Hello. This is Francesca Matthews with the Becker's
ASC review podcast.
I'm thrilled to be joined today by Brent
Maxfield,
CRNA,
president and CEO of Maxfield Healthcare Solutions. Brett,
thank you so much for being here today.
Hey. My pleasure, Franchesca. Thanks for having me.
Yeah. Of course. To start us off, could
you please introduce yourself and tell us a
little bit about your background?
You bet. Yeah. Absolutely. So my name is
Brett Maxfield.
As you mentioned, I am a, by licensure,
CRNA,
but that's not really what I do anymore.
So life has kind of evolved and changed
a little bit. So,
I,
originally, that was the plan, was to be
a a CRNA and do anesthesia, and life
kinda changed a little bit. So about fifteen
years ago, I had some pretty significant health
issues
and had to kinda
transition careers.
And so, out of that necessity,
the consulting firm was born. And so I
transitioned from doing bedside anesthesia to now I,
I do a whole bunch of different things,
kind of all under the umbrella of that
health care solutions.
So I guess kinda just naming things off.
I own a multi specialty surgery center in
Southeast Idaho.
And then,
with the consulting firm,
I helped to supply, manage, direct, aid, train,
multitude of different things with, about 400 to
450,
different
surgery centers and office based surgical practices
worldwide. So we're in all 50 states and
expanded internationally.
In addition to doing that, I also am
one of the a member of the board
of directors for Quad a.
I'm also the president of the Idaho Ambulatory
Surgery Center Association.
I am an international surveyor for quad a.
I'm the chair of the practice committee for
the American Association of Nurse Anesthesiology.
And,
yeah. That kinda covers pretty much all my
professional life. So I like to stay busy.
I,
I'm kind of all over the place and
rarely home. So it's kind of a fun
life.
Yeah. I got the background there. Thanks for
for sharing that. I always love to talk
with people who have kind of a wide
range of experiences.
Yeah, I feel like it always it's always
interesting.
Jumping just right into questions here. What are
the top three trends that you're following in
health care and ASCs today?
You know, there's a couple. Obviously, the thing
when you talk about ASCs, the thing at
everybody's forefront of their mind right now is
the the cost involved and how it's just
our reimbursements going down and our expenses are
going up.
You know, and when you stratify those costs
post pandemic, the first thing that hit us
was
the the cost of supplies, you know, that
supply chain got disrupted,
supplies went up, and quite honestly,
we were hoping that things would come back
down, and I don't know if the the
actual expense has stayed that high or if
people just realized, like they often do, that,
hey. You know, people will pay these prices
and just kept things high. But, you know,
that was the first wave to hit us.
The next wave to hit us was the
anesthesia shortage. So,
I think that
doing what I do, working in the consulting
field,
I saw a big, big, big uptick in
demand for my services
post pandemic
because a lot of the people who were
deemed nonessential
decided that they weren't gonna let the hospitals
determine,
their livelihood. And so they said, you know,
we're taking this out of your hands. And
they they started reaching out to people like
me and creating office based surgical practices, ambulatory
surgery centers, things like that,
which most of the hospitals didn't care because
it was, you know, again the ones they
deemed non essential. So this was the plastics,
the podiatry,
things like that, you know, pediatric dentistry.
I think what they failed to realize though
was that when those people left the hospital,
it also meant they're going to take anesthesia
with them. And then a lot of these
things, you know, especially for CRNAs, you know,
my background,
the opportunity to leave and do your own
thing was significantly more lucrative with a better
lifestyle than staying in the hospital.
And so I think that was an unforeseen,
result
of that
kind of push to,
you know,
deprioritize
the nonessential,
providers, was the hospitals didn't realize they're gonna
lose a big chunk of their anesthesia. So,
obviously, that's another big one that we're watching
right now.
And then the newest latest entry into the
the mix
is, AI. You know, AI is definitely something
that
as we
integrate it more, see it more in play,
it's definitely gonna change things within the ASC
realm.
