1 00:00:00,160 --> 00:00:02,639 Hello, everyone. This is Erica Spicer Mason with 2 00:00:02,639 --> 00:00:05,279 the Becker's Healthcare Podcast Series. Thank you all 3 00:00:05,279 --> 00:00:06,740 so much for tuning in today. 4 00:00:07,200 --> 00:00:09,119 I'm thrilled to be joined by Doctor. Greg 5 00:00:09,119 --> 00:00:12,660 Colbath, an orthopedic surgeon with Spartanburg Regional Healthcare 6 00:00:12,719 --> 00:00:13,219 System. 7 00:00:13,679 --> 00:00:16,484 He's also fellowship trained in sports medicine and 8 00:00:16,484 --> 00:00:17,464 shoulder reconstruction. 9 00:00:18,404 --> 00:00:20,244 Today, doctor Colbath and I will talk about 10 00:00:20,244 --> 00:00:22,964 how ASCs can enhance at home care and 11 00:00:22,964 --> 00:00:24,265 increase patient satisfaction 12 00:00:24,644 --> 00:00:25,544 after surgeries. 13 00:00:25,925 --> 00:00:28,324 Doctor Colbath, welcome to the podcast. Thank you 14 00:00:28,324 --> 00:00:30,260 so much for joining us today. Thank you 15 00:00:30,260 --> 00:00:32,740 for having me aboard, Erica. Appreciate it. Yeah. 16 00:00:32,740 --> 00:00:34,579 We're thrilled to have you with us. And 17 00:00:34,579 --> 00:00:36,520 before we get into our conversation, 18 00:00:36,899 --> 00:00:38,740 can you share just a little bit more 19 00:00:38,740 --> 00:00:39,560 about yourself, 20 00:00:40,420 --> 00:00:42,340 any detail, anything about yourself that you think 21 00:00:42,340 --> 00:00:44,280 would be helpful for our audience to know? 22 00:00:45,174 --> 00:00:47,814 Certainly. I've, been practicing for about 15 years 23 00:00:47,814 --> 00:00:50,314 now. I'm based in Spartanburg, South Carolina. 24 00:00:51,414 --> 00:00:53,094 One of the things that I've, 25 00:00:53,494 --> 00:00:55,894 you know, focused on primarily after my fellowship 26 00:00:55,894 --> 00:00:58,954 was sports medicine shoulder reconstruction. And, 27 00:00:59,574 --> 00:01:03,070 despite all these surgeries that we do, shoulder 28 00:01:03,210 --> 00:01:05,290 surgery can be painful. We found that to 29 00:01:05,290 --> 00:01:05,790 be 30 00:01:06,250 --> 00:01:08,109 that patients come with the notion 31 00:01:08,729 --> 00:01:10,269 that it can be painful, but we've 32 00:01:10,650 --> 00:01:13,034 been able to come up with better ways 33 00:01:13,034 --> 00:01:16,015 to treat pain following surgery before surgery. 34 00:01:16,555 --> 00:01:18,395 And I think that's allowed us to have 35 00:01:18,395 --> 00:01:19,615 the shift to, 36 00:01:20,075 --> 00:01:21,454 be able to take care of patients, 37 00:01:21,755 --> 00:01:22,495 treat them, 38 00:01:23,034 --> 00:01:25,215 with less pain, faster recovery. 39 00:01:25,594 --> 00:01:27,899 And, ultimately, that's that's kind of the the 40 00:01:27,899 --> 00:01:29,299 the whole goal is to get these patients 41 00:01:29,299 --> 00:01:31,079 back to their prior level of function. 42 00:01:31,700 --> 00:01:34,260 So that's what I find challenging anytime we 43 00:01:34,260 --> 00:01:37,620 have, new technology and new strategies in order 44 00:01:37,620 --> 00:01:40,579 to, try to maintain that, and, that's our 45 00:01:40,579 --> 00:01:42,680 goal. That's what we're always striving for. 46 00:01:43,354 --> 00:01:45,994 Yeah. Doctor Colbatch, thanks so much for sharing 47 00:01:45,994 --> 00:01:48,234 a bit more about yourself. And you kind 48 00:01:48,234 --> 00:01:50,394 of touched on something that was top of 49 00:01:50,394 --> 00:01:52,075 mind for me as we're diving into this 50 00:01:52,075 --> 00:01:54,474 conversation, and that's, you know, you're trying to 51 00:01:54,474 --> 00:01:55,215 get patients 52 00:01:55,939 --> 00:01:58,500 back home and back to their regular life 53 00:01:58,500 --> 00:02:00,920 after their surgeries as quickly as possible. 