This is Laura Dirdo with the Becker's Healthcare
Podcast. I'm thrilled today to be joined by
Eliza August, administrator of Precision Care Surgery Center
and vice president of the New York State
Association of Ambulatory Surgery Centers. Eliza, it's a
pleasure to have you on the podcast today.
Thank you so much for having me. Now
I'm really looking forward to our conversation because
I know there's so much happening in the
ASC space. It's really an exciting time to
be, in the surgery center business.
But before we dive into that discussion, I
was wondering, could you tell us a little
bit more about yourself as well as, your
career journey in the ASCs?
Sure. So I started basically out in the
ASC industry about 15 years ago. I have
actually worked my way up from the front
desk all the way to admin. I currently
run a center that does orthopedic
spine pain management and podiatry cases out in
Long Island, New York. Fantastic. Well,
first and foremost, I know ASC volume across
the country is expected to increase by around
16%,
through 2032.
And with this in mind, that type of
growth, what are some of the most pressing
challenges,
to maintaining a positive patient experience?
So I would have to say the most
challenging, I think, is the access
as well as the cost. The issue that
we're having across the country right now is
that a lot of states basically are very
individualized
with the abilities of services that ASCs can
provide. For example, in New York, we tend
to be a little bit behind the 8
ball. So, for example, our big bush is
cardiac procedures.
Other states are already ahead of the game
doing cardiac procedures, whereas we don't do that
currently in New York. The second thing really
is cost. As we all know, it's upfront
cost, deductibles, co coinsurance.
You know, patients basically right now don't really
understand sometimes
what a deductible is, what a coinsurance is
when they're signing up for insurance. When they
come to the surgeon for space, they're not
being charged, you know, 1,000 of dollars, basically,
you know, for their care and not, you
know, fully understanding.
And I think, you know, with the increased
want to go to a surgeon for your
surgery and not understanding the cost, sometimes it
ends up being prohibitive for patients because they
always sit there and say, well, you know
what? I know I need this knee scope
done, or I may need a carpal tunnel
done, but can I truly afford it? And
that seems to kind of be the issue
that they're constantly battling with.
Absolutely. And that's such a a big challenge,
and I can imagine, you know, trying to
move forward and working with patients,
having that great experience, not only on the
clinical side, but on the, revenue cycle in
payment side as well is so important.
What are some of the strategies that have
worked for you,
in terms of tackling these challenges? What's a
recommendation that you have for health care leaders
to stay ahead?
So in regards to the financial aspect of
it, basically, part of it is really educating
your patients as well as educating your staff.
You know, the difference between deductibles,
coinsurances,
co pays, how they take a part basically
in that patient's care. Also being upfront with
your patients, you know, weeks ahead of time,
days ahead of time. If you can't explain,
hey. You're getting the surgery done. This is
the cost you're looking forward to. You know,
at my facility, we actually provide the patients
with a written, you know, documentation saying, hey.
Listen. You're gonna get 3 different bills, 1
from your doctor, 1 from your search center,
1 from your anesthesiologist.
Here's all the phone numbers. All the billing
departments you can call and get that transparent
estimate of how much you expect it to
basically pay. We work out payment plans. We
do the best we can to kind of
help basically get the patients the care that
they need while not having to basically hinder
their own care because of affordability
issues. On the second hand in regards to
access of care, basically, as a state association,
basically, you know, for I am vice president.
I'm working with my state association to push
forward basically for cardiac procedures,
you know, different types of procedures that were
moving from the hospital space to the surgery
center space and working together kind of as
a unit. If you're doing it by yourself
as one person, there may not be much
traction, but there are power numbers.
Also, working with the other states that are
already you know, basically have programs in place
to learn what they're doing and how they
did it, how it was successful so that
we can kind of copy that.
Absolutely. I think that's such a good point.
And, you know, really relying on those who
are within your network is helpful.
And I appreciate your advice here.
How can leaders ensure that their staff are
well equipped to help patients navigate
the
financial aspects of their care?
