Addressing ASC Headwinds w/ Rena Courtay

Erik Sunset: [00:00:00] All right. Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy. We deliver healthcare solutions that take the painting costs out of broken workflows like with Op Note, which gives ASCs the power of instantly generated operative reports approved from the point of care.

Erik Sunset: You can learn more about op Note and all of our solutions at docbuddy.com and today I am really happy to have Rena Courtay back on the show. Uh, Rena joined us. Oh gosh. A few dozen episodes back at this point. Uh, for those that need a refresher, Rena is the VP of Ambulatory Surgery at Trinity Health, and she’s also an officer on the ASCA Board of Directors.

Erik Sunset: Rena, thanks for making a little more time for us.

Rena Courtay: Well, thank you for having me, Erik.

Erik Sunset: Our pleasure. And it’s, it’s fitting, uh, that the last time we saw each other was at ASCA in Denver just, uh, a month or so ago. Time is flying.

Rena Courtay: It does.

Erik Sunset: Another great event. Obviously great venue too. It was kind of nice to [00:01:00] not be on the east coast for

Rena Courtay: Yeah. I think we got a lot of great feedback that from people that liked the venue a lot, and it was our biggest attendance ever, so it was exciting.

Erik Sunset: Yeah, it was kind of funny talking to, uh, some of the organizers of the event, Chris and, and Alex, among others. There was concern about getting to Denver and I’m thinking that’s a direct flight from just about anywhere in the country. So definitely the attendance beared that out.

Rena Courtay: Yes, yes. It’s pretty easy to get there.

Erik Sunset: And we’re, uh, we’re together today to talk about solving all of the biggest challenges in healthcare in one fell swoop. But that’d be pretty easy to tackle, uh, some of these things. But, you know, at, at the top of the list is this recurring theme around the shortage of anesthesiologists, the shortage of CRNAs, and then something that’s not getting quite the publicity that it should in my opinion, but I’m sure that it will soon. It just the outright of physicians, non anesthesia physicians. So, [00:02:00] Rena, get out your magic wand here. What, what do we need to do to fix this problem?

Rena Courtay: let’s solve it today. No, um, we, uh, are seeing the anesthesia shortage at all of our sites. You know, we’re feeling the impact of that across the country at Trinity, and we have 101 hospitals in 27 states. So we see this and. You know, on top of that, we’re seeing it much more broadly in the ASC industry.

Rena Courtay: Two, three years ago, you never heard of, of ASCs having a problem. In fact, you’re like, oh, let’s get proposals from three or four anesthesia groups, pick the one we like. You know, I mean, because you, you could just really do that and you would never be paying a subsidy. The hospitals have always paid one. I think, but we have not, and now almost every ASC I talk to is either paying a subsidy or they’re being asked to pay one.

Rena Courtay: And, you know, that’s including big companies like HCA and SCA and, [00:03:00] uh, you know, others that, uh, have not historically had that problem. But, you know, we, we have to be creative now, and you have to think about a lot of things that you didn’t think about before. Such as, you know, how do you run your schedule and how do you run it very efficiently because you’re gonna be paying for this anesthesia time and their salaries have skyrocketed.

Rena Courtay: You know, when you, when we compare ’em on the MGMA, you know, s we have to do fair market values, of course, of all their salaries before we enter into any contracts with a subsidy. So I’ve become very familiar with what are these salaries? And you know, some markets like Chicago is really high. You know, they’ll be at like the 90 percentile of all salaries for anesthesia, CRNAs in that market and they’ve, I mean, this is almost double what I would see salaries a few years ago.

Rena Courtay: For these, for these CRNAs especially. And so how [00:04:00] do we make our schedules more efficient? That helps us as well. We should have always been doing this, but we weren’t. ’cause we could just get anesthesia to come in and do one case. You know, if we wanted to, uh, a doc wanted to do one case, we will open a room.

Rena Courtay: Okay, good. We’ll do it. We, we can’t do that anymore because that’s not cost effective for anybody and it’s real. You’re gonna end up paying anesthesia more than you get reimbursed on the case. S So, you know, looking at vertical scheduling, looking at, um, do we need a free MD like we’ve always had in the past.

Rena Courtay: A lot of places have had the model where we’ve had one free md, four CRNAs, one MD for every four CRNAs and the md, you know, unless they’re doing blocks all day, they probably have a lot of free time. We can’t even afford to do that anymore. You know, unless you’re doing, like you have a heavy orthopedic center and you have to have someone doing blocks all day long, then that’s a different story.

