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forward slash beckers podcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are live at the business
and operations of ASCs.
I'm joined right now by doctor Chol Kim,
who is a minimally invasive spine surgeon at
Excel Spine Center. So, doctor Kim, thanks for
being here today. We'd love for you to
take a moment to introduce yourself and tell
us a little bit more about your work
in the space.
Let's see. I've been in practice for about
twenty two years. I feel really old now.
It just seems like yesterday.
I'm board certified in orthopedic surgery,
and I did a fellowship in spine surgery
at the Mayo Clinic.
And I pretty much just take care of
spine patients
both in the neck and the back.
And I started out initially at the university,
at UCSD Medical Center in San Diego.
I'm like a San Diego
Native wannabe because I went to undergrad there,
then I went to
residency there, and then I came back there.
My brother went there. I met my wife
there. So,
spent a lot of time in San Diego.
But for the last sixteen years, I've been
in private practice.
And in the last
two years,
essentially since the start of COVID, I've
morphed my practice into
a somewhat unique practice where
for me to practice the medicine that I
do, where I really focus on minimally invasive
surgery and state of the art surgery, especially
endoscopic surgery, which is a total pain, but
more on that later. I couldn't keep up
with the insurance.
So, like, my practice now is kind of
an out of network private pay practice
where I don't have to do a lot
of surgeries
per year.
I just do the same number of surgeries
that I've always done. And so
I have kind of a a niche practice
now where I take care of
a few simple problems. Like, I try not
to do everything. I just try to focus
on a few surgeries. I try to do
those surgeries really, really well by being able
to take my time both with the patients
and during surgery
to do the most minimal invasive job possible.
So,
I think I have a bit of a
unique situation in terms
of my my practice
compared to most of my colleagues. Yeah. Absolutely.
Sounds like it.
And let's start our conversation here talking about
ASC volume.
So this is expected to increase by 16%
all across the country by 2032.
With this growth, what is the most pressing
challenge to maintaining a positive
patient care experience?
By the way, that
percent increase, I think, is probably for all
ASC
surgeries.
Yes.
But I think for spine surgeries, you know,
we do a lot of spine surgeries. We
do
300 and something thousand lumbar fusions per year,
and probably a significant
majority of those are just simple one and
two level fusions.
And then we do probably
well over half a million nonfusion spine procedures.
And
right now, most of those are still done
in the hospital even though they really don't
need to be.
So the likelihood
of
a big change within the spine field, I
think, is gonna be much more dramatic than
the overall
group. I think the same thing will be
for, like, total joints, but I think the
anticipated growth
has to take that into account where it's
not just the general growth, but there's gonna
be some pockets in some areas where they're
gonna grow a lot faster.
And for me, I guess the question is,
are we just trying to recreate a hospital
that does,
you know, a lot of different specialties, but
as an outpatient setting, or should we be
more like
I don't know. In San Diego, we have
this
fast food Mexican restaurant called Roberto's.
And and this is not a place like
that anywhere, not even in LA. But they
just specialize
in kind of what we call street Mexican
food. Same thing with Starbucks. I mean, a
highly specialized,
consistent,
efficient
system.
So
I would like to see personally
surgery centers that may just specialize in spine
surgery or just two or three subspecialties
instead of I see a lot of orthopedic
surgery, gastrointestinal,
ENT,
gastric,
gastric bypass that's called bariatric,
and even GI.
And I can't remember if I've mentioned ENT,
but, I mean, having,
you know, five, six, seven different specialties makes
the growth of ASCs kind of,
in my mind, not as meaningful as if
we use this opportunity to really subspecialize
because I just really can't imagine
how anybody can do better. For example,
in the outpatient spine setting,
if you're trying to compete with a
a center that just does spine compared to
another center that does, like, two or three
or four different specialties, it would be very
difficult to compete within that spine field. So
I hope
it's not just about the growth, but about
a fundamental change in just the way we
deliver health care.
Absolutely. And going off of those points that
you made, I'd love to know what strategies
have worked for your organization as you tackle
some of those challenges
and what recommendations you may have for health
care leaders looking to stay ahead.
A lot of
success
in the outpatient setting has to do with
what patients
are expecting to occur.
So if if you just let a patient
decide how long they wanna stay in the
hospital after any spine procedure, they'll wanna stay
in for, like, a week because they just
think it's better even though it's not. They
just
you know how sometimes people just don't know
what's what's good for them because they just
haven't experienced it yet? Mhmm. And we're the
experts.
