Dr. Alex Zusman: Unfolding Situation for ASCs THA/TKA PRO-PM

Erik Sunset: [00:00:00] All right. Hello and welcome back. I’m Erik Sunset, the host of the DocBuddy journal. Here at DocBuddy, we deliver healthcare solutions that take the pain and cost out of broker workflows like with Op Note, which gives ASCs and their affiliated clinics, the power of instantly generated operative reports.

Erik Sunset: You can learn more about that and all of our solutions at docbuddy.com. And we’re kicking off 2025 with a really cool guest today. We’re joined by Dr. Alex Zusman. Dr. Zusman is chief medical officer at the clinician where he oversees medical governments, develops clinical policies, and collaborates with product teams to ensure safety and compliance.

Erik Sunset: He’s also a board certified pediatrician who’s provided care at UCSF Benioff children’s hospitals, John Muir health. And Kaiser Permanente. Dr. Zusman, thanks so much for joining us today.

Alex Zusman: Thanks, Erik. It’s great to be here. Um, it’s a pleasure to be able to talk about things that I love, um, with your members in your audience.

Erik Sunset: And it’s, uh, it’s notable for some, for, for some that we are [00:01:00] closer than ever a podcast guest and, uh, the host of the show have been you’re, you’re in Miami as well, just across town. So I’m glad to have you, uh, in Miami Dade County. Uh, before we get into our show today, what else should listeners know about you and your work at the clinician?

Alex Zusman: Sure. Um, so, uh, my role in the clinician, as you mentioned, is the chief medical officer, and I like to think of myself, uh, as standing at the intersection of the product and the customer. Um, I like to add a clinical perspective to what most oftentimes ends up being a really technological conversation. Our customers and our clients tend to have Uh, clinical questions.

Alex Zusman: They’re seeking a clinical solution. They have a problem in their in their hospital, in their patient workflows, possibly in their surgery centers. And we’re looking to meet them exactly where they are. And so Adding a clinical perspective to the things that come up [00:02:00] is kind of where I see myself in my role.

Alex Zusman: Um, I’ve spent, you know, over 20 years in the clinical setting providing direct patient care. And I’ve also been involved with quite a few quality improvement, um, measures, um, at the, you know, departmental level, also at hospital level. And now I have an opportunity to kind of flex into, um, um, a technological space where We get to use digital health tools.

Alex Zusman: We get to leverage this technology to do bigger projects to do solve bigger problems. Um, we’re looking at regional public health, population health kind of, um, situations. And so, um, it’s a, it’s a real challenge, but it’s, uh, I welcome that and it’s exciting. Um, um, one of the main. areas of focus for, uh, our work at the clinician, which is, um, uh, the company that I [00:03:00] work for, uh, we’re based in New Zealand in Auckland and we are experts at, uh, prompts, which many people don’t know, uh, about, but PROMS stands for patient reported outcome measures.

Alex Zusman: Um, PROMS can be thought of as, PROMS Directly accessing the patient voice and so traditionally a patient and a provider will interact in the clinic or in a hospital or in a pre op area and there’ll be the interactions and there’ll probably be some notes and there’ll be documentation. These days, it can be found in an EHR, and that tends to be where the interaction stops.

Alex Zusman: And so, it will only be picked up again when a patient and a provider come back into contact. And so, there is a space in between the visits that is kind of open. We, at the clinician, have been, uh, We’re working very hard to develop ways to access that space and to engage [00:04:00] patients directly when they are not in the clinic.

Alex Zusman: This is something that we’re really good at, and we have a technological platform which enables providers, enables providers to hear the patient voice when the patient isn’t there. So this is a, this is a very powerful tool that can be used in a variety of different settings.

Erik Sunset: Well, yeah, and that’s, uh, that’s sometimes a very big blank space between either episodes of care or visits into the clinic. A lot of great reasons to have that interaction, whether that’s something related to value based care, potentially even practice marketing, and certainly don’t want to put words into your mouth.

Erik Sunset: But before we started to record, I really liked the phrase that you spun. There’s a situation unfolding for ASCs. around proms that nobody’s really talking about. And that’s what we’re here to dive into today. Can you give us a rundown on this situation?

Alex Zusman: Yeah. I mean, A. S. C. S. R. A. Pivotal, you know, component of our health care system. [00:05:00] And over the last decade or two, they have been absorbing more and more of patient care responsibilities. A lot of inpatient work that was previously inpatient is now shifting over to A. S. C. S. And so the burden of delivering that care and specifically the burden of delivering that care at a high quality.

Alex Zusman: Is now being placed on the shoulders of ASCs. Now, um, ASCs have to be equipped to handle this new burden. And so, um, when we’re talking specifically about, uh, uh, PROMs, um, you mentioned value based care. PROMs are a very important tool in the value based care, uh, toolkit, if you will. And, um, this is not new.

Alex Zusman: PROMs, PROMs are a tool. They’ve been, uh, uh, Collecting patient data and using that to assess quality for a while. Um, what’s new as [00:06:00] of especially for 2025 is that CMS, um, is now beginning to utilize proms in a way that they’ve never utilized, um, problems in the past specifically for patient care and, uh, ensuring the highest quality of care.

