ASC Finance Insights, Managing Costs w/ Rena Courtay

Erik Sunset: [00:00:00] Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy, we deliver healthcare solutions that take the pain and cost out of broken workflows like Op Notes, which gives ASCs the power of instantly generated operative reports approved from the point of care. You can learn more about that and more at DocBuddy.com

Erik Sunset: Today, we’re joined by a special guest, Rena Courtay. Rena is VP of ambulatory surgery at Trinity Health, and she’s also a member of the ASCA board of directors. In addition to being a long time ASC experts, Rina, thanks so much for joining us.

Rena Courtay: Thank you for having me, Erik.

Erik Sunset: It’s going to be a lot of fun to have you on the show. And we are, I know everybody at DocBuddy is really looking forward to the upcoming ASCA annual conference two weeks away. And this is an event that you are once again, speaking at. What can you tell us about your talk without giving too much away?

Rena Courtay: Well, you know, my talk is this [00:01:00] year is titled finance basics for clinicians and being a nurse, it’s kind of near and dear to my heart because in nursing school, like medical school, you don’t learn about finance, really at all. And then you get in health care. And if you become a leader of any sort, you need to be learning about finances.

Rena Courtay: And how that impacts the bottom line and how what you do as clinicians impact the bottom line. And we have a lot of, you know nurses running ambulatory surgery centers. And sometimes they got those jobs by default. Sometimes, you know, they, they, they were running the operating room or they were running the pre op PACU and then all of a sudden they’re the administrator and nobody’s told them.

Rena Courtay: Hey, half of, like a lot of your job is financial management and fiscal, fiscal responsibility, fiduciary duty to the partners and all these things and, you know, they’re like an income statement and all those type of [00:02:00] things, they, they just don’t know. They don’t know about those things and how the different things they do impact that.

Erik Sunset: Absolutely. And you know, in your experience, and again, without giving too much away, because we are just a couple of weeks away from ASCA, what are some of the biggest blind spots you see other than just, Hey, how do I even read a PNL? You know, what’s a balance sheet?

Erik Sunset: And I

Rena Courtay: you know, and one of the, you know, staffing, what, you know, I see a lot of common things, but staffing’s like our biggest cost right now. It is, you know, it’s the biggest cost percentage of your net revenue. And a lot of them don’t even, you know, it’s like, Oh, how do you get the net revenue?

Rena Courtay: Let’s start with that. But, you know, when you’re talking about expenses staffing, you know, people oftentimes, especially nurses, and I’m a nurse, So I know this happens. They staffed the place for peak volume. Well, on this day we needed, you know, all of our operating rooms are running and we need this many staff.

Rena Courtay: So then they hire that many full time [00:03:00] staff. Well, what do you do on the next day when your volume is half what it was? Or, you know, because in ASCs, the volume fluctuates. Every ASC, no matter how busy it is it fluctuates very frequently. So, so you have to learn about that and how that impacts and how, you know, how your labor hours per case, how that impacts your financials.

Rena Courtay: So that is one thing, supply costs, you know, how, you know, especially if you come from a health system, a lot of times you, you know, you’ve worked in an environment where you get whatever the doctors get, whatever, especially an academic medical center. That’s the worst one. Where, oh yeah, they get whatever they want to get.

Rena Courtay: And we have to be very cognizant of our supply costs, how that affects what’s, what are we getting reimbursed for. And that’s all stuff they may not know when they become an administrator of a surgery center. if they’re coming from the nursing field. [00:04:00] So how do they figure all of that out? Another big one is, you know you open a new ASC or you buy new equipment, you take out a loan and you finance a lot of money.

Rena Courtay: Well, yeah, that, you forget about that. It’s not really in your inventory. You know, it’s under the line, but when you’re talking about cash flows and distributions to your physician partners, it’s very impactful. And, you know, we, I bought centers in the past where the doctors can’t understand, and nobody understands why.

Rena Courtay: They’re not profitable because, you know, their supplies, their staffing and all that is in line with their, well, well below the line you’ve got this much in interest payments, so you’ve got to generate that much cash to pay for that before you can pay, you know, before you can give a distribution.