54 00:02:01,379 --> 00:02:03,299 And we know that that's something that's really 55 00:02:03,299 --> 00:02:05,619 driving that rapid growth in the ASC space 56 00:02:05,619 --> 00:02:08,659 right now. Patients really appreciate that ability to 57 00:02:08,659 --> 00:02:10,439 return to normal, so to speak, 58 00:02:10,865 --> 00:02:11,764 quickly as possible. 59 00:02:12,305 --> 00:02:14,324 So can you explain the challenges 60 00:02:14,784 --> 00:02:17,284 that patients face with medication management, 61 00:02:17,585 --> 00:02:19,365 especially disposing medications 62 00:02:19,905 --> 00:02:22,965 once they leave an ASC after their procedure? 63 00:02:24,310 --> 00:02:24,810 Certainly. 64 00:02:25,750 --> 00:02:28,069 The last 10 years, that's really been my 65 00:02:28,069 --> 00:02:30,550 goal is to try to reduce the amount 66 00:02:30,550 --> 00:02:33,610 of opioids that we're prescribing to our patients. 67 00:02:33,990 --> 00:02:35,669 And not because I'm trying to be a 68 00:02:35,669 --> 00:02:37,530 nihilist or not understand 69 00:02:37,990 --> 00:02:39,370 they're having pain, but 70 00:02:39,855 --> 00:02:41,294 we know that we can do a better 71 00:02:41,294 --> 00:02:43,075 job for the patients and their recovery 72 00:02:43,694 --> 00:02:45,855 if we can limit that. And we don't 73 00:02:45,855 --> 00:02:47,235 always do it completely 74 00:02:47,534 --> 00:02:49,935 opioid free, but if we can limit that, 75 00:02:49,935 --> 00:02:52,175 then the patients do better afterwards. And study 76 00:02:52,175 --> 00:02:53,990 after study has shown that. And we no 77 00:02:53,990 --> 00:02:55,530 longer have the issues 78 00:02:56,229 --> 00:02:59,129 with the side effects, whether it's constipation, nausea, 79 00:02:59,669 --> 00:03:00,169 vomiting, 80 00:03:00,790 --> 00:03:01,290 secondary, 81 00:03:02,469 --> 00:03:04,550 or unintentional falls. I mean, all those things 82 00:03:04,550 --> 00:03:06,629 we'd see with our patients after coming in 83 00:03:06,629 --> 00:03:07,449 for a routine 84 00:03:08,125 --> 00:03:09,105 outpatient surgery 85 00:03:09,965 --> 00:03:10,444 and, 86 00:03:10,925 --> 00:03:12,844 felt like it's that we we could do 87 00:03:12,844 --> 00:03:14,385 a better job. And so 88 00:03:15,245 --> 00:03:17,805 by being able to provide patients with what 89 00:03:17,805 --> 00:03:19,585 we call multimodal treatment, 90 00:03:19,885 --> 00:03:22,064 and that can entail everything from 91 00:03:22,469 --> 00:03:23,209 anti inflammatories, 92 00:03:24,150 --> 00:03:25,289 ice, compression, 93 00:03:26,150 --> 00:03:27,370 early physical therapy, 94 00:03:27,909 --> 00:03:29,610 general range of motion, compression. 95 00:03:30,229 --> 00:03:32,330 All of these things can can help, 96 00:03:32,870 --> 00:03:35,830 provide that pain care afterwards and including some 97 00:03:35,830 --> 00:03:37,514 of the regional blocks we have now. So 98 00:03:37,514 --> 00:03:39,115 we've really come a long way, I think, 99 00:03:39,115 --> 00:03:40,794 in the last 10 years of of being 100 00:03:40,794 --> 00:03:42,414 able to do this, effectively 101 00:03:43,194 --> 00:03:45,275 with a safe discharge to home. That's always 102 00:03:45,275 --> 00:03:46,955 our goal, safe discharge to home for these 103 00:03:46,955 --> 00:03:47,455 patients 104 00:03:47,754 --> 00:03:49,675 and ultimately get them back where they need 105 00:03:49,675 --> 00:03:52,930 to be sooner and with less complications and 106 00:03:52,930 --> 00:03:53,909 less side effects. 107 00:03:54,930 --> 00:03:57,650 Yeah. Thanks so much, doctor Colbath. And, you 108 00:03:57,650 --> 00:03:59,270 know, as patients are 109 00:03:59,890 --> 00:04:02,129 going home more quickly, which is something that 110 00:04:02,129 --> 00:04:02,870 they appreciate 111 00:04:03,170 --> 00:04:03,615 about, 112 00:04:04,415 --> 00:04:06,814 you know, what ASCs are enabling them to 113 00:04:06,814 --> 00:04:08,514 do in terms of their recovery. 