Alex Zusman: And what I mean by that is that for the first time ever, CMS is relying on the patient voice. which is transmitted via a prom or an instrument or a survey, um, to actually, uh, uh, develop quality improvement programs. And the capstone or the flagship program that CMS has been, um, rolling out now is called the THA TKA ProPM.

Alex Zusman: And THA is Total hip arthroplasty and TKA is total knee arthroplasty. Pro PM stands for patient reported outcome, PM is performance measure. And so, [00:07:00] um, what CMS is doing with this is fascinating. And they are using the patient voice and they are conditioning the payments to ASCs, payments to hospitals and providers. Based on what patients are reporting now, you may think traditionally quality measures were things like, did you get a bloodstream infection? Were you admitted to the I. C. U. Um, you know, was there, was, you know, uh, did you, did you, did you get readmitted within 30 days? These are these kind of objective measures that you can generally pull off of an EMR or, um, you know, a hospital administration kind of record.

Alex Zusman: What hasn’t been ever used before is, can this patient go up the stairs now? Um, how would this patient rate their, uh, their back pain or their knee pain? Or can they play with their grandkids, for example? And so CMS is actually going directly, [00:08:00] uh, to the patient and asking the patient, About their quality, about their, about how they feel, about how they’re doing post surgery.

Alex Zusman: And then CMS is sensing, if they’re doing well and you’re asking enough patients, you will get your financial payments. Um, and in addition to that, they’re also going to be, uh, adding this level of transparency, which is fascinating because they will be publicly reporting the results of these quality measures so that the public.

Alex Zusman: Can see what surgery center is doing and what they’re and how they’re performing and compare it to the one down the road so people will begin to vote with their feet. And so this is really going to hold A. S. C. S. This is going to hold their feet to the fire. I think so. There’s going to be quite a bit of work ahead.

Alex Zusman: Among other things that we can discuss that’s going to be landing on the plate of the ASC administrators and providers,

Erik Sunset: Well, like we said, this is a situation unfolding that hasn’t [00:09:00] gotten a lot of attention yet. And I know we’re going to talk about that. Um, we have many clients at the ASC, administrators, surgeons, they want the very, very best outcomes for their patients. That’s why they do it, obviously. That’s why they are surgeons.

Erik Sunset: And whether choosing to work in the ASC, you have that triple aim of health care all aligned. So then you have CMS, uh, bringing this news down that, by the way, we know you do good work. We see the cost data, we see the outcomes data, you’re getting as good or possibly even better care at the ASC than at an HOPD.

Erik Sunset: And that’s, that’s not really up for debate. There’s, uh, There’s data around that. But by the way, we’re gonna insert ourselves into this process when the patient’s not in front of you, by the way, and we’re gonna be collecting that data, scoring you on it and reimbursing you based on it. This has already happened to some extent in the inpatient setting, if I’m not mistaken.

Erik Sunset: What’s the reaction been there to this? Because as a, as a lifelong health IT guy, I can’t imagine too many [00:10:00] providers are all that thrilled about this

Alex Zusman: no, I think I think no one’s no one’s thrilled with more regulations and more mandates And as you said, this is now live and mandated for the inpatient setting so any knees and hips That are being done in the inpatient setting in the Medicare population. There’s some other eligibility criteria. Um, um, these, these cases need to be reported on right now.

Alex Zusman: Um, and there are financial penalties if you don’t report on enough patients. And as I mentioned, there’s going to be public reporting of the of the results. Um, At the moment, ASCs are under, or outpatient procedures are under a voluntary, they’re in the voluntary period, which means, um, that they’re being encouraged to collect data.

Alex Zusman: Analyze the data and report the data back to CMS. But at the moment, CMS is not publicly reporting the data and there are no financial penalties. [00:11:00] You can think of this voluntary period as kind of a dry run. And in the inpatient experience, the hospitals that participated fully Um, in the, in the voluntary period are the ones that are doing the best right now in terms of, uh, collecting the data and reporting the data back to CMS, because as you can imagine, this is going to entail a certain amount of infrastructure.

Alex Zusman: Um, if you think about the small and the medium sized ASCs out there. Maybe they don’t have all the infrastructure that maybe the larger ASCs or the larger ASCs, you know, um, national ASC, regional ASC networks already have in place. Maybe they don’t have dedicated staff. Maybe they don’t have, um, uh, the tech tools, the digital health tools to collect that data and to report it.

Alex Zusman: So it’s quite a bit of burden, especially on the small and the middle sized, uh, players. Um, but in the hospital, Um, the people who got a jump on [00:12:00] it, the people who got a head start, they were able to build up their workflows. They were able to assign their tasks. They were able to make all the mistakes, frankly, okay, before it counted.

Alex Zusman: And so right now, the ASCs are in this kind of unique period. They’re being asked to collect data, um, and, uh, so that they could basically get their workflows up and running. If you’re, if you’re in the ASC world, you know that on January 1st, 2025, OAS CAHPS also went into, uh, mandatory, um, uh, effect. And again, this is a patient experience measure, a little different than outcome measure.

Alex Zusman: Um, this is a patient experience measure, which is also going to be integrated shortly. imminently, I guess, into the A. S. C. Q. R. And so, you know, I’m not gonna mince words. I think the A. S. C. S are getting hammered right now. They’re getting hammered with regulations. They’re getting hammered with mandates.