Erik Sunset: it goes a long way to having that financial literacy with the administrator within the practice. [00:05:00] I’ve, I’ve seen this in the past and I don’t know how widespread this experience is, but like doc, yep, you know, we have to service this note. There’s this much cash needs to come in before any cash can go out to anybody. Who told you that? Was it the accountant? I don’t think so. Call them again. Tell them they’re wrong. It’s like, well, no, because that’s how it works. We don’t need to call the accountant and get a second opinion. This is how finances work.

Rena Courtay: Right? I mean, the cash is the cash. It’s like, you know, even though we use accrual based accounting, and that’s another thing people often don’t understand. You know, the accrual based accounting, and I’m, I don’t even know that I’m going into that with my talk, because that’s a little more advanced talk.

Rena Courtay: But, you know, how, how does that work, and how, how the supplies you order, and, You ordered them that month, then, you know, you have to accrue for those expenses, you know, they don’t, that is especially coming from physician owned centers, people don’t often, cause physician owned centers usually work off cash based accounting.[00:06:00]

Rena Courtay: So then you get into all that, but I don’t think I’m getting into quite that much detail this time.

Erik Sunset: that’ll, that’ll be the level two talk. After the event for the day is over. You can find Rena at X, Y, and Z spot. She’ll

Rena Courtay: we can talk about that any more detailed talks.

Erik Sunset: Well, and some of the things you’re hitting on I’m not sure that it’s, it’s ever been any different. However, the ability to project and to measure and track, because you, you talked about some pretty important things staff staffing for given block time, utilization of surgery hours and operating versus the cost of supplies versus the reimbursement that you’re expecting Expecting is a key word there.

Erik Sunset: You can have a pretty good idea, but guaranteed is maybe a little bit too strong, but you have all these forces coming together and we hear from ASC administrators that there are certain types of procedures that are going to be a loss. if you’re not looking ahead and you don’t understand that that’s a possibility.

Erik Sunset: So in, [00:07:00] in, in that sense, what can you do to stave that off or what technology and what data do you need at hand to be confident that every procedure you perform will put you in the black?

Rena Courtay: Yeah, and that is a really important thing. And, and you have to educate people dramatically, you know, it’s educating your staff, your business office staff, the surgery schedulers at the doctor’s office, your scheduler at the surgery center, the surgeons, because, You know, if they’re investors, hopefully they care about these things.

Rena Courtay: They don’t want to bring cases that are going to lose money at your place. And then if they’re not an investor, you, they, they may just find that you’re not going to do that case. Cause it’s going to be a loss. So you’re going to say, sorry, you have to go somewhere else for that, but you have to understand all of your payer contracts.

Rena Courtay: And you have to understand the ASC Medicare fee schedule. Cause that typically it’s a minimum. I’d say no matter where I’ve been, it’s a [00:08:00] minimum of 25 percent of your business is Medicare or Medicare advantage, which is basically the same reimbursement. So you have to understand it. And typically that’s going to be the floor of your reimbursement.

Rena Courtay: So you, if you know what that is and you know that you’re not going to make money on that on Medicare. You’re probably not going to, you know, then you can look at other things your commercial cases. Are you going to make money on that? You may, because Medicare doesn’t pay for implants, for example. So you know, you have to understand all this.

Rena Courtay: What I like to do is, you know, have a pretty detailed kind of, I, you call it a cheat sheet. I call it a stoplight report, but it has for every specialty or an ortho, every subspecialty because there’s. Those are very different. Orthopedics is not just orthopedics because hand, total joints, sports, foot and ankle, all those things reimbursed [00:09:00] very differently.

Rena Courtay: And so, and the costs are different. So you have to, you know, put your most common CPT codes on this thing, put all your payers, your main payers and Medicare. And then I, I came up with the system to, I just color code that for offices, and if that CPT code is green, that’s good. You can do it. If it’s yellow, then we need to talk about the implant cost.

