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This is Alan Condon with the Becker's ASC
podcast. I'm delighted to be joined today by
doctor Bethuel Rehore
from Apex Spine and Neurosurgery
in Georgia. And doctor Rehore, a real pleasure
to have you join us for the podcast
today. Before we get things going, I'd love
to turn the floor over to you, hear
a little bit more about your role and,
of course, your practice in Georgia.
Oh, thank you very much, Alan, for having
me as a guest today.
I belong to a 4 person,
neurosurgery
group. We're independent.
I've practiced now for 12 years. 8 of
those, I was employed.
And, 4 years ago, we made the switch
against the current
of
going to set a private practice group.
So we started, and
now we're excited. We have our AAC up
and running.
Fantastic. Yeah. I know. So 4 person group,
I believe you've got 4 locations including that
one ambulatory service center that you just mentioned.
But can you talk to me a little
bit about what prompted that that,
move to go independent, start this practice of
your own, and how has it been in
the last 4 years or so?
Well, you know, it's not been easy. We
were not very good at telling the future
because we left employment
right before COVID hit.
Mhmm. And,
it's not been easy. It's been quite difficult.
But the reasons we decided to not be
employed
still made sense
that we go independent.
You know, as employed surgeons, you have
a very good floor. You have a good
base, but you also have a roof. You
have a ceiling on your head of how
far you can go.
And
being the people who are creating the value
in patient care,
we are not only doing the surgery, but
we generate
all the other ancillary
incomes for the hospitals.
We thought we had more value, and we
worked very hard.
And
our goal was to maximize the value that
we bring into the system.
And
as a surgeon, as a physician, there's really
no way you're going to maximize it
unless you get a role
in the ancillaries
and
the surgical centers, etcetera,
which is part of the value that you
bring to
a hospital system.
So
that was our second reason. Our first reason
was we just wanted to take care of
our patients better.
Mhmm. We wanted to
have a more active role
in
being in charge of the experience that our
patients have,
you know, when you're employed.
Obviously, your employer determines
how many,
you know, support staff you can have, and
sometimes that does affect the quality of care
that you're able to give.
In one of my previous jobs, you know,
I I'd I'd see 35 patients in clinic
without a mid level. And, obviously, the quality
of
patient 35 at about 6 PM in the
evening,
you know, you need was not
the way you wanted your patients
to experience you as a surgeon.
So
our first goal was
to be in charge of our patient experience
and,
to make it better,
which was still our goal. Now just like
I said, we did not read
the weather well. And in February of 2020,
when we,
wrote our resignation letters, COVID had not showed
up.
So it's been rough trying to
manage and stabilize, and I believe we are
at a at a good point
currently.
Obviously,
all the challenges of a start up,
getting the right
employees
who want to do the right thing
with the markets the way, you know, the
way it was coming out of COVID,
trying to be competitive
in,
you know, in the salaries that you're paying
in the rough,
climate was quite a challenge.
But I believe we've surmounted all of those
challenges at this point,
and our practice is actually growing.
Yeah. Absolutely. And and who could have foreseen
what was gonna come in March 2020 just
to force the fair concern, but, great to
hear. Really kinda weathered those challenges by the
sound of things and really getting back to
a point of growth for your practice.
I'm curious to hear for any, for any
neurosurgeons,
spine surgeons who are thinking about following in
your footsteps, I. E, potentially leaving the hospital
world to set up their own practice. Is
there 1 or 2 key piece of advice
that you'd have for them?
Well, the first piece of advice out of
our experience is know the contract you signed
for your employment.
We actually got sued for noncompete,
and that take us out of our area
where we had the sweet spot,
and we had to stay out for 2
years.
But we eventually came back into the area
where people knew us and people trusted the
quality of our work.
So first of all is know your contract.
But even before you know your contract, I
would suggest don't even think of leaving
if you're not confident of the quality that
you're going to provide to patients out there.
I think that's the first thing. You know?
You have to care for your patients, and
you have to really love taking care of
your patients because
that's what comes through whether you're in an
independent group, whether you're employed.
If you don't care about your patients, then
maybe stay employed
because there is a a net, a fifth
net.
But, yes, the two things is
be confident about the care
that you're giving the patients
and the quality and the value that you're
bringing into people's lives.
Secondly,
know the contract
of your employment
and obviously know where you want to go
start, but
it's gonna be uphill.
You know?
Starting a practice is uphill. Starting any startup
is always uphill.