And so those those are kind of the
big things we're watching right now, as those
those different trends kinda seeing what's happening. You
know, we're kinda watching a little bit to
see what's still coming out. Again, you know,
being
kind of on a a 30,000
foot view of things with what I do,
it's been interesting to see which specialties
have also kinda taken off in that ASC
world. So, you know, the last five years,
we've seen a huge uptick.
And a lot of stuff that used to
be mainly just hospital based, you know, the
vascular,
areas, the, you know, as things come off
the inpatient only list, we're seeing more of
those GYN specialties leave again.
And, you know, it it'll be interesting. I'm
we've got a health care crisis right now.
We've got an affordability crisis.
This
government shutdown really kind of brought that to
light
and kind of brought to light how ridiculous
a lot of this stuff is, you know.
For an example, my family of five,
pre
Affordable Care Act, paid about $800 a month
in premiums
to for our insurance, you know, for a
a barely moderate plan, like a silver level
type plan.
And as soon as the Affordable Care Act,
it did anything passed. It did anything but
make things affordable. Like, for my family, it
jumped from $800 a month to $2,500
a month to where now we're sitting close
to, I think, $4,000 a month
for that same silver type plan. So so,
anyway, we're watching all those different things. I
think you're gonna see some big changes coming.
I think we're gonna have to see some
big changes coming there because
the average person making $46,000
a year
cannot afford to make a $48,000
a year health insurance payment. It's ridiculous. So
there's gonna be some changes coming and there
have to be. So those are kind of
things we're keeping our eye on, watching what's
happening, and a lot of it circles around
that finance component.
Yeah. Absolutely. I think I think the shutdown
and a a number of things in the
last year, so I have kind of done
that, like,
behind the curtain
effect.
So, yeah, all totally relevant topics there. What
are you most excited about right now? You
know, honestly, the thing I am most excited
about has to do with that AI. I
think,
I think it's a tool that, you know,
like, we wanna be a little bit doomsday.
We have to be a little bit careful
and not not trust too much in AI
because
we, you know, we don't want things to
suddenly end up that we have no idea
how to do things without AI. But on
the flip side,
you know, there's some really cool opportunities there.
There's some,
real opportunity, especially on the revenue cycle side
of things,
to see
where a lot of this inefficiency that happens,
this back and forth, the stupidity of we're
gonna deny, deny, deny, and then approve with
no changes. You know, just that stupidity that
happens there. The ability to control costs a
little bit better within your systems.
The ability to, really, honestly, with AI, have
almost immediate input from your quality assurance programs.
You know, looking at things like, hey. Let's
plug in all this surgeon's data. We've got
a guy who claims that he takes two
hours,
to do this particular surgery, but survey says
AI
tells us you're three and a half hours.
So guess what, buddy? You're not scheduling for
two hours anymore. Your cases are scheduled for
three and a half. You know, increasing efficiency,
decreasing patient satisfaction with wait times, things like
that. I just I think there's a lot
of potential
with AI application within the ASC field.
Mhmm. Yeah. Absolutely. And it's something that's interesting
to me just I know that, like, within
the ASC field, the use of technology
is kind of fragmented or I noticed there's
some large gaps. You know, a lot there
are plenty of ASCs that are still,
you know, don't have EMR systems. And then
there's I just wrote an article not too
long ago about a totally AI powered ASC,
going up on the East Coast. So I
think that's something really kind of being reconciled
within the industry right now. Yeah. Well, I
think for ASCs and especially,
the office based surgical practices,
a lot of times these EMRs are just
priced so high that they price themselves out
of a client. And so I think that's
something we're gonna have to see kind of,
you know, balancing itself out and reconciling itself.
But as we drift to the technology driven
side, you're gonna have to see some of
these disruptors enter into the market to bring
things that offer the same quality
at a an affordability
price point where a lot of these places
can get in. You know? I I know
speaking from from experience,
a lot of the practices that I work
with have that issue where they would like
to have that. They would like to have
that gathering ability at their fingertips,
but it's just so cost prohibitive
that it's it really makes it difficult. And,
you know, again,
coming from the anesthesia background, I can tell
you as an anesthesia provider, I hated EMRs.