Rena Courtay: If it’s red, you really don’t want to do that here. So to try and help educate and make it easier for people to figure out what they can and can’t do at the office and at the surgery center too. And then, you know, educating people on the costs of the case. Physicians usually, if they come from a hospital, they have no clue what anything costs.

Rena Courtay: And why would they?

Erik Sunset: No, it’s fair.

Rena Courtay: But when they come into a surgery center, hopefully they want to know this stuff [00:10:00] because they’re an investor and they have, you know, they care about it. And they should care anyway because it’s overall about the cost of health care in the U. S., you know, and how high it is. And they can be drivers of that.

Rena Courtay: And also, if they’re too high cost, as I’ve told many of them in the past, they’ll get, the insurance company may find you’re too high of a cost provider. They don’t want you in their network.

Rena Courtay: You know, they’re measuring these things. So, so, you know, really educating the physicians on the cost and the reimbursement.

Rena Courtay: I, whenever I onboard a new physician at, at a facility, I recommend that. At sitting down, I mean, it takes a couple hours, go through all this stuff with them so they know and keep them updated on, hey, this is what, and we may call you about this case because it’s too expensive. And we need to see if you could use something else, or is there an alternative?

Rena Courtay: What can we do? Because we want to do the case, but we don’t want to do the [00:11:00] case at a huge loss.

Erik Sunset: Well, with again, everything confluence of factors, the insurance reimbursement, the cost of the implants, just your cost to have the lights on and have people in the building working for you. Your stopper at stoplight report. Sounds like it’s bringing together a few of these different pieces of data. I would imagine it takes less time than you would think to put it together.

Erik Sunset: Not to say that it’s fast, but or necessarily easy, but I would imagine that comes together pretty readily. And then you’ve got sort of a bulletproof. System to know like we really can or cannot do this procedure or want

Erik Sunset: to do

Rena Courtay: it, it’s a really helpful tool. I have to credit one of my orthopedic vice chairs at Duke for helping me think of that. And then I just sort of came up with the format, but she was like, we need something to, to help the offices, you know? And I’m like, okay, what can we do? And, and that’s sort of how we came up with that, to make it [00:12:00] simple.

Rena Courtay: Cause they don’t need to know the actual reimbursement for every single. But if you put in the Medicare reimbursement for the CPT codes, then you at least have the, usually have the floor, except for maybe Medicaid. Medicaid’s usually worse, but you’ll have, you know, it gives you a good idea of where you are with those CPT codes.

Erik Sunset: for, for our listeners out there. And many of them are in the ASB, ASC space. Maybe don’t have the level of support that you provide to your centers. So the reimbursement data is pretty easy to pull together. That should, that ought to

Erik Sunset: be in your, your PM system or search for your, through your file of contracts for things that you’ve signed and accepted. How can you figure out the cost to the center fairly

Erik Sunset: easily?

Rena Courtay: And that’s, you know, that is a piece that is, A little more challenging. I mean, we haven’t used a lot of electronic inventory systems or anything like that at at ASCs. I, it’s getting a little more prominent depending [00:13:00] on, you know, if you’re part of a management company or a health system, maybe you have more resources on that.

Rena Courtay: front. It’s typically been, you take the preference cards of the doctors and you know, you cost out everything that’s on there. And it’s a man, been pretty manual process. Sometimes there are people have loaded them into their patient accounting systems and you have to keep up the pricing, you know, of that.

Rena Courtay: It’s a lot of manual work when you don’t have an, an automated, you know, barcode scanner or something like that to manage inventory. It’s, it’s. Manual, but it’s really important, at least for the higher cost cases that you are on the edge with, you know, especially orthopedics, because a lot of it is Medicare.

Rena Courtay: And, you know, if you’ve got a hand surgery, this happens a lot, and the more technology we come out with, and little gadgets, and whatever, And you’re gonna get paid $1,400 for that from Medicare. And you’re using, [00:14:00] you know, two products by a certain manufacturer called tight ropes and they’re 800 and some dollars a piece.

