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forward slash beckerspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are recording live at the
thirty first annual business and operations of ASCs.
I'm currently joined by Patrick Garman, who is
the executive administrator at Spartan Health Surgis Center.
So, Patrick, thanks for being here. To kick
us off, can you please share a little
bit about yourself and your work in the
ASC space? Surely. Thank you for the invite.
Spartan Health Surgis Center is in its twentieth
year. We celebrated our twentieth year last September.
We're a joint venture with a hospital partner,
multi specialty
facility,
15,000 square feet, three ORs, two procedure rooms.
We do a lot of GI, ophthalmology,
pain management, and orthopedics.
We're located in the Pittsburgh, Pennsylvania market, Southwest
Pennsylvania.
Wonderful. Well, thank you for taking the time.
And let's start our conversation with the ASC
market. In The US, it's projected to reach
$60,800,000,000
by 2030 and continues to experience strong year
over year growth. From your perspective, what are
the most significant trends in market forces driving
this expansion, and how should ASC leaders be
preparing today?
Well,
I think a lot of what's gonna propel
this movement is physician choice,
a a transient
physician population. As the older physicians retire, the
new newer, younger doctors are coming out of
their fellowships and their residencies.
Some of them are very entrepreneurial in spirit,
which is a very good thing for the
surgery center market.
Every couple
years, the, CMS Medicare model releases more procedures
that can be done, allowed to be done
in the outpatient setting that's providing some great
opportunity for surgery centers.
Twenty years ago, it was unheard of to
be able to do orthopedic joints. Now my
facility is doing them. A lot of facilities
are being done. They're gonna be done safely
and actually better. Now there's discussion about having
cardiac procedures done in the surgery center setting,
which is a phenomenal development and achievement.
The cost savings,
is very apparent. It's very transparent.
Surgery centers have a role in saving the
health care system billions of dollars a year.
The efficiency model is pretty much was invented
by surgery centers. If hospitals only would take
the chance, the opportunity to look at how
surgery centers run an efficient
method, they would probably reduce their cost as
well.
So
all surgery centers are for profit. Very, very
few are not for profit. The majority of
the acute care hospital settings in The United
States are not for profit. So it's a
totally different
mind frame, a totally different
established setup.
Absolutely.
And from AI and robotic surgeries to advanced
DHR systems,
technology remains both a make or break factor
and a critical driver of ASC operations at
scale. So how do you see deeper tech
integration shaping the way ASCs deliver care and
manage their business over the next few years?
I think
the technology
that I've seen, for a long time, it
was electronic medical records. Everyone's up to speed
should be up to speed on that.
Artificial intelligence. For the surgeon, it works one
of two ways.
It's an attractive
marketing tool.
It's it there's some glamour to it. It's
terribly expensive.
It is
prohibitive and that it slows the the surgeon
down. So if the surgeon values
his or her time and they're efficient and
they're they have great outcomes
and they move with precision and speed,
adding artificial intelligence or AI at that cost
is actually gonna slow them down. That's a
fact. Some of the,
hospital settings or the large surgery centers that
include
AI, robotics, things like that,
especially robotics and orthopedics.
They're doing it because nobody else is doing
it, and they're doing it because it's an
attractive
there's some traction. Some patients are saying, hey.
I like this concept. I heard it's state
of the art. It's a thing of the
future.
I'm gonna go to a doctor that
engages with that technology.
There's so there's the place for it right
there.
The flip side of that is it's time
consuming.
It slows the doctor down.
It's not cost effective.
So it's a it's kind of a happy
medium. The rest of the technology coming across
the table is gonna be
from GI, from ophthalmology,
gynecology,
the whole spectrum. There's always advancements in medicine.
There's always advances in pain relief.
Orthopedics,
especially, when you're having your shoulder, knee, or
hip replaced,
the patient is in a great deal of
pain.
That medication, that interventional pain relief is very
critical.
It's a difference between a successful outcome and
a painful one. So So those are the
kind of technology improvements that we need to
watch, we need to enhance.
And quite honestly, we'll let we'll let the
vendors compete with one another who comes out
with the best products. It's an exciting place
for us to be at right now because
all of the
all all of the vendors, all of the
the labs, all of the companies are all
striving to be as good as they possibly
can. They're always out offering the newest, latest
platform,
to trial. And, it's all it is, it
just benefits us in the industry just to
watch this technology unfold. It was on it
wouldn't didn't happen forty years ago. It didn't
happen twenty years ago. So every two to
three years, it continues to happen. It's very
exciting to see, and it helps our patients
out.
Some. And kind of a follow-up to that,
I'd love to dig in a little deeper.
