ASC Expert Emily Spooner Talks Meaningful Digital Workflows

Erik Sunset: [00:00:00] Hello and welcome back. This is Erik Sunset, your host of the DocBuddy Journal. We’re recording this episode today on Tuesday, August 22nd. Wanna wish you one more. Happy National ASC month before we intro our guest, Emily Spooner. She’s the founder and president of Marissa Consulting, the owner and operator of South Florida Same Day Surgery Center.

Erik Sunset: She’s been featured on Becker’s Healthcare Podcast’s. Gonna be speaking at the Becker’s ASC conference later this fall. She’s also the Creator and the star of Emily, and so Flow, which is a great YouTube series. So the bottom line is Emily knows ASCs. Emily, thanks for joining us today.

Emily Spooner: Thank you so much, Erik. I really appreciate it and I

Emily Spooner: love this opportunity.

Erik Sunset: Oh, it’s our pleasure to have you. And we’re, we’re really excited to get some of your expertise on, on ASCs the technology that they’re using or maybe should be using. And I think we can just jump right in here. Sort of a standard when you look at the healthcare technology landscape is that ASC have sort of lagged in their utilization [00:01:00] of good technologies, the right technologies, and sometimes really any technology at all.

Erik Sunset: But that’s changing really quickly. ASC are seeing the need to digital here in 2023. Why do you think that they have lagged historically in adopting tech? And why do you think that’s changing now?

Emily Spooner: Well, I think back to when. EMRs first came about, and I am proud to say that I was in that generation of when EMR changed the world of from paper charts to EMR, I think that. The reimbursements and things that didn’t affect an ambulatory surgery center really made all of those previous owners and corporate just say, you know, well, we’re not gonna do it.

Emily Spooner: It’s not gonna affect us. It doesn’t matter. And in the clinic side, they came out with like a hundred thousand different types of EMRs and. Based on your specialty urology, ob, g y n, you know, there were so many and none of those really [00:02:00] were compatible with an ambulatory surgery center. So because they were so specific to, to the clinic specialty, and so I, I think that there have been some opportunities in the ASC space, but, but now with.

Emily Spooner: The development of more technology and automation and ai. There’s just so many more opportunities and I think that now the surgeons are like, you know what? It’s time. And they are a lot more content with having more technology in an ambulatory surgery center because now they’re doing it at the hospital.

Emily Spooner: Hospital, they’re doing it at their clinic. They don’t wanna turn back time in an ASC and have to hand write orders. So I think that everyone’s getting to the point where, okay, we don’t have a choice. It’s time to

Emily Spooner: change.

Erik Sunset: Yeah, I think you make a lot of great points there, and you bring to mind an interesting split that if you look at the, the best in class reports, it’s class research.com class with a k klas research.com. When you their best in class ratings for the ambulatory, [00:03:00] so the clinic EHRs. best in class winner is getting by essentially with a B minus.

Erik Sunset: And we know that the clinic, e h r, is the source of a lot of gnashing of teeth and for the providers that are using them in the clinic. So then when they are doing procedures at the ASC and there’s an e h R in place, what’s your take on the sentiment there? Is there a big difference between clinic-based softwares and ASC based softwares, or, or what do you see?

Erik Sunset: You’re on the front line.

Emily Spooner: Well, I think that there are some, Clinic-based softwares that have tried to develop an ASC platform and have not been successful at it, to be honest from my experience, because it’s a totally different. Set up, you’re, you’re scheduling per, or the billing is completely different. If you want something that’s an all-inclusive product, you’re not gonna find that out there right now in an ASC space that has all of the things that are actually necessary.

Emily Spooner: Management, your [00:04:00] inventory, preference cards, those are completely different from any kind of clinic setup. So those aren’t things that you’re tracking in, in a, in a clinic, and those are things that we definitely need to track and bill for. In an ASC plus credentialing, you’re not having to credential providers in your clinic space, not like at an ASC, where you need to keep track of their licenses and their. They’re a C L S certifications and all of these things that are really important for them to be able to perform surgery. So having one product that has everything involved in there, I think would be ideal. And I think that there are a lot of things up and coming that people are realizing with the, the advances in technology and realizing that the ASC space is so far behind the rest of the world when it comes to technology, that there’s lots of room

Emily Spooner: for improvement. And it’s exciting.