Alex Zusman: And as the burden mounts, you know, you [00:13:00] are hearing people complain. It’s not fair. It’s too much too soon. Um, we don’t have e h r integration. Um, you know, it’s we need to test this a little bit more. And I think that, you know, I’m a provider and I think at the end of the day, I keep in mind that what is the most important thing here is the quality of the care.

Alex Zusman: I mean, what are we doing for our patients, right? You know, and it’s good for business too. You want to be the best. Think about this as an opportunity. You’re going to be getting publicly reported on. This is an opportunity to shine. You want to be the best in your region, in your neighborhood, in your state, or wherever, so that people flock to you for the procedures.

Alex Zusman: I mean, this is what we want, right? A business, but you also want to be providing patients with the best care possible. So, CMS is pushing ASCs in this way. They’re pushing them in this direction. And of course, they’re gonna have to go, [00:14:00] but at the moment, it feels like they’re going kind of kicking and screaming.

Alex Zusman: And sure, I get it, you know, this is gonna cost money. People are gonna have to, um, figure it out, right? And so, what ends up happening is this, uh, this new challenge is begging for solutions, right? And this is kind of what we’re working on right now at The Clinician.

Erik Sunset: Well, now I want to talk a little bit about EHR. You referenced EHR a couple of times, and there’s certainly some amount of parallel back to meaningful use. Not completely the same. I mean, it is very different, but still kind of CMS putting their foot down and saying, no, this is how it’s going to be or else, uh, this is all.

Erik Sunset: Reporting that, to my knowledge, isn’t something that the leading ASE EHRs have functionality around, you know, surveying, collecting surveys, and then being able to report on the results of those surveys. I don’t believe that’s functionality that, that currently exists. And depending on who you ask, depending on who you ask, [00:15:00] there’s some amount of penetration of EHRs into ASCs.

Erik Sunset: They all have a PM. They all practice management system. Not all of them have an EHR. And that penetration rate will vary, but this is something separate and

Alex Zusman: Yeah, totally separate and distinct. And like I said, this is the first time CMS is doing it. So there really hasn’t been a need. Well, welcome to 2025. And I think that if you look at the CMS language, what’s coming out of CMS Innovation Center, and this all started with the ACA back in 2010. There’s a pipeline of ProPMs coming.

Alex Zusman: This is now a thing. This is now a functionality that all providers, not just ASCs, not just orthopedics, um, are going to have to figure out. Patient reported outcome measures are going to just become part of the daily, what you need to do. It’s also part of good providing good care and good patient engagement.

Alex Zusman: Just always keeping the patient in mind here. But when you bring up [00:16:00] EHRs and the functionality of EHRs, absolutely, they’re very limited in this respect. And what we’ve learned kind of as we kind of are developing some products and learning about this space is that, um, the EHRs will respond and they will begin to incorporate, um, Disfunctionality, but only when people start asking for it. And so what’s interesting, though, is, um, in all of my conversations with possible customers or clients who are looking for solutions, um, to, to address this, uh, the CMS mandates. Um, one of the first questions they ask is, do you integrate with my EHR? Um, I feel like this is. Somehow been conditioned into, um, so we’ve got some sun on my face.

Alex Zusman: Uh, I feel like this has been conditioned into everyone’s dialogue where it’s something, there’s almost like this, um, this belief [00:17:00] that integration into the EHR is the, is a good thing. It makes your life easier. It makes your life more simple. It provides you with a better or more robust data, um, uh, data experience.

Alex Zusman: Um, but actually. It takes a very long time to implement. You have to do leaps and jumps and all the hoops to meet all the compliance and security regulations. And as you can imagine, every hospital has their own, every clinic has their own. Um,

Erik Sunset: Alex, I don’t have to imagine, by the way. I just want that on the record.

Alex Zusman: It’s expensive. Okay. It’s expensive. It costs more. Um, and it’s prone to problems, right? I mean, you’re multiple moving parts with EMR integrations. And so, um, I feel like this is the kind of like the old way of doing things. Where we sit down, we get an integration specialist and we bring them in and we start creating APIs and we start linking [00:18:00] into these, uh, these large, the Cerner’s and the epics and the, you know, all scripts of the world.

Alex Zusman: And sure, it’s very slick and, and, and it’s definitely doable, but I’m thinking about the future here, Erik, and I’m thinking about more and more ProPMs coming down the pipe, and I’m thinking about the burden and I’m thinking that as. Things get stacked on the shoulders of not just ASCs, but hospitals and providers across the board from regulatory bodies like CMS.

Alex Zusman: The need to have a simplified solution, okay, becomes more and more imperative. And what I mean by simplified is the need to have a solution which is almost independent from the EMR. Um, it becomes more and more relevant. And so this, this may be a controversial point, but when we talk about How we would like to position ourselves to solve these mandate challenges.

Alex Zusman: We’re actually focused on solutions which are detached [00:19:00] from the EMR. We’re actually looking at, um, non integration kind of, uh, uh, solutions. And one of the things that we’ve been trying to pivot toward is the SAS model. And the enterprise model, you know, is the of creating a solution is is very laborious.

