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This is Laura Dirdo with the Becker's Healthcare

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Podcast. I'm thrilled today to be joined by

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Eliza August, administrator of Precision Care Surgery Center

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and vice president of the New York State

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Association of Ambulatory Surgery Centers. Eliza, it's a

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pleasure to have you on the podcast today.

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Thank you so much for having me. Now

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I'm really looking forward to our conversation because

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I know there's so much happening in the

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ASC space. It's really an exciting time to

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be, in the surgery center business.

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But before we dive into that discussion, I

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was wondering, could you tell us a little

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bit more about yourself as well as, your

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career journey in the ASCs?

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Sure. So I started basically out in the

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ASC industry about 15 years ago. I have

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actually worked my way up from the front

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desk all the way to admin. I currently

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run a center that does orthopedic

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spine pain management and podiatry cases out in

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Long Island, New York. Fantastic. Well,

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first and foremost, I know ASC volume across

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the country is expected to increase by around

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16%,

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through 2032.

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And with this in mind, that type of

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growth, what are some of the most pressing

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challenges,

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to maintaining a positive patient experience?

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So I would have to say the most

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challenging, I think, is the access

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as well as the cost. The issue that

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we're having across the country right now is

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that a lot of states basically are very

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individualized

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with the abilities of services that ASCs can

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provide. For example, in New York, we tend

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to be a little bit behind the 8

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ball. So, for example, our big bush is

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cardiac procedures.

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Other states are already ahead of the game

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doing cardiac procedures, whereas we don't do that

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currently in New York. The second thing really

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is cost. As we all know, it's upfront

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cost, deductibles, co coinsurance.

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You know, patients basically right now don't really

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understand sometimes

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what a deductible is, what a coinsurance is

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when they're signing up for insurance. When they

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come to the surgeon for space, they're not

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being charged, you know, 1,000 of dollars, basically,

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you know, for their care and not, you

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know, fully understanding.

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And I think, you know, with the increased

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want to go to a surgeon for your

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surgery and not understanding the cost, sometimes it

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ends up being prohibitive for patients because they

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always sit there and say, well, you know

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what? I know I need this knee scope

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done, or I may need a carpal tunnel

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done, but can I truly afford it? And

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that seems to kind of be the issue

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that they're constantly battling with.

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Absolutely. And that's such a a big challenge,

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and I can imagine, you know, trying to

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move forward and working with patients,

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having that great experience, not only on the

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clinical side, but on the, revenue cycle in

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payment side as well is so important.

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What are some of the strategies that have

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worked for you,

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in terms of tackling these challenges? What's a

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recommendation that you have for health care leaders

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to stay ahead?

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So in regards to the financial aspect of

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it, basically, part of it is really educating

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your patients as well as educating your staff.

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You know, the difference between deductibles,

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coinsurances,

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co pays, how they take a part basically

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in that patient's care. Also being upfront with

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your patients, you know, weeks ahead of time,

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days ahead of time. If you can't explain,

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hey. You're getting the surgery done. This is

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the cost you're looking forward to. You know,

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at my facility, we actually provide the patients

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with a written, you know, documentation saying, hey.

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Listen. You're gonna get 3 different bills, 1

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from your doctor, 1 from your search center,

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1 from your anesthesiologist.

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Here's all the phone numbers. All the billing

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departments you can call and get that transparent

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estimate of how much you expect it to

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basically pay. We work out payment plans. We

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do the best we can to kind of

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help basically get the patients the care that

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they need while not having to basically hinder

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their own care because of affordability

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issues. On the second hand in regards to

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access of care, basically, as a state association,

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basically, you know, for I am vice president.

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I'm working with my state association to push

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forward basically for cardiac procedures,

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you know, different types of procedures that were

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moving from the hospital space to the surgery

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center space and working together kind of as

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a unit. If you're doing it by yourself

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as one person, there may not be much

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traction, but there are power numbers.

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Also, working with the other states that are

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already you know, basically have programs in place

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to learn what they're doing and how they

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did it, how it was successful so that

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we can kind of copy that.

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Absolutely. I think that's such a good point.

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And, you know, really relying on those who

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are within your network is helpful.

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And I appreciate your advice here.

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How can leaders ensure that their staff are

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well equipped to help patients navigate

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the

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financial aspects of their care?