Erik Sunset: it is

Erik Sunset: very exciting. I mean, software has eaten the rest of the world. I mean, think about how you used to order a taxi and now it’s, [00:05:00] it’s an app on your phone. People do not like the old way, but because it’s worked for so long, there hasn’t been a whole lot of reason to change.

Erik Sunset: At least that’s what we see here at DocBuddy.

Emily Spooner: Definitely.

Erik Sunset: One of the things that that I wanna pick on just a little is around supply chain management. ’cause that’s obviously a hot button issue for ASCs. Because you own and South Florida, same day surgery center, I imagine you’re feeling a lot of this crunch that you’re seeing in the news of just being able to get what you need to do procedures.

Erik Sunset: Have you seen that gotten any better, any worse over the last 6, 12, 18 months? What are you seeing?

Emily Spooner: You know I, with the supply chain, It’s probably been five years going downhill. But with, with C O definitely hit rock I feel like. And there have been some improvements definitely with certain supplies and there have been lots of improvements with technology to be able to find these different supplies. But think it’s still trending towards the [00:06:00] cost. Is rising of supply reimbursement, obviously staying the same or lowing going lower. And being able to diversify what you have when it comes to. Distributors and going sometimes local, there’s some local pharmacies, things like that, that you’re able to get medications from that you aren’t from these large distributors even. So really diversifying what companies that you’re using in your ASC and it’s, it’s hard because you are constantly having to keep those vendors honest also and negotiate and. I think that everybody thinks that everybody at an ASC makes a bazillion dollars, but when, when you think about the cost of supply, the rise of supply chain, and the fact that, that the reimbursements are staying the same, it’s a, it’s a struggle to stay private

Emily Spooner: and independent. [00:07:00]

Erik Sunset: Yeah, and you’re seeing that more and more in the news. Becker’s who we referenced earlier has put a couple of pieces lately on the top five. Challenges facing down ASCs that’s ownership versus employment That’s a pendulum that seems to go on a 10 year cycle at least on the clinic side of things. looks like we’re starting to see more of a swing on the ASC side. Is that your experience?

Emily Spooner: Yeah, definitely. I feel like once again, moving away from independence and really depending on that corporate model and that employment model and it saddens honest, but I’ve been doing, this is my 21st year and it is totally, it’s a roller coaster and it comes back up and goes back down.

Emily Spooner: On a regular

Emily Spooner: basis.

Erik Sunset: Yeah, and it’s kind of interesting, this is a little bit of a tangent to go down, but when you look at the, the burnout factors that are reported by physicians, not just surgeons, but physicians at large, some of it’s using poor technology or no technology, that takes away their time. So they’re spending a lot of extra time charting [00:08:00] and documenting after hours and through the weekends.

Erik Sunset: Then when you get past that technology layer of burnout, it’s a lack of control. It’s a lack of autonomy. So I find it really interesting that we’re seeing the pendulum go back to employments where you’re most likely your own control over your own day. And this just is a, a cataclysm waiting to happen, the shortage of physicians.

Erik Sunset: But you’re seeing the things that they say they don’t like. Lack of autonomy but you’re seeing them migrate to a where you’re giving up even more autonomy than you already had. can you rectify that? Is there an explanation?

Emily Spooner: I think the economy has scared people and I think that the government has scared people and that they’re really not sure what is gonna happen to the community, especially here in South Florida. I mean, in Florida in general, just the way that. The different laws have changed recently, and [00:09:00] it’s governing healthcare, and so if they’re going to be governed in one way or another, I think that they want a, a steady paycheck. And so I think that makes sense. Right?

Erik Sunset: Yeah, that’s all the rectifying you need to do there. One, let, let’s go back to a little bit brighter topic ’cause we can go down this path and solve all the world’s problems on on this episode. And we can do we can do it, if we want, but on a little sunnier notes, because of your experience both operating South Florida same day surgery center and your Marissa Consulting line of business as well, you see a lot of technology in use, probably some of it better than others.

Erik Sunset: But the real question that needs to be asked when you’re talking about technology at the ASC is, what does, what does that do for our efficiency, both for the surgeon and then everybody else, if that’s a fair characterization.

