This is Alan Condon with the Becker's ASC
podcast. And I'm delighted to be joined today
by Doctor. Sharyn Tofai,
hernia and laparoscopic
surgery specialist
at Beverly Hills hernia center.
Doctor. Tofai,
pleasure to make your debut appearance with us
on the Beckers ASC podcast.
He is familiar with you the work that
you do at your surgery centre. Do you
mind giving us a little bit more insight
into your background?
Yeah. Sure. Thank you very much.
I am a board certified general surgeon, and
I do a lot of,
minimally invasive surgery, including
laparoscopic and robotic surgery.
And I'm an active member of our own
surgical center,
which was a great venture that started by
physicians and now is partially hospital owned.
And
it's been a great,
experience seeing how a surgery center can ex
to multiple specialties
and then be
involved
in helping the hospital offload during COVID pandemic
times
and now start to be
kind of, one of the premier
surgical centers in the nation. I believe we
were voted number one in the nation by
Newsweek recently.
Honestly. Wow. What an accomplishment by both of
your colleagues at your surgery center.
So huge accomplishment. Thank you, Converse. Send a
little bit more insight to yourself, your background,
your surgery center there. General surgeon, laparoscopic and
robotic surgeries, a couple of minimally invasive areas
that you're really focusing on.
But more broadly, I guess, two or three
kinda key
big health care trends that you're paying close
attention to today. What's on your radar?
Yes. Absolutely. I would say that
there's definitely a push to
which which has been going on for decades
now to move as much surgical care
outside of the main hospital as possible to
put it into
surgical centers, and that's put the onus on
surgical centers to
be able to provide hospital level care in
terms of technology.
I think the next step is having
a broader
availability
of robotic surgery
at surgical centers. It's been something that
we really haven't been able to do from
a financial
standpoint,
but that seems to be
moving in a direction where
collaborating with industry is making it so that
we're
more likely to be able to offer robotic
surgery in the surgical center. And as you
may know,
the more you offer minimally invasive or robotic
surgery, the more
likely you are to be able to provide
care to patients as an outpatient
and not require hospitalization because the pain
the pain is pretty well tolerated with those
operations.
That's number one. I would also say that
this idea of,
you know, multi specialty
surgical centers is becoming
better. It used to be, at least I
know I'm in Los Angeles, Beverly Hills. Most
of our surgical centers are
cash
based for cosmetic and plastic surgery,
and that's really changing,
where we're seeing
serious operations,
whether it's hysterectomies
or prostatectomies
being performed at an outpatient setting as well.
And nurses and surgeons and anesthesiologists
are becoming more comfortable
offering higher level of care at a surgical
center.
I would say those are the top two.
Got it. So I'm I'm fascinated by
both both of those trends, but I think
particularly the first one. I think, as it
relates to robotic surgery, like you said, one
of those key minimally invasive techniques is that's
really the onus for a lot of these,
complex surgeries being driven away from the hospitals
to outpatient settings, ASCs.
He did mention we we hear so often
that the barriers to ASCs for some of
these robots was
number one. So we are so often hear
about the cost, the size. Seems like those
two barriers are are coming down a little
bit now. To your point, collaborating with industry
is a big thing.
I'd love to hear your insight kind of
how do you see kind of the future
of robotics at ASCs And and and to
your point, collaborating with industry, how does that
kinda relate to this whole, movement to the
ASC outpatient setting with those robots?
Sure. I have a great story to share
for you. So
when I first got involved with the surgery
center back in 2013,
robotics for general surgery was just becoming
something of interest and mostly it was urology.
You know, prostatectomies were pretty commonly performed
robotically.
And
my hope was to bring the robotic technology
into the surgical center, but at that time,
you had to spend $2,000,000 to buy a
robot.
And the insurance will never
provide you payments
any differently if you use a robot or
didn't use a robot. So there was no
way financially to make sense of that.
And at that time, industry was also not
eager to bring down their pricing,
to accommodate for a larger
volume of surgeons in the surgical centers,
they were still expanding out in the the
main hospitals.
I must say over time and partially that's
because of,
interest of industry to penetrate more, and, also,
there's more competition,
in the robotic field.
The price of
of robotic surgery has reduced, and they've come
up with a bit more interesting,
ways. You don't have to buy the
robot outright anymore, for example.
You can lease it. You can do these,
what we call,
pay pay per click. It's basically you pay
each time you use the the the robot.
So
it's like leasing a a luxury car, right,
as opposed to buying your luxury car. It's
a little bit more manageable.
So kudos to industry for doing that because
when we first spoke to their leadership,
now it's, what, twelve years ago, there was
zero interest. And now there's a lot of
interest
to work with surgical
centers to go in to to enter surgical
surgical centers because they've pretty much done a
good job of
of saturating the market on the hospital side.
The problem is
the other arm of the finances here, which
is insurance,
has not kicked in. So
as your viewers probably know, there's three tiers
of payment by insurance for the same exact
operation.
If instead of the main hospital,
you get a large amount of money for
it.
If the same operation is performed
at a hospital based outpatient surgery center, you
get a lesser amount,
and the least amount is paid to a
freestanding surgical center.