Alex Zusman: It’s expensive. It takes time and it’s customized and they’re beautiful. I mean, with things that we’ve created, we’re very proud of. But think about the small and the middle sized A. S. C. S. And the small and the middle sized, um, providers out there. They may not have budget for a customized solution. They may not have time.

Alex Zusman: For a customized solution, they may not even have an EMR because I know there’s a pretty low EMR uptake in some of the smaller middle sized, um, ASCs, um, and providers. Maybe they have, like, like you said, practice management software. And so I feel like when you position ourselves to [00:20:00] create a SAS solution, which is EMR free, we actually position ourselves to create a very efficient and easy to implement solution.

Alex Zusman: And, and, and, and part of that is also cost effective because the price tag on these SAS solutions are a fraction of what the price tag on these enterprise solutions are. And so if you’re an ASC administrator, or if you’re out there trying to figure out what the heck to do with THA TKA, maybe you’re not familiar with SAS solutions.

Alex Zusman: Maybe you’re, uh, you know, you really are, you know, are, are, uh, committed to integrating with an EMR. I would just challenge that thought. I would just say, what about doing something that’s quick and easy. I like to think of it as the turbo tax of, um, uh, of proms or, you know, uh, CMS mandates, you know, before you used to go to an accountant, spend a lot of money, takes a lot of time to file your taxes.

Alex Zusman: These days, most [00:21:00] people can probably download TurboTax for 40 and probably finish your taxes in a week. And so I like to think of us as kind of moving toward a TurboTax model for these kind of solutions. And that’s kind of what I want to, I wanted to put forth because when we talk about EMRs, um, they lack the functionality.

Alex Zusman: They may or may not rise up to this level, but in the end, we’re trying to pivot away from the EMR.

Erik Sunset: That makes a lot of sense. And I, I mean, I, I see your side of it just as well as I can see the conditioned response of, Oh, it’s got to be integrated. But that really only saves you the time of entering in a patient name and I assume email to distribute the survey. So how much time are we really talking about here?

Erik Sunset: Not very much. And you go a step further. You mentioned it’s not necessarily every patient that had. A THA or a TKA, it’s potentially a subset or you only need to submit a subset of responses. I would imagine there’s a little bit of, uh, and don’t take [00:22:00] me out of context. I know you won’t, but listeners don’t take me out of context.

Erik Sunset: I would imagine there’s some amount of gamesmanship there where, you know, somebody who is not well to begin with has this procedure performed. That’s not going to reflect well on you because they’re nearly at that store to begin with. Whereas most of my panel that had these procedures performed is doing

Alex Zusman: It’s interesting. Interesting you bring it up, bring that, that point up. Um, um, CMS has a recipe and they have eligibility criteria. And it’s, it’s going to be very hard to cherry pick your patients,

Erik Sunset: okay,

Alex Zusman: um, for this specific mandate. Now, other, other ProPMs, other CMS programs. Maybe, maybe so. This one, they have eligibility criteria, and they have some strict reporting criteria.

Alex Zusman: And if you don’t report on the mandated number of patients, you will get hit with a financial penalty. So, I think providers and ACs have to be very careful about how they want to approach this. [00:23:00] Um, you know, because there’s a recipe, there’s very little customizations. Hey, you know, your providers can’t come in and be like, you know, I’d like to do this, but not that a CMS will have none of it.

Alex Zusman: And because at the end of the day, all the data that you collect on all the eligible patients need to be reported. And another piece of the solution that we’re working on is facilitating this reporting function. You can imagine what CMS is asking people to do is engage with patients before their surgery.

Alex Zusman: and after their surgery, collect data from before the surgery and after the surgery. I just want to point out that the time points are over a year apart. And so you’re asking an ASC to engage with a patient over this extremely long period of time. It’s, this is an administrative challenge. It’s a very difficult thing to accomplish, especially with ASCs that sometimes only interact with patients.

Alex Zusman: For a limited number of hours, really, or [00:24:00] during the procedure or with their providers, you know, it’s a one and done. And so, um, again, the lack of customization favors the SAS approach to the solution. This is not something that we’re going to sit around and, you know, discuss about, you know, what elements of the, of the medical record we’d want to include or not.

Alex Zusman: It’s prescribed. It’s just set. And so it’s an off the shelf kind of an experience. And that’s what we’re leveraging to create a digital health solution that will streamline workflow, right? That’s the whole point here. Create some efficiencies, create some cost effectiveness. Um, we really believe that, especially the THA, TKA, ProPM is right for this kind of a solution.

Erik Sunset: well, I certainly didn’t mean to suggest any sort of gamesmanship or cherry picking, but it sounds like there’s even less to think about since that’s an impossibility. It has to be really highly systematized. And then, [00:25:00] you know, the burden of this really falls to the patient because on the facility side or on the hospital side or the practice side, whatever it may be, you load up the hopper with email addresses, the surveys go out, and then we wait.

Erik Sunset: But I think about how many survey emails I get, how did we do? How did we do? And guess what happens to virtually 99 percent of the, virtually all of them, they just go straight trash. So what do you do as a facility to guarantee that you’re not guaranteed responsible, what can you do to elicit any type of

Alex Zusman: Well, you want to stack the deck in your favor. And, of course, CMS will allow you to do this in any way, shape, or form. You can do it on the phone, and you’re going to have people phone calling before or after. You can do this, um, through your EMR portal. Um, if it if it has that functionality, um, you can do this, um, in any way, CMS will allow you to collect the data in any way, but you should stack the deck and to address the issue that you raise, which is basically, you know, response rates.