And so you have to start from the
beginning
and establish the expectation that, like, we're doing
mental invasive surgery here. Everyone goes home, and
it's better to be home
and have
a compelling message to that. I mean, my
compelling message is that
sleep is such an important part
of healing and just feeling comfortable. And
the best example is you may have gone
to the most awesome vacation in the most
beautiful tropical setting, But when you walk in
through your door and put your suitcases down
in your living room, assuming you like your
house, you get that feeling like, oh, it's
still good to be home.
And that is an important part of the
healing process. So that sleep and a bunch
of other things,
staying in the hospital just delays things. So
you you get it from the beginning so
that patients are expecting minimal
invasive surgery expecting to go home,
expecting that to be better of an experience,
which it should be, but you have to
actually then
get the buy in of all the people
that are participating in the care. Even the
preoperative nurses, as well as the post op
nurses, but especially the post op nurses, they
have to know how to manage all the
little things things that come up because a
lot of it has to do with patient
anxiety. And I get it.
I mean, when you don't know anything about
something and it's happening to you, it's really
scary, especially when you're having spine surgery. So
there has to be a level of education,
not just in terms
of the medicine part of it, but
the
the kind of the art of caring for
patients. I guess the closest thing would be,
like, in the hotel industry, somebody that, like,
is really good with customer service and knows
how to, like, calm people down.
Yeah. Absolutely.
Because sick people are kind
of crazy.
Like you know?
And I get it.
A %. Well, thank you for your insights
on that topic. Shifting gears just slightly toward
the financial side, how can leaders ensure their
staff are well equipped to help patients navigate
the financial aspects of care, and how does
this benefit patient provider relationships?
That is a tough question for me to
answer because
I'm in a a strange situation where, as
the physician,
not only am I trained, but just in
my kind of,
I don't know, my hardwiring, it's really hard
to, like, take care of a patient
and try to worry about how much things
are gonna cost even though
you have to to a certain extent. But
I really
have a hard time dissociating things because
as I mentioned, you know, my practice is
kind of geared toward, like, a really high
level of service where I don't rely on
what I think insurance should pay me. I
rely on what I think I should be
paid for the amount of time and effort
that I put into it. And and
when I see a patient in front of
me, I take care of them like they're
my own family. And and spine patients can
be kinda complicated
because you can't just look at the imaging
studies to decide. So I would say that,
really focusing on
providing the highest quality of service
and try not to think about the costs
is the way I go about doing business.
But I just don't think that that's something
that is
for everybody. I I guess I'm just lucky
and that I have this little,
like, false world
that I have to myself right now. But
I guess that's my long winded way of
saying I really don't know how to balance
those two things. And I'm lucky that I
don't have to because
I don't I can't imagine anybody can do
that well. That's gonna require some really smart
people that knows both medicine
and, you know, the business of health care.
Absolutely.
Well, as we wrap our conversation up today,
is there any closing remarks you'd like to
share on the podcast?
I really am excited about the future of
the spine field because, you know, as a
spine surgeon, that's really the only field that
I know. But I suspect that
many people that are listening, I suspect that
even you
either know someone,
that has a spine problem.
And the general thinking is that that's a
scary proposition.
The idea that you might might need spine
surgery
for most people
generates
an unusually high level of fear. Mhmm. And
it's
in some ways justified, but in general, most
spine patients do well. And those patients, they
kinda forget they had a spine problem. It's
all the patients that don't have that don't
do well after spine surgery that they know,
and most patients are doing horribly. So it
just seems like no one does well. But
by and large, we're getting better and better
and better. And
as we
do things more as an outpatient
and we have the ability to track our
patients, it's almost
difficult now to not track our patients because
our patients are tracking themselves through all these
digital means.
So
the future of spine care is just, I
think, gonna
take a a dramatic turn
for the better.
And this may sound very egocentric, but
seems like spine is
really in need of a great amount of
improvement, and we're gonna make a big improvement.
Whereas a lot of the other specialties are
already pretty dang good. Like OrthoSports
and total knees and total hips, those are,
like, some of the best surgeries that we
do. Spinal fusion surgery,
I suspect if we just had, like, a
just a random poll of opinions, they would
put that at the bottom even though it's
really not. But
we're on the cusp of making that so
much better
just by
the new technologies that are coming out,
which not only includes minimal invasive techniques, but
with navigation and robotics, it it's all coming
together,
combined with the ability to track our results
for the first time, whether we like it
or not. And if you don't track your
results, it's really hard to figure out if
you're gonna get better or not.
And when people are tracking you, you tend
to be a lot more careful, and I
think that's gonna be an important part of
the future of the field of spine. And
it's gonna be a a good future if
it goes in the direction that I think.
Absolutely. Well, doctor Kim, thank you for joining
me today on the Becker's Healthcare Podcast. Again,
we are live at the business and operations
of ASCs. Thank you. Thank you.