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So, basically, in order to get your staff

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to really be equipped, as I said, it's

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really on yourself as a leader to make

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sure that you get all the knowledge possible

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that you can train your team. I always

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say your team is the strongest. It should

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be this link. For myself, I take the

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time to explain to all of my nursing

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staff, all of my PAT staff. Hey. This

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is the difference of the different, you know,

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cost patients have because sometimes patients call for

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the, you know, pre op call, and they'll

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ask nurse, hey. Can you let me know

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what my deductible is? And instead of having

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that nurse having to call around or say,

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hey. Call this number, they can explain, you

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know what? I booked my system. This is

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what your deductible is. This is what you

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need to kind of bring in. Because part

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of this idea that, oh, that's not my

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job,

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no longer should apply. And I feel like

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that doesn't give confidence to the patient. If

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everyone they speak to can speak to, hey,

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this is my responsibility, and you can answer

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basic questions. I don't expect anyone to be

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an expert, but at least have the basic

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knowledge of it's a simple question, you should

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be able to answer it. And if it's

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a major question, just say, hey. You know

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what? Hold on. Let me go get that

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answer for you as opposed to just trying

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to kick them down the road to the

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next person. That's a really great point. And,

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you know, I I really appreciate that kind

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of approach and that it seems like almost

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a culture shift within your team in order

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to really serve the patient well and make

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sure that they're able to provide information, be

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very transparent, and then comfortable because it's not

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always an easy conversation to have, I can

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imagine. Yes. Did you have to do extra

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training or anything along those lines? So I

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did some extra training kind of with my

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team. Basically, I sat down with the individual

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department and let them know, you know, you're

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gonna expect these kind of questions. Also, what

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I do, I'm very big kind of on

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documentation.

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We do everything from, like, case costing ahead

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of time. You know, we break down the

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insurance basically, like, payments and estimates. We give

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it to the nursing staff. They know where

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to find it within the system. If they

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have questions, my door is always open so

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I can kind of explain it. You know,

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even for patients, I get calls all the

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time from patients like, hey. Can you just

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walk me through what, you know, my responsibility

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is, how I can do this? Because, you

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know, growing up in the health care, basically,

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you know, facility

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and realizing that a lot of times, especially,

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especially they're older, don't truly have anyone to

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really understand, like, you know, explain to them

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what their cost is. I've had patients call

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crying because they're like, I need my surgery,

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but I'm scared because, basically, I'm gonna have

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to pay, like, this amount of money. And

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I just feel like, you know, I'm gonna

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push it off because I can't afford it.

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And I said, wait. Wait. Wait. There are

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options.

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Let us talk it out. Let me help

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you. How can we figure this out? Even

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getting the doctor's offices involved and saying, hey.

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Let's as a team, what can we do

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to kind of help this patient? How do

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we figure it out? I love that approach.

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It seems like such a very patient centric

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way to approach these issues. So,

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thank you for describing that to us, and

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it's just really inspiring to hear how you

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can do that throughout the whole organization.

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Now I'm wondering how can leaders ensure their

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staff are well equipped to help patients navigate

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the financial aspects of care? How does that

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benefit

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the patient and provider relationships as well? So

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I've come to realize having that full transparency

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has actually helped

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patients basically be happier. We have really high

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patient satisfaction scores because they always feel as

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if, you know what, this is somewhere that

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I can go that they'll truly work with

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me and truly teach me how to navigate

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my insurance. Also, kind of getting the providers

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basically educated on the differences of cost respect

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for the patient has actually helped

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them kind of steer. Okay. This patient probably

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should go to the hospital because they don't

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have coverage for a surgery center. This patient

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should go to the surgery center. Because beforehand,

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what was happening is that doctor would just

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push patients, you know, to whichever facility. Not

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having an understanding or thinking, you know, ahead

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of time, let me figure out where is

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best for this patient because what kind of

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sucks for a patient let's say, you send

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to a search center and you don't double

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check their insurance ahead of time, then they

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get they they they get booked. And then

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2 weeks ahead, we're like, hey. Listen. We

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checked your benefits. You don't have any coverage.

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You don't have to go to the hospital.

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And that's really frustrating for them because they've

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made plans, arrangements, the changes of schedule. And

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I've realized how the transparency has strengthened the

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relationship between the provider and the facility, the

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provider and the patients, because they truly feel

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like someone actually cares and is doing their

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due diligence ahead of time for them so

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that they don't have that much to deal

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with in the back end. That's such a

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good point. And, you know, really interesting to

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have that kind of,

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transparency, to have that trust that's built. I

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just imagine it does wonders for the reputation

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overall. So

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amazing. Well, is there anything else you'd like

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to add or talk about, something that, you

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know, really would be beneficial for other surgery

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center leaders, administrators,

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and physicians to think through as they're approaching

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what

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certainly is a challenging topic in patient payments

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and trying to figure out the revenue cycle?

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I would say, honestly, it's just to be

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patient and understanding with your patients.

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I do understand running a surgery center sometimes

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is that we kind of get lost in

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trying to make profit

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all the time because, you know, at the

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end of the day, revenue is what pays

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the bills and keeps everything going. It allows

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for you to kind of expand the business.

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However but sometimes we also have to remember

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why we got into the business, and it's

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truly about patients and their care and making

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sure that they're getting access to what they

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need.

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That's a really good point. So thank you

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so much for being here on the podcast

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today. This has been a fun conversation. I

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appreciate your time and look forward to connect

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with you again soon. You're welcome. Thank you

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so much for having me.