Rena Courtay: But, [00:05:00] um, then you’re probably doing okay because you’re busy all day long. But, uh, it, it’s become, you know, you just have to look at absolutely everything. Some states allow, um, CRNAs to practice independently. And in those states, um, they’re, we’re getting more and more, uh, locations where we just don’t have an MD at all

Erik Sunset: Right.

Rena Courtay: because we just can’t afford it.

Rena Courtay: And so states like Idaho or Iowa where you’re allowed to have, um, CRNA’s practice completely independently, that’s becoming more commonplace. And CRNAs are opening their own groups without any MDs. So there’s all kind of things you have to look at. Just depending on, um, you know, what market you’re in, but how do you structure your subsidies too so that you’re able to true this up?

Rena Courtay: You know, because you can’t just say, well, I’m gonna pay you this subsidy. Well, how do we know what you’re collecting? So you have to put a method in place to, [00:06:00] in your contract to true this up. The way we’ve been doing it is we do, we have our contracts truing this stuff up every month. They show, they show our us what our, their collections are as to what we’ve agreed on as the maximum monthly subsidy.

Rena Courtay: And then you pay the difference between that and I, obviously your goal is to reduce it to zero, but that’s been proved really hard to do.

Erik Sunset: Yeah, I mean, simple supply and demand there. If there are not enough anesthesiologists and not enough CRNAs, I mean, in a way you can rate your own ticket if you’re that type of a provider. And you, you, you’re mentioning the subsidies here just two weeks ago at Healthx in Nashville, the the big McDermott, um.

Erik Sunset: Um, PPM and ASC event. Some of the numbers being thrown around for annual budgeting, just for this anesthesia stipend, this anesthesia subsidy. It’s not insignificant even on a line item for a

Rena Courtay: Oh no. It can [00:07:00] be over a million dollars.

Erik Sunset: Tens of millions were some of the numbers I was hearing

Rena Courtay: Wow.

Erik Sunset: larger management companies. And they’re going, we know to plan for this, but it just doesn’t feel real that this is how much we are going to spend this year on anesthesia subsidies. And I don’t know, uh, systemically what we need to do to fix that because that’s, you know, kind of a symptom of a broader. healthcare economic system that works in some ways really well, and in other ways it’s like, why are we doing this? Why is our cost of care so high? And, you know, I’m not sure this is the forum for me to solve all those

Rena Courtay: Right.

Erik Sunset: but many more smarter folks than I on on this podcast. But just simply the supply of, of anesthesiologists. Where, where do you even start to get more folks interested in the, in that career?

Rena Courtay: Well, and you look at the proliferation of even ASCs, you know, we now, uh, have like around 6,500, uh, Medicare certified ASCs, [00:08:00] but like 11,000 total ASCs that all need. Probably anesthesia providers. So that keeps growing and growing. So the need for anesthesia keeps growing and there’s less providers because partly a lot of them, you know, re retired early after COVID went and did something else.

Rena Courtay: ’cause that was a pretty rough time for anesthesia providers. Very rough. They had to do a lot. I remember it clearly. And you know, it was not pleasant for them. Um, and then, you know, the Balance Billing Act, and they were, they, they’re not allowed to do certain things that they were allowed to do before that, um, improve their reimbursement so that that’s hurt them too.

Rena Courtay: And then number one is really their reimbursement from Federal pay. You know, government payers is so low. I mean, it, it equates to like $84 an hour. I mean. Really, you know, they had to go to school for a long time, you [00:09:00] know, so,

Erik Sunset: of drugs is greater than the reimbursement for the procedure.

Rena Courtay: so and so how, what can we do about that? You know, and that’s something we are talking about a lot at asca. We talk about anesthesia at every board meeting because it’s such a big topic and it’s impacting so many, you know, all of our ASCs, where it could, like you said, if your subsidies are so high, you may not be able to afford to stay in business.

Erik Sunset: Right. Well, this is obviously tongue in cheek. This is kind of a flippant comment, but the, the end point of all this is that there’s not enough anesthesia to go around. Then procedures just, they’re not gonna be performed.

Rena Courtay: Yeah, because I don’t think anyone wants to have any surgeries without anesthesia. Not, yeah, not likely.