You know, you wanna slow me down and
make me inefficient, give me an EMR. That's
a great way to do it. So I'm
kind of a dinosaur. You know, technology is
not my best friend. I'm not, you know,
a 20 who's grown up with an iPad
or an iPhone in their hand their whole
life. So that could be part of my
problem. I readily, you know, acknowledge that could
be one of my limitations. But, you know,
at the same time, we'll we'll see how
that all plays out and if we can
eliminate some of those inefficiencies that make practitioners
not want to use those.
Absolutely. Yeah. No. I hear you there on
the the the dinosaur aspect. I'm I'm honestly
in my twenties and sometimes still feel like
I'm not really with with it as far
as all the technology, like, the way that
some of these kids are. But how are
you thinking about growth over the next twelve
months? You know, as far as growth goes,
it's an interesting time for growth. A lot
of it I'm seeing a little bit of
hesitation
in the kind of in that ASC market,
kind of waiting to see what happens with
our economy. You know, there's been so much
there's been so much partisan politicking that it
just makes me wanna vomit when it comes
to that kind of stuff. They
you know, if people would just do what's
best for the country instead of what's best
for themselves, that would be amazing. But that's
an aside.
Because of a lot of what's going on,
I've seen people either going headfirst into the,
hey. It's good now. We've got to go.
Let's do this as quick as we can
before it goes away. And I've also seen
even more to the other side where it's,
hey. I'm not sure how certain the future
looks.
Let's be cautious. Let's kind of hold off
on some of these projects.
But really, honestly, where a lot of the
growth that I see coming is we've had
this exodus. Right? So
we've had
all these people redeemed non essential,
during the pandemic
step out and take their services to other
locations.
They have been in turn seen the benefit
of, dang. You know what? It's kinda nice
to collect a facility fee when I own
an ASC as a podiatrist, as a plastic
surgeon,
as a reproductive specialist, you know, whatever it
may be.
And they're seeing that as an an additional
revenue stream.
So what we're now starting to see on
the growth side is that hospitals
have gotten smart and said, oh, shoot. We
kind of messed up there. And so
I've had several opportunities recently where
an an opportunity has presented itself
to
kind of incorporate these surgery centers back into
hospitals.
And the hospitals, especially some of the larger
hospital systems, have gotten smart and realized that,
hey. You know,
here's an example. We've got one that's close
enough to be an HOPD.
They started out that path and go, hey.
Yeah. We can make HOPD. We could generate
these hospital
rates. We could, you know, have that extra
revenue coming in.
But then they take a pause and they
go, okay. But what are we gonna do?
We're gonna alienate these surgeons again that we've
just worked hard to come get back in.
So I've actually seen an interesting trend in
the growth where a lot of these hospital
systems
are actually purchasing
ASCs
with the intent of keeping
them just an ASC, not an HOPD,
for the purpose of being able to have
an investment mechanism
to get
surgeons, primary care physicians, things like
that incorporated into the hospital system and buying
into the hospital system, kind of essentially
allowing them
some legal loyalty there. Who knows how long
it'll be before somebody in the government decides
that, you know, while they can take kickbacks
and bribes, again, we can't let the can't
let the physicians do that, so let's ban
it. But for now, that's looking like possibly
an avenue for growth for quite a few,
of the smaller ASCs and no BSs.
Yeah. Definitely the laughing at your bribe comment
because yeah. Oh, let's be honest. But, you
know, like Yeah. No. For sure. Hold back
the curtain there and just say the truth.
I mean,
the ASCs were originally
you know, when they first started coming around,
everybody had to have a certificate of need.
And basically, the intent there was, hey. The
American Hospital Association is afraid.
You know, these are gonna come in. The
OR is the only place where a hospital
really generates any money. These ASCs are gonna
pop up everywhere in every corner and cripple
everybody.
That didn't happen.
