in the surgery center, or
has it been a little bit of a
a journey to really make that transition?
Yeah.
I think there's a small subset of patients
that are a little bit reluctant. They feel
safer in the traditional brick and mortar hospital
as opposed to the ambulatory space. But if
you take the time to talk to the
patients to educate them
on why an ASC may be right for
them,
they tend to really favor that even with
those higher acuity cases. I think most people
would expect to go to an ambulatory surgery
center for rotator cuff or an ACL.
Some people look at you kind of wide
eyed when you talk about joint replacement or
spine surgery in that environment.
In fact, interestingly enough, you're seeing side of
service shifting from
carpal tunnel and trigger finger type cases out
of the ASC even into minor procedure rooms
that are built in our orthopedic clinics.
So we're we're seeing
benefit there,
where patients may once it paid a facility
fee at an ASC rate now coming to
the office to have a carpal tunnel and
paying an office co pay,
which is considerable savings for them, and and
that's been proven to be safe, and reproducible
from a quality perspective.
That side of service shift is very powerful.
Once you explain that to patients
and they understand it, you get great deal
of buy in.
That's really great advice and certainly glad that
it's worked out well for you. Now I'm
wondering, you
know, what when you look ahead,
what are the things that make you most
excited and what are you nervous about?
Well, looking ahead, particularly,
with what we've been able to create here
in Hickory, the thing that makes me most
excited is is to gain
even more,
control and impact on the patient relationship that
I have. I I don't I don't have
the
barriers that often come with traditional inpatient care.
We have a lot of freedom in how
we choose to deliver care in the ambulatory
environment,
giving us a lot of opportunity to innovate
and to be creative to continue to improve
outcome and lower cost.
That gets me very excited both from the,
ability to control
that episode of care,
and then expand,
the opportunities we can deliver patients.
In that same vein, it's exciting to build
new service lines. At our ASC in particular,
we've
expanded our spine service line. Recently, we're offering
numerous,
ENT cases
that have,
that have grown such as the Inspire
sleep stimulator.
We're bringing head and neck cancer cases
into our ASC that have typically been done
at the hospital.
We're able to expand the complexity of the
patient from a health perspective. We're able to
take a little bit more sick,
patients to the ASC,
with our
anesthesiology
group we work with being top of the
line and additionally,
having overnight stay capabilities at our center as
well.
From a worry perspective, I think the one
worry is that we that we get,
too aggressive too fast. When you when you
get some opportunity
to think outside the box and get some
of,
for lack of a better term, freedom, I
think you need to make sure you're
paying attention,
not getting too aggressive
and getting too far out on the fringes.
So taking this, with a
scientific cautious
stepwise approach as we expand
indications
and procedures is is the one place where
we could slip up, so we need to
be smart about that.
That, you know, is really I can imagine
a fascinating discussion that you're having, and cool
to hear, you know, you've been able to
expand the types of cases and types of
patients you're able to,
perform cases on at the surgery center.
I'm wondering, you know, when you look at
that focus on the value based care and
focus on
providing additional care for those types of patients,
what do you really see as being essential
as your guiding light going forward? Do you
foresee more of the of, these types of
cases going to the surgery center, or what
comes next?
Sure.
I think
it's certainly been proven to be safe
to do hip and knee replacement in particular
to at an ambulatory surgery center,
in a same day discharge setting.
I think in my practice, studying my individual
practice and then looking out at the more
large scale macro level,
I think it's very reasonable
to
believe that 75 to 80%
of joint replacement patients
can safely be done in an ambulatory surgery
center.
I've recently
expanded my indications and and virtually eliminated
age as a restriction.
Just a couple weeks ago, we did an
86
year old healthy,
patient,
sent them home the same day from an
ASC.
Patient's doing beautifully, had good family support.
So
the number of patients that can shift over
there in the joint replacement realm, I think
we have good science and a good understanding.
