1 00:00:00,399 --> 00:00:03,060 This is Alan Congdon with the Becker's ASC 2 00:00:03,120 --> 00:00:05,279 Podcast, and I am thrilled to be joined 3 00:00:05,279 --> 00:00:06,980 today by Tina Piotrowski, 4 00:00:07,679 --> 00:00:11,359 CEO at Copper Ridge Surgery Center in Traverse 5 00:00:11,359 --> 00:00:13,059 City, Michigan. Tina, 6 00:00:13,535 --> 00:00:15,214 pleasure to have you back on the podcast 7 00:00:15,214 --> 00:00:16,114 with us again. 8 00:00:16,494 --> 00:00:18,894 For our listeners who mightn't be as acquainted 9 00:00:18,894 --> 00:00:20,814 with you or your surgery center, can you 10 00:00:20,814 --> 00:00:22,175 take a moment to just tell us a 11 00:00:22,175 --> 00:00:23,535 little bit more about your role and your 12 00:00:23,535 --> 00:00:24,035 background? 13 00:00:25,134 --> 00:00:26,434 Sure. Thank you, Alan. 14 00:00:26,974 --> 00:00:29,030 This is my 20th year in the ASC 15 00:00:29,030 --> 00:00:31,269 industry. I am the past president of the 16 00:00:31,269 --> 00:00:33,369 Michigan Ambulatory Surgery Association. 17 00:00:34,310 --> 00:00:36,229 I have held the cast credential as a 18 00:00:36,229 --> 00:00:38,869 certified administrator since 2016, and I am on 19 00:00:38,869 --> 00:00:41,210 the board of ambulatory surgery certification. 20 00:00:43,094 --> 00:00:45,655 Fantastic. Thank you so much, Tina. So we 21 00:00:45,655 --> 00:00:47,015 offer to do, I think there's so much 22 00:00:47,015 --> 00:00:48,454 going on at any one time in the 23 00:00:48,454 --> 00:00:50,855 health care space, in the ASC space in 24 00:00:50,855 --> 00:00:51,355 particular. 25 00:00:51,734 --> 00:00:53,255 Can you take a moment to tell us 26 00:00:53,255 --> 00:00:55,409 what are 2 or 3 trends that you're 27 00:00:55,490 --> 00:00:58,369 paying close attention to in this space and 28 00:00:58,369 --> 00:00:58,869 why? 29 00:00:59,969 --> 00:01:00,469 Sure. 30 00:01:00,929 --> 00:01:03,649 Well, as we know, the CMS 2025 final 31 00:01:03,649 --> 00:01:06,229 payment rule is out, and we are internally 32 00:01:06,370 --> 00:01:09,010 analyzing the impact to our organization based on 33 00:01:09,010 --> 00:01:10,444 our top volume procedures. 34 00:01:11,625 --> 00:01:13,965 The overall less than 3% increase 35 00:01:14,265 --> 00:01:16,265 is not enough as we know to offset 36 00:01:16,265 --> 00:01:18,284 increased wages and benefit costs, 37 00:01:18,825 --> 00:01:19,325 unfortunately, 38 00:01:19,784 --> 00:01:22,590 and to support the anticipated continued shift of 39 00:01:22,590 --> 00:01:25,009 cases from the inpatient to the ASC setting. 40 00:01:25,549 --> 00:01:27,729 So we will see what that looks like, 41 00:01:28,109 --> 00:01:29,729 particular to our 42 00:01:30,349 --> 00:01:33,329 center and, the industry as a whole. 43 00:01:34,269 --> 00:01:34,769 Additionally, 44 00:01:35,149 --> 00:01:37,924 and of significant importance is the change in 45 00:01:37,924 --> 00:01:41,224 administration that will be taking office in January. 46 00:01:42,405 --> 00:01:44,644 I know there's been some recent news out 47 00:01:44,644 --> 00:01:45,384 with some 48 00:01:45,924 --> 00:01:48,905 positions being appointed in the federal agencies. 