114 00:04:09,375 --> 00:04:11,955 Where does medication management fall 115 00:04:12,335 --> 00:04:15,075 fall in there? You know, are there particular 116 00:04:15,215 --> 00:04:15,715 considerations, 117 00:04:16,175 --> 00:04:18,495 maybe safety considerations, other things like that when 118 00:04:18,495 --> 00:04:21,229 it comes to medication disposal that that need 119 00:04:21,229 --> 00:04:22,870 to be top of mind, not just for 120 00:04:22,870 --> 00:04:24,649 patients, but providers as well. 121 00:04:25,189 --> 00:04:26,169 Right. I think, 122 00:04:26,870 --> 00:04:29,029 the biggest thing for me and the biggest 123 00:04:29,029 --> 00:04:30,410 wholesale shift was 124 00:04:31,110 --> 00:04:33,745 about 8 years ago, really involved in this 125 00:04:33,745 --> 00:04:35,904 opioid reduction strategy. How can we do a 126 00:04:35,904 --> 00:04:37,985 better job? And one of the things, that 127 00:04:37,985 --> 00:04:38,564 I was 128 00:04:39,264 --> 00:04:41,425 fortunate to to be a part of was 129 00:04:41,425 --> 00:04:43,605 a task force here in our local community 130 00:04:43,665 --> 00:04:45,444 to through our medical society 131 00:04:46,384 --> 00:04:46,884 to 132 00:04:47,720 --> 00:04:49,240 try to look at some strategies. How can 133 00:04:49,240 --> 00:04:51,240 we do a better job? Is it, drug 134 00:04:51,240 --> 00:04:52,379 take backs? Is it, 135 00:04:53,000 --> 00:04:55,660 decreasing the, prescriptions that we're giving? 136 00:04:55,960 --> 00:04:57,400 And one of the tools that came to 137 00:04:57,400 --> 00:04:59,480 the that kinda bubbled up to the top 138 00:04:59,480 --> 00:04:59,980 was, 139 00:05:00,280 --> 00:05:01,020 the simple 140 00:05:01,355 --> 00:05:03,694 strategy. It's a disposal bag from Deterra. 141 00:05:04,634 --> 00:05:05,134 And, 142 00:05:05,595 --> 00:05:07,595 what it allows us to do is it's 143 00:05:07,595 --> 00:05:09,855 basically a a pouch with charcoal, 144 00:05:10,875 --> 00:05:11,855 kind of a formulated 145 00:05:12,394 --> 00:05:14,415 charcoal. You can add any of the unwanted 146 00:05:14,475 --> 00:05:14,975 pills 147 00:05:15,329 --> 00:05:17,910 after the patients have finished using the medications 148 00:05:17,970 --> 00:05:18,470 postoperatively 149 00:05:19,730 --> 00:05:21,410 and add a little bit of water and 150 00:05:21,410 --> 00:05:23,250 then shake it up, so like a ziplock 151 00:05:23,250 --> 00:05:23,750 bag. 152 00:05:24,290 --> 00:05:27,089 And then that allows for the medications to 153 00:05:27,089 --> 00:05:28,214 be neutralized 154 00:05:28,834 --> 00:05:30,914 and then also safely disposed. You can then 155 00:05:30,914 --> 00:05:32,914 put this in the trash. It goes in 156 00:05:32,914 --> 00:05:35,475 the the waste system rather than flushing it 157 00:05:35,475 --> 00:05:36,294 down the toilet 158 00:05:36,675 --> 00:05:39,235 or leaving it in your medicine cabinet or, 159 00:05:39,235 --> 00:05:41,040 you know, for a rainy day. And that's 160 00:05:41,040 --> 00:05:43,220 that's where diversion and misuse 161 00:05:43,759 --> 00:05:45,860 comes into play. And these patients, 162 00:05:46,240 --> 00:05:48,660 you know, keep the medications unfortunately around, 163 00:05:49,199 --> 00:05:51,520 and it can fall into unwanted hands. And 164 00:05:51,520 --> 00:05:52,020 so 165 00:05:52,560 --> 00:05:54,754 this is a a a good strategy. We 166 00:05:54,754 --> 00:05:55,714 felt this was, 167 00:05:56,194 --> 00:05:58,354 very effective. And one thing I I found 168 00:05:58,354 --> 00:06:00,935 was even more effective was having this discussion 169 00:06:01,314 --> 00:06:02,134 at the