Erik Sunset: It’s, it’s not happening. And

Rena Courtay: Yeah.

Erik Sunset: you, you call back to post COVID or coming out the other end of COVID and through it as well, and lots of. Lots of different kind of stories for physicians and all types of providers through COVID, but that seemed to kind of be the straw that [00:10:00] broke the camel’s back initially because just like this anesthesia shortage, there are, know, on a national average, a huge shortcoming of the providers needed to treat the amount of patients that need care and, and prior guests of the show.

Erik Sunset: And I’m sure we’ve talked about it as well, you know, what do we need to do to get more folks interested in becoming a doctor, period. I’ve heard a lot of good ideas, but I have yet to hear sort of a silver bullet. You know,

Rena Courtay: Yeah, I mean, uh, you know, it takes a long time. It’s really expensive, you know, so, uh, there’s all that. And do we have enough medical schools and how, you know, because I think they’re all full, as far as I know, it’s still really hard to get into medical school.

Erik Sunset: Right, right. I haven’t applied lately, but.

Rena Courtay: So I think it’s pretty hard and, uh, pretty hard to get into residencies and all that stuff. But how do we, you know, it seems like we would need to expand the number of those, um, those type of things, medical schools and the number of residencies and things [00:11:00] like that, because otherwise. How are we gonna get more providers if we keep the number the same of those, you know?

Rena Courtay: And they’re all full because I know they’re full. Because I know people who try to reply to them. You know it so.

Erik Sunset: The, the, some of the suggestions I’ve heard that, uh, and I guess to zoom out a little bit, this isn’t a suggestion. This is just market forces, but you kind of have this pendulum that’s swings back and forth over every 15, 20 or so years. Obviously the, the amount of money being injected into big healthcare, if you will, by PE and, and other groups, you know, that’s probably.

Erik Sunset: Unprecedented to this point, but you had, you used to have this pendulum that go from employed physicians to independent physicians. If you’re employed, you might deal with, uh, a little bit less autonomy than owning your own practice, obviously, but a lot less administration that you have to put up with as well, or administrative tasks is what I’m trying to say there. you’ve got this balance that goes back and forth over time. [00:12:00] just the amount of time providers are spending on these administrative tasks, and I’m kind of looking at you macro MIPS and quality reporting and all these different registries and all these things that take physicians away from being the physician that they would like to be. Uh, that was, that’s been one suggestion. Lighten the administrative load on independent practices. Uh, the next is sort of tied to it. Get them better software to use their core EHRs, you know, aren’t. Known to be the most friendly software that

Rena Courtay: Right.

Erik Sunset: used. A lot of great fr friends and vendors in that space doing, doing good work. It’s the requirements, the quality reporting requirements, which I’m kind of talking out of both sides of my mouth. I’m not opposed to that, but how can we make it easier

Rena Courtay: Right. I mean, even for ASCs, our quality reporting requirements are, I mean, we’re still reporting COVID vaccines and things like that, you know, which doesn’t seem to have a whole lot of value. And that’s another thing that we work on at Ask is to [00:13:00] try and. You know, make these, if, if it’s gonna, if we’re gonna have to do it, what is it being used for?

Rena Courtay: And is it a value because it requires a lot of administrative time and it’s difficult to do, and is it making any sense to do, or are we just doing this to do it?

Erik Sunset: Yeah. The, the classic example was the pediatrician’s office asking a smoking status on like a two and a half year old, 3-year-old child, like. I’m sure it happens somewhere, and hopefully not often, but what are we, what are we doing? not a smoker, like they can’t even,

Rena Courtay: Right.

Erik Sunset: such bad taste. They can’t even light the cigarette.

Erik Sunset: What do we do in asking these questions and being scored and reimbursed based upon their completion

Rena Courtay: Yeah, and some of the stuff for ASCs, it’s like we see the patient that day and we do follow up phone calls, but that’s it. We don’t, we can’t be checking their eyes later and doing all these other things after they’ve gone. That’s not what we do at ASCs. That’s not the nature of our business. Nature of our businesses.

Rena Courtay: Same [00:14:00] day surgery. That’s what we do. We don’t. These, like the doctors are at their office.

Erik Sunset: No. Right, right. So anyway, those are just a few of the high level things that I’ve heard. They, they seem to make sense to me, but we still have to address the bigger issue that people, um, we, we can’t produce enough physicians if we wanted to or produce more than we currently are. And we need to drive more demand in that as a career.