I think that number is a little bit
perhaps unknown. What percentage of patients could ultimately
from a spine perspective be done there? I
think we're gathering data and expanding those indications,
but
I'm very comfortable
with the type of patient that we can
take to the ASC,
and that's a large number. And so it's
gonna have a significant impact on on health
care spend,
across the entire country, quite frankly.
That makes a lot of sense, and you're
excited for that future to to come. Now
before we wrap up our conversation here, what
do you think most effective health care leaders
will need in order to be successful in
the next 2 to 3 years, especially as
more of health
care goes into the value based realm and
outpatient
procedures become more common?
I think you have to have a a
really structured approach to this.
You have to have physician leaders that are
willing to
to step up
to change the paradigm of care in your
community to I I don't wanna say take
risk, but certainly change their practice patterns.
It has to be driven, I think, by
physicians, particularly
in the ambulatory surgery setting where physicians have
opportunities for equity ownership.
But
equally important as in our community with Viewmont
Surgery Center, you have to have hospital
buy in and partners. What you don't wanna
do is create
a total war
between you and your local hospital where you're
pulling all of the volume out of the
facilities
and leaving them with the highest acuity cases,
that are not necessarily
the best and healthiest of patients that may
be more costly.
Our particular situation here in Hickory at Beaumont
is really unique.
We have 2 hospitals in our community.
One is a,
for profit private owned facility, and the other
is a county facility.
The hospitals
are both of them joint ventured in our
ambulatory surgery center.
So for us to have the ability to
have recently expanded our surgery center from 3
rooms to 6 rooms,
to have the ability to have renovated our
surgery center, we needed to have our hospital
partners bought in.
And in our community,
we're very fortunate.
Both of our facilities for our regional medical
center,
which is a Duke, Lifepointe facility and Catawba
Valley Medical Center, our county hospital, have had
forward thinking leadership
that has partnered with us in a cooperative
way
and not in the manner in which, they've
obstructed the growth of the center and the
shift to the ASC.
The physician leaders,
having good strong relationships with your hospital partners
are super important.
And then from there,
it just is a matter of developing the
culture at your center, getting the right staff,
having fantastic anesthesia partners like we do.
Putting all of that together, I think it
gives you a recipe for success. I think
doctors can be perhaps a little shortsighted if
they get too aggressive too quickly,
about the growth of the center.
And they're not considered particularly in smaller communities
like ours, unlike bigger cities,
of the implications that side of service shift
would have for their local hospital facilities.
So my suggestion is to, when possible,
think think about partnerships, think about,
integrating all aspects of your local health care
market into it. Again, we're lucky we have
a multispecialty
center where we have ENT and pain partners
that are able to,
be involved in this. And I think when
you do it that way,
you get a huge win and a huge
lift for for multiple people as opposed to
one subset of physicians,
or
a hospital entity in and of themselves.
That's really such a great point. And I
know that,
kind kind of dynamic that you talked about
between physician surgery centers and hospitals is a
very real and evolving,
relationship.
I can imagine a lot of, different regions
and cities physicians are trying to navigate that.
And your advice
is certainly helpful to have that stealthy navigation
through, and have a very, you know, strong
working relationship with those folks because, as you
mentioned, it's so important to have all aspects
of the health care system represented in the
most appropriate way, within the broader communities.
I I'm
really excited that this partnership that we've created
will provide
for the next 20 years minimum,
opportunity for the patients of our community to
find
really high quality health care that's going to
be affordable.
And,
and when needed, we have 2 hospital facilities
to take them
to that will provide similar,
care,
of that high quality nature,
but, you know, obviously
not going to be something that everybody needs.
So this investment we've made in our facility
and our community is one that I think
will pay dividends for everybody,
all of these stakeholders, and most importantly, our
patients and employers locally.
Absolutely. That's, you know, really great to hear.
Well, thank you so much, doctor Krenzel, for
joining us on the podcast today. This has
been such a a great conversation, and I
look forward to connecting with you again soon.
Thank you, Laura. Appreciated,
opportunity to speak to you and your time
today.