Emily Spooner: I really feel like we can use technology to improve all of these processes, [00:10:00] especially with the lack of staffing that we have right now in the healthcare world. Being able to use technology with the clinic side, having them be able to schedule their own surgeries, that’s one f t e less that you have to pay at an ambulatory surgery center. The, the that’s out there, not being able to have to pay a. Billers if you have a lot of automation when these same codes are denied the same time every single time. So using to our advantage when it comes to the staffing shortages, I think that’s gonna be our greatest advantage, is this, this, the technology. Because the staffing, I don’t feel like it’s changing. I, I would love to say that it, it is changing, but I feel like if anything, it’s going in the opposite direction. So I, I think that we’re going to have to maximize this technology to be able to do everything that we can. And if that means losing, sorry, lo using less, less staff at your ambulatory surgery center and maintaining [00:11:00] these workflows a lot tighter Without trying to burn out your staff that you have, it’s

Emily Spooner: tough to juggle.

Erik Sunset: It, it is tough to juggle and for, for me, who’s never worked in a medical practice or at an ASC, you know, I just think. Software. How are you keeping track of everything you need to keep track of? Is it post-it notes? Is it, it’s obviously paper charts to some extent, but that just seems so foreign in 2023, but I’m sure it’s still happening.

Emily Spooner: Oh yeah, it’s definitely still happening. That you’re able to. Easily used such as an iPhone or something like that, instead of having to write everything down and then go back and put it into the software, that’s not using anybody’s time wisely. So using a software or the technology that’s very easy to use, very user friendly for analytics and the data that you’re able to see at one glance to know. Equipment and [00:12:00] what is scheduled correctly. Your staffing, being able to do all of that without having to have these extra hands and these extra phone calls back and forth between the clinic’s, offices and you using, using that program for everyone, be able to, to be able to see what’s going on, including the surgeon moly or, or with a tablet or a laptop without. All of the phone calls and all the text messages, that’s what uses so much time and that’s what causes so much overtime in an ASC, really scheduling surgeries and getting those things back and forth, especially if you’re doing 600

Emily Spooner: surgeries a month

Emily Spooner: and it’s, it’s a lot of FTEs.

Emily Spooner: It’s.

Erik Sunset: Yeah, and that’s, that’s another one. It seems like healthcare is the only industry that would tolerate that type of a workflow. Like you said, scheduling a surgery, it’s the phone, it’s email, hopefully encrypted. You know, everybody hopefully is aware of that one by now. It’s faxes, it’s signals and that’s just how it’s done.

Erik Sunset: And

Erik Sunset: that’s crazy.

Emily Spooner: It’s so [00:13:00] outdated. So I, I am excited for the new and up coming technology that’s coming up

Erik Sunset: Hundred percent. One of the, one of the things I wanna pick on a little bit more is around surgeon efficiency. So we just called out the amount of overtime that gets racked up, handling all these manual processes. Obviously software can and, and does and will fix that. What about for the surgeon and what are sort of the, the second order consequences or benefits I guess would be of saying you have a more efficient surgeon with respect to technology procedures, take how long they’re gonna take, obviously, but all of the administrivia that follows.

Emily Spooner: S I mean, it’s all about using their time the most wisely and it the most effectively. So if they’re able to follow your schedule, their schedule right on their phone, and not have to show up at a surgery at eight o’clock in the morning when either that surgery, that patient’s not ready, the patient had to cancel they’re waiting on a prior being able to [00:14:00] track all of those things ahead of time, then you’re not wasting the surgeon’s time and you’re not having with him.

Emily Spooner: I. Or her constantly because they’re able to have that technology. Okay, I am gonna switch the order of this and move things around and do everything electronically. I, I think it can use their time a lot more wisely. But also in the being able to have those templates completely ready to go for them when they’re dictating their op notes or not dictating on their op notes if they’re able to have that. Note already transcribed for them and them able to choose the laterality or whatever changes may have happened during the surgery, but their orders, having the standard orders, having the preference cards, being able to real time change those preference cards if need be. The correct way from the first time, your processes and the surgeon’s time is going to be used so much more effectively. So I think it’s the revenue cycle starts from that very first either phone call or [00:15:00] first schedule of that surgery, and that should dictate your effective and efficiency for that surgeon from the

Emily Spooner: get go.