beginning 170 00:06:02,914 --> 00:06:05,970 of their surgical planning. So not after 171 00:06:06,290 --> 00:06:07,990 surgery, 1 week later, 172 00:06:08,529 --> 00:06:10,310 but within their preoperative discussion, 173 00:06:10,850 --> 00:06:12,610 we would provide all of our patients with 174 00:06:12,610 --> 00:06:15,250 these the tear bags. And it really allowed 175 00:06:15,250 --> 00:06:16,949 us to have that conversation early, 176 00:06:17,810 --> 00:06:20,449 and recognize it and start the discussion then 177 00:06:20,449 --> 00:06:22,925 with a very non threatening manner 178 00:06:23,305 --> 00:06:24,985 and get some patient buy in. You know, 179 00:06:24,985 --> 00:06:26,524 put the impetus on the patient 180 00:06:26,985 --> 00:06:27,564 to be, 181 00:06:28,024 --> 00:06:30,524 you know, part of their their own pain 182 00:06:30,585 --> 00:06:31,085 control 183 00:06:31,464 --> 00:06:31,964 afterwards. 184 00:06:32,264 --> 00:06:34,285 So I think it's very effective. 185 00:06:35,279 --> 00:06:37,199 We are very fortunate enough to get a 186 00:06:37,199 --> 00:06:39,139 grant through our foundation, our 187 00:06:39,439 --> 00:06:41,539 our Spartanburg Regional Hospital Foundation. 188 00:06:42,000 --> 00:06:44,339 We were able to purchase about 5,000 bags 189 00:06:44,959 --> 00:06:46,740 to, start this this program. 190 00:06:47,279 --> 00:06:48,879 And it's been very well received in the 191 00:06:48,879 --> 00:06:50,479 community. Initially, I thought it was gonna have 192 00:06:50,479 --> 00:06:50,774 a 193 00:06:53,334 --> 00:06:53,735 lot of pushback from patients, saying I'm not 194 00:06:53,735 --> 00:06:55,754 treating their pain well. But we found that 195 00:06:56,134 --> 00:06:58,294 most patients didn't need all the pain meds 196 00:06:58,294 --> 00:07:00,134 that we were giving them. And I've ratcheted 197 00:07:00,134 --> 00:07:01,514 it down from when I started 198 00:07:01,894 --> 00:07:04,694 my practice 10 years ago from maybe 30, 199 00:07:04,694 --> 00:07:06,879 40 pills to now we're only giving 10 200 00:07:06,879 --> 00:07:07,620 or 15. 201 00:07:07,920 --> 00:07:09,680 And even then, most of the patients are 202 00:07:09,680 --> 00:07:11,519 saying they still have pills left over. The 203 00:07:11,519 --> 00:07:12,019 average, 204 00:07:12,399 --> 00:07:14,240 number of pills that our patients are taking 205 00:07:14,240 --> 00:07:15,220 are 5 or 6 206 00:07:15,759 --> 00:07:18,800 after any given shoulder surgery, whether it's rotator 207 00:07:18,800 --> 00:07:19,540 cuff repair 208 00:07:20,324 --> 00:07:21,944 or a total shoulder replacement. 209 00:07:22,725 --> 00:07:25,685 And, we're we're having good success, and the 210 00:07:25,685 --> 00:07:28,084 patients are are participating with it. So it's 211 00:07:28,084 --> 00:07:30,165 been really one of the easiest things we've 212 00:07:30,165 --> 00:07:31,144 been able to implement, 213 00:07:32,245 --> 00:07:34,805 beyond all this other innovative technology that can 214 00:07:34,805 --> 00:07:36,379 be pricey and expensive. 215 00:07:36,839 --> 00:07:39,639 This is simple, effective, and it allows a 216 00:07:39,639 --> 00:07:42,120 patient to have some control of their own 217 00:07:42,120 --> 00:07:42,620 perioperative 218 00:07:42,920 --> 00:07:44,540 or postoperative pain management. 