Are your patients looking for an easy way
to pay for health care? Want to level
up the way you do business? Then the
CareCredit Health and Wellness card just might be
the answer.
For over 30 years, CareCredit, a Synchrony solution,
has been providing patients with a modern, flexible
way to pay for their health and wellness
expenses.
CareCredit seamlessly integrates with your business, helping minimize
account receivable, all while your patients enjoy budget
friendly financing options.
To learn more about how CareCredit works for
you and your patients,
visit carecredit.comforward/beccarspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are live at the business
and operations of ASCs.
I am joined right now by Michael Gail,
who is the administrative director of Centerra Obici
Ambulatory Surgical Center. So, Michael, thanks for joining
me today. Would love to have you take
a moment to introduce yourself and talk a
little bit more about your role in the
industry.
Oh, sure. I've been in health care senior
leadership,
for better than 20 years. Currently, I'm at
Sentara Obici,
Ambulatory Surgery Centers on the campus of, Sentara's
Suffolk Hospital.
Sentara
is a health care large health core large
health care organization that,
that is mostly in North Carolina and Virginia,
and it also has a health plan.
So there's,
8 surgery centers in the region that I
participate in. The I'm I'm a director at
one of those facilities.
I was recruited from, Southern California
where I ran, endovascular
surgery corporations.
Wonderful. Well, thank you for being here. And
let's start our conversation today talking about ASC
volume. So this is expected to increase by
16%
across the country by the year 2032.
With this growth, what is the most pressing
challenge to maintaining a positive patient experience?
Well, it's it's that's
a multifaceted
question,
with a lot of answers.
I I would say it starts with, ramping
up,
labor resources for the patient's benefit.
And and that means
resources for patient patient education
as well as counseling for patients on,
their financial obligations,
pre and post op education,
coordination with the referral sources for physical therapy,
home health.
There are transportation issues, of course, but most
of our resources as a facilitator of surgery,
are
are dedicated to the day of and preparing
getting clearance for those patients to to come
to the facility, educating them about what to
expect,
talking to them about the financial obligations they
may have,
and coordinating,
heavily with the physician
surgeon's
office
to make sure those patients,
are able to pass through all those bureaucratic
hurdles
without much exposure to them. But I would
say,
it's already a challenge,
across the board in health care, finding competent
people,
to help shepherd patients through an ever
through the ever increasing complexity
of, of that experience.
A lot of patients, depending on their socioeconomic
backgrounds,
you know, they they're barely
keeping their heads above water,
with with,
with life.
So it it can be a challenge adding
on, you know, complexities of healthcare that have
concepts that,
are alien to them.
Oftentimes, they just want the conversation reduced to
what I have what do I have to
pay you?
And issues that that are more profound
that have to do with,
on our side,
because we're experts in the field. They have
to do with our side, about good clinical
outcomes and their proper the proper informed consent
process
leading up to their their,
their surgery,
is is oftentimes
things that they can't process,
are too busy to process, or unwilling to
process for all the all the same reasons.
Absolutely.
And going along with that, what strategies have
worked for your organization to tackle some of
these challenges, and what is the recommendation you
have for health care leaders to stay ahead
of them?
Again, another another very good question, very broad.
I'll give you a quick example to sort
of silo this a little bit,
make it more comprehensible.
The
we started a total joint program this year.
So total knees and total shoulders.
So,
there's a there's a pre and post op
patient education component to that thing. So if
you if you're having a total knee surgery,
that nurse nursing education, that clinical education you're
supposed to get is very important because you
don't know what to expect. A lot of
these patients are aged.
So, you know, they have Medicare.
And so these can be as simple as
as we may perceive them to be.
That education about what comes next
through that pre and post experience is very
important. So having, for example,
an ambassador, like a nurse ambassador
or a nurse
and another clinical person like a scrub tech
who has experience
in those surgeries, intraoperative experience for those surgeries
supporting supporting those surgeries,
Having those kind of people speak to the
families of the patients,
before they get there for clearance issues,
and then during their stay while they're there,
in coordination with the physician surgeons communication with
them, can be very important. So that's one
example of how to how to prepare
for the transition
that Medicare wants us to make, CMS wants
us to make, to some of the procedures
that are currently done in a hospital setting
that can easily be done in an outpatient
setting.
