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This is Laura Dierda with the Becker's healthcare
podcast. I'm thrilled today to be joined by
Jacob Rodman, chief executive officer at Raleigh Neurosurgical
Clinic. Jacob, it's a pleasure to have you
on the podcast today.
Pleasure to be here. Thanks for having me.
Absolutely. Now I know we're gonna get into
some of the big things that are happening
in the ASC industry as well as in
spine and neurosurgical care. But before we do,
can you tell me a little bit more
about yourself and your
background? Yeah.
I've been been in my current role about
fourteen years here with the clinic. I've been
in health care leadership for about twenty five
years,
and, I've been in Raleigh about twenty years
and, from Kentucky originally.
Oh, it's great to hear. And, you know,
definitely, awesome to have that kind of background
in health care and leadership management too. So
from your perspective, what are some of the
top three trends that you're following in health
care and ASCs today?
I would say
number one is anesthesia.
I'm trying to sort out,
how anesthesia works in the ASC and how
to be efficient and,
you know, work with the anesthesia teams that
we have and,
make sure they're adequately
compensated and fairly compensated,
while keeping an eye on the bottom line
from the center.
It's probably first and foremost.
Secondly, really
hoping the the government reopens and, gets Medicare
payments flowing again.
But more importantly,
for 2026,
there's some great proposals for spine,
that is coming off the inpatient only list
that, we can start doing some more cases
in the ASC for Medicare patients.
So really really hoping that comes through and
stays stays the way it is,
so we can still continue to shift some
some cases out of out of the hospital.
And third, I'd say is just really AI.
You know, how can we utilize AI and
make our center more efficient,
help patients get the information they need,
kinda where it fits.
So for me, I'd say those are the
top three.
Absolutely. That's great to hear. And, you know,
I I wanted to dig deeper into all
of those themes,
especially you mentioned anesthesia first. I know that's
something that we have seen just a huge
uptick in interest about and, you know, challenges
for surgery centers across the board, whether it's,
as you mentioned, you know, making sure you
can find the right anesthesiologist
and enough anesthesiology
support and and leaders for the surgery center,
but then, you know, how you can, develop
those partnerships and and compensation,
because it is a challenge. So can you
tell us a little bit more about, some
of the things that you've been,
seeing
and doing, to make all of that work?
Yeah. We we had an external group for
a while, and,
they they did really well. Good partnership with
them. And but
we we got
kinda they they're asking for some stipends, which
we know is a national trend,
and just needed clear data.
So we actually transitioned July 1, ended up
hiring our own anesthesia team
that that works for the clinic, and so
we're doing the billing and collections. And,
and so it just kind of,
for us, felt like it really aligned the
incentives of the center of the practice and
of the anesthesia team,
kinda all be under the same umbrella and
kind of on the same team, if you
will.
And we've we've seen that go really well.
We've actually we're averaging about 14 cases more
per month since we made that move,
in the ASC. So we're really, really happy
with that and pleased with the move.
Absolutely. Wow. That's significant results,
you know, just from that one switch. And
when you look at,
hiring your own internal anesthesia team, did you
have to, you know, do anything differently from
operations perspective, or,
was it really just a matter of, you
know, making those hires and and recruiting people
in house?
Yeah. We definitely had to make some adjustments,
and and kinda get our team up to
speed on the anesthesia billing,
because we've never really did that before.
We got plenty of anesthesia
pain docs in our group, but mostly just
doing office based and ASC based pain procedures.
So it was,
a big shift for our team to kind
of
modify our billing procedures to make sure we're
getting that right.
Thankfully, the we we found a great anesthesiologist
who's kinda leading the efforts, and, he's been
in this market for about twenty years.
We knew him from the hospital previously.
And so he he's fully versed
in anesthesia billing and units and all the
stuff that goes into it. So he's been
a great asset. So I think having him
on board to kinda lead the efforts has
really been a game changer for us. I
I can't say we would have done done
it as well or been successful without them.
Absolutely. Absolutely. That is so helpful to know.