Erik Sunset: And I, I’d imagine that you see that as a competitive advantage. You’re able to offer that to all the surgeons doing procedures at your facility, make it as easy on them as possible, so they want to come back and do more procedures with you, maybe as opposed to the ASC down the street where it’s a mess, everything’s in chaos.

Emily Spooner: And they have paper and,

Erik Sunset: Yeah.

Emily Spooner: and their preference cards are handwritten and now everybody has a hard time reading them.

Emily Spooner: So yes, I do think we. Offer a competitive advantage because we have the most up to date software, the the highest technology out there when it comes to ambulatory surgery centers and maintain everything all in the same space.

Emily Spooner: So,

Erik Sunset: That makes sense to me. And you, you mentioned one of my favorite topics being a former revenue cycle solution selling and [00:16:00] marketing guy, revenue cycle of course. We’ve talked a lot about staff efficiency and efficiency now, but what does the right technology at an ASC do for the facilities revenue cycle?

Erik Sunset: What kind of impact does that have?

Emily Spooner: It is so ma, so much impact because if. Like I said, the revenue cycle starts at time of surgery scheduling. So if the surgery is scheduled correctly, if the patient’s demographic information is correct from their date of birth to their insurance information, to their self-pay information, if all of that information, including the actual surgery that’s going to be happening, if those codes are correct, if the diagnosis codes are correct, if all of those things are correct from the get go, then it will easily translate to the rest of. The patient experience because that it goes from one thing to the next. The right preference card is pulled because the right code was done chosen. [00:17:00] The right right equipment is there. And putting that back onto the, the surgeon’s office is really important to me because I feel like they need to take responsibility to schedule the surgeries correctly from the beginning so we can bill them correctly at the end. And collect the correct amounts. It it, if that’s done correctly from the get go and the surgery doesn’t have too many complications that you’re having to change too much, then the revenue cycle flow for that patient should be fairly easy. You don’t have to do a ton of new billing and coding at the end of it. Everything’s done the beginning and it’s, it’s a smooth, it’s a much

Emily Spooner: more smooth process.

Erik Sunset: So to my, my layman’s ear, it sounds like the right technology with respect to revenue cycle will give you a process to be followed, both on the clinic side, doing the scheduling, and then on the facility side to accept that procedure. Right.

Emily Spooner: Right to accept that procedure, to know that it’s scheduled correctly and that the [00:18:00] billing will be a piece of cake at the end with the new software that’s out there. It’s so automated. All of those things don’t have to be data entry twice, that everything is going from there from the beginning and entered in as long as it’s entered incorrectly. You should need one person to manage that

Emily Spooner: patient’s chart.

Erik Sunset: I love the sound of that. Then you speak to the difficulties making any type of a hire, let alone a great hire, which is obviously what everybody wants, but if you have the right technology to sort of maximize everybody’s utility using it, all the better.

Erik Sunset: And that’s how it should have been to start with, if, if you asked me you didn’t, but if you did, that’s what I would’ve said.

Emily Spooner: Yeah.

Erik Sunset: So let’s, let’s open up Pandora’s box here. Let’s Let’s see comes to mind with this one. What do you think the most important thing in a s e could or should be doing now through the end of the year and even looking ahead to 2024?

Emily Spooner: Well, I think I kind of [00:19:00] touched on this. Like I said, top trends that I would say right now are the changes in technology and the supply chain prices that continue and the fact that yes, a lot of the supplies that we were missing during covid are now available, but there’s still some that we cannot. Maybe we’re available during Covid, but now we’re not available. So I, I think those things are gonna continue to happen and we need to do what we can to be able to fix that problem before it happens. So with the supply chain, as admins, make sure you’re diversifying all of your, your suppliers, your distributors. Companies and keeping those vendors honest and continuing to negotiate with them. And there are some products out there that are helpful and useful when it comes to implants and negotiating prices, but constantly negotiating because if you are just staying in the [00:20:00] same place, you’re going to continue to pay the same prices when they’re , much more competitive, better pricing out there if you ask. And the, technology watching all of the technology that’s being developed right now and wanting to take part in that, being able to contribute to that the the betterment of ambulatory surgery centers and join into this technology rush when it comes into the ASCs. Having gone to these conferences this last year I went to three last year and it. The technology that’s out there blows me away even so there’s so much opportunity there and speaking to those vendors, really making an effort to learn about the technology is really important. Let’s not just stay where we’re at, let’s continue to improve what we’re doing. Let’s try and stay independent.

