At athenahealth,
we know your ambulatory practice wants healthier, a
healthier business, healthier care teams, and healthier patients.
But the complexities of modern health care tech
make it hard for you and your care
teams to focus on what matters
most? That's where athenahealth can help. Our AI
native all in one solutions reduce administrative burdens,
streamline billing and payments, and deliver critical insights
when clinicians need it most. That means fewer
clicks, more time for patients, and stronger bottom
lines.
Practicing medicine is complex, but running a practice
can be that much simpler with athenahealth.
See how simpler is healthier@athenahealth.com.
Hello. This is Francesca Matthews with the Becker's
ASC review podcast.
I'm thrilled to be joined today by EJ
Ledesma,
chief executive author officer of three sixty Orthopedics.
EJ, thank you so much for being here
today.
Yeah. Thank you for having me. Of course.
To start us off, could you please introduce
yourself and tell us a little bit about
your background?
Sure. My name is EJ Ledesma.
I'm the CEO of three sixty Orthopedics, as
you've mentioned. We are a midsize
orthopedic practice in the Sarasota County that we
service Manatee and Sarasota County.
We're multi specialty.
So we have not only
the vast array of specialties within orthopedics, including
joint replacement, spine, pain, foot and ankle, etcetera,
but we also have ancillary services
at each of our three locations. So all
in all,
we see roughly 80,000 patients a year, and
we have roughly a 125
FTEs.
My background is a little bit diverse. I
I have a master's degree in health administration,
but also have additional
education
in in finance,
AI,
etcetera.
I've worked in the not for profit health
care world, big system health care hospital systems.
I've done some consulting
at, at one of the big five at
the time. Now I think it's the big
three. Done a little bit of life sciences
work, some private equity. So I've done,
had an opportunity to do a a vast
array of different things within the health care
arena,
that
I think puts me in a unique position
to be able to run the orthopedic practice
here, especially with everything that's going on in
the health care landscape today.
Absolutely. I was I was just about to
say it's always great to talk to people
who have kind of a a wide range
of backgrounds and hear sort of, what lessons
you're able to apply to
to administration
and, you know, practice management and whatnot.
Kinda jumping in here, what are the top
three trends that you're following in health care
and ASCs today?
Well, I think it's very interesting. I would
say it's a little bit market specific, and
I would I would preface that with saying,
you know, depending on where you're at, if
you're in a CON state or certificate of
knee state or not,
how big the landscape is in terms of,
I'll call big system health care where big
hospitals have a little bit of an entrenched,
control over the market. But I would say,
generally,
we we we've talked a lot about
what's happening in the world of artificial intelligence
and that how can that benefit an organization,
whether it's an ASC or whether it's a
private practice, etcetera.
The second is we continue to see what
we've already been discussing for the last two
decades, the growth,
or the movement
of cases being,
in the outpatient
setting, whether that be in a hospital outpatient
setting or an ASC, more more so ASC,
and and how
hospital systems are being able to compete
and the dynamics of which depending on the
market, whether it makes it difficult for physicians
to privately
be able to open ASCs, or are they,
in de facto, having to
partner with health care institutions, big systems to
be able to make it work? And then
the last is
is I think there's been a lot of
talk, and, again, market specific depending on how
segmented the market is with, I'll say, de
novo or unique ideas of how to grow
the their their respective businesses. I see this
a little bit more in private practice where
they're looking of ways to be able to
maintain margins
knowing that the cost curves are
are are not working in their favor and,
diversifying their revenue streams and especially adding either
new specialties
or
creating joint ventures with other orthopedic or health
care organizations in their market to be able
to leverage reimbursement and scale on on areas
that they can seek efficiencies.
So I think those are the three key
things, the AI movement,
the sort of move to outpatient. We've which
we already know, but what does that mean
as it relates to new strategic decisions?
And then the last one is seeking new
alternatives to to grow the revenue base in
specialty practices knowing that the that things are,
you know, are a little bit tough and
and are cost prohibitive, but there is still
a lot of opportunity if there are if
the organizations are willing to think outside the
stereotypical
traditional health care box.