219 00:07:45,080 --> 00:07:47,319 So that's but nothing but a win for 220 00:07:47,319 --> 00:07:47,819 us. 221 00:07:48,564 --> 00:07:50,964 Yeah. Doctor Culbeth, I I really appreciate you 222 00:07:50,964 --> 00:07:52,884 sharing all these details. It it's great to 223 00:07:52,884 --> 00:07:54,824 hear that you were able to secure that 224 00:07:54,884 --> 00:07:57,604 that grant to purchase 5,000 bags. And to 225 00:07:57,604 --> 00:07:59,204 say that this was a really easy to 226 00:07:59,204 --> 00:08:01,044 implement and kind of an easy win for 227 00:08:01,044 --> 00:08:01,784 your organization, 228 00:08:02,245 --> 00:08:03,259 that that's huge. 229 00:08:03,720 --> 00:08:06,120 And, the fact that patients are feeling more 230 00:08:06,120 --> 00:08:08,680 involved in their care sounds like a big 231 00:08:08,680 --> 00:08:09,819 win as well. 232 00:08:10,519 --> 00:08:13,000 So for other leaders who are kind of 233 00:08:13,000 --> 00:08:15,240 intrigued by this idea and who maybe have 234 00:08:15,240 --> 00:08:15,740 considered, 235 00:08:17,404 --> 00:08:19,985 safe medication disposal as part of a safer 236 00:08:20,044 --> 00:08:21,745 medication practice and protocol. 237 00:08:22,365 --> 00:08:25,084 What are other what are effective ways that 238 00:08:25,084 --> 00:08:27,404 you would recommend that they kind of start 239 00:08:27,404 --> 00:08:29,040 to implement these practices 240 00:08:30,060 --> 00:08:32,059 within their patient base. Can you share any 241 00:08:32,059 --> 00:08:33,759 best practices or next steps? 242 00:08:34,620 --> 00:08:36,620 Certainly. And part of it, I may have 243 00:08:36,620 --> 00:08:39,440 touched on some of those multimodal pain regimens. 244 00:08:39,580 --> 00:08:42,105 So, the ice, the compression, 245 00:08:42,485 --> 00:08:45,285 and then the anti inflammatories, and that's actually 246 00:08:45,285 --> 00:08:47,605 been shown to have better pain relief than 247 00:08:47,605 --> 00:08:48,105 narcotics. 248 00:08:49,205 --> 00:08:51,605 So that's part of it. We've been very 249 00:08:51,605 --> 00:08:53,545 fortunate to have dedicated anesthesiologists 250 00:08:54,004 --> 00:08:56,740 who are fellowship trained in regional blocks with 251 00:08:56,740 --> 00:08:57,240 ultrasound. 252 00:08:57,779 --> 00:08:59,160 So there's a lot of advancement 253 00:08:59,620 --> 00:09:00,519 on that end. 254 00:09:00,899 --> 00:09:02,360 And then for a system, 255 00:09:03,220 --> 00:09:05,139 some of the, I guess, the the drug 256 00:09:05,139 --> 00:09:07,160 control or the medication disposal 257 00:09:07,779 --> 00:09:09,914 options are to to engage 258 00:09:11,034 --> 00:09:12,954 your systems and make sure we have drug 259 00:09:12,954 --> 00:09:14,014 take backs. Also, 260 00:09:14,554 --> 00:09:15,375 drug disposal 261 00:09:16,315 --> 00:09:18,714 boxes are very common now. So back when 262 00:09:18,714 --> 00:09:20,875 we started this kind of crusade, if you 263 00:09:20,875 --> 00:09:21,990 would, 8 years ago, 264 00:09:22,470 --> 00:09:23,129 the pharmacies 265 00:09:23,589 --> 00:09:25,769 were more than happy to fill the prescriptions 266 00:09:25,830 --> 00:09:27,990 for you. But they did not want you 267 00:09:27,990 --> 00:09:30,470 to bring any unwanted medications back to them 268 00:09:30,470 --> 00:09:33,110 in a brown paper bag because they felt 269 00:09:33,110 --> 00:09:34,490 it was liability, and, 270 00:09:35,190 --> 00:09:36,789 they didn't want to have that chain of 271 00:09:36,789 --> 00:09:38,875 custody. But now just about every 272 00:09:39,334 --> 00:09:41,995 major retailer and and even local pharmacies, 273 00:09:43,014 --> 00:09:45,254 will be happy to take those back for 274 00:09:45,254 --> 00:09:47,514 you. We have some drug disposal boxes, 275 00:09:48,054 --> 00:09:50,855 at our facilities at, not only in our 276 00:09:50,855 --> 00:09:53,860 hospital, but also at the fire stations and 277 00:09:53,860 --> 00:09:56,179 police stations. But not everyone's wanting to take 278 00:09:56,179 --> 00:09:57,940 their day out to go to swing by 279 00:09:57,940 --> 00:09:59,539 the police station to do that. So we 280 00:09:59,539 --> 00:10:00,899 try to make it a little bit more 281 00:10:00,899 --> 00:10:01,399 easy, 282 00:10:01,779 --> 00:10:03,399 for them, a little bit more accessible. 