Emily Spooner: That, I mean, I’m gonna talk about that all day long because I, I think that there’s a way, there [00:21:00] are different ways that you can beat the corporate. Employment model and, but it’s, I feel like it’s harder. I feel like it’s harder, but it can be done. And that’s what I would just encourage everyone to do is talk to those vendors. It can make a huge difference that you don’t even know what’s out

Emily Spooner: there.

Erik Sunset: Yeah, and especially when you look at your average case profitability, like on average to keep the lights on, you need to be in the black numbers. Obviously business 1 0 1 there, but I would imagine if you do a deep dive analysis and all the procedures that are happening, there’s probably some that are pretty.

Erik Sunset: And with the right negotiating tactics and being able to source alternative vendors if needed, I would imagine you go from maybe a very small positive number or a slightly negative number back to.

Emily Spooner: Mm-hmm. Just by negotiating with those vendors, talking about volume with them and, and of better pricing that they can give you, they can look at at past trends maybe that you’ve, [00:22:00] you’ve already purchased this amount of. Supply from them. So let’s, let’s renegotiate our deal here. I am not after six months of doing this certain procedure, making the money, the margins are a lot smaller than what I thought.

Emily Spooner: I’m gonna go back to that vendor and say, Hey, I need some help here. I really wanna continue to use your product, but I think that there’s something else that we can do, and I’ve done that all the time. I’m not vendors feel about that. I would love to get their take on it once in a while, Erik, but, you know, negotiating with your smiling face really works,

Erik Sunset: Yeah, it absolutely does. And you know the golden rule there is the answer is always no unless you ask.

Emily Spooner: right. Exactly.

Erik Sunset: It’s I think everything is up if you’re kind and persistent professional in your pursuit of that, that price break.

Erik Sunset: So, can I put you on your soapbox a little bit? We’ve talked about maintaining independence for physicians a couple of different times in [00:23:00] a different ways.

Erik Sunset: There said it’s a little bit trickier. There’s a lot of headwinds. There’s a lot of really, happy news coming out asc, about the level of investment and the level of commitments. This is one of the rare places of service, and if you’re a regular listener of this podcast, you’ll hear, you’ll have heard me say it’s the only venue in healthcare where the value chain is completely aligned between the patient, the provider, and the payer.

Erik Sunset: It really doesn’t happen outside of the ASC. So in my own opinion, this isn’t a necessarily a doc equity opinion, but my own opinion is that more independent physicians is good for me as a healthcare consumer. It’s good for my family, it’s good for my friends. It’s good, really. To the overall system of healthcare in the US on which we spend 18% of our G D P every year, which is one whole other topic.

Erik Sunset: So this is a really long rambling lead into what would you do with your magic wands, Emily, to ensure that more physicians are able to remain independent?[00:24:00]

Emily Spooner: I think doing your research, I think there are so many opportunities out there for physicians, surgeons. To be able to take part in an ambulatory surgery center without a huge buy-in. I think there are so many opportunities to be able to sit on boards and to make those, make those ambulatory surgery centers better. I think they have to actually treat the patient how they think that the patient needs to be treated, the autonomy that is there. As an independent not dictated. To by necessarily insurance companies or by your employer on how many patients you need to see, how many surgeries you need to see, how many surgeries, certain types of surgeries you need to perform. Great patient care because you are able to have that one-on-one experience with them. And. Provide the best care for them, specific to them. Not this group of people is going to have [00:25:00] this kind of healthcare. But be able to have real relationship with your patient in an ambulatory setting, in a clinical setting. But being able to provide the best patient care for sure. And it’s, it’s for me. I when I have a patient leave here and they’re like, oh, I need to see Emily before I leave, and I need to give you a hug. Thank you so much for calling me ahead of time before my procedure. Thank you for Everything being able to have that one-on-one patient experience is so important to me, and I’m not a provider of healthcare.

Emily Spooner: I can’t imagine how that would be for the provider and how rewarding that would be to be able to treat this patient for exactly what they need, because they’re not a group of people. They’re one patient, and that care needs to be individualized.

Erik Sunset: Wow. What else can you say to that? That’s perfectly, perfectly put.

Emily Spooner: Thanks.