49 00:01:49,844 --> 00:01:52,659 Don't know exactly if everything is gonna 50 00:01:53,120 --> 00:01:54,659 line up the way that 51 00:01:55,040 --> 00:01:56,959 we've heard about in the last 24 hours 52 00:01:56,959 --> 00:01:57,459 but 53 00:01:57,840 --> 00:02:00,000 we will be following closely the changes in 54 00:02:00,000 --> 00:02:00,500 leadership 55 00:02:01,040 --> 00:02:02,180 of the federal agencies, 56 00:02:03,185 --> 00:02:03,685 particularly 57 00:02:04,305 --> 00:02:06,225 CMS and the Department of Health and Human 58 00:02:06,225 --> 00:02:08,465 Services and, you know, what kind of impact 59 00:02:08,465 --> 00:02:10,885 this is gonna have on our ASC industry. 60 00:02:12,064 --> 00:02:12,564 Also, 61 00:02:13,344 --> 00:02:15,264 at the recent Becker's meeting, there were several 62 00:02:15,264 --> 00:02:17,824 discussions on using AI in our setting which 63 00:02:17,824 --> 00:02:19,080 I find very interesting 64 00:02:30,120 --> 00:02:30,620 Yeah. 65 00:02:31,985 --> 00:02:32,805 Yeah. Yeah. Absolutely. 66 00:02:33,104 --> 00:02:35,424 I think no doubt, obviously the CMS outpatient 67 00:02:35,424 --> 00:02:37,745 final rule, like you said, not enough to 68 00:02:37,745 --> 00:02:40,544 offset the wages of benefit costs and we've 69 00:02:40,544 --> 00:02:42,944 seen the spiraling labor costs across the last 70 00:02:42,944 --> 00:02:45,039 couple of years. No doubt the changes in 71 00:02:45,039 --> 00:02:46,099 the federal administration 72 00:02:46,400 --> 00:02:47,699 are big one as well. 73 00:02:48,079 --> 00:02:50,419 I guess quick follow-up on that. I guess, 74 00:02:50,479 --> 00:02:53,379 specifically as it relates to you, your ASC, 75 00:02:53,680 --> 00:02:55,840 what are you most concerned about? And what 76 00:02:55,840 --> 00:02:57,939 kind of impact are you preparing for 77 00:02:58,705 --> 00:03:00,405 potentially in in the coming years? 78 00:03:02,064 --> 00:03:02,564 Sure. 79 00:03:02,944 --> 00:03:04,865 Great question. And I feel like there is 80 00:03:04,865 --> 00:03:07,604 still a lot to be unknown out there, 81 00:03:08,385 --> 00:03:11,044 as to what specifically to expect. 82 00:03:12,300 --> 00:03:14,960 You know, really it comes down to what 83 00:03:15,260 --> 00:03:17,520 changes will we see coming from CMS 84 00:03:17,819 --> 00:03:18,319 regarding 85 00:03:19,260 --> 00:03:21,760 procedures that can be performed in the ASC. 86 00:03:22,780 --> 00:03:24,735 Also regarding quality measures, 87 00:03:25,275 --> 00:03:27,594 I know we've worked hard as an ASC 88 00:03:27,594 --> 00:03:29,775 industry and ASCA certainly 89 00:03:30,314 --> 00:03:31,935 has been working very hard 90 00:03:32,395 --> 00:03:32,895 representing 91 00:03:33,194 --> 00:03:35,514 ASCs across the country on some of the 92 00:03:35,514 --> 00:03:38,335 quality reporting measures that we feel are 93 00:03:39,050 --> 00:03:41,150 administrative burdensome to us. 94 00:03:41,610 --> 00:03:43,849 So, we'll be watching closely to see if 95 00:03:43,849 --> 00:03:46,729 some of those quality reporting measures will be 96 00:03:46,729 --> 00:03:47,229 reduced 97 00:03:48,330 --> 00:03:51,775 and also if there's the possibility of further 98 00:03:51,775 --> 00:03:54,574 shifting of some procedures that we've been wanting 99 00:03:54,574 --> 00:03:57,875 to move into the ASC space that