Erik Sunset: So it’s a, that’s a tough one, you know, we’ll have to come back to that. Maybe we won’t solve that one today.

Rena Courtay: not, but.

Erik Sunset: And on the other, the other end of this, you know, we’ve talked about physician shortages and anesthesia shortages. about staffing? Because coming out the other end of COVID, it’s not easy to hire, entertain good talent either.

Rena Courtay: No, I mean, you know, during COD we, you know, that the health system I was at at the time and at most other ones, I mean, the, the amount of agency staff that you had was just astronomical and the amount of extra [00:15:00] cost that was, you know. Was to the health system in the United States. I don’t even know what the dollar amount is, but for each individual hospital, it was astonishing.

Rena Courtay: And even surgery centers that we never had to use travelers, you know, and we had to because we couldn’t get enough staff. And travelers are like three times the price of a regular staff. So, you know, that’s obviously not something you wanna do. And I think we, we’ve largely gotten back to normal where we don’t have.

Rena Courtay: To many travelers. There’s still some, I think, but one of the most difficult to recruit positions is a certified surgical technologist, and that is at the hospitals and at the surgery centers. And again, I don’t know if there’s not enough. You know, tech programs out there for them to get trained. I don’t know, but it’s been a huge shortage in that.

Rena Courtay: And you don’t wanna pay RNs to do something that you can have surgical techs do [00:16:00] necessarily. And you know, it’s much more expensive to have rn. Can they do that? Yes. But you know, you’d rather get surgical technologists. Who can do it. But that’s been, uh, the hardest position to fill everywhere. I’ve, everyone I’ve talked to in our health system for sure.

Rena Courtay: And that’s at hospitals and surgery centers. And then the next one is, uh, central sterile processing folks to do our instruments. Um, it’s gotten so very complicated to do that work and the salaries that we pay these people are, you know, and are, are not. Awesome. They have to learn a lot and they have to know a lot.

Rena Courtay: And, um, it’s hard to find these folks and you need more and more of them because our requirements are so many, plus we’re doing complicated procedures that require a lot more trays and all this stuff. So you need more manpower in that, in that, uh, sterile processing department. It’s hard to find.

Erik Sunset: Well, just [00:17:00] on, on the balance overall. So I heard you loud and clear. Your surgical techs really tough to come by. Sterile processing, also tough to come by, but on on the whole, how are you seeing c uh, the COVID impact on staffing change? Now it’s 2025, we’re almost halfway through the year. it getting better overall, staying the same worsening?

Rena Courtay: it’s certainly much better. Than it was, you know, because again, you had to reach out and get travelers at surgery centers, which you don’t wanna do. But we still have like a little tiny bit of that, but much, much less now. The salaries have increased a lot, you know, which as a nurse, I’m glad for that, you know, to see that, uh, the average salary of of our nurses across the nation has gone up a lot.

Rena Courtay: Um, since COVID and because they had to, to keep the nurses ’cause it’s a lot cheaper to pay our existing nurses more than pay travelers.

Erik Sunset: Oh sure. Sure.

Rena Courtay: So I think, you [00:18:00] know, instead of, uh, nurses getting a two or 3% increase, most of ’em were getting 10. Plus percent increases as, um, market adjustments or, you know, whatever to, to their salary because they had to do the hospitals and the surgery centers had to do it to keep, keep people.

Erik Sunset: Yeah. Hard earned and well deserved. Um, if you ask me,

Rena Courtay: Me too. I, you know, like I said, as a nurse, it’s like teachers, I don’t think we’re, you know, we certainly weren’t being paid enough for many years. Um, and you know, it, it seems to be getting a lot better and that will also attract more people to go into nursing.

Erik Sunset: Well, that’s, that’s a big, that’s a part of an organization’s culture and a big part. You know, I’ll, I’ll admit to this. If I hit the Powerball this weekend arena, I’m not sure how many more podcast episodes I’m gonna

Rena Courtay: You might not be doing it. I get it.

Erik Sunset: But, uh, you mentioned something else too, that you don’t necessarily want [00:19:00] RNs fulfilling duties that are not, you know, at the top of their, their license, for lack of a better

Rena Courtay: Correct.

Erik Sunset: of their, to the height of their training, so that that’s also a really big part of culture. Um, what, what are you doing to ensure cohesion within the team and helping to make folks work meaningful, you know, beyond just the patient care? ’cause that’s, that’s the point I.