Rena Courtay: And then you put a nerve graft shield on there and it’s like 2,500. I mean, you’re at like $4,000 for three things and that you’re only getting 1400 for the case. So these are the kind of things that easily happen. And you don’t always know, because you, the other thing that happens is reps come in and they give the doctors things in the case that you didn’t even know were on their preference card.

Rena Courtay: And you have to have a process in place to eliminate that from happening. Because if it, if it wasn’t okayed by you and the administration of the surgery center and that got brought into the O. R. and utilized without anybody’s A. O. K., then my stance on that is that rep needs to eat that.

Erik Sunset: [00:15:00] Either that or consent to a strip search. The next time you walk into my facility,

Erik Sunset: make sure you know what you got on there.

Rena Courtay: kind of stuff happens a lot because there’s so many reps in the OR with orthopedics, especially,

Erik Sunset: Oh yeah,

Rena Courtay: you’re coming in with all kinds of things and some, you know, you get them, you’re like looking at what is this, who, who said you could use that here, you know, and the doctor doesn’t know, and they don’t even know how much it costs.

Rena Courtay: They’re like, Oh, yeah, that looks cool. I think I’m going to try to, you

Rena Courtay: know,

Erik Sunset: Well, that, that, that prep card exercise is interesting. Not only just from the kind of the accounting or the projecting and cost on the procedure side of things, but I would imagine that yield some dividends to like pay doc, you know, this prep card hasn’t changed in a decade. Like, what’s going on?

Erik Sunset: We can do better than all these. You tell me, because I don’t work in an

Erik Sunset: ASC.

Rena Courtay: Well, and then the other thing that’s really good, if you have a, a few doctors in a given specialty, or even like in ortho, like it’s got to be the sub specialty then [00:16:00] you can, you know, benchmark them all against each other, and for similar cases, that’s a great method that’s tried and true. Hopefully you have a Better electronic.

Rena Courtay: If you had Epic, it’s easier to do. Honestly, that’s one benefit of something like that, but you can do it. And if you had a bunch of ophthalmologists, I mean, that’s a real easy one. And you, you know, you’ve got a cataract. It’s a cataract. You have ten ophthalmologists, and you do their average cost per case, and you show it to them at a meeting.

Rena Courtay: Well, none of them want to be the highest cost per case.

Erik Sunset: Oh no.

Rena Courtay: They don’t like that. And especially when you show it in a group like that, and then, then you just get them talking to each other about what they could do. And you just really have to set the stage for it. And then they start having these conversations with each other about what can they do to lower their costs.

Rena Courtay: And even, then they [00:17:00] went, well what about this? What about that? Ortho does it, I’ve seen it, it’s fun, and I like to sit there and watch because they, you know, they know what they’re using and why they’re using it and what the alternatives, and then they’re talking about techniques, you know, surgical techniques oftentimes.

Rena Courtay: Well, you could do this, what about that? And it really spawns a lot of great discussion, and that’s a really good way to reduce your costs. It’s have them engaged in things like that and show them where they fall. as relation to each other in given cases.

Erik Sunset: And we all know the

Rena Courtay: We did that. My last total joint program at Duke, the docs were great.

Rena Courtay: They wanted to know every month we, we updated the data every single month as to the cost per case for hips and knees for each doctor. They wanted to send it out to every doctor. So every doctor sees. every month where they’re falling [00:18:00] in terms of the total cost for their implants and supplies. And they also wanted to include stuff like the, you know, the length of the case and all these other things so they could really watch each other.

Rena Courtay: And I tell you, I didn’t have to do much, but they all lowered their cost of care over a year. I mean, just like it just kept going down by doing something like that. And they weren’t even owners. But they were very engaged in this, you know, because they wanted to lower their cost of care.

Erik Sunset: public scoreboard for even a moderately competitive group is such a powerful tool, and there’s not many surgeons I know that are only moderately

Erik Sunset: competitive,

Erik Sunset: so.

Rena Courtay: and especially

Rena Courtay: ortho. Ortho is number one competitive, because they’re usually, they were usually in sports, very active in sports in school, and may, may have played sports in high school and college and all that. So they’re, they tend to be a really competitive [00:19:00] group.