So, basically, in order to get your staff
to really be equipped, as I said, it's
really on yourself as a leader to make
sure that you get all the knowledge possible
that you can train your team. I always
say your team is the strongest. It should
be this link. For myself, I take the
time to explain to all of my nursing
staff, all of my PAT staff. Hey. This
is the difference of the different, you know,
cost patients have because sometimes patients call for
the, you know, pre op call, and they'll
ask nurse, hey. Can you let me know
what my deductible is? And instead of having
that nurse having to call around or say,
hey. Call this number, they can explain, you
know what? I booked my system. This is
what your deductible is. This is what you
need to kind of bring in. Because part
of this idea that, oh, that's not my
job,
no longer should apply. And I feel like
that doesn't give confidence to the patient. If
everyone they speak to can speak to, hey,
this is my responsibility, and you can answer
basic questions. I don't expect anyone to be
an expert, but at least have the basic
knowledge of it's a simple question, you should
be able to answer it. And if it's
a major question, just say, hey. You know
what? Hold on. Let me go get that
answer for you as opposed to just trying
to kick them down the road to the
next person. That's a really great point. And,
you know, I I really appreciate that kind
of approach and that it seems like almost
a culture shift within your team in order
to really serve the patient well and make
sure that they're able to provide information, be
very transparent, and then comfortable because it's not
always an easy conversation to have, I can
imagine. Yes. Did you have to do extra
training or anything along those lines? So I
did some extra training kind of with my
team. Basically, I sat down with the individual
department and let them know, you know, you're
gonna expect these kind of questions. Also, what
I do, I'm very big kind of on
documentation.
We do everything from, like, case costing ahead
of time. You know, we break down the
insurance basically, like, payments and estimates. We give
it to the nursing staff. They know where
to find it within the system. If they
have questions, my door is always open so
I can kind of explain it. You know,
even for patients, I get calls all the
time from patients like, hey. Can you just
walk me through what, you know, my responsibility
is, how I can do this? Because, you
know, growing up in the health care, basically,
you know, facility
and realizing that a lot of times, especially,
especially they're older, don't truly have anyone to
really understand, like, you know, explain to them
what their cost is. I've had patients call
crying because they're like, I need my surgery,
but I'm scared because, basically, I'm gonna have
to pay, like, this amount of money. And
I just feel like, you know, I'm gonna
push it off because I can't afford it.
And I said, wait. Wait. Wait. There are
options.
Let us talk it out. Let me help
you. How can we figure this out? Even
getting the doctor's offices involved and saying, hey.
Let's as a team, what can we do
to kind of help this patient? How do
we figure it out? I love that approach.
It seems like such a very patient centric
way to approach these issues. So,
thank you for describing that to us, and
it's just really inspiring to hear how you
can do that throughout the whole organization.
Now I'm wondering how can leaders ensure their
staff are well equipped to help patients navigate
the financial aspects of care? How does that
benefit
the patient and provider relationships as well? So
I've come to realize having that full transparency
has actually helped
patients basically be happier. We have really high
patient satisfaction scores because they always feel as
if, you know what, this is somewhere that
I can go that they'll truly work with
me and truly teach me how to navigate
my insurance. Also, kind of getting the providers
basically educated on the differences of cost respect
for the patient has actually helped
them kind of steer. Okay. This patient probably
should go to the hospital because they don't
have coverage for a surgery center. This patient
should go to the surgery center. Because beforehand,
what was happening is that doctor would just
push patients, you know, to whichever facility. Not
having an understanding or thinking, you know, ahead
of time, let me figure out where is
best for this patient because what kind of
sucks for a patient let's say, you send
to a search center and you don't double
check their insurance ahead of time, then they
get they they they get booked. And then
2 weeks ahead, we're like, hey. Listen. We
checked your benefits. You don't have any coverage.
You don't have to go to the hospital.
And that's really frustrating for them because they've
made plans, arrangements, the changes of schedule. And
I've realized how the transparency has strengthened the
relationship between the provider and the facility, the
provider and the patients, because they truly feel
like someone actually cares and is doing their
due diligence ahead of time for them so
that they don't have that much to deal
with in the back end. That's such a
good point. And, you know, really interesting to
have that kind of,
transparency, to have that trust that's built. I
just imagine it does wonders for the reputation
overall. So
amazing. Well, is there anything else you'd like
to add or talk about, something that, you
know, really would be beneficial for other surgery
center leaders, administrators,
and physicians to think through as they're approaching
what
certainly is a challenging topic in patient payments
and trying to figure out the revenue cycle?
I would say, honestly, it's just to be
patient and understanding with your patients.
I do understand running a surgery center sometimes
is that we kind of get lost in
trying to make profit
all the time because, you know, at the
end of the day, revenue is what pays
the bills and keeps everything going. It allows
for you to kind of expand the business.
However but sometimes we also have to remember
why we got into the business, and it's
truly about patients and their care and making
sure that they're getting access to what they
need.
That's a really good point. So thank you
so much for being here on the podcast
today. This has been a fun conversation. I
appreciate your time and look forward to connect
with you again soon. You're welcome. Thank you
so much for having me.