You have to obviously have some finances,
stored up
because
everything in health care takes time.
You know, if you do a case,
the insurance company will pay you in 2,
3 months,
but the people who work for you want
their checks every 2 weeks.
Mhmm. So there is a big huddle,
but it's surmountable,
definitely. It's
you can surmount all the huddles. Yes.
And and I'm curious to hear. You said
you're surmounted
a lot of these challenges in getting getting
to a point where you're now growing your
practice. You you'd mentioned earlier in the conversation
about how important those ancillary services are. I'm
curious to hear from you, what are the
couple of areas that you're really focused on
in terms of growing your practice, for the
future?
Well, for right now,
we are we've we've focused heavily on getting
into an ASC,
And after several hurdles, we finally have an
ASC that's running and taking care of patients
with great outcomes,
but also the ancillary area with with, setting
up an imaging center.
100%
of my patients are the neurosurgeon will get
some form of imaging.
And
being able to participate as a provider
of some of the imaging that
that they need, I think, does improve our
bottom line and makes
the whole system,
you know, be worth how you want to
take care of your patients. You know? When
you order an image
and
you're able to get them scheduled in a
an efficient manner,
in a comfortable environment.
No.
You know, it's not uncommon patients come and
tell you how
cramped
the imaging place they went to was,
how the magnet was not
you know, was uncomfortable.
And for us to say, hey. This is
what the patients are telling us.
Why don't we fix that problem? We get
the right magnet. We get the right environment.
We schedule them in an efficient manner.
And as a you know, when we when
we as a as a as a provider
is controlling all of that and not just
some back office somewhere that received the referral,
I think there's more soul and human to
it and more care we put on to
that.
You know, we also have,
partnered with providers of other services like physical
therapy, etcetera.
But, you know, in the future, could those
potentially come in house? Yes.
At this point, we are just going
in a stepwise version,
to see what we could
utilize and,
bring to fruition
in a
appropriate way as we are now
we are walking. I think we've come off
the crawling phase.
Now we are in the walking, and hopefully,
we'll start running and adding on all the
ancillary parts
and all the value chain players into our
Apex
environment.
Yeah. Absolutely. It sounds like really kind of
taking seriously
that feedback that you're getting from your patients
and then working, to kind of incorporate these
things into your practice to really improve the
overall patient experience. Am I right? Yes, sir.
Yeah. And and, doctor Rory, I'm curious,
there's so much going
on, in the world of health care and
the ASC space at the moment.
I'm curious to hear, is there anything if
you could kind of pinpoint 2 or 3
trends that you're really focusing on and following
in health care at the moment, what might
they be?
I think right now,
the first trend that I'm really excited about
is
how much technology is improving
to allow us to do cases that once
took a lot more time in the hospital
to be able to do them in an
efficient way, in a safe manner in the
ASE space.
And, you know,
using,
you know, using things like stealth
navigation
allows us to make very small incisions.
You know, using a microscope, we've been able
to extend and even do a complete
decompression
without having to do an a traditional open,
you know, open type of spine surgery. So
I think that
the improvement of technology and the AI parameters
in helping us
extend the cases we're able to do in
the ambulatory center, I think that's a huge
trend.
Secondly,
the patients are becoming aware.
You know?
If I have a disc herniation, will I
go to the hospital
and mix with other people with their COVID
and their diarrhea issues while I can go
to a surgery center where,
you know, everyone who goes in there is
healthy and the nurses will have full attention
on me. You know, we only have 2
rooms in our surgery center. So most times
we have,
at the most, maybe 2 to 4 patients
in our recovery area, and all of those
are healthy patients. So the trend of patients
becoming aware that
ambulatory
surgery
center is an option, that's an exciting trend.
The third trend is
the assimilation by payers and, the government payers
into
extending the procedures that they can pay for
in the ambulatory surgery center space. That's also
an exciting trend.
Is there any particular
surgeries or procedures when you talk
spine procedures specifically on the outpatient setting? Or
Yes. This,
we only do spine procedures. That's that's that's
the reference.
Yeah.
Doctor Riordan, a real a real pleasure, having
you on the podcast.
Fantastic to hear about your transition.
No doubt it's come with some challenges over
the past 4 years, but great to hear
how you're not walking, maybe walking, and so
hopefully sometimes running into the future. But really
great to hear the growth of your practice,
and I can't wait to have you back
in the podcast down the line. Thank you
very much, Alan, for your time and for
the invitation.