Erik Sunset: we’re kind of coming down the home stretch here, Emily, what, what didn’t we cover that you’d like [00:26:00] to? What else comes to mind when we’re talking about either technologies in the ASC, maintaining independence as a physician or as a facility?

Erik Sunset: What else is front of mind for you?

Emily Spooner: Well, I, I’m not sure who your audience is, but I am really educate the public. About ambulatory surgery and why they should choose to have their surgery done in a surgery center. And also maybe encouraging their surgeons to look at ambulatory surgery centers as another option. Some of the old don’t.

Emily Spooner: Go to ambulatory surgery centers as much as they possibly could. And then when they come, they’re like, oh my gosh, this is a whole new world. It’s so much easier. I don’t have to wait. I don’t have to turn over time. You know, all of those complaints that they hear, that I hear about them going to a hospital, but really encouraging the patients to use the ambulatory setting. To their advantage because there are so much out there that they don’t [00:27:00] realize. So one of the things that I’ve really been focused on is doing this web series called Emily and so Flow, we took it off of Emily in Paris and it’s I wouldn’t say it’s become super popular, but it’s really definitely getting the word out there.

Emily Spooner: And And things that we do. I think to the lay people that don’t know about healthcare and specifically don’t know about ambulatory surgery centers or surgery in general, why do you have to be fasting when you come for your procedure? What is to anesthesia and malignant hyperthermia?

Emily Spooner: What. Why do we have to have a driver, you know, all, all of these things. Just so people that what we’re doing is about safety and it’s about good quality healthcare. I really want these patients to know and to trust healthcare providers again, and if. By providers, I mean facilities after the patient trust went way downhill. So let’s, let’s bring it back to, [00:28:00] to where it should be, that there are people out there that really do wanna provide the best patient care. That really do care about your health, that really are going to listen to you and really do wanna educate you of why we do the things that we do and why you need to take the medications that you’re taking and, and, and all of those things that people actually do care. And, and that’s been my goal the last few months and, and I’m super excited about it. It’s really fired me up to do even more. And so that’s one of the reasons why I’m doing this. And that’s what I would say to everybody. Like, what else can we do to be able to educate these patients that this is, this is the way to go.

Emily Spooner: This is the safer way, this is the infection free. This is the these, this is the better care for them for most surgeries that are out there

Emily Spooner: nowadays.

Erik Sunset: Well, again, fantastically well put. I don’t have I will say, I guess I can add one thing that I’ve gotten to watch some of the Emily and so [00:29:00] flow very much worth your time, especially for those in the industry. You mentioned our audience, we have a lot of, a lot of industry folks in the ASC and the clinic and the hospital space.

Erik Sunset: We have administrators across all care settings, but there’s a lot more kind of friends and family that listen than than you may expect. So that awareness around the ASC and what you’re doing with Emily, and so flow, which you can find on YouTube by searching Emily and so flow. That is very much worth a share because the awareness around the ASC is what’s going to keep them around as long as possible.

Emily Spooner: Definitely. Thank you.

Erik Sunset: So with that, Emily, where can our listeners find more of you? Are you big on social media?

Emily Spooner: Yeah, we do have

Emily Spooner: a, a quite a big social media presence. So flow same is our tag on just about everything. For my surgery center specifically I have Instagram, so Flow Instagram where you can also see our TikTok, We have under So flow same day [00:30:00] and, and YouTube.

Emily Spooner: So it’s, it’s been a. Fun ride with the social media. It’s definitely was so out of my comfort zone when I first started and I was like, oh my gosh, I looked like such a nerd, but, but it’s really, it’s become a lot more

Emily Spooner: fun for me, so,

Erik Sunset: Yeah, the, the thing with that is nobody likes to hear themselves speak, and it might be even worse to see and hear yourself speak. I’m not totally over that after however many podcasts and videos and whatever else. So if you want to hear more from Emily live and in person, you’ll be able to see here at the Becker’s ASC conference, which is the beginning of October.

Erik Sunset: We’ll point you to becker’s healthcare.com for more information about that. As always, thank you for listening to the DocBuddy journal. To learn more about DocBuddy or our solutions, visit DocBuddy.com. Be sure you’re subscribed on Apple Podcasts or Spotify, and until next time, this is your host, Erik.

Erik Sunset: Talk to you [00:31:00] soon.