So when you have a low acuity base,
something that's less complicated,
less challenging,
that has a lower risk factor,
and can be done in an outpatient setting,
that volume,
just by virtue of who's paying for it,
the payers,
they're driving that volume to us. So that
increase in volume, we have to speak to
the challenges of patient education.
In addition to all of the other things
we already do, we just have to ramp
up the game,
for what we already do, especially with the
communication between us and the physician referral source.
Their their office people change a lot, for
example.
And we just have to keep that
that knowledge bin rotating through that cycle of
ever increasing business,
more demands on us to to process those
imp those patients, without making it seem like
it's an assembly line. And you do that
with more,
labor resources
that are trained
and competent
in communicating with those patients. That's the whole
ballgame right there. Because if you treat people
like it's an assembly line,
they'll react like they're in a factory.
And nameless with a number and just being
processed.
They're just a paycheck to us. And that's
not the case at all. The other issue
I would say is, to prepare for this
is is all the background stuff that happens,
like good clinical out that produce good clinical
outcomes. And I know this is like a
very boring subject.
But, you know, a lot of what a
lot of the
the the adverse events, the bad things that
happen in an in an OR,
we keep track of, right? We keep track
of all of them. And a lot of
the thing all of the things that happen
postoperatively,
that are reported to us
by the physician surgeons,
post operative infections, people had to be hospitalized
for it.
The corrections that they had, revisions that they
had to make on the surgery that they
did. Those things are reported to us, too.
And the more we keep track of those
things,
without letting them fall by the wayside,
the better able we are to correct and
produce better clinical outcomes. So patients can be
assured,
sort of,
on the back end, that we're minding our
own house
from a from a quality outcomes point of
view.
So I would say those kinds of resource
dedicating
those kinds of
labor resources to that process
is important. Forming those committees, participating them, in
them. Again, as boring as it may sound,
it's extremely necessary and it bear it bears
results. You have QI, QA studies that you
produce from those things.
A lot of times, licensure, the people that
license you to do this do this work
on an outpatient setting require you anyway
to have,
those kinds of QA studies? Why not base
them on something that's real instead of something
you go in search of?
Base it on the real challenges you have
every day. There's plenty of them.
Yes. Absolutely. Well, thank you for those insights.
And I'm gonna shift gears a little bit
here toward the financial side. So how can
leaders ensure that their staff are well equipped
to handle patients navigate financial aspects of care,
and how does this benefit patient provider relationships?
So
it
it's
it's easy to say
that
to tell a patient or their relatives
that they always that they owe you money.
The hard thing is is doing it
in a constructive way, in a way that
inspires conversation and compromise
about how to settle that obligation. We don't
do things for free.
And
we have contractual obligations that require us with
some of the payers,
to collect that money. So if if I
were to decide, for example,
just because of what the insurance company pays
me, that whatever the patient obligation is is
superficial and unnecessary,
I would I could be in violation. I
probably am in violation,
of the of the clause in the contract
that says if they have a co pay,
if they have a deductible coinsurance, a share
of cost, I have to make a good
faith reasonable effort to collect it. I can't
just let it go.
Now, a lot of times,
with because of the shifting market of insurance,
the the expense of it,
the higher expense of it, people are choosing
higher deductible plans. And so their share of
cost is not some superficial thing any longer.
It could be very substantial.
So their their their their total,
allowance for the year as a share of
cost could be could be 4 or $5,000.
And if they have a family, could be
even higher than that. So
the point is that
having a conversation with patients well in advance
of surgery,
making them aware of this,
and making them aware that you have payment
plans and that there are options. There are
options like CareCredit,
the sponsors of your program. We use them,
by the way, as I mentioned earlier. That's
that's that long term payment option,
at a low interest rate is often a
a a deal breaker or a deal maker
sometimes.