CMS 100 00:03:57,935 --> 00:03:59,794 has been hesitant to do so. 101 00:04:00,655 --> 00:04:02,435 Mhmm. Is is there a particular 102 00:04:03,055 --> 00:04:05,074 procedure or specialty that you 103 00:04:05,454 --> 00:04:07,560 really advocating for that would benefit your surgery 104 00:04:07,560 --> 00:04:09,080 center the most to be shifted over to 105 00:04:09,080 --> 00:04:10,139 the outpatient side? 106 00:04:10,919 --> 00:04:13,319 Well, we are a very large multi specialty 107 00:04:13,319 --> 00:04:17,100 surgery center. We perform 11 different surgical specialties 108 00:04:17,240 --> 00:04:17,740 here. 109 00:04:18,439 --> 00:04:19,580 So we, 110 00:04:19,959 --> 00:04:22,455 you know, I know cardiac is a big 111 00:04:22,455 --> 00:04:23,175 one in, 112 00:04:23,894 --> 00:04:25,095 ASCs that, 113 00:04:25,495 --> 00:04:28,055 is is working well for some centers to 114 00:04:28,055 --> 00:04:30,774 consider adding that service line. That isn't one 115 00:04:30,774 --> 00:04:33,274 that we're looking to add here in our, 116 00:04:34,050 --> 00:04:34,949 in our region, 117 00:04:35,730 --> 00:04:36,050 but, 118 00:04:36,610 --> 00:04:38,689 who knows? It could be something, you know, 119 00:04:38,689 --> 00:04:40,550 in years down the road. But 120 00:04:40,930 --> 00:04:43,089 I think that right now, we're pretty well 121 00:04:43,089 --> 00:04:45,730 rounded with all of the offerings that we 122 00:04:45,730 --> 00:04:46,550 can provide. 123 00:04:46,930 --> 00:04:48,310 We're very invested 124 00:04:48,930 --> 00:04:49,430 in, 125 00:04:49,875 --> 00:04:51,415 you know, different technology 126 00:04:51,795 --> 00:04:52,295 for 127 00:04:52,754 --> 00:04:54,835 different service lines that maybe we'll be talking 128 00:04:54,835 --> 00:04:57,735 about, in a little bit little bit later. 129 00:04:58,675 --> 00:05:01,095 But I think, really, we just want to 130 00:05:01,314 --> 00:05:03,175 see how is it benefiting 131 00:05:03,555 --> 00:05:05,899 the ASC industry as a whole. And, 132 00:05:06,919 --> 00:05:07,740 some of the, 133 00:05:08,759 --> 00:05:10,860 you know, some of the spine codes that, 134 00:05:11,479 --> 00:05:13,639 we'd like to see that might be an 135 00:05:13,639 --> 00:05:15,319 area for us to be looking at in 136 00:05:15,319 --> 00:05:17,979 the future. But I think, you know, whatever 137 00:05:18,120 --> 00:05:18,620 benefits, 138 00:05:19,245 --> 00:05:21,564 you know, surgery centers as a whole is 139 00:05:21,564 --> 00:05:23,964 just good for our industry overall, whether it's 140 00:05:23,964 --> 00:05:27,084 a service line that you intend to provide 141 00:05:27,084 --> 00:05:29,185 in your facility or not. It's still 142 00:05:29,644 --> 00:05:30,625 good for patients, 143 00:05:31,084 --> 00:05:32,289 good for health care 144 00:05:32,669 --> 00:05:36,189 and, hoping to see some shifts, continued shifts 145 00:05:36,189 --> 00:05:36,930 that way. 146 00:05:37,550 --> 00:05:39,550 Yeah. Yeah. Definitely aligns with what we've heard 147 00:05:39,550 --> 00:05:42,189 at the recent COBRA meeting. A lot of, 148 00:05:42,750 --> 00:05:45,310 surgery centers like yourselves really looking forward to 149 00:05:45,310 --> 00:05:46,610 more of these high acuity 150 00:05:47,305 --> 00:05:49,704 spine codes like you mentioned, higher acuity cardiac 151 00:05:49,704 --> 00:05:51,884 care as well, moving more towards the outpatient 152 00:05:51,944 --> 00:05:53,004 setting as well. 153 00:05:54,185 --> 00:05:56,524 We're coming towards the end of 2024 154 00:05:57,144 --> 00:05:59,724 here. When you look ahead to next year, 155 00:06:00,104 --> 00:06:01,805 what are you most excited about? 