Erik Sunset: And that’s awesome. When they’re bought into the mission of the center and competing with each other for, you know, the best outcomes, the best outcomes with the least expensive costs, I imagine is a pretty sought after title,

Rena Courtay: Right, and you know, it’s not the, because we don’t want to, obviously have lower quality or bad patient outcomes or do things that are detrimental to patients or, well, this is not as good. You know, we would never want that. Not as good as not what we’re looking for. We just want to have the best outcomes with the, you know, and the most cost efficient.

Erik Sunset: highly optimized, I think is the, the phrase we should be using there and in that, in that same vein, when you look at the the adoption of technology by ASCs, that curve is steepening. I mean, Obviously ASC is spared from any type of meaningful use type law. At least for now, there’s kind of some whispers out there. But it’s exciting to, to me to see ASCs freely [00:20:00] adopt these electronic health records and other digital workflow tools in their centers, aside from sort of the basics of better record keeping, better quality reporting, being able to submit data to registries more easily, those are kind of like the no brainer, like, yeah, of course, any EHR is going to help you do that. What do you think is the most exciting aspect, though, sort of beyond the basics, Rena, of starting to see ASCs really wrap their arms around tech?

Rena Courtay: Well, you know, the EHRs are getting more common in ASCs because the cost to get in on the on the main ASC EHR platforms, which there are only really a couple that are truly for ASCs, you know, they’re, they’re seeing, oh wow, it’s not going to cost us that much more to get to implement the EHR piece. They may have already had the patient accounting software from those vendors, you know, and then they can add on the EHR and it gives you just so much more opportunity to aggregate your data, look at your [00:21:00] efficiencies.

Rena Courtay: You can have so many more templates set up and, and shortcuts, I’d say, to standard documentation. You know, your patient estimates and things like that can be more automated. You’re, hopefully you’re using online patient registration and things like that that make, that’s a, a huge time saver because And we’ve been using it for years in many ASCs, but a lot of people weren’t, and you know, you, the average time on a phone call for a pre op phone call is like 20 minutes.

Rena Courtay: That’s like, you know, 20 minutes. That’s one person, 20 minutes, times however many patients you have. That’s a lot of labor. To ask. questions that you could get the patient to submit online, obviously. So hopefully you’re doing that and you know, if you don’t, you should investigate it because having the online patient registration with these [00:22:00] EHRs too, they can do online scheduling.

Rena Courtay: You know, the offices instead of calling and, you know, hey, you know, talk, they can put it like into a depot or whatever, and they can, you can schedule online into the block time or open time that’s available at the center instead of having to be on the phone. And maybe you didn’t get your phone call answered right away.

Rena Courtay: And. You know, it’s just a way, it’s such a time saver for a lot of these things. And I think the more we can use it, the other thing is patient communication, getting texts to patients and to keep, where family members keep, to keep updated on what’s happening. You know, or let them know whatever you want to let them know.

Rena Courtay: You can even, some places I’ve heard of are using those texts to determine if the patient needs or wants a post op phone call in person. Or they can just reply to the text. [00:23:00] Everything’s great! instead of people having to call. So there’s just a lot of ways you can use it to limit, to limit labor hours at your center.

Erik Sunset: just said a moment ago is like a dog whistle for me. That’s a lot of labor. So 20 minutes on the phone on average pre op per patient, not to mention talking to your practices and making sure You know, operative reports get routed where they need to go. Only healthcare, only healthcare. And thankfully healthcare is, is evolving and moving away from this, but it has been the classic healthcare fix.

Erik Sunset: Just hire somebody, they’ll do it, hire another person when they run out of bandwidth, not only is that not a great ethos to operate any type of a business, whether it’s a business that cares for patients or not. But now you can’t really do that. A lot of centers are having a lot of difficulty hiring and retaining staff.