Mhmm. Absolutely. And I think, you know, something
we hear a lot is that ASCs, especially
sort of, you know,
medium sized practices or even small practices,
you know, while some of those the things
that you've mentioned, like ASCs have to be
mindful of sort of their bottom line is
smaller practices. It's also,
they're more easily able to adapt to the
market and can be sort of nimble due
to their size as well.
Absolutely.
And what are you most excited about right
now in health care and ASCs?
Personally and professionally, I would say how to
leverage the AI component because I am not
a clinician, but
what I've seen and I, 100%
endorse is the organizations
to examine
ways to use artificial intelligence to to improve
the customer experience.
And that may be, you know, whether it's,
describing in the clinic to be able to
allow
the the
face to face interaction with a physician and
a provider or a provider and a patient
to be that much better.
The other piece would be in in call
centers or scheduling environments, authorizations,
areas that allow the the individual that's contacting
the practice or the organization
to be able to get the answers that
they need or the direction without having to
wait. So access
to being able to get the answers that
they need is is very big. So I'm
very excited with that. And the other, as
I mentioned, is this,
exploration
of partnerships or collaborations with what what would
have been known as competing organizations
to try and figure out a way to
improve,
their bottom line by taking advantage of
of teams
that do things better than they do and
and try to just
be open ended partners
and and look knowing that we're all facing
the same challenges. And and that takes a
little bit of courage, but those are the
things that excite me the most right now,
and how we can bring that to the
we have a 34% ownership in the ASC.
And one of the things we've been discussing
with them is
is how to look at at the, of
course, the revenue per case and not focus
so much on how much, quote, unquote, volume
we bring in, but more so, what are
the quality of earnings and, and and how
can we get the best value for the
cases that we push through
while maintaining high margins and and by default,
not necessarily having to have the highest level
of staffing or cost structure because at the
end of the day,
you can generate 10,000 cases a year. But
if you're making a 4% margin, it's not
better than 5,000 cases a year with a
35% margin.
Mhmm. Absolutely.
Yeah. And that definitely echoes,
other things that we hear here in our
reporting.
And how are you thinking about growth over
the next twelve months?
So we're we are currently and we're we're
doing this.
Our our approach is twofold. The first one,
which is a little bit easier, is
if it it being in orthopedics, it's,
I'm just gonna use our example, is
a lot of our joint doctors
see
individuals that have venous insufficiency. And we know
that there are vein centers that do vein
ablations,
either in a vascular,
specialty setting or in an interventional radiology office.
Our data show that
roughly fifty percent of our,
population that's 50 and over that come to
our practice
probably have some sort of venous insufficiency.
So it's thousands of patients a year that
we are now
poised to launch
our vein program in the clinic. So we
will be providing
those services to our patients
rather than than referring them out. So it's
a it's, again, it's a additional
revenue,
line for the practice that can generate
significant return
while providing great customer satisfaction because what we
try to do in our organizations
is try to provide as many services as
possible so that we can retain the patient
in our in our circle. So this adds
another
wonderful addition
to to what we can offer the patients
in our in our communities.
So that's that's very exciting because we're we're
expanding our our reach beyond orthopedics
with the same population.
The the second
one
is
what I'll call the affiliate model. So we
are in the process of having conversations with
a practice that's south of us that we
are very friendly with, but they have their
own market share, their own providers. They do
great work,
but they're
facing
what a lot of other small practice are
facing, which is higher cost. They are they
don't have the negotiating power to seek better
reimbursement.
So they're facing something,
that they know is gonna come over the
next twelve months, which is potentially
significant margin erosion
while having two of their providers aging out.
So we are gonna be speaking to them
next month about an opportunity to join our
group as an affiliate,
which allows them to benefit from our our
reimbursement
model, which is,
the best in our area
in addition to seeking economies of scale
through our revenue cycle, our authorizations team, our
scheduling department. So at the end of the
day,
both practices can can work together to create
a
a more profitable
organization
that allows our affiliate practices
to retain their independence, their brand, etcetera. So
we're providing, if you will, those management services
on the back end
to to benefit both organizations.