283 00:10:04,014 --> 00:10:05,454 And one of the things I found in 284 00:10:05,454 --> 00:10:07,534 some of our discussions in the community is 285 00:10:07,534 --> 00:10:10,434 that this is actually a green measure. So 286 00:10:10,735 --> 00:10:14,174 we talked to the wastewater management managers, and 287 00:10:14,174 --> 00:10:16,689 they don't want these things being flushed down 288 00:10:16,689 --> 00:10:19,029 the toilet. It seems like an easy solution, 289 00:10:19,089 --> 00:10:22,289 but, it contaminates the the water supply. It, 290 00:10:23,009 --> 00:10:25,190 is very costly for them to have to 291 00:10:25,490 --> 00:10:28,129 process that. So the the safest way is 292 00:10:28,129 --> 00:10:28,789 this disposal 293 00:10:29,730 --> 00:10:30,230 mechanism, 294 00:10:30,785 --> 00:10:32,465 whether it's a drug disposal or whether it's, 295 00:10:32,705 --> 00:10:34,085 through the the tear vacs. 296 00:10:34,545 --> 00:10:35,524 So those are all, 297 00:10:36,065 --> 00:10:38,465 sort of multi pronged approach in order to 298 00:10:38,465 --> 00:10:41,105 to get this engagement and and, hopefully, get 299 00:10:41,105 --> 00:10:43,825 some of these pills, unwanted pills, off the 300 00:10:43,825 --> 00:10:44,325 streets. 301 00:10:46,000 --> 00:10:49,120 Yeah. It's fascinating how something as small as, 302 00:10:49,120 --> 00:10:50,420 you know, a few leftover 303 00:10:50,879 --> 00:10:53,279 pills in a prescription could go so far 304 00:10:53,279 --> 00:10:54,180 as to contaminate 305 00:10:54,639 --> 00:10:56,800 any water waste, as you mentioned, doctor Colbath. 306 00:10:56,800 --> 00:10:58,259 And then, of course, there are other 307 00:10:59,084 --> 00:11:01,004 ramifications for the home and for patients and 308 00:11:01,004 --> 00:11:03,404 their family members. So it's a really important 309 00:11:03,404 --> 00:11:04,944 issue that you're touching on here. 310 00:11:05,404 --> 00:11:07,004 And kind of as we close our discussion, 311 00:11:07,004 --> 00:11:08,865 I'd love to know if there's any innovations 312 00:11:09,004 --> 00:11:11,584 or trends in this space that you're particularly 313 00:11:11,804 --> 00:11:13,860 excited about that you'd like to highlight for 314 00:11:13,860 --> 00:11:14,360 listeners? 315 00:11:15,379 --> 00:11:17,539 Certainly. I would say that, you know, 8 316 00:11:17,539 --> 00:11:19,379 years ago, this is a very hard discussion 317 00:11:19,379 --> 00:11:20,360 to have with patients. 318 00:11:20,899 --> 00:11:22,740 If you told them, hey. We're in the 319 00:11:22,740 --> 00:11:25,159 middle of a drug crisis or an opioid 320 00:11:25,220 --> 00:11:25,720 epidemic, 321 00:11:26,579 --> 00:11:28,065 most patients said, well, I don't 322 00:11:28,784 --> 00:11:29,924 see it. But luckily, 323 00:11:30,544 --> 00:11:33,345 the press and multiple organizations have have been 324 00:11:33,345 --> 00:11:36,065 very effective as far as getting the word 325 00:11:36,065 --> 00:11:38,404 out. And I think the the general public 326 00:11:38,544 --> 00:11:40,470 is is well aware that we are facing 327 00:11:40,470 --> 00:11:41,809 this, and there's so many ramifications, 328 00:11:42,429 --> 00:11:44,509 not only in the medical community, but also 329 00:11:44,509 --> 00:11:47,970 in just our our general community. And so 330 00:11:48,269 --> 00:11:50,190 that has been very helpful. So that conversation 331 00:11:50,190 --> 00:11:51,629 is a lot easier to have on the 332 00:11:51,629 --> 00:11:52,610 front end now. 333 00:11:53,465 --> 00:11:57,004 Moving forward next year and, January 1, 334 00:11:57,305 --> 00:11:59,785 the no pain act will now mandate that 335 00:11:59,785 --> 00:12:00,764 Medicare