And just interesting to,
think about having that right team in shift,
you know, in leadership in place. And then
when you look at averaging those 14 cases
per month, after hiring your own team,
is that primarily just
aligning incentives and, seeing increased efficiencies because, you
know, the team is internal? Or,
I guess, what do you attribute that addition
to? Because that that's a lot of cases
per month.
It is. And I think I think it's
more about aligning,
the vision for the center,
and and having,
you know, a steady hand that's it's the
same anesthesia team that's preop in the patient,
the same one to delivering care.
One of the things we noticed with the
external team and, again, the you know, they
were great partners, for for several years. But
there's oftentimes where one anesthesiologist would be do
the preop for the patient, and then another
one would be administering anesthesia on the day
of surgery. And they didn't always align clinically,
on the patient.
And so we've that led to sometimes same
day cancellations
or rescheduling.
So I think having the consist consistency now
through the process
and having our pre op nurse be able
to go to one person kinda get some
direction has been really beneficial.
And then we've also noticed with the actual
delivery of anesthesia,
since it's, again, same team, they've been able
to kind of customize some of the anesthesia
delivery. So it's not quite cookie cutter like
it is in some of the larger systems
where,
you know, my smaller procedure, minor procedure may
not go as deep, with anesthesia, which, you
know,
leads to quicker wake up, quicker turnover, all
those things. So it definitely increases efficiency.
That's great to hear and, helpful to understand
where those efficiencies are coming from. Now I
I know you also mentioned,
looking at current political climate with the government,
shutdown and then, you know, how Medicare payments,
have been challenged during this time. Of course,
you know, a lot coming down the pipe
too for,
changes overall with Medicare and, just some of
the policies happening. So can you talk a
little bit more through that and,
how you've been planning for the future when
there are some uncertainties? Not really sure, you
know, what's gonna happen and then what, changes
are gonna stick.
Yeah. So Medicare is about 40% of our
our revenue stream. So any any disruptions
to that, you know, are are pretty impactful
on our practice.
You know, so some of it's just been
been planning, you know, and trying to save.
You know, the, it doesn't,
at least from my perspective, doesn't feel like
we're anywhere close to a resolution.
Hopefully, I get surprised.
Both both sides seem to be pretty dug
into the positions.
And so I I think, you know, just
navigating that with our bottom line and, you
know, what we need to be doing as
a practice to kinda circle the wagons.
And but but really hopeful for the future
with some of the changes that are coming.
You know, hopefully, we can get get this
shutdown behind us and get get the Medicare
funds flowing again,
and then really look to the future on
how we can really take great care of
patients in our ASC.
So we are excited about some of the
site of service changes coming.
I think there's a huge opportunity there to
really care for those patients.
That's great to hear. And having those extra
cases, I know, is always helpful,
on a variety of fronts.
And finally, when you talk about AI and
mentioning that, becoming more efficient with it, that's
something that came up a lot at our
recent, ambulatory surgery centers conference in Chicago. You
know? And I was a little bit surprised
by that because I, you know, wasn't
sure how much of, AI was on their
radar for ASD leaders, but it seems like
there's a lot going on and, you know,
a lot of excitement in the space around
what the potential is. So how are you
thinking about things at Raleigh Neurosurgical Clinic? And,
you know, what are you doing now? What
do you anticipate will be the most helpful
ways to, you know, make those AI
investments?
Yeah. So I I can tell you on
the on the hospital based side, we've been
using AI for stroke treatment for many years,
company called Biz AI to kinda help, you
know, read a CT and
kinda give an indication if there's a large
vessel occlusion or not, kinda real time. So
we've we've had some experience with it on
our stroke treatments.
But we're we're using it now in the
clinic in terms of the ambient software,
ambient listening software,
to help kinda streamline patient care visits.
And we're trying to figure out how that
can be applicable and apply in the ASC
setting as well. We're not quite there yet,
but we do think there's some some opportunities,
whether it's through, you know, OTNotes or even
just supplies,
through the ordering and inventory process. So we're
we've it's been a great
ad in terms of the clinic,
in terms of offices, it's in patient care,
but we're trying to see what what the
next iteration is. And, unfortunately, I don't have
a real clear picture of what that looks
like today, but we're we're exploring and having
lots of conversations with folks.