Erik Sunset: They’re either competing with their, you know, their friendly neighborhood health system, or the talent pool [00:24:00] just has seemingly dried up for them. Obviously technology can help you curb some of those issues if you’re using it the right way to need less FTEs. But do you have any thoughts on like, what is actually going on and what can centers do to navigate this weird hiring sort of paradigm we’re in right now?

Rena Courtay: Well, one thing that’s really important, and I see a lot, people, you know, they look at total FTEs. Well, you also have to look at your total salary cost because are your licensed professionals, your nurses, are they practicing at the top of their license or do you have them spending tons of time on things that have nothing to do with their nursing license?

Rena Courtay: You know, such as, you know, taking patients to their car in a wheelchair taking vital signs, taking, you know, doing paperwork, all kind of things that aren’t really needing to be done by an RN. [00:25:00] You could hire nursing assistants. You can hire patient care assistants. You can hire other people to do a lot of these things.

Rena Courtay: Even at, even at charge entry, they have nurses spending a lot of time on that. Why are we having nurses do that? Editing in time, you know, anything that’s paperwork related that’s not charting, you know, that they have to do, obviously. But other paperwork stuff putting charts together. Why would you have nurses doing, I mean, you know, just all kind of things that we do in surgery centers that, because we want to limit FTEs, but are we thinking about using the, the licensed staff at the top of their license and you won’t need as many of those.

Rena Courtay: And those are the people that are making the most money in your surgery center. I just reviewed a, a report yesterday about all the average nursing salaries in all 50 states. And it’s gone up. I mean, it is, it’s a [00:26:00] great time to be a nurse, I guess. You know, as it always is, you can always get a job. It’s a great profession.

Rena Courtay: But, you know, a lot of states are above 100, 000 a year for average nursing salaries. Just staff nurses. So you know, you have to figure out a way, just like anesthesia, we have to think about anesthesia in a different way, or we’re not going to be able to afford it.

Erik Sunset: Yeah. And that’s, that’s the other big piece of the puzzle. We talked about case profitability with utilizing block times, right? Having staffing there, understanding reimbursement supply costs. Anesthesia though, you know, unless you’re one of the lucky, very lucky few that has, I guess, employed anesthesia working for your center, you know, you have a lot more to think about if you’re dealing with an anesthesia partner.

Rena Courtay: You know, it’s interesting because, like I said, I’ve been doing this for a really long time and we were insulated at ASCs from anesthesia subsidies, you always knew hospitals were [00:27:00] paying subsidies to anesthesia groups because OB coverage, all the different things, they’re just pay or mix, whatever, at hospitals and they’ve paid those subsidies, but ASCs until very recently were not really having to pay subsidies for anesthesia and now it’s pretty much the norm

Rena Courtay: if you need anesthesia and even I talk to my friends at very busy surgery centers, they’re having to pay.

Rena Courtay: very large subsidies because the anesthesia salaries have just gone through the roof, especially CRNAs, and their reimbursement has gone down since the, you know, balance billing acts and things like that really kind of eliminated them using out of network models.

Rena Courtay: And that’s where they were making up a lot of, you know, revenue on the, on that out of network side and they can’t do it anymore.

Rena Courtay: And unfortunately, Medicare pays them. I mean, like it’s a pittance for what they [00:28:00] do. It’s literally three to four times less than a commercial payer will reimburse them. And it doesn’t even cover. The salary of a CRNA, a Medicare, an hour of Medicare is way less than they have to pay one CRNA, you know, so it’s just the math doesn’t add up and that’s why we’re seeing all the subsidies and so you have to really, that really pushes you at a surgery center to, to schedule in a vertical manner and not a horizontal manner so

Erik Sunset: Right. Well put.

Rena Courtay: Yeah, because, you know, you’re paying for all these people, and you’ve got to pay for their whole day, whether they’re there for one case or ten.

Rena Courtay: So you have to really think about, okay, how can we do this coverage, and how do we schedule to, so we’re not, you know, losing money on anesthesia, because it’s become a very large line item.