I, for example,
am willing to take payments over 6 months,
up to 6 months. But I don't carry
anything over $2,000, to give you a concrete
example.
So no matter what you owe me,
I'm gonna divide it by 6 months at
most. And then it's gonna go to a
collections company, if you haven't settled it by
then. But I'll I'll get that understanding with
you in advance. And as long as you're
transparent, you say, here's what happens at this
stage, I'll trust you for this at this
stage, I won't at this stage.
Here are the consequences that could happen if
you don't pay altogether.
You could be refused service if you show
up day of surgery
and and you're not true to the arrangements
that we made. You don't bring in the
the the down payment, so to speak, for
that surgery of the day, no matter how
minor it is. If you don't keep your
word from the very beginning, it could be
a problem.
All of these things go to patient education.
And many times you have to refer the
patient
back to their their insurance company
for that more elaborate
explanation of why they owe that money. Sometimes
they don't know. They legitimately don't know, like,
they have other priorities in life. Now how
does that help the how does that help
our relationship with the physician's office? Easy.
When the patients don't understand why we're asking
them for a couple of $1,000,
they're gonna go back to their physician surgeon's
office and say, why are you making me
go over to this place that wants money
that I don't have? It might as well
have been $1,000,000.
I can't pay $2,000.
So if you didn't take the time to
reason through this with somebody and be reasonable,
it gets back to the physician's office. They
have to call me because I'm just a
facilitator of the surgery. I don't in my
case, I don't own the docs. They're not
my employees.
Now I have had owned docs, but I'm
speaking to the current situation.
It gets back to them, they have to
get involved, and then they catch all the
grief. Mhmm. Because in the patient's perceptive
perception, it's the doctor who set them up
for for that that surprise, that big financial
surprise that they can't afford. And then there's
the humiliation of it. There's the embarrassment.
You know, it people have pride. You don't
wanna speak to peep these are your patients.
And and they and they're emotional about it
because they need the surgery. I mean, what
are you supposed to do? You need the
surgery. You know you need the surgery. You're
gonna say whatever you have to do on
the phone call. If you don't have the
money to get to the place, get the
surgery done, and worry about everything later. Right?
So you might as well have an honest
conversation with people upfront and not put them
in that place.
Absolutely. Well, thank you for sharing your insights
today. Is there any parting words you'd like
to share on the podcast before we wrap
up?
I I would just like to say that
we are
reception people in in nursing clearance.
All of the people that have an interaction
with the patient
intraoperatively,
the pre op nurses, the post op nurses
in a surgery center setting, and in health
care in general.
If we treat people
like we would wanna be treated, I know
it's an old adage, it's an old saying,
It's it's rather cliche.
But if we were to treat people like
they have common sense,
like they have,
like they're middle class people with
other competing priorities in their lives,
especially when they have to take off a
day of work or something at surgery,
they they have to manage all this all
of the things they're going through in healthcare
in addition to just surviving life. And if
we were to have more sympathy for the
for people in the practical sense, speak to
them in the practical sense, considering those issues
that they have to deal with, allowing for
us to have a conversation
that's maybe a little bit broader than just
the issue of the day with the surgery
of the day.
And hearing them, it will go a long
way to helping people
to for them to be more open minded
and less fearful,
not just about what procedure they're having that
might save their lives
and the necessity of it, But just about
what's gonna happen to them afterwards, is that
is the other shoe to drop
some big thing that's in and of itself
unmanageable?
You know, with home health or all the
complexities of health care now. We're getting better
at what we do, more technologically
advanced,
for surgical procedures.
And as we do, we have to explain
how beneficial that that is going to be
for them from
a from a quality of life perspective.
We we have to start being human beings
in that conversation
so that their minds can be open to
the process.
Absolutely. Well, thank you for taking the time
to join me on the Becker's healthcare podcast
and share these insights on this topic. Again,
we are live at the business and operations
of ASCs. Thank you.