Alex Zusman: What we call response rate [00:26:00] is you want to have a good, reliable and effective patient engagement, and this is where levering leveraging digital health solutions really comes into play. If you have something. You know, can reach your patient effectively. It makes it easy for them to answer these surveys, which like you said, 99 percent of the time gets deleted.

Alex Zusman: Go in your spam folder. Um, you get something in the mail, you don’t know what it is and it gets chucked with the rest of it. You really need something that’s going to engage the patient. And like I said earlier, can you imagine engaging a patient a year after the surgery? They may be like, what are these people even asking me about?

Alex Zusman: And so our, um, our idea here is that we create, um, a, uh, a relationship with a patient over time. It starts before the surgery and carries through, um, uh, through, but through the post op period. And we’re able to engage patients. [00:27:00] Um, while we’re developing our tools right now around THA and TKA, our response rates for our other products has been upwards to 70 to 80 percent with response rates.

Alex Zusman: And it’s important to mention that the financial penalties that CMS will enact. are based on the response rates. And so you can be an awesome surgeon and get an ASC and get great results and every one of your patients are happy, but you’re not collecting enough surveys. You’re going to get dinged and the ding is significant for inpatient.

Alex Zusman: It’s 25 percent of your annual payment update. And for ASCs, it’s going to be 2%, but with ASCs, there’s really going to be no way around this, this reporting requirement, because not only are they requiring it for the knees and hips, but they’re bringing this into the ASC QR. In 2025, 2025 or [00:28:00] 2026, the ASC 21 is going to be the newest addition to the litany of ASC QR, um, uh, data points that need to be collected.

Alex Zusman: I mean, I think if you speak to any ASC, they’re pulling their hair out with what they need to deal with to meet all the ASC QR requirements. Um, OAS caps on top of that, again, the burdens that are mounting. They beg, they’re begging for a simple, efficient and cost effective solution.

Erik Sunset: Well, this is kind of the, the other foot or the other shoe dropping, I guess, all of these procedures coming off the inpatient only list, uh, out to. Being eligible to be performed at the ASC. It’s a little, little give and take from CMS there. Some, some prior guests have suggested, and I happen to agree to an extent, that an EHR mandate is probably not too far away.

Erik Sunset: Unless they can get all the data they want out of, uh, patient [00:29:00] surveys such as this, and that’s, that’s actually a point of interest for me. How long is a survey? Uh, you know, as a patient, they get the survey. Is it a five minute bubble in a few answers? Or are we talking like a half hour thinking about?

Alex Zusman: question. Um, well, so there’s, there’s two time points. There’s the preoperative and the postoperative. The preoperative has more questions. Um, um, uh, CMS is collecting some, uh, extra data to risk stratify. And so this goes back to your comment about how my patients are sicker. So my results are going to be worse again.

Alex Zusman: CMS is not penalizing anyone for worse results. They’re penalizing people for not collecting data. They are collecting some, um, some data to risk strat, uh, risk stratify. So to create a case mix adjustment, so to speak. I think they have their own methodology and their own, Biostatistical models to do that.

Alex Zusman: You just have to submit the data. Um, but in terms of the surveys [00:30:00] themselves, um, the, uh, the, the mandate functions on the who’s junior for hips and the coups junior. For, um, these are surveys. These surveys are not lengthy. Um, I would, I’d say, um, on paper, you could probably fill one out in about, um, three minutes, three to four minutes, um, with a digital health solution that shows up on your phone as a text message or as an email that you can click on.

Alex Zusman: You could probably click through in about, um, one to two minutes. I think, um, that being said, yeah, If you speak Spanish, maybe you get an English survey and you delete it and it or you have to find someone to help you translate it. Um, and so that takes a lot longer. There’s 100 different obstacles that will get in the way of between you and filling out a survey, even if it’s a minute or two long.

Alex Zusman: But just again to reiterate these 1 2 [00:31:00] minute surveys. This is what CMS is using to determine if you get your money and if you can, You know, shine, uh, with this, uh, public reporting. It’s wild. I think it’s great. It’s a great effort to, um, to put quality at the forefront and in addition to put the patient’s voice at the forefront.

Alex Zusman: But there’s quite a bit of, um, figuring out that needs to happen. And so, um, you know, levering digital health solutions in this moment, I think is going to be the key. To any kind of long term strategy as more and more programs come out out of the pipeline and also, you know, helping, helping, uh, lift yourself up to become one of the best quality providers in your area and your network or wherever it’s good for business to

Erik Sunset: Yeah. CMS is the ultimate Yelp, uh, as a worker. So I’m not, I’m not sure how much of a policy wonk you are. You mentioned this came about with the [00:32:00] ACA 2009, I think. That was signed into law. What was the end goal? What was the stated goal of collecting all this data? Cause I’m sure. Uh, folks like the American Medical Association lobbied, I would guess, against this as it’s one more thing providers have to do.