156 00:06:03,360 --> 00:06:06,079 Sure. Well, patient centered care has always been 157 00:06:06,079 --> 00:06:07,379 a focus of our organization 158 00:06:07,759 --> 00:06:10,019 as well as the entire ASC industry. 159 00:06:10,720 --> 00:06:13,039 And for us in 2025, I'm excited about 160 00:06:13,039 --> 00:06:16,016 some patient engagement tools that we will be 161 00:06:16,016 --> 00:06:19,221 implementing to support and enhance our current practices. 162 00:06:19,221 --> 00:06:21,223 We're also working through some, 163 00:06:21,624 --> 00:06:24,827 updates and modifications on our website to make 164 00:06:24,827 --> 00:06:27,389 it more patient forward and not only promote 165 00:06:27,389 --> 00:06:28,930 the benefits of an ASC, 166 00:06:29,470 --> 00:06:31,149 but also address some of the key questions 167 00:06:31,149 --> 00:06:33,470 our patients have regarding receiving care at our 168 00:06:33,470 --> 00:06:35,649 facility and making our website, 169 00:06:37,149 --> 00:06:39,229 a better resource for them to get the 170 00:06:39,229 --> 00:06:40,610 information that they need. 171 00:06:41,675 --> 00:06:43,754 Got it. So really honing in, developing your 172 00:06:43,754 --> 00:06:46,475 website, some improvements there, and then honing in 173 00:06:46,475 --> 00:06:48,175 on some patient engagement 174 00:06:48,475 --> 00:06:48,975 tools. 175 00:06:49,595 --> 00:06:52,235 Curious, is there anything specific that you're looking 176 00:06:52,235 --> 00:06:52,894 to implement, 177 00:06:53,274 --> 00:06:54,735 in the patient engagement area? 178 00:06:56,060 --> 00:06:59,339 Sure. We want to be more interactive with 179 00:06:59,339 --> 00:07:01,360 the patient prior to the date of service. 180 00:07:01,899 --> 00:07:02,399 So, 181 00:07:02,860 --> 00:07:06,000 both in their, you know, expected payment 182 00:07:06,379 --> 00:07:09,519 in advance as well as any other communications 183 00:07:09,819 --> 00:07:10,245 that 184 00:07:10,805 --> 00:07:13,305 are important regarding some preoperative instructions. 185 00:07:14,404 --> 00:07:16,345 We're also looking at internally, 186 00:07:17,285 --> 00:07:20,504 how to provide more real time communication 187 00:07:20,964 --> 00:07:22,584 to the patients and 188 00:07:22,884 --> 00:07:23,865 patients' families, 189 00:07:24,644 --> 00:07:25,144 and 190 00:07:25,470 --> 00:07:26,290 how we can, 191 00:07:28,029 --> 00:07:30,670 provide, you know, more real time data as 192 00:07:30,670 --> 00:07:33,150 far as, you know, where the patient is 193 00:07:33,150 --> 00:07:35,009 at, how they're moving through 194 00:07:35,470 --> 00:07:36,529 their perioperative 195 00:07:37,150 --> 00:07:38,370 experience here, 196 00:07:38,750 --> 00:07:40,850 and any updates that are needed 197 00:07:41,754 --> 00:07:44,014 to improve that communication between 198 00:07:44,555 --> 00:07:45,375 what's happening, 199 00:07:46,235 --> 00:07:47,935 in the back with, 200 00:07:48,394 --> 00:07:51,035 keeping the families updated in a more timely 201 00:07:51,035 --> 00:07:51,535 manner. 