reimburse, 336 00:12:01,225 --> 00:12:01,965 for qualified 337 00:12:02,345 --> 00:12:05,805 non opioid options, at all outpatient surgical 338 00:12:06,460 --> 00:12:09,580 facilities and procedures. So now allowing for some 339 00:12:09,580 --> 00:12:10,799 reimbursement for, 340 00:12:11,500 --> 00:12:14,159 some of the innovative technology that's available. So 341 00:12:14,460 --> 00:12:15,759 long acting injections 342 00:12:16,700 --> 00:12:18,075 for your regional blocks 343 00:12:19,035 --> 00:12:22,815 There's 1. Another is, for other modalities 344 00:12:23,274 --> 00:12:25,835 as far as long acting non narcotic pain 345 00:12:25,835 --> 00:12:26,335 medications. 346 00:12:27,355 --> 00:12:29,995 So these reimbursement strategies that are now gonna 347 00:12:29,995 --> 00:12:31,134 be covered by Medicare 348 00:12:31,529 --> 00:12:32,509 and accepted, 349 00:12:33,290 --> 00:12:35,610 I think are are very exciting that we 350 00:12:35,610 --> 00:12:38,009 now have these tools available for us and 351 00:12:38,009 --> 00:12:40,730 that, even our legislation is is getting behind 352 00:12:40,730 --> 00:12:42,830 us. So that's that's exciting for us. 353 00:12:45,004 --> 00:12:46,764 Physicians here in our own community have looked 354 00:12:46,764 --> 00:12:48,144 into, some other, 355 00:12:48,524 --> 00:12:49,184 I call it, 356 00:12:49,565 --> 00:12:52,285 you know, other non opioid options such as 357 00:12:52,285 --> 00:12:53,184 laser treatment, 358 00:12:53,725 --> 00:12:56,205 physical therapy. All of these are are good 359 00:12:56,205 --> 00:12:56,705 options, 360 00:12:57,325 --> 00:13:00,639 to help in that postoperative pain period to, 361 00:13:00,799 --> 00:13:02,820 make sure that we're reducing and minimizing 362 00:13:03,839 --> 00:13:06,159 the amounts of opioids we're needing to use. 363 00:13:06,159 --> 00:13:08,000 I have several patients who now come to 364 00:13:08,000 --> 00:13:10,339 me because they know that I'm I'm opioid 365 00:13:10,399 --> 00:13:10,899 sparing 366 00:13:11,684 --> 00:13:12,165 surgeon, 367 00:13:12,644 --> 00:13:15,044 with a sole intent purposes. Let's get through 368 00:13:15,044 --> 00:13:17,945 the surgery without doing any opioids as well 369 00:13:18,164 --> 00:13:20,725 at all. And I think that is, is 370 00:13:20,725 --> 00:13:22,725 encouraging. That tells me that we've we've, 371 00:13:23,285 --> 00:13:24,664 we're making some strides. 372 00:13:25,365 --> 00:13:27,100 And I get it. I know this is 373 00:13:27,100 --> 00:13:30,320 this is we we're surgeons. We, we we 374 00:13:30,379 --> 00:13:32,620 we can put some some hurt on patients 375 00:13:32,620 --> 00:13:35,740 with, we're not careful. And so, I've gone 376 00:13:35,740 --> 00:13:38,139 through it myself. I had back surgery about 377 00:13:38,139 --> 00:13:39,740 4 years ago, and I was determined to 378 00:13:39,740 --> 00:13:42,164 go through it without having any opioids. And 379 00:13:42,164 --> 00:13:43,544 I was able to do it with, 380 00:13:44,404 --> 00:13:46,424 anti inflammatories, ice, compression. 381 00:13:47,125 --> 00:13:50,004 And I was early moving, got back to 382 00:13:50,004 --> 00:13:52,404 the office pretty soon. So within a couple 383 00:13:52,404 --> 00:13:53,625 of days, I was 384 00:13:54,500 --> 00:13:57,299 back to, I'd say, 90% normal. And so 385 00:13:57,299 --> 00:13:58,899 it's all about getting through that storm of 386 00:13:58,899 --> 00:13:59,399 surgery, 387 00:13:59,860 --> 00:14:02,100 having a good support group, and knowing that 388 00:14:02,100 --> 00:14:03,860 you can do this without opioids. And I 389 00:14:03,860 --> 00:14:04,919 think that's the key. 390 00:14:06,339 --> 00:14:09,799 Yeah. Doctor Culbeth, really appreciate how you've highlighted 391 00:14:10,264 --> 