Erik Sunset: Well, I, I tell [00:29:00] you something right now, I’m hoping to bump into some folks that are much, much smarter than me at ASCA and that won’t be too hard to do, but especially just to talk anesthesia because that. It serves the system right. And I don’t mean Medicare. I don’t mean the federal government. I just mean the whole system, everybody that’s involved in this. What did you think was going to happen if you decide you’re going to pay less, pay less, pay less, no surprises act, which I have mixed emotions on as healthcare consumer myself and my family

Erik Sunset: is. But then on the other end, like what, how did these Folks supposed to pay back their tremendous medical bills and earn a living for the service that they provide. It just

Erik Sunset: doesn’t make sense. Like if this is a total disalignment of the incentive chain,

Rena Courtay: it really is. And anesthesia. I mean many anesthesiologists are some of my best friends and I mean, they’re indispensable to surgery. Obviously,

Erik Sunset: I’m not having any surgeries that anesthesia

Erik Sunset: I’ll tell you

Rena Courtay: mean, I don’t think obviously the surgeons are bringing the [00:30:00] patients, but our anesthesia colleagues are key and critical to what’s happening.

Rena Courtay: And we, you know, they’re It’s just become challenging. So we have to help help them and work out solutions where we can continue to do what we do in ASCs at a, at a, in a cost efficient manner.

Erik Sunset: cost efficient and ASC is a place where it’s a win, win, win for patients, providers, and. And even our friends at the payers. And that’s what you have to do in dealing with anesthesia is be really savvy with your schedule. Like you said, schedule vertically, not horizontally.

Rena Courtay: And you also have to look at your payer mix. You know, if it’s really heavy on the Medicare, it’s going to be a problem. You know, you have to, Evaluate that. Do you have enough commercial payers to offset, you know, in some markets, especially in Florida, where I know you are, there’s, you know, the highest Medicare markets in the nation are in some of the counties in Florida, [00:31:00] where 70 percent of the population have Medicare or Medicare Advantage.

Rena Courtay: So, you know, it, it just depends, where you go to Orlando, it’s 25 percent. You go to, you know, some of these other counties, like Naples, where a lot of retirees are, and things like that, and other areas of the country, the more Medicare you have, the harder it is for anesthesia.

Erik Sunset: Absolutely. Yeah. Here, here on the East coast, we’ve still got a pretty healthy mix. West coast, as you said, Naples, Fort Myers, maybe not so much Fort Myers,

Rena Courtay: Not too much, but in Naples. And then you get up, you know, in the central Florida and a lot of those retirement communities up there, north of Orlando, north of Tampa, some

Rena Courtay: very

Erik Sunset: can’t forget about our friends at the villages.

Rena Courtay: Yes. The villages, there’s, you know, north of Tampa, there’s count County la citrus County that supposedly is the highest Medicare population per capita of [00:32:00] any county in the nation.

Erik Sunset: Not a great place to be an anesthesiologist in 2024.

Rena Courtay: you, so yeah, you have to figure out, you know, how you can make that happen and be creative in solutions that are obviously safe, but you know, think it may change. You have to change your thoughts on anesthesia delivery and, and how that’s done.

Erik Sunset: Absolutely. And I, I know we’re we’re wrapping up our time together here. Rena would love any thoughts that you have on AI in healthcare.

Rena Courtay: Well, you know, it’s the hot topic on everybody’s mind and it’s on every. media outlet, you know, how are we doing? Of course. But I think in terms of ASCs, there’s a few things that that we really could benefit from right off the bat, which one is robotic assisted surgery, which we do, do, do now. Mostly I would say in ASCs, it’s more of the orthopedic variety, but, you know, That has a lot of [00:33:00] advantages for patients and because they use AI and determining preoperative, using medical records, imaging and things like that preoperatively, it, it influences the surgery directly and may result in better outcomes for patients and those are great.

Rena Courtay: So that’s one of the things that looks, when you look at these technologies, that’s, that’s One of the top potential annual value drivers, you know of AI and then the other one is Administrative workflow, which we’ve talked a little bit about, you know How burdensome is that you can do a lot of things with AI to help reduce?