202 00:07:52,475 --> 00:07:54,495 Gotcha. So really doubling down on 203 00:07:55,560 --> 00:07:58,199 patient experience, honing in on that concierge care 204 00:07:58,199 --> 00:07:59,980 that no doubt your ASC provides. 205 00:08:00,759 --> 00:08:03,160 I'm curious to hear, when you look ahead 206 00:08:03,160 --> 00:08:04,779 the next 12 months or so, 207 00:08:05,160 --> 00:08:06,759 how are you thinking about growth that your 208 00:08:06,759 --> 00:08:09,194 surgeries are? Is it adding new procedures, new 209 00:08:09,274 --> 00:08:11,375 specialties, more physicians, locations? 210 00:08:11,915 --> 00:08:13,774 What's the next step look like for you? 211 00:08:14,714 --> 00:08:18,074 Sure. We are continuously exploring avenues for increased 212 00:08:18,074 --> 00:08:20,335 growth, whether it be, you know, new procedures 213 00:08:20,395 --> 00:08:21,455 as well as adding 214 00:08:23,569 --> 00:08:25,170 We aren't looking to expand, 215 00:08:25,490 --> 00:08:26,230 by locations 216 00:08:26,770 --> 00:08:28,930 at this time. We're large. We have 8 217 00:08:28,930 --> 00:08:30,790 ORs and 4 procedure rooms 218 00:08:31,330 --> 00:08:34,129 and 5 overnight stay rooms that we use 219 00:08:34,129 --> 00:08:35,429 on a regular basis. 220 00:08:36,129 --> 00:08:36,629 So 221 00:08:37,105 --> 00:08:39,365 paying attention to the continued growth of procedures 222 00:08:39,424 --> 00:08:41,764 moving from the inpatient to the outpatient setting, 223 00:08:42,465 --> 00:08:45,024 we've seen continued growth in our surgical robotic 224 00:08:45,024 --> 00:08:47,365 program since we launched it 4 years ago, 225 00:08:47,504 --> 00:08:51,024 particularly in GYN procedures. So these are higher 226 00:08:51,024 --> 00:08:52,165 acuity cases 227 00:08:52,649 --> 00:08:54,829 and demonstrates that ASCs with 228 00:08:55,209 --> 00:08:57,690 well trained staff and investments in technology can 229 00:08:57,690 --> 00:09:00,269 provide safe high quality care for these patients. 230 00:09:00,809 --> 00:09:03,289 We also added an orthopedic robot earlier this 231 00:09:03,289 --> 00:09:04,750 year for total knee replacement. 232 00:09:05,574 --> 00:09:08,235 So the investment in both of those technologies 233 00:09:08,375 --> 00:09:10,454 has fueled the migration of cases from the 234 00:09:10,454 --> 00:09:12,074 inpatient setting to the ASC 235 00:09:12,534 --> 00:09:16,074 and brought along additional providers that normally weren't 236 00:09:16,615 --> 00:09:19,495 performing procedures in our facility. So we're gonna 237 00:09:19,495 --> 00:09:21,034 continue to focus on, 238 00:09:21,700 --> 00:09:23,559 adding providers, adding additional, 239 00:09:24,659 --> 00:09:27,240 service lines as we can, particularly 240 00:09:27,860 --> 00:09:31,320 some expansion possibly in our pain management offerings 241 00:09:32,100 --> 00:09:35,639 and, continue to recruit and retain providers. 