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Hello, and welcome to the Becker's Healthcare podcast.
I'm joined today by Janet Carlson, executive director
of ASCs at Commonwealth Pain and Spine. Janet,
Janet, would you take a moment to introduce
yourself and, tell us a little bit about
your background? Yeah. Good morning. Thank you for
having me. So I am Janet Carlson. I'm
a registered nurse. I'm the executive director of
ASCs for Commonwealth Pain and Spine. We are
located
in Louisville,
Kentucky with a clinical footprint in 4 regional
states in that area.
I'm building 3 de novo ASCs
ground up right now, and I'm looking to
add more ASCs
to match our clinical
and ever expanding growing footprint.
So ASC volume across the country is expected
to increase by 16% by 2032.
With this
growth, what are the most pressing challenges to
maintain that positive patient experience?
One of the top things that I think
impacts patient experience in the ASC
are the payer contracts and the issues we
have with reimbursement
for these cases.
We are continually
migrating higher acuity cases from the hospital to
the ASC,
and with that comes the cost for
implants,
supplies,
trained,
clinicians,
and more labor.
In addition to that capital expenditure to have
the equipment there to do the higher acuity
cases.
And so a patient experience where they would
be better off from a safety perspective,
outcome perspective with a very concierge experience
in an ambulatory surgery center,
they may have the challenges
of having to come out of pocket because
we don't have adequate payer reimbursement
contracts. Mhmm. Mhmm.
And just to kinda add on to that,
how would you say
the patient experience differs
from, you know, in an ASC spine environment
versus, like, a, you know, a large health
system?
So I've worked in the interventional
and perioperative surgical world in both the inpatient
setting and the ambulatory setting.
The big difference for the patient experience in
an ambulatory setting is the very concierge feel.
Mhmm.
Additionally,
we are much more accessible
to the patient. We can get a patient
from clinic
to posting on the surgical schedule
a lot sooner than you can within a
health system.
One thing that sets us apart from health
system cases is that these patients
are able to be managed
by the same team at the ASC.
So, for example, my pre assessment
registered nurses that are making the phone calls
are the ones that work with our surgeons
day in and day out and know all
of our anesthesia selection criteria guidelines.
The hospital is fragmented. And so, a hospital
has so many
silos,
if you will. So we have a patient
that needs to go get their labs in
a certain market. Then we have a patient
needs to get imaging from another
department and a different appointment time. Then they
have to be assessed by anesthesia
or cleared for cardiac clearance.
And so that patient is moving around the
health system.
And I would argue that it would take
a lot longer for that patient to get
to day of surgery than it would for
the patient in an ASC.
So
what are some of the strategies that have
worked for your organization to, you know, tackle
some of the challenges you previously mentioned? Mhmm.
And, you know, what's some advice you have
for other health care leaders to kinda stay
ahead?
So
we are using
electronic health record in the ASC.
It's time for us to put the paper
charting to bed permanently,
allowing us to use that platform
more comprehensively
so that we
can fill block time
using the platform of the software that we
schedule in. And so that's a challenge right
there is block utilization and maximizing it. So
if we are all reading from the same
sheet of music, understanding the block availability,
we're able to get people in and seen
a lot sooner than we would if we
were phone calls back and forth, text messages
back and forth. So that's a technology that
we are adopting with very much success.
And, you know, out of curiosity, you mentioned
paper charting. Mhmm. Is that something that's still
fairly commonly used? Very common. Oh, wow. And
I'll tell you why.
Surgery centers that are doing
one day,
low acuity but very high volume cases,
you don't have the time to do the
full complement of the patient charting
and also keep up with the surgical volume,
the pace that the surgeons are moving at.
And so you can catch up on your
charting at the end of a very busy
day like that. Mhmm. But that is the
one thing that will slow down your patient
throughput
and the opportunity for
maximized
block utilization to then obviously have increased revenue.
Mhmm. So
patient charting
in paper and ASCs is still widely accepted
because it hasn't been federal regulatory mandate that
we go to an electronic medical record like
the health systems
have. And so that's
I find the reason why surgery centers use
it because of the throughput issue. And then
the adoption of new technology,
there's there's always pushback on that in addition
to the cost. But I would argue the
cost of a new
platform
could quickly be recouped for your return on
investment
because you will have that consistent patient through,
but with no slowdown whatsoever
based on the charting. Well, isn't there an
increased amount of AI and notation, like Yeah.
Tools out there to start templates. Right. And
so when we dial it in for a
physician let's just say that it's a carpal
tunnel.
Well, there's is it endoscopic carpal tunnel, or
is it an open incision?
Okay. Well, we're gonna load both templates,
and the physician can decide. They may post
it as one case, but it has to
convert to the other. We can quickly decide
to choose the other template,
and it auto populates the physician preferences.
And then they go in and dictate very
quickly postoperatively
as we're required to do and just add
the laterality and all the information
about the surgery, and it's taken care of
right there for you. Mhmm. Mhmm.
So, you know, once the surgery's done and
it's time for the, the patient to
navigate that that financial aspect of their care,
You know, how can leaders such as yourself
ensure that they're well equipped to kinda help
these patients with with that?
So I believe
transparent pricing is something that we excel at
in the ambulatory space.