Rena Courtay: Administrative workflow it could be you know templates. It’s for dictations for For operative notes all kinds of different things that could be used to improve administrative workflow and then on the back end billing and collections and just [00:34:00] some leaving messages for people, getting information from them.

Rena Courtay: It all doesn’t have to be done by a person, you know, it could be done by AI.

Rena Courtay: So those are great ways. And then virtual nursing assistants, you know, that are calling, giving, like you, if you, I mean, maybe some set instructions or something like that, you know, you can give and a lot of places are employing virtual nursing assistants.

Rena Courtay: We haven’t done it yet in the ASCs, but it might, it might be coming.

Erik Sunset: I imagine it’s coming down the pike. Everything you just lined out was less labor throw less labor problems. I would tend to see it your way. I didn’t hear any suggestions around. What do you need a doctor for? You

Erik Sunset: just stick somebody in front of Chad and ask

Rena Courtay: no, it’s, it’s funny and there’s articles out there that you can, you can find about, you know, using AI in the wrong way, which would be you know, I read one, but written by a friend, I think it was in [00:35:00] Time Magazine, and it’s, you know, it was a whole case study about Somewhere that had used AI to deliver laboratory results and pathology results.

Rena Courtay: Well, that’s okay, maybe. If they’re normal, but, you know, I don’t think I want to get a call from a robot telling me that I have cancer. And I need to see A hematologist or an oncologist or whatever, you know, so we have to be careful because you still, you still need that human factor in these kind of things.

Erik Sunset: That is obviously I’m laughing at the absurdity of that. None of anybody’s cancer diagnosis. That would be that would be pretty shocking to get that

Erik Sunset: phone call.

Rena Courtay: Yeah, it was a real case study. It was kind of shocking. So I wouldn’t, I wouldn’t say we want to do that, but,

Erik Sunset: Take me off that

Rena Courtay: great great opportunities, I think to, again, improve efficiency and decrease labor costs.

Erik Sunset: Well, well put hard to argue with any of those [00:36:00] points, Rena. And then. The thing that we ask our guests at the end of of every show, what is the one thing that you wish every surgery center would either know or do?

Rena Courtay: Well, I think one thing, I think we know this, but we have to keep it in top of mind that ASCs It, we in the industry of ASCs know this, that we’re critical to the, to delivering the triple aim in healthcare, and that’s to improve the experience of healthcare, improve the health of populations, which we’re doing by getting them back, getting them surgery, getting them back to movement, if it’s orthopedic surgery, back to what they do, back to quality of life, and reducing per capita costs of healthcare, because it’s imperative that we do that.

Rena Courtay: And when you look at the spend we have in the U. S. per capita compared to any other industrialized nation. But we as ASCs are a big part of the solution,

Erik Sunset: I love it. And if you’re a listener of the [00:37:00] show, you’ll know that we fly the ASCA flag as high as anybody. We had Bill Prentice on last year for those who may not be familiar with the leader of ASCA. If you have a friend that doesn’t know what you do for surgery centers, and this is both for you, Rina, obviously, and for our listeners, tell them, tell them about a surgery center because that awareness is a key piece to continuing down this road

Rena Courtay: absolutely. And we’re saving billions of dollars for the Medicare system. And we could save billions more the more codes that get

Rena Courtay: added,

Erik Sunset: that’s getting started. Yeah. We’re whittling down that IPO list and it’s, it’s all good things.

Rena Courtay: absolutely.

Erik Sunset: Rena, as we wrap up here, where can our listeners connect with you? Are you big on any social media?

Rena Courtay: I’m on LinkedIn,

Erik Sunset: Okay.

Rena Courtay: so, and I do, I get a lot of messages on there and I do reply to them.

Erik Sunset: I know we are out of time for you, Rena, and on behalf of the entire DocBuddy team, I want to thank you for listening and for you, Rena, for joining the [00:38:00] show, be sure you’re subscribed on Apple podcasts, Spotify, and YouTube.

Erik Sunset: And we will talk to you on the next episode of the DocBuddy journal.

Rena Courtay: Great. Thank you so much for having me.