So
as the states have gotten smart to that
and realized that they've gone through and kind
of a lot of the states have started
removing these,
certificate of need areas.
So there's a couple things happening with this,
and and I wanna address this one a
little bit. You know, you've still got
some of these places where, quite honestly, it's
it's a bribe. You know, like, I let's
call a spade a spade. You know, in
Chicagoland area, when you build an ASC, you
have to find the right person, you have
paying the right amount, and then suddenly you
get a certificate of need.
It's not
it's not an honest process.
And it's it's not just Chicago. It's New
York. It's, you know, even Alaska. I mean,
I had an opportunity present where literally a
converted Jiffy Lube
was being offered as a,
surgery center because it had a certificate.
The building itself was in a horrible area.
It was a trashy building. But because they
had this certificate of need, they were asking
a ridiculous amount for it because, again, you
know, you have to pay off the right
people, grease the right wheels, which is wrong.
So we've now you know, the pendulum swings
each way.
It can't swing too far the other way.
I think the
the thing that will prevent
kind of that fear, that original fear and,
honestly, the the original fear was that if
these pop up everywhere, they're gonna be unregulated.
They're gonna be unsafe. We're gonna have patients
dying all over the place. That's a legitimate
fear.
You know, The United Arab Emirates is an
example I'll use. Right now, they've got a
huge growth happening.
And so rather than
creating this false bribery system that we have
going on, they basically just said, hey. You
know,
fine. Go out and do your thing. Set
up. But you have to be able to
get accredited. And so that kinda covers both,
hey. It fills the need, and, hey. We
also are assuring that it's safe because
you have to go through a an approved
accrediting agency
to make sure that your
you know, what you're doing there is legit.
It's safe. We're not gonna have, you know,
somebody's garage in Miami with silicone being injected
into a buttocks from Home Depot. Right?
So, anyway, again, I'm a little biased. I'm
I'm with QuadE,
so there is some bias. I I see
the value in accreditation or, agencies and organizations,
but the data is there too. You know?
When you look at accreditation,
accredited versus nonaccredited facilities,
your morbidity
morbidity and mortality
drop off pretty significantly
from the random pop ups that are just,
you know,
by the seat of your parents type thing
versus the ones that are doing things right.
So, anyway, there you go. There's my little
soapbox for a minute there. No. We love
we love a soapbox here.
Is there anything else that I haven't touched
on that you think is important in this
conversation?
You know, that's a good question.
There's a lot
you know, as we're talking about growth, I
think there's more opportunity for growth. I think
that's a really important thing for people to
understand is that
health care is in need of disruptors right
now.
I think that the trend to ASCs, as
long as it's done the right way,
is definitely that pop potential disruptor.
I had an opportunity to speak, and I
I won't say the state, but I was
meeting with the,
the,
basically, the health care panel within the state
government.
So senators and representatives,
had a discussion with them, had a good
lunch. We were talking about how ASCs get
reimbursed versus hospitals and HOPDs.
And
these people who are making the decisions about
things like Medicaid reimbursement
and, you know, hospital policy, health care policy
for the state,
as we got talking with them, it became
very clear that they
didn't really know how any of that works.
You know, one of the specific examples we
use was we talked about how in an
ASC, a true ASC,
your CPT code is kind of the ceiling.
So if you're having code, you know, whatever
for a bunion correction, you know,
I can't think of the code off the
top of my head. But, anyway, with that
code, if they say, hey. For this code,
we reimburse you $6,000.
That's it. Period. That's the end of the
statement. So you get $6,000, and that's what
you get reimbursed for any hardware, any facility
fees, paying your staff, paying for, medications, paying
for anesthesia.
You know, all that kind of stuff outside
of the the anesthesia professional fees are paid
with that facility fee, with that one CPT
code
versus in the hospital where that's kind of
your floor instead of your ceiling. So you
start with that, then you get to charge
for nursing fees and facility fees and,
you know, medication administration fees and all kinds
of, you know, your DME, all that kind
of stuff gets added on top.