I, myself, have had surgery centers where we
will post cash bundle pricing
on our website. And so folks can decide
if they wanna use their insurance or not,
or they'd just rather come out of pocket
and pay cash, which is a whole another
conversation, by the way, and the trends that
are in that area.
I will say the financial component begins when
the patient is scheduled from the clinic, and
they agree with the surgeon to the surgery.
Once that posting comes across,
that is when the CPT code revenue cycle,
they should start working that case right then.
Your business office manager to then
verify the patient insurance,
understand if they have any
deductible they have to meet, out of pocket
co pay, and also what their coinsurance is.
And that needs to be communicated
as soon as possible, as accurately as possible
to the patient so that there's no surprises.
Mhmm. Mhmm. And and with this price transparency
and potentially, you know, having discussions with them
around,
you know, payment plans or things like that
after the fact? You know, how does that
that transparency and assistance benefit that, patient provider
relationship and that trust? So
I believe patients trust providers that are willing
to post their prices. Mhmm.
And we hold ourselves accountable to our quality
outcomes.
And we we can have the quality outcomes.
We can choose
the procedures
that are safe for the center and the
patient.
We can have the success, and it and
it just feeds itself. So your quality outcomes,
your affordable
pricing,
and your accessibility,
all are bonuses to the patient coming. And
and I've found many patients that are willing
to pay
the fees to come and have their surgery
center
experience
intentionally.
They're also willing to pay the cash, like
I said, out of pocket Mhmm. Mhmm. And
not even worry about using their insurance.
And and and so with this, you know,
promotion of transparency and also, you know, the
the financial literacy of the patient, then you
talked about the growth. But, like, how how
does that can you kind of elaborate a
little more on how that benefits your organization?
So I believe it fosters and engenders trust.
A 100%.
It's all about trust.
So we keep the patient the center of
the care continuum.
We all orbit around the patient experience and
the patient's safe safety and their outcomes.
And so
leading with that, then everything else naturally, organically
falls in line, meaning
the right culture for the patients
that the surgeons are selecting to do at
their surgery center, the surgeons
being excited, incented, rewarded, and aligned to bring
their cases to the surgery center that they
have an ownership stake in.
It's the best day of their week is
when it's their day at the ASC. They
look forward to it. The surgeons do.
And then the team, the culture of your
team. So you have folks that are motivated
to be there, take care of the patient,
serve our surgeons.
You're gonna have a wonderful experience all the
way around, and that conveys to the financial
aspect of it as well. Mhmm. So I
think it's all tied together, frankly. Right. Right.
And that word-of-mouth has to be powerful too,
not just from the surgeon perspective, but also
the rest of the staff and the patient.
I can't tell you how many times we've
started to do a new procedure
or a service line or a higher higher
acuity case,
and we have excellent outcomes.
And that person will go to the bridge
club, to Perch, to the tennis group, to
their pickleball
Right. League. And before you know it, word-of-mouth
is powerful.
And that has been some of our best
free marketing, if you will.
I bet. I bet. And so, Janet, it's
been an absolutely lovely conversation today. Thank you.
But before we wrap up, I do have
to ask, you, do you have any final
thoughts you'd like to leave with our audience?
I just think it's an exciting time to
be in the ASC space.
The shift there
is growing exponentially
year over year. The shift will continue the
rest of my professional life. Mhmm. And so
I'm really thrilled to be in this space.
You're allowed to have a lot of creativity
in the ambulatory surgery space.
You have the decision makers at the table.
You're very accessible to
the physician owners, the clinicians on your team,
and your leaders. You all can be very
adaptable and make decisions quickly
where there's not a long delayed decision process
that usually plagues health systems.
And so it's a wonderful time to be
in the ASC space, and I just see
it continuing to grow. And I see physicians
looking to come out of their employment contracts
with large health systems and gain some professional
clinical surgical autonomy back in their practice.
So before we finish, one last question. Of
course. You talked about this being an exciting
time to be in the AC space. Would
you say throughout your career, this has been
the most exciting time? It is because it's
dynamic. Right. You know, we have federally on
the federal level, we have non competes being
challenged. Mhmm. And so that's going to start
that shift from what physicians just naturally do
right now, come out of fellowship and just
get employed with a large health system. Obviously,
they need to they need to start earning
income to pay off all of their medical
debt,
but they haven't learned the business model Mhmm.
Of the value proposition of working in an
ambulatory surgery center. It's a new thing to
them. It's not something that's taught in medical
school as an option. I didn't learn about
it in nursing school. Right. Right. This is
something you have to seek out. But as
physicians are now challenging the non competes,
they're looking at alternative
employment models
or productivity models in private practice, ownership
in an ASC.
These things are going to continue to shift
the health care away from the health system
inpatient ORs where there's a need for patients
to be done in the hospital. And I'm
happy for them to be done all day
long there for the safety reasons. But the
cases that we are seeing could and should
be done. We can leave more money in
the proverbial till for the patients if we're
doing these patients in an ASC. It costs
so much less for these Medicare patients, and
that, hence, will allow more money to be
available to take care of more people. A
100%.
A 100%. Well, Janet, thank you again for
joining us today on the Becker's health care
podcast. I hope you have a lovely rest
of your day. It's been my pleasure. Thank
you.