Erik Sunset: I’m just guessing there. I don’t know. Why, why are we going through all this rigmarole to collect patient data? You know, looking back at time 15

Alex Zusman: Yeah. I mean, I think, yeah, yeah, going way back and I’m not a policy wonk. So I don’t, I don’t claim any area of expertise, but what I do understand about the ACA and kind of the climate of 2010 was that it all went down. It all came back down to value based care. And, um, Dr. Porter and the value based care, um, kind of ethos is essentially, um, creating the highest quality care for the lowest cost of care.

Alex Zusman: price, you know, the lowest cost. And so this is, this is, these are the driving principles of the A. C. A. Is just [00:33:00] again, delivering the highest quality care at the lowest cost. And so how do you do this? Um, There’s a variety of different, um, uh, I think practices that were implemented at that time. They all were kind of spinning out of the CMS Innovation Center.

Alex Zusman: Um, other, other programs which you may or may not have heard of, um, are accountable care organizations like ACOs. Um, that came out of, um, the CMS Innovation Center and the ACA. Uh, Merit Based Incentive Payment System, the MIPS. Um, came out of that too as well. These are all again, quality measures to increase quality, drive down costs.

Alex Zusman: Um, you know, the prioritization on quality metrics, patient satisfaction, care coordination, um, is, is, is, um, You know, these are priorities. Now here we are 15 years later, and they’re now implementing programs. I mean, that’s the snail’s pace. I think that we work on. [00:34:00] Um, there is, um, there’s quite a few propions that are coming out, um, and through the pipeline, which are going to be focused on care coordination, leaving the hospital coordinating with your primary care provider, there’s gonna be lots of financial incentives for people to work on that care coordination piece.

Alex Zusman: And so, not a policy wonk, but my impression of the ACA was, we need to up the care, up the quality, and drive down the costs. And, you know, programs like the THATK ProPM, that’s what they’re gunning to do. Okay? Now, doesn’t mean it’s easy, doesn’t mean it’s not gonna cost money, doesn’t mean it’s not, it’s gonna create headaches. What I would say is, um, can’t bury our heads in the sand. Um, you know, I know we have a new administration coming in. I’ve heard people say, maybe this is all going to vanish. I don’t know. I think that’s a little unrealistic. Um, you can’t just delete [00:35:00] this, these things as quick, you know, these types of things as quickly, but I think it’s inevitable. You know, I think it’s inevitable. And you know, what I would suggest is that we. We pivot away from kind of throwing our hands up in the air and, you know, crying foul, and we support our providers and our ASCs by giving them the best tools to get the job done, um, the best tools to avoid financial penalties, um, and the best tools, like I said, at the end of the day, to elevate the quality of the care being delivered to the patients. You know, at least for A. S. C. S. Inpatients already in the mandatory phase, but at least for A. S. C. S. The time to start is now we’re in the voluntary period. You know, there are no penalties. There’s no public reporting right now. There’s a great opportunity right now. Let’s create some efficient workflows.

Alex Zusman: Let’s explore digital health tools. Um, and get get the compliance dialed in, you know, before it becomes mandatory. Everyone’s going around crazy trying to figure something [00:36:00] out, you know, last minute.

Erik Sunset: Yeah, now, now’s the chance for the running start and I want to, I need to editorialize for a second. Misspoke! I, uh, Reference the ARRA, which included the High Tech Act so often. That’s 2009, you’re spot on. ACA is 2010. And you also mentioned a dog whistle for me, which is MIPS. The success I mean, you’re the exact right guy to ask about this, that a long time ago was in the practice EHR space.

Erik Sunset: We have pediatric offices wondering why on earth they’re asking five year olds their

Alex Zusman: Yes, yes.

Erik Sunset: That’s a dumb question. Now, pediatricians treat patients all the way through to 18 and, you know, they, they might have some smokers on their panel. So I’m not saying it’s an outright bad measure. What you’re describing with ProPM though, seems a little more thoughtful than asking, you know, little Susie, you know, how many packs a day do you smoke?

Erik Sunset: What are your, what’s your take on that?

Alex Zusman: Um, well, I mean, I’m a pediatrician and I have, I have, I’ve encountered a lot of, [00:37:00] you know, in pediatrics, we say, um, the kids are not just little adults, right? We, um, they’re kids. And so, yeah, there needs to be pediatric specific stuff. And, um, Yeah, they’ve, they’ve, they’ve kind of messed things up, I think, um, from time to time.

Alex Zusman: Um, uh, Erik, can you repeat your question again? I missed that last part of it there. I got into the pediatrics piece.

Erik Sunset: It was, it was bait for you. It was too juicy to pass up, but when you look at these older measures around meaningful use and MIPS, and that’s the example that comes to mind for me asking a five year old child if they smoke or not. Hopefully the answer’s always no. I would imagine there’s an exception to that, but when we look at that as a mandated quality measure to ensure you retain the integrity of your Medicare payments versus what we’re talking about with pro PMs for THA and TK, it seems a little more

Alex Zusman: Oh yeah, for sure. And, and it’s interesting because as I’ve been diving into this pretty deep, I’ve always [00:38:00] been struck by the fact that we’re just talking about orthopedics right now. And, um, you know, I think it’s orthopedics are an easy target. Um, even before this came out, it’s very interesting.