Rena Courtay: One of the things, you know, you mentioned working at the top of their license. I mean, RNs, you know, if we can get them some patient care assistance, some aides and things like that in the pre-op PACU and in the operating room, that makes them so happy that they don’t have, you know, they’re, they can spend the time doing the things that they’re trained to do and they get helpers for.

Rena Courtay: Turning over beds, turning over rooms, wiping stuff down, uh, pushing patients out to their car in a wheelchair. Um, you know, all these kind of things that someone else could do that. And it also, it makes, [00:20:00] uh, it may, that helps the culture and it also helps the finances because if you’re not using RNs to do all those things, so you have to think about where can you use sort of those patient care assistance and, um.

Rena Courtay: I think you can, uh, save a lot of money and also improve the culture. The, the most important thing too, I think, is celebrating successes and having little celebrations at the center and making, you know, the. The administrator, whoever’s running the center, making the staff there feel like they really care about them as a person.

Rena Courtay: And those are basic things, but that’s really important. I mean, little lunches, little this, little that. Asking ’em about their kids may, you know, being involved with them as people. And I think that’s really important so that it feels like a little family at the surgery center because that’s what makes us, one of the things that makes us unique from a hospital, I.

Erik Sunset: Oh, big time. And I mean, [00:21:00] those are things that you want to do just as a, as a decent person, as a good person. Like you want to take an interest in the folks that you spend so much time with. But on the pure business side of this, if you’ve got a good culture. not be easy to hire that next surgical tech that you need or that next sterile processor, you gotta be doing something to keep the ones that you already have.

Erik Sunset: And obviously this is line item management, not human, you know, real human interaction. But culture goes a long way there, doesn’t it?

Rena Courtay: Yes. And like I said, it’s little things. They just like little things they wanna know. They’re appreciated, you know, everybody does, but it’s just little things and. You know, uh, I once had my best mentor always said, uh, do not skimp on food that’s never gonna make your bottom line. And that’s really important for morale.

Rena Courtay: And it’s true because they really like food. I mean, if you have chocolate in your office as the administrator, whatever, whatever the staff likes, and they know that that little stuff like that little [00:22:00] rewards for things they do, you know, um, that it. You know, when they get, uh, called out in a good way on patient satisfaction surveys.

Rena Courtay: What are we doing about that? Are we making sure everybody knows about that? And you know, how, how can, and make it fun there because you wanna make it fun.

Erik Sunset: The food is really talking to me. I’m gonna note this down.

Rena Courtay: Yeah, I, I had one place I went and they go, oh, well they, they said we had to get rid of the coffee. I’m like, are they kidding? They had to pay. People were gonna have to pay for the coffee. I’m like, no. Wrong. No. That is the wrong strategy.

Erik Sunset: That’s the worst possible

Rena Courtay: Worst possible idea. In fact, my idea is to have the best coffee because, uh, if, if you’ve ever been to a hospital for special surgery in West Palm Beach, Florida, they have the best coffee maker and the doctors will come down to the first floor to get the coffee because it’s so good.

Rena Courtay: But it’s, you know, just little things like that really make a.

Erik Sunset: Yeah. Yeah. Uh, I’ll, [00:23:00] I’ll make note of that. The next time I need a procedure done. I’ll be

Rena Courtay: You are going, uh, hospital up in West Palm Beach in the first floor lobby. They have the best coffee maker. I actually had one of our centers in Fort Lauderdale get a similar coffee maker. And you couldn’t believe they had like one of those old kind of coffee makers like you would see in a diner, you know, with the little picture with the orange for decaf and the brown handle for regular.

Rena Courtay: And I made them get rid of that and I’m like, get, get, I promise you. I mean, the response was unbelievable.

Erik Sunset: People will do just about anything for a good cup of coffee and.

Rena Courtay: were, and I ca the next time I visited the center, everybody was coming up. Oh, Rena, thank you. We are so excited about this coffee maker. I’m like, oh, look at that.

Erik Sunset: You are welcome.

Rena Courtay: In fact, I think I’ll get a cup myself. Yeah, well, you know, in Miami it’s very [00:24:00] important, you know, if you don’t have your, uh, your Cuban coffee down there and your cafe con leche, you’re gonna have problems.