So
it makes no sense financially to do a
robotic operation, which is expensive,
in a in a environment such as a
freestanding outpatient surgery center
that
gives you the lowest reimbursement for that operation.
So even though industry has kicked in to
help
on their side,
insurance really has not,
done their job of of allowing that to
be a feasible financial situation. So that's a
major roadblock right now, which is what operations
does it make sense to do in an
outpatient surgery center if you're the, let's say,
the hospital or health care system.
Mhmm. And how do you make that, in
your own surgery center? How do you make
those decisions, those choices, if you don't mind
me asking? A little bit of perspective from
from your ASC in terms of, is this
a procedure I'm gonna do robotically? Is this
something I'm gonna do a traditional method? Just
curious to hear your thoughts on that.
I mean, we're we're very lucky. We're in
a very robust outpatient freestanding surgical center. We're
partnered with our major hospital.
We're very high volumes. So based on that,
we're a bit, stronger financially than maybe your
standard
privately owned surgical center.
So we're very lucky with that, and our
partnership with the hospital has made it so
that,
there's some efficiencies we can we can build
into,
running the surgical center.
Our hope is that within the next year,
we will have a robot
as we're expanding our surgical center. And,
honestly,
if it were completely up to the business
people,
it would probably not be a good good
idea to have a robot.
But the demand for robotic surgery is so
high. In order to maintain
high quality,
surgeons,
you kind of have to
offer the technology that's out there. So that's
really what's
I think that's my impression.
I'm not, like, the CEO of the hospital.
I'm one of the surgeons. I'm part of
their leadership, but I would say that my
impression is that,
the demands
of the per of the surgeons
is one that's making it so that we
are moving towards getting a robot.
But it's now twelve years after I've I've
initially requested a robot. So it's a slow
process, and,
hopefully, will not be
a financially detrimental
decision.
Mhmm. No. It's fascinating to kinda get your
thoughts or insight there kinda more broadly and
then also as it affects and relates to
your center.
Really, really excited to kinda hear the developments
there. Many meaning based tech technology as it
relates to general surgery.
I'd love to get your perspective kind of,
fantastic surgery center, number one ranked on Newsweek,
like you've mentioned at the top.
How are you thinking about growth over the
next twelve, twenty four months or so? Like
you said, you've got a partnership with a
hospital, high, high volume center. Is growth them
adding more physicians, more surgeons, tacking on new
specialties? Kind of what what are your thoughts
there?
Oh, well, we are very excited,
about growth. We were the first surgical center
for our hospital to
to partner up with. I believe now they
have
upwards of 12 or more,
in the Greater Los Angeles County area.
And it's
been
because we were such a successful
endeavor that they continue to do that. And
the key is
and I'll add to you, we are adding
a third surgical center in our own
in our,
the same facility as the original surgical center
that was opened. So we went up to
two during the pandemic,
and then now we're up to three by
next year. So
the volume is there.
The interest is there. My patients prefer
to be operated on at the surgical center.
I have my own team at the surgical
centers to the same
circulating nurse and and so on. So it's
much more efficient
and much more likely to
get standardized care for my specific patients.
So I love working at the surgical center,
and the more surgeons we recruit to come
to the surgical center and bring their cases
as opposed to
the bulkier, less efficient time wise
hospital, the more they like to be in
the surgical center too. So I would say
it's like going to a a big box
hotel versus to, like, a boutique y hotel.
You get better service and potentially nicer
nicer options.
Mhmm. And that kinda ties into just the
last question I have here. I think it'd
be a crime for me not to ask.
I mean, such a fantastic surgeon, fantastic leadership,
it sounds like, Beverly Hills hernia center.
For for ASC physician owners, ASC administrators listen
to this podcast,
obviously, it's so so highly rated, fantastic achievement
by Newsweek.
One or two maybe key tips,
to to really kind of elevate that patient
experience care
for for surgery centers who really look at
the booster,
their position and their markets.
What what what advice would you have for
them?
I would say proceed with caution. I have
a feeling there there are many,
doctors and surgeons who are interested in opening
up a surgical center because the
the payment that you see
to a facility is so much more than
the typical payment for
the, surgeon provider.
And so from a financial standpoint,
they feel that that
it just makes sense to open up your
own surgery center.
But it's highly regulated.
It's a very serious business.
Staffing is critical,
and it it really
needs to be done with a lot of
thought and not just be a reflex
of, oh, I can have a one or
two bed surgery center and make a lot
of money off of it.
There's so many surgical centers that fail
and so many that are end up in
some type of poor outcome for patients
because
there have been situations where
corners are cut and maybe you don't really
have a qualified nurse doing this or you
don't have an anesthesiologist.
You're it's you you can't cut corners with
patient care.
And so
if you're just looking at it as a
way to make money, that's just not appropriate
because you're you've got patient's lives at hand.
So I would say proceed with caution,
surround yourself with
really smart, experienced
people,
and,
make sure you're doing it
with, good intentions in mind.
I think two fantastic kind of tips and
takeaways to round out our podcast today. Doctor
Tofai, an absolute pleasure speaking to you and
catching up here in a lot about your
surgery center. Sounds like a ton of excitement,
a ton of growth ahead. Thank you so
much for taking the time, and look forward
to catching up with you down the line.
I appreciate it. Thanks so much.