So when we started talking about that,
it became very clear that they had no
idea that's how it worked. They had no
idea why it was that ASCs were cheaper.
They just thought maybe we charge less, you
know, on the goodness of our heart or
something. Right?
So as we discussed this, about fifteen minutes
into the conversation, one of the state senators
says, hey, can we regulate can we can
we mandate that anything that can be done
in ASC is done in ASC?
I kind of just looked at him and
laughed at him and said, hey, you're the
government. Do whatever you want, you know? You
guys can do whatever you wanna do. And,
they kinda discussed that quite a bit about,
hey. How do we how do we require
that, you know, if this is an ASC,
potential
that we send that they have to at
least evaluate that as a spot first before
they go to the hospital to have it
done.
So theoretically, one fifteen minute conversation
with the right people within the government could
have saved this particular state literally hundreds of
millions of dollars in Medicaid fees
and could have generated additional revenue for these
ASCs.
You know, it just, you know, all the
while saving
taxpayers money and saving patients money
and
throwing things into a system that's, you know,
a little bit more
efficient, I guess, would be the best way
of putting it. You know?
I use the example. This is this has
been quite a few years ago,
but I was doing anesthesia
for a,
OBGYN surgeon.
He came in, and he did a robotic
hysterectomy. And then he, he left and came
back to do, something small, like a bladder
sling or something like that. But anyway,
got it done, took him out, hit, said
hi to the patient,
rolled the patient to the the hysterectomy patient
out to the Recovery Room, went out. I
saw the patient, brought him back, got him
up, got him hooked up. We were ready
for surgery. I called the surgeon and said,
hey. We're ready. Come on in. You know,
we're good to go. And he's like, hey.
What do you mean you're good to go?
I'm I'm at lunch.
I'm like, yeah, dude. It's been fifteen minutes.
Get your butt in here. It's time to
go.
And he's like, hey. I'm I'm used to
this hospital. He's like, I I thought I
had time to go eat. I'm actually at
a restaurant. I, and we're like, dude, you
saw this patient. You signed off. You said
it was ready. We're in the OR. And
so just that kind of that
that inefficiency, you know, eliminating things like that,
you know, just
I've got all kind of anecdotal stories from
that from my previous anesthesia career where there's
just a lot of inefficiency that can be
eliminated and where we can, you know, through
some of these other methods. Again, looking at
AI at ways to eliminate, hey. This particular
anesthesia provider is able to get a patient
in and get them to sleep in this
amount of time. Hey. This particular surgeon
can,
get this exact same procedure done in one
third the amount of time that the other
partners there at the surgery center can. What's
he doing differently? Let's bring him in and
have him maybe train with the others, you
know. So I just I see a lot
of potential for growth, for efficiency, for progress
there.
And,
I think as we do that, as we
become more efficient,
it'll have ripple effects
as long as
administration
treats things ethically. So that's a whole other,
like, a whole whole different side side quest
here, if you will.
I just look at it as, you know,
treat your people right,
and they're gonna do their best for you.
I I've always tried to live,
with that as far as the areas where
I've been director and manager, and it really
has paid off. You know, I've had some
just incredible
employees
who are just willing to absolutely go to
bat for me.
And it's because they know that on the
flip side, I am a 100% on board
to do the same for them. That,
you know, if it doesn't seem fair to
them, if it doesn't seem fair to me,
then it probably isn't fair. We need to
make a change type thing. And I just
I wish that we had a little bit
more of that
in this world of kinda corruption and greed,
you know, who
what
health insurance CEO really needs to be taking
in 350,000,000
a year, you know, while I don't know.
Another soapbox. We yeah. I was like, well,
we've got many. We can get a whole
series of podcasts about that. I don't even
get this started. But,
absolutely.
Well, that is all I have for you
today, Brett. Thank you so much for joining
us today. It has been a pleasure speaking
with you, and I look forward to connecting
with you again in the future.
Hey. My pleasure's all mine. Thank you so
much, Francesca. Good to hear from you again.
Yeah. Absolutely.