Erik Sunset: That’s, that’s what’s so funny about the coffee culture in Miami is that there is always a pot of coffee on. And if you want something, like what you just mentioned, courts of Vito Cafe call for it now.

Rena Courtay: Yeah, you gotta have the ability for that in those centers because otherwise, you know, I learned that when I first moved to Miami in 1999. I think I learned that on my very first day.

Erik Sunset: Oh yeah. Everybody’s running around down here. Highly caffeinated. You gotta be, you gotta be. So that’s a, that’s a good, that’s a really nice ray of sunshine for staff. And on a, on a culture note, but let’s go macro. We talked about some kind of, kind of, we talked about big problems that are already having an impact on the delivery of care today. not gonna get a whole lot better unless something changes around physician and anesthesiologist shortages. But there’s still a lot to be proud of in [00:25:00] the ASC space. You know, we fly the ASCA flag Very high and proud here at DocBuddy. I know you do as well. Tell us some good news, Rena, what’s going well in surgery centers?

Rena Courtay: Well, I think what’s going well is we continue to be the beneficiary of, you know, procedures migrating out from the hospital and the hospitals really need to focus on what. Uh, they do well and people need the hospital. They’re always going to need the hospital and, you know, making room for those high acuity procedures that can’t be done anywhere else.

Rena Courtay: You know, and I work for a hospital company, but we, we know that at our executive leadership level, you know, we have to, uh, move these things to the appropriate sites of care. And so we’re getting all the thing, you know, we’ve been the beneficiary for many years of total joints, and that just keeps increasing and increasing.

Rena Courtay: And it’s projected to be like 60% of all the total joints in the, you know, next few years that that’s [00:26:00] been an, you know, a really successful migration of something that was always done in the ho. Pi, um, that’s exciting is migrating those things. Cardiac a little slower, but also, you know, insurance companies, United really took the lead on it to have a list of thousands of CPT codes really, or hundreds, but that they only will pay for at the surgery center unless there’s a really good reason to do it elsewhere.

Rena Courtay: I mean, you have to justify it if you’re not gonna do it at the surgery center, and that’s, that helps, you know, move things in the right direction. Um, and you know, probably, I would assume other insurers will get on that bandwagon. Aetna has a little bit, but then you have Medicare where we are constantly focusing at ASCA on how do we sort of more equalize the playing field.

Rena Courtay: We have some good momentum, we have some potential legislation to. Uh, it, um, to put a cap on the [00:27:00] copays for Medicare for ASCs, which is interesting that, you know, Medicare and their infinite knowledge, uh, has removed for hospitals and hospital outpatient departments. They have a cap, so patients could actually pay less to have a total joint in the hospital than they would the surgery center.

Rena Courtay: And that just is contrary, you know? It just doesn’t make any sense. So we’re working hard, um, to get that kind of fixed because, um, it makes all the sense, and I’ve never talked to a legislator yet. We met with one when we were in Denver, and they’re like, well, that makes all the sense. Why would we not do that?

Rena Courtay: You know? But what, what happens to get it actually passed is they always wanna put it in with some other legislation and then. That’s what it makes it more tricky to get past, but we feel, we feel like we might have a good shot to get this passed.

Erik Sunset: Well, I hope you have more than a good shot. I mean, as a healthcare consumer myself [00:28:00] and just seeing the amount of money that we spend on healthcare, it, it’s a no brainer. It doesn’t seem like a no brainer. is. So, you know, definitely don’t air out any, any of CM S’s dirty laundry here, but

Rena Courtay: Yeah.

Erik Sunset: until 2025 to have this be under serious consideration?

Rena Courtay: Well, one of the issues was really, it didn’t really bubble up, you know, until we started doing more of the high end acuity procedures. ’cause the cap never came into play with most of the stuff we did. Like it, that wouldn’t have come into play anyway. It’s when we started getting into more, uh, high dollar procedures like total joints, pain stimulators, things like that, that we started seeing, oh wow, if you don’t have a secondary insurance, um, you’re gonna pay more to have that procedure at the surgery center than you’re at the hospital ’cause of this cap situation.

Rena Courtay: And it was really only, it’s only the high acuity expensive procedures, you know.

Erik Sunset: Yeah, my spear is [00:29:00] sharpened and it’s always ready to be thrown CM S’s

Rena Courtay: Right,

Erik Sunset: sounds kind of reasonable. I’ll give him a

Rena Courtay: right. So, I mean, I think it, so it’s only been like a really prominent issue for the last few years. So we’ve been working on it, but like I never even knew about it until again, we started doing these high. Higher, you know, we call it implant intensive, device intensive procedures is what they use at uh, CMS.