Alex Zusman: Michigan. Has a program very similar to this called marquee and they have been collecting state. level data in this way. And so, um, orthopedics. And so my point in bringing that up is to say that, um, this is, these procedures are, um, uh, uh, have been worked on from a quality point of view now for quite a while.

Alex Zusman: Um, also these are somewhat discrete events. You get a knee and that’s, should be the, you know, that should be, we’re done with that procedure. Um, as opposed to chronic conditions where, you know, you’re going to. You have this long, um, uh, relationship with a provider. Um, so I think that, um, I think these are more thought out.

Alex Zusman: I think that, um, there’s going to be expansion [00:39:00] of ProPMs from CMS. I think there’s going to be more and more patient voice injected into quality improvement measures across the board. Just some, I, um, just some examples really quickly, um, which are not necessarily ASC focused or not necessarily knee and hip focus, but, you know, for 2025, it’s going to be a big year.

Alex Zusman: Um, there’s going to be team, which is transforming episodes, accountability model, this is going to take five different episodes from the inpatient space. It’s going to be everything from coronary artery bypass. to GI surgeries. It’s including knee and hip as well. Spine. There’s one more off the top of my head.

Alex Zusman: I can’t remember, but these are going to be about coordination of care. There’s going to be guide, which is another program that focuses on dementia. There’s going to be transforming maternal health, the TMAH program. And this is going to be focused on, um, uh, maternal [00:40:00] health and obstetrics. There’s the information transfer propium.

Alex Zusman: This will affect some of the surgical specialties because again, coordination of care. This is about how they did. I think it’s six weeks after their surgery, and were they given the right information, post op care, and the details? Um, there’s quite a few of these measures which are coming out. Um, so it’s a, it’s an exciting time for PROMs in the world.

Alex Zusman: Um, it’s an exciting time to be developing solutions to tackle these kind of, um, mandates and these kind of propriums that are coming out of CMS. Um, it’s a great time to be a patient because your voice is going to be heard. You know, it’s a tough time to be a provider, um, because you’re being asked to do more things.

Alex Zusman: So we just need to get smart. We need to get the right tools, you know, like, just like, um, you need, uh, you’re, you’re building something. You need the right tool to build it. Um, you need the right tool to, to, to meet these, um, new requirements. Yeah. [00:41:00] Yeah.

Erik Sunset: Well, this is a huge tangent, but we’d be curious to get your thoughts on this, that I’ve had, uh, many guests on to talk about value based care and the one that sticks out most of my mind is Dr. Dan Blumenthal. He’s been on the show a couple of times, chief medical officer for CVA USA. So somebody that knows a thing or two about value based care.

Erik Sunset: Quality care, value based care, rather, I’m paraphrasing. So we’ll have to point you to the episodes to hear exactly what he said. But in the value based care programs that he oversees and has helped to launch with CVA USA, some of the challenges he has are around patients being accountable for their own health outcomes.

Erik Sunset: And this is a, this is a big discussion, right? Socioeconomic impacts on health. I’m not going down that path. Paths specifically. But do you think these, these problems and this pro PM requirements are going to be a way to spur patients into taking more interest into their own health outcomes in the, the ethos now is I go to the doctor, I get a medicine and, you know, that’s kind of it, I [00:42:00] take the medicine.

Erik Sunset: I didn’t stop smoking. I didn’t stop eating fast food three times a day. I mean, that’s a, that’s a big issue though.

Alex Zusman: I think it’s really interesting. And, you know, I’m sure there’s a variety of opinions on this, but I feel like the more involved that a patient is in their care, the more involved the patient is in their care. And I think that what’s interesting about PROMS is that it is changing the paradigm because, you know, the paradigm, I think, and from the old school provider point of view is that providers talk down to patients.

Alex Zusman: They have all the knowledge, they have all the information, they come up with a plan, and they transmit that to the patient. They create, they, they create the bridge to over the information gap, the knowledge gap between a patient and provider. Now we’re getting the patient’s voice. And the patient’s voice begins to matter.

Alex Zusman: And so, for example, I’m sure you could envision a situation where a patient would go to see your, uh, a provider for follow up every six months for a condition or maybe [00:43:00] every year. And between those two, between those visits, the patient voice wasn’t really being heard. So maybe they had a horrible time during that time, during that interval, but no one accessed that patient voice.

Alex Zusman: Now we have a way and we have an interest in collecting that patient voice. It gives the patient a level of empowerment of, you know, an individual empowering of the patient to be involved in their health. And I think that can only benefit the patient. Like I said, this is for value based care. This is supposed to increase the level of quality of care.

Alex Zusman: It’s going to raise an alert. When there’s a problem. And so, whereas patients may have been going to the ER to deal with their problems in between, you know, set visits now a provider might actually say, Hey, you know, we got the survey back from a patient because we’re on this or because we as a provider group created a quality improvement program, which leverages problems [00:44:00] they’re having an issue.

Alex Zusman: Let’s bring them in. Let’s, let’s, let’s be proactive about it. And let’s get in front of this. This is preventative health. This is public health. You do this on the, on a large scale, and then you’re doing population health. It could screening, it could be any level. It also keeps providers accountable because there’s benchmarking.