00:14:12,345 kind of the current state and how the 392 00:14:12,345 --> 00:14:15,384 public is seeing this topic, kind of some 393 00:14:15,384 --> 00:14:18,105 best practices in prescribing and the multimodal pain 394 00:14:18,105 --> 00:14:18,605 management, 395 00:14:19,144 --> 00:14:20,845 and then also how you're 396 00:14:21,144 --> 00:14:23,799 encouraging your community to safely dispose of their 397 00:14:23,799 --> 00:14:26,700 medications. It's it's been a really interesting conversation, 398 00:14:26,759 --> 00:14:28,299 and I appreciate it so much. 399 00:14:28,679 --> 00:14:31,080 Before we we end our time together, were 400 00:14:31,080 --> 00:14:32,600 there any other final thoughts you wanted to 401 00:14:32,600 --> 00:14:33,500 share with listeners? 402 00:14:34,664 --> 00:14:37,304 I think the biggest thing is have this 403 00:14:37,304 --> 00:14:40,345 discussion even with your younger patients or even 404 00:14:40,345 --> 00:14:42,904 with patients who you think may not be, 405 00:14:42,904 --> 00:14:45,065 you know, exhibiting the drug seeking behavior. The 406 00:14:45,065 --> 00:14:46,745 the more you discuss this and the more 407 00:14:46,745 --> 00:14:49,325 that you provide some awareness about it, everybody 408 00:14:49,500 --> 00:14:51,259 is going to have somebody, either a family 409 00:14:51,259 --> 00:14:52,399 member or a coworker, 410 00:14:53,179 --> 00:14:55,440 who has been affected by this. And 411 00:14:55,820 --> 00:14:57,899 it's something that I think is probably the 412 00:14:57,899 --> 00:14:58,879 most impactful 413 00:14:59,580 --> 00:15:01,820 way that I've changed my practice in the 414 00:15:01,820 --> 00:15:03,659 the 10 years that I've I've been in 415 00:15:03,659 --> 00:15:06,454 practice is to be more aware of this 416 00:15:06,595 --> 00:15:09,235 and to be proactive. And, again, that's that 417 00:15:09,235 --> 00:15:11,954 discussion needs to start before you even consider 418 00:15:11,954 --> 00:15:13,334 surgery. And so, 419 00:15:13,954 --> 00:15:16,274 Plan For Pain is, one of the other 420 00:15:16,274 --> 00:15:17,654 sites you can go to, 421 00:15:18,194 --> 00:15:21,779 but awareness and then just being vigilant. So 422 00:15:21,779 --> 00:15:24,019 it's amazing how many patients I think we 423 00:15:24,019 --> 00:15:25,079 have saved 424 00:15:26,179 --> 00:15:28,980 by implementing these things. So it's it's, it's 425 00:15:28,980 --> 00:15:31,299 probably the most impactful thing for my my 426 00:15:31,299 --> 00:15:34,454 practice. So I'm very thankful for all of 427 00:15:34,454 --> 00:15:35,274 these organizations 428 00:15:35,975 --> 00:15:38,774 coming together and, providing this because it's we 429 00:15:38,774 --> 00:15:40,534 can all get behind this. Right? It doesn't 430 00:15:40,534 --> 00:15:42,375 matter what side of the political aisle you're 431 00:15:42,375 --> 00:15:44,375 on. Everybody can get behind this and say 432 00:15:44,375 --> 00:15:47,194 this is this is worthwhile for our communities 433 00:15:47,254 --> 00:15:48,074 and our patients. 434 00:15:49,470 --> 00:15:53,230 Absolutely. Doctor Colbath, fantastic insights. Thank you so 435 00:15:53,230 --> 00:15:55,149 much again for your time and the great 436 00:15:55,149 --> 00:15:57,250 discussion today. It was great having you here. 437 00:15:57,309 --> 00:15:59,230 Thank you for the opportunity, and appreciate all 438 00:15:59,230 --> 00:16:00,610 the work you guys are doing. 439 00:16:01,295 --> 00:16:03,295 And we'd also like to thank our podcast 440 00:16:03,295 --> 00:16:05,475 sponsor for today's episode, Deterra. 441 00:16:06,095 --> 00:16:08,175 You can tune into more podcasts from Becker's 442 00:16:08,175 --> 00:16:10,995 Healthcare by visiting our podcast page at beckershospitalreview.com.