Rena Courtay: So the, that’s what’s driven it. Uh, and then I guess they didn’t think about it. Now they gotta figure out how to fix it.

Erik Sunset: It’s always those second order consequences that are so tough to

Rena Courtay: Yeah.

Erik Sunset: sometimes. Okay. So that’s, that’s good. Those are some really nice rays of sunshine there. And as we kind of get to the end of our chat today, I know there’s a couple thoughts on AI and healthcare. We wanted to cover. You know, it doesn’t have to be any type of expert opinion.

Erik Sunset: I certainly don’t have an expert opinion, but I have a lot of thoughts on it.

Rena Courtay: Okay. Well, and [00:30:00] again, I don’t have any expert opinion either because I have limited experience, you know, but I think, um, we can use it a lot in our administrative functions in ASCs. That’s how I see it fitting very easily and pretty quickly into what we do, whether it’s, um, you know, appeals for claims, writing appeals, whether it’s coding, you know, things like that.

Rena Courtay: Um, we have oftentimes hard time finding, you know, coders. Certified coders to do the coding and uh, it seems like boy, AI would be a great, uh. You know, application for that and really eliminate and make it faster to get your op reports coded, get your bills out the door, things like that. So administrative stuff, taking minutes for meetings I’ve seen, you know, where.

Rena Courtay: People have used that. And how do you use that to, you know, we all have to take minutes for our medical executive committee meetings, our governing board meeting, quality [00:31:00] committee, all these things. And you have to put ’em into nice pretty formats for the accrediting bodies. And you know, that’s probably a good use of it too.

Erik Sunset: Yeah, I know, I know. You’re right about that. And for any of my, any of my providers out there, my doctors, my surgeons, or otherwise. Don’t be putting PHI into something like chat GPT. I know that’s not what you’re suggesting,

Rena Courtay: No, no, no, no, no. And that’s, we kind, we just, I just did our training for our annual, uh, like it, training, whatever, and that was on there. Like, we don’t, don’t do a, ’cause people don’t think like, okay, you can’t put that in chat g pt. ’cause then it’s gonna be out there, it’s gonna be explorable.

Erik Sunset: Scary stuff. People just don’t know. Although I’m sure this doesn’t happen at at any of the organizations you work, but the emailing of completed operative reports around, we hear about that from time to time. Not good.

Rena Courtay: No, no. And then, you know, doc, the other thing that happens is surgeons wanna take pictures with their cell phone, like [00:32:00] in the or, no. They’re not supposed to do that either. That was on the training. Also, you can’t, that was on the HIPAA training. The HIPAA training. You can’t do that.

Erik Sunset: Can’t do that. Can’t do that. Not unless you got an app like DocBuddy. I can’t resist there. Um, there’s a, a right way to do it

Rena Courtay: Yeah. But your cell phone and then sending that. No, no.

Erik Sunset: do it

Rena Courtay: don’t do it. I’ve had to counsel a few doctors on that and they’re like, well, why? I am like, oh my God, why? Let me list of many reasons why.

Erik Sunset: a refresher on there,

Rena Courtay: I know. It’s like, oh my God. And I just did all that, like our, you know, the HIPAA training plus all the, all the IT training and it, so it’s fresh in my mind, but it it, the examples they were showing, it’s like, yeah, people are really doing that stuff still. Even after all the years we’ve had hipaa.

Erik Sunset: you know, it’s a good, uh, compliance training. When they give you an example and you’re going, oh my gosh, who would do that? You know, that’s a shocking abuse [00:33:00] of, uh, of PHI.

Rena Courtay: Right, right. Yeah. But you know, it’s, it’s easy to forget sometimes people get complace, you know, we get all, get complacent with what we do, and then it’s like, oh, but these are very serious problems if you do it.

Erik Sunset: Yeah. Very, very serious. Very serious is right. Uh, so Rena, any, uh, any closing thoughts? Is there anything we wanted to cover but we didn’t?

Rena Courtay: Oh gosh. We could talk all day, you know, about different things, but you know, I think we covered a few, uh, variety of topics.

Erik Sunset: Yeah, we made a good run at the, uh, some of the most pressing challenges around, uh, physician shortages and anesthesiologist shortages.