242 00:09:36,865 --> 00:09:39,585 Okay. Sounds fascinating to hear. The expansion, excuse 243 00:09:39,585 --> 00:09:41,425 me, right, to the launch of your surgical 244 00:09:41,425 --> 00:09:44,545 robotic program specifically for GYN, but also added 245 00:09:44,545 --> 00:09:47,184 that orthopedic robot last year or this year, 246 00:09:47,184 --> 00:09:49,125 excuse me, for total knee replacement. 247 00:09:49,825 --> 00:09:50,565 I'm curious, 248 00:09:51,105 --> 00:09:53,330 is it kind of we hear we hear 249 00:09:53,330 --> 00:09:56,690 a lot about how patients are now seeking 250 00:09:56,690 --> 00:09:58,789 out these new technologies, seeking 251 00:09:59,169 --> 00:10:02,610 out ASCs, hospitals that have these robots that 252 00:10:02,610 --> 00:10:05,284 perform these procedures. But it's I'm curious, is 253 00:10:05,284 --> 00:10:07,524 it also almost a recruitment tool for some 254 00:10:07,524 --> 00:10:10,404 of these, the next generation of surgeons who 255 00:10:10,404 --> 00:10:13,125 are training in residency and fellowship programs? Or 256 00:10:13,125 --> 00:10:14,644 is it also a recruitment tool for some 257 00:10:14,644 --> 00:10:16,085 of these guys to come into your your 258 00:10:16,085 --> 00:10:16,985 AIC as well? 259 00:10:17,769 --> 00:10:20,009 Absolutely. And you you hit the nail on 260 00:10:20,009 --> 00:10:20,990 the head there, Alan. 261 00:10:21,610 --> 00:10:23,769 You know, younger physicians that are coming out 262 00:10:23,769 --> 00:10:26,009 of their programs, this is a standard of 263 00:10:26,009 --> 00:10:29,149 care for them. They've been using robotic technology 264 00:10:29,289 --> 00:10:30,350 in general surgery 265 00:10:30,889 --> 00:10:33,345 and g y n surgery for some time 266 00:10:33,584 --> 00:10:34,084 and 267 00:10:34,384 --> 00:10:36,245 they like to have that 268 00:10:36,625 --> 00:10:39,444 access to that technology and that equipment, 269 00:10:39,904 --> 00:10:42,544 you know, as they move on to their 270 00:10:42,544 --> 00:10:43,444 private practice. 271 00:10:44,064 --> 00:10:45,584 So we've been happy to be able to 272 00:10:45,584 --> 00:10:47,730 have that. It has definitely been a recruitment 273 00:10:47,730 --> 00:10:48,529 tool here, 274 00:10:49,009 --> 00:10:50,950 as well as, you know, with the orthopedic 275 00:10:51,090 --> 00:10:52,309 side as well. And, 276 00:10:53,570 --> 00:10:55,889 it's, you know, it just shows that you 277 00:10:55,889 --> 00:10:56,389 are, 278 00:10:57,330 --> 00:11:00,289 you know, investing in what really is the 279 00:11:00,289 --> 00:11:01,429 standard of practice 280 00:11:02,174 --> 00:11:04,654 that physicians coming out of their programs are 281 00:11:04,654 --> 00:11:05,794 expecting to have. 282 00:11:06,815 --> 00:11:08,735 Yeah. Fascinating to hear to see where we'll 283 00:11:08,735 --> 00:11:10,174 be in the next couple of years as 284 00:11:10,174 --> 00:11:12,174 more of these technologies advance and the the 285 00:11:12,174 --> 00:11:13,950 next generation come out of these programs. 286 00:11:14,509 --> 00:11:16,990 Tina, it's fascinating to get your perspective, to 287 00:11:16,990 --> 00:11:18,509 touch base a little bit more with you, 288 00:11:18,669 --> 00:11:20,110 and look forward to connecting with you again 289 00:11:20,110 --> 00:11:20,850 down the line. 290 00:11:21,389 --> 00:11:23,070 Very good. Thank you so much for your 291 00:11:23,070 --> 00:11:23,809 time, Alan.