Alex Zusman: Okay. And so the traditional benchmarking might be how many surgeries you did or how many readmissions you had, or how many, you know, surgical site infections. Now it might be, you know, how’s your patient doing? Like, are they happy? Um, do they have, do they have the functionality that your surgery or your treatment was supposed to restore?

Alex Zusman: And I think it’s a little morbid, but You may have heard of this. It’d be like, oh, the surgery went really well. It was a success, but the patient died. So there’s two perspectives there, right? And traditionally it’s always been about the provider where great surgery, everything went great, but the outcome was bad.

Alex Zusman: [00:45:00] Now we’re getting a little feedback from the. And that, that knowledge gap, that knowledge gap is actually being bridged by the patient. The patient’s voice is now being heard and it’s becoming part of the care. And I think that moment, we’re, I don’t know if we’re at, we could be at a tipping point, but bringing the patient’s voice to the level of the doctor’s voice here is, I think, paradigm shifting.

Alex Zusman: Um, and so. Um, you know, this is what value based care is trying to do, raise the quality, um, and at the same time lower the cost. Um, so I, I do think, I do think that this, this hopefully has great potential to, uh, to, to move us into a different space, uh, with quality.

Erik Sunset: I think you’re right. And even though pure patient accountability for their own outcomes is maybe a pipe dream, it does offer the provider at least a chance for an intervention. Hey, we got this response back and there is a problem. [00:46:00] Please reach out and come back

Alex Zusman: Yeah. And we have several examples, uh, uh, programs that we’ve been working on that, um, that have flagged. patients for early intervention. Um, we have several examples of programs that we worked on where, um, uh, we’re doing remote symptom monitoring. Um, there’s a really interesting program that we’re involved with, which is actually flagging chemotherapy side effects.

Alex Zusman: And allowing providers to early intervene on chemotherapy side effects, allowing them to get more chemotherapy is a side effects would prevent you from getting the chemotherapy. They said too many side effects to stop. They’re getting more chemotherapy. They’re treating the cancers more aggressively.

Alex Zusman: They’re saving lives because of that. That’s fascinating, right? This is all because of a survey that was sent out. You know, so there are lots of potentials, um, for proms in the space and for quality. [00:47:00] Um, you know, I think I mentioned benchmarking where providers, you know, will be measured against one another.

Alex Zusman: This is where, uh, you know, you’ll look at, you’ll look at all the providers in a network and you have some outliers. Why are you? Why are you here? And everyone else is here. You know, um, evidence based. There’s lots of evidence based standards out there. And so, you know, keeping people in in their lane and creating systems to ensure quality from benchmarking is hugely important as well.

Erik Sunset: Hard to argue with that. And as we get to the, uh, the end of our block, you’ve been so generous with your time. We got to say it one more time. We’re in the voluntary period now for ASCs. What do they need to be doing now? And when isn’t it voluntary?

Alex Zusman: Uh, yeah, so we’re in the voluntary period now for ASCs and for outpatient THATK procedures right now is a perfect time to be developing your workflows, searching out solutions that are going to work for [00:48:00] your, uh, systems, um, building that infrastructure, figuring out how, when CMS, you know, starts to, starts to collect mandatory, um, uh, data from you, that you have everything in place and you’re not scrambling.

Alex Zusman: Um, look, look for the solutions that are going to work for you. Um, I encourage everyone to, uh, stay open to the idea of SAS solutions, which are quick, cost effective, easy to implement and very, uh, and you know, very, very amenable to the THATK ProPM because there’s no customization. Um, and yeah, now’s the time to act.

Alex Zusman: For sure. Um, the mandatory period, uh, reporting, I believe in 2027, it could be crossing over to 2028 for outpatient providers. So there is a little time, but now is the time to act. Definitely would encourage that.

Erik Sunset: I’ll just, I’ll just add to that. All of our clients who are EHR users prior [00:49:00] to the beginning of meaningful use. Had no issue. There were many that bought at the last minute at the end of a eligible reporting period, lost money. So I totally echo those sentiments. Now is the time to get it sorted out.

Alex Zusman: Agreed.

Erik Sunset: And with that, where can listeners connect with you either on LinkedIn, across the web, where would you point folks to learn more about you and the

Alex Zusman: Yeah. Um, the clinician, uh, we come to our website, theclinician. com. Um, uh, as I mentioned, we’re a value based care, uh, PROMS focused, uh, digital health company. Um, it is, um, uh, able and willing and ready to help, um, A. S. E. S. And providers with solutions, um, the leverage digital, um, uh, capability across a variety of different, um, um, uh, situations.

Alex Zusman: Um, also, you can find me on LinkedIn. Um, Alex Zusman. Z as in zebra. U. S. M. A. N. And you can connect with me there.[00:50:00]

Erik Sunset: As always, we’ll get those links into the show notes. Alex, really appreciate your time. Thank you for joining

Alex Zusman: Thank you, Erik. It was great to be here and really appreciate the time.

Erik Sunset: We’ve got a standing invite to come back. And on behalf of the entire DocBuddy team, I want to thank you for listening. Be sure you’re subscribed on Apple Pods, Spotify, and YouTube so you always get the newest episodes of the show. Until next time, I’m your host, Erik. We’ll talk to you soon.