Rena Courtay: Yeah. I. The only other thing we had, we might have talked, we said we might mention was cardiovascular procedures moving into the ASCs. And I think you know it, it’s one of those things where we’ve heard that that’s gonna happen for many years. And, um, back in 2010, I know my center started doing [00:34:00] pacemakers, defibrillators, cardiac rhythm procedures.

Rena Courtay: And then we actually lost those because those cardiologists became employed. And when you look at the number of cardiologists who are employed, it’s one of the highest specialties that’s employed. I think it’s close to 80%. And so it’s tough for, you know, ASCs, um. Unless they’re part of that health system.

Rena Courtay: So that’s the probably one of the biggest barriers is employment. But the second is state regulations because a lot of states still don’t allow, uh, anything but cardiac rhythm procedures at ASC. So even though CMS has put, um, some of the interventional. Uh, cardiology on their list that’s approved for ASCs.

Rena Courtay: Uh, states still don’t approve it in many cases, so we’re, you know, I see it’s, that’s changing a little bit, but, um, it’s been a little slower than I think people thought because of those, mainly those two things.

Erik Sunset: Sure. And that, uh, this [00:35:00] is just a point of curiosity. Why do you think that such a high proportion of cardiologists. Are employed as opposed to independent.

Rena Courtay: I guess, you know, to me it’s just because most of it lends itself to. Hospitals, you know, and their patients are in hospitals and they’re doing rounds on their patients and you know, they have a lot of in, you know, inpatients plus the interventional procedures. I think a lot of providers are reluctant still, or, and certainly were to do it if it’s very far from a hospital.

Rena Courtay: ’cause what if you find something and you have to take the person for, you know, that’s, that’s a common thing I hear. Well you have to take ’em for open heart or whatever. Further interventions. And, you know, we. They worry about that, you know?

Erik Sunset: That’s fair. And I’m glad they’re thinking about it that way. Um, even, um, I referenced him before we started to record Dr. Dan Blumenthal with C-V-A-U-S-A, you know, is saying some of the same things. We just, we haven’t tried this in the ASC yet. It’ll probably be fine. [00:36:00] But my thought back, and this is just kind of tongue in cheek again, like I’m not gonna be the first one.

Erik Sunset: Like, are you, you gonna be the first one to do it in a C? Like, no, I’m not.

Rena Courtay: Well, it’s kind of total joints was like that for a long time, you know? And spine still is to some degree. You know, some doctors still aren’t comfortable doing spine in the ASCs. Like I’m talking about adfs and things like that. Multi-level adfs and more advanced. I mean, some are, but some still aren’t.

Rena Courtay: You know, so it depends on what your comfort level, what your training was, all that stuff. So I’m sure it’s gonna keep evolving and, uh, it, it’ll be interesting ’cause I, I have a few that want to explore and they’re employed groups, you know, they wanna explore having a, having a, a free freestanding, uh, C-V-A-S-C.

Rena Courtay: And I know there’s many in the country, but it, I think, uh, it’ll ke it’ll continue to grow.

Erik Sunset: Yeah. Pushing, uh, pushing the envelope, always innovating. Gotta like that. [00:37:00] MaRena, it’s been so much fun to have you back on. Before you go, where can listeners connect with you?

Rena Courtay: Well, I am on LinkedIn, um, so I am happy to connect with anybody on LinkedIn and then, uh, you know, that’s the easiest way I’d say to connect with me.

Erik Sunset: LinkedIn’s always a winner, and obviously you can see. The work that she does at the ASCA website, which I’ll get a link to that into the show notes. And, uh, you’ll see all the great work that ASCA does advocating for surgery centers nationally. And is there anywhere else to point people to Rena, or is that a pretty good shake?

Rena Courtay: That’s pretty good because e um, you know, I always respond if somebody message me on LinkedIn. LinkedIn. So.

Erik Sunset: perfect. Well, thank you again for coming back to the show. Really enjoyed our chat again.

Rena Courtay: Thank you for having me. I enjoyed it as well.

Erik Sunset: Oh, it’s totally our pleasure. And on behalf of the entire DocBuddy team, we want to thank you for listening. Be sure you’re subscribed [00:38:00] on Apple Podcast, Spotify and YouTube, so always get the newest episodes of the show. And until next time, I’m Erik. Talk to you soon.