Interesting. It's just fascinating to see how quickly
the technology is evolving on the clinical side
as well as, on the operational side in
where the applications make the most sense. I
I think, you know, wanted to ask you
now, when you're looking into the future, what
are you most excited about? What is top
of mind for you that you think will
make a big difference for the practice and
surgery center?
Yeah. I I'm really just
I love the opportunity to deliver care the
way we do in our ASC.
And it's kind of a, you know people
use the word holistic, and I hate to
overuse that because I feel like it's used
incorrectly sometimes. But, you know, our our ASC,
our clinic space, our office based angiosuite are
kinda all cohabitated, so it's kinda one building.
So we were trying to develop kind of
a one stop shop for patients,
where they can come, see their surgeon,
get their nonoperative pain management if they need
it. But, ultimately, if they do unfortunately need
a procedure, we can take care of them
kinda within the confines of our walls.
And I'm really excited about, again, for the
future with some of these Medicare changes coming
and as we continue to develop the center,
and expand cases. We've got some of our
neurosurgeons that are really trying to figure out
how to safely, you know, push the limits.
You know, I look back some of our
older surgeons thirty years ago, you know, when
they a lot of them didn't even do
fusions in the residency program, and now, you
know, it's one of the top cases in
neurosurgery neurosurgeons do today.
So I think there's still some some more
changes coming on other centers across the country
that are doing a lifts and,
o lifts and those type of things in
their facility.
North Carolina has not quite gotten there yet,
but I am excited because I think we
will be on the forefront of that in
our center.
And so I'm I'm really excited for the
future and
kind of the ASCs, I think, continue to
be strong. And I think, finally, insurance is
recognizing that, you know, they're the best place
for patients to go,
with the exception of, obviously, some cases that
really do need to be in a hospital
with an ICU setting. But short of that,
I think people have recognized there's there's a
big role for ASCs in the future.
A 100%. There's just so much energy, it
seems like, around figuring out the right dynamic
for outpatient and how ASCs can complement other
services. And as you mentioned, just have that
high quality,
high value care.
Are you when you're looking at expanding these
procedures, potentially,
others coming into the ASC setting, do you
see needing to expand your space at all,
or,
how are you thinking about growth of the
physical operations?
Yeah. I think we will.
I think we've we've added,
a team of eight providers to our pain
service here in Raleigh, this year.
And that's kind of maximized our space as
it sits today. So,
and we wanna have kinda everything under one
roof. So, eventually, there will will be a
need for some more space in the future.
Not sure exactly what that looks like. We're
also exploring some
smaller,
like, locations
kind of in and around the triangle as
a way to kinda offset some of that
the space needs, but still kinda long term
deciding what our what our future holds.
Absolutely. The big decisions, but, you know, good
ones for the growth of the practice overall.
And just looking in the next twelve months,
is there anything else that you wanted to
share with us or can mention,
about what growth looks like and how you're
thinking about strategy in leadership in the future.
Yeah. I think just for me, personally, it's
kinda continuing to develop our leadership team. You
know, we
fourteen years ago, we're a small practice and
kinda everybody reported to me in the clinic.
We had eight total employees, and today we
got about a 175.
So kinda developing our our leadership team and
giving them the tools they need to kinda
lead,
from the heart and lead in great ways.
And I'm really excited for who we have
in those roles and who we're gonna continue
to recruit and grow with. So to me,
it's really focusing on our leadership team and
and kinda what they look like in the
future,
and giving them the the space and the
grace to to fly and grow and develop.
And I think that leads to excellent patient
care.
We're on target to treat about fifty five
thousand, 56,000 patients this year.
And, again, ten years ago, that number was
three to 4,000.
So we're we're able to kinda do a
lot more today and touch and treat a
lot more patients than we have in the
past. And, to me, that's really exciting.
That's amazing to hear. Jacob, thank you so
much for joining us on the podcast today.
It's been such a fascinating conversation. I appreciate
your candidness talking about some of the things
that you're seeing in the industry and how
Raleigh,
neurosurgical clinic will continue to grow. And, thank
you again for your time today. I appreciate
it.
Happy to. Thank you again for having me.