Can you identify one specific technology or innovation
that stands out to you as especially transformative?
Well, to go from paper
to electronics
is very, very important. There was a lot
of fight, a a lot of pushback from
the doctors. They didn't wanna have to slow
down. They didn't they'd rather whip the page
and sign something, and they don't have to
type up this laptop and do all this
stuff. But physician offices led the way. Almost
every physician office I know of, there's a
laptop in the doctor's office, whether it's a
pediatrician, a GP,
orthopedic, neurology, whoever.
That's
way it's happening. The the the hospitals all
have sophisticated electronical mac matter of hours now.
So the paper chart to paper chart format
is really a thing of the past. As
far as other technology go, getting back to
artificial intelligence and robotics,
that's still
finding its way. Because of its cost, because
of its expense, it's finding its way. Not
everyone's embraced it. Others have. So it's kinda
fifty fifty.
Absolutely.
And with 60% of health systems,
considering ASC joint ventures, and many ASCs are
already partnering with systems in their communities, what
opportunities do you see for collaboration, whether with
providers or vendors, to strengthen patient care and
operational efficiency?
Forming a joint venture with either a hospital
system
or a management company
has to fit the needs of the doctors.
The doctors, the surgeons are the single most
important component.
Without the doctors
writing the prescription
or the order to have the surgery performed,
whether it's an admission at the hospital or
a procedure in a surgery center, That's where
it starts. It's all centered around the doctor.
My opinion, I've been in the field thirty
five years, the doctors rule.
So that's why
hospital groups try to employ them.
That's why surgery centers are were invented as
a as an extension of physician,
you know, practice and and, entrepreneurial
spirit. So
leave it up to the doctors. If the
doctors
want a collaboration,
if they think it makes sense to partner
with a management company to get enhanced insurance
contracts or cost savings on purchasing supplies, things
like that, a bigger, larger network, if it
makes sense to partner with a local hospital
because the hospital would would, you know, find
a creative way to get them privileges and
have them earn a stipend for doing inpatient
care at the same hospital. There's all that
stuff will play out, but it has to
be focused to start on the doctor,
whether it's a group of physicians, all aligned,
or just an individual surgeon.
And is there anything we didn't touch on
or any final thoughts you'd like to share
as we wrap up this conversation?
Yes.
It's a painful one.
Anesthesia
is becoming an unsustainable
expense.
Okay?
Five, six years ago, pre COVID, it was
not an issue that we really, really had
to concern ourselves with.
But, as in most professions, you have
one segment of the population retire
either replaced properly with enough volume or not.
And so the cost of anesthesia continues to
rise. That's also offset with declining reimbursements for
anesthesia.
For too long,
anesthesiology
as a profession was caught up in this
battle between the physician, anesthesiologist,
and the CRNA,
sir certified registered nurse anesthetist. Okay? Both qualified
in individuals. The majority of the procedures performed
in the surgery center are performed by CRNAs,
but they spent so much time feuding
from state to state and around the country.
They took their eye off the ball. They
did not pay attention to their own reimbursement.
So the anesthesia reimbursement continues to plummet
while hospitals get increases every year, and the
surgery center gets a little bit of a
bump. Some of the doctors get a bump,
some of them don't in the right direction.
Anesthesia reimbursement continues to plummet. So now in
order to sustain their costs and the expense
of providing,
you know, the necessary anesthesia so we could
do surgery, we have to sustain that with
a stipend,
and sometimes it gets uncontrollable.
That's a major issue. I've heard about it
all day today from a variety of different
settings. I don't remember discussing it this seriously
before, and this I've been this is my
twelfth straight year coming in June and October.
I've never seen it reach a point where
it's it's unsustainable
concern.
That's one.
The paper payer reimbursement issues,
yeah, everybody has revenue cycle challenges. We have
to make sure that we're getting paid for
what we do because whoever we buy supplies
from sends us an invoice, and we're gonna
they're gonna get paid regardless of what we
get paid. That's an ongoing challenge for us.
We have to make sure that we're doing
a diligent job.
And then it just like I said, leave
it up to the doctors to figure out
exactly
how kinda what kind of a model they
want. If they wanna be a solo,
no partners necessary,
employ good people, form their own governing board,
that's fine. If they want a joint venture
with a management company, of which there are
several good prominent large ones around the country
or a local regional hospital, that's fine too.
So
that determination will be made once, the people
that are the true stakeholders,
sit down at the table and figure out
how they're gonna do with how they're gonna
go forward.
Absolutely. Well, Patrick, thank you so much for
sharing these thoughts and insights today on the
podcast. And joining me, again, we are recording
live at the thirty first annual business and
operations of ASCs.
Thank thank you for having me.