I I think
and I would hope that other organizations, whether
orthopedics or not,
would look at that as as an opportunity
for the future
if indeed they're not looking to sell to
private equity. They're looking to improve their bottom
line, and they're open to
to seeking best practices and economies of scale,
without having to entrench in each other's market
share.
Mhmm. Absolutely. And I think those those kind
of, you know, exploring new types of
nontraditional acquisition models, partnerships, joint ventures, that's definitely,
something we're talking about a lot with leaders
over here at Becker's.
Is there anything else I haven't touched on
or asked you about today that you'd like
to add?
No. I I but I I I've been
thinking, and I don't know if this is
something that your organization, your team has talked
about. But
in all the conferences that I've been with
Becker's, I mean, I as you may know,
AI is a is a big thing they're
talking about, whether it's robotics in the clinical
setting or or AI as it relates to
support services, back office, etcetera. And one of
the things that I just can't help to
think is,
will it be a matter of time before
CMS or other payer entities
start
to
lower reimbursement
on average, like they have been over the
last couple of years because the assumption is
efficiencies,
create value, and and therefore,
what used to pay at, using this number
a $100 cannot pay at $90 because the
cost to deliver those services
are lower based on technology, etcetera. So I
would not be surprised
if over the next five years we see
changes in reimbursement
and not to the better,
but lower because these agencies are gonna apply
AI to their systems if they already have
which they've already had in many cases, but
they're going to, by default,
push private practices, push hospitals, etcetera,
to adopt AI
in their organizations
as a means to define lower reimbursement because
there's opportunities to seek better efficiencies.
And, and I I think that that may
happen. I I really do, and it's gonna
force
smaller organizations
or organizations that not are not very AI
focused right now to have to look at
that as a ways to compete.
Mhmm. Absolutely. I could definitely I could definitely
see that happening being the case. I mean,
I definitely it reminds me of one conversation
I had at our health IT conference,
where someone asked a question of sort of
yeah. Like,
you know, we have AI, but it it
it's only as good as sort of the
system that it exists in. And if it's,
you know, modeled and sort of molded in
a system based on, you know,
the processes we have for reimbursement, then, you
know, something like that is definitely a possibility,
it would seem.
Yep.
But, yeah, that that's actually all I have
for you today, EJ, unless there's anything else.
Well, I said, I would say, first of
all, thank you so much. My experience with
Becker so far,
has been fantastic. The first, meeting I went
to was almost twenty years ago and then
took a little sabbatical and then started going
back in in June. I've had a
a tremendous amount of fun, have learned a
tremendous amount.
But one of the things that I take
away
every time I I go to the the
the conferences is,
how a lot of organizations are are trying
different things. And I would encourage
organizations, whether ASCs or or medical practices or
hospitals, to continue to think outside the box
and and look outside of health care
to find opportunities
to scale
and, create better strategies to deliver
care and, be members of their communities and
have strong roots in the communities that they
serve and and make sure that they always
put the patient first,
even though we all struggle in with the
challenges of of the ever changing dynamics in
health care. And and the fact is,
we have to do the right thing,
even if it means we have to work
a little harder at that. And and in
the short term, might be a little bit
challenging, but but if the long term is
what we're all looking for, which I hope
we are,
Our strategic outlook, I think, looks bright if
we have
a good diverse a set of diverse opinions
and thoughts,
at the table, regardless of whether you're at
hospitals or ASCs or private practice, etcetera.
Absolutely. I like I like ending it there.
Well, thank you so much for joining us
today.
It's been a pleasure speaking with you, and
I look forward to connecting with you again
in the future. Thank you so much, Francesca.
Have a wonderful day. You too.
At athenahealth,
we know your ambulatory practice wants healthier,
a healthier business, healthier care teams, and healthier
patients.
But the complexities of modern health care tech
make it hard for you and your care
teams to focus on what matters
most? That's where athenahealth can help. Our AI
native all in one solutions reduce administrative burdens,
streamline billing and payments, and deliver critical insights
when clinicians need it most. That means fewer
clicks, more time for patients, and stronger bottom
lines.
Practicing medicine is complex, but running a practice
can be that much simpler with athenahealth.
See how simpler is healthier at athenahealth.com.