Getting Tech in Your ASC, Why Data is King with Katie Pierson DNP, RN, ONC, CASC

Erik Sunset: [00:00:00] Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. This is episode 42. We’re recording it on November 8th, 2023. I’ve got a very special guest with me today. It’s Katie Pierson. She has a long list of accolades, Doctor of Nursing Practice, Registered Nurse. She’s got the orthopedic nurse certification and she recently achieved her CASC cert, which is the Certified Administrator of Surgery Center.

Erik Sunset: Congrats on that, Katie.

Katie Pierson: Thank you.

Erik Sunset: She has got an obviously strong background in healthcare. She’s got experience managing joint replacement programs, administering ASCs, and much, much more, all based in Austin, Texas. Thank you, Katie, so much for joining us today. How are you?

Katie Pierson: I’m doing great, Erik. Thank you so much for having me today.

Erik Sunset: It’s my pleasure. We’ve we’ve threatened for a long time now. It’s probably been about a year. We’ve threatened a long time. We’re going to get you on the podcast. You got to share some of your expertise and I’m so glad we can finally make it happen.[00:01:00]

Katie Pierson: Me too. Thank you so much for forcing, I mean, allowing me to be here today.

Erik Sunset: You got it. Anytime. Well, you know, the, the bulk of our listenership on the DocBuddy Journal is sort of housed in that ambulatory surgery center vertical or. Place of care, I guess would be a better way to put it. That’s an area, you know, really well, and we’re coming up on another, essentially another new year.

Erik Sunset: We’re less than a quarter away from getting into 2024. The topic of technology in the ASC has never been hotter. We’re sort of seeing a sea change where everybody knew they needed to have it. And some were using it. But now you’re getting into a reality where you really have to have it. How are you seeing this shift unfold from your perspective in an ASC?

Katie Pierson: Yeah, it’s a really good question. Having spent the beginning of my career in the hospital setting and then moving into the ASC setting about [00:02:00] six years ago, I had assumed That ASCs would have been more progressed in technology because they’re a newer setting for healthcare, right? So they’ve been around since what, the seventies where hospitals have been around since, I don’t know, longer than I can even imagine right now. And yet you walk into any hospital and they’re. you know, undoubtedly is going to be a EMR of some sort set up. And yet you walk into most ASCs these days, and that’s not the case. So I have just found it really intriguing and of course challenging, but in a good way to say, you know, why are we behind the ball?

Katie Pierson: And how do we get this? This arena up to speed in technology because they’re missing so many opportunities for efficiencies for you know, return on investment in, in regard to reimbursement, you know, from the [00:03:00] payers you know, time, time is money in healthcare. So I’ve definitely seen the challenge of, you know, how do we, how do we get the ASC setting up to speed? And I’m assuming a lot of it is due to the fact that they don’t necessarily pull in the same amount of, you know, money as the hospital setting, right? They just don’t have that, that capital to spend as, as easily as, as a hospital setting.

Erik Sunset: Yeah, I think you’re spot on there. And, you know, it remains to be seen if Medicare and if CMS issues any sort of mandate for the ASC, you know, as procedures come off that IPO list, especially the cardiologic type stuff, Medicare may have a change of heart and say, you know what, since we’re reimbursing.

Erik Sunset: You you guys here in A. S. C. Lane, maybe it’s time for us to get a little bit of data back out. We’ll see. I don’t have a guess there.

Katie Pierson: Yeah.

Erik Sunset: But when you look at the lack of tech in A. [00:04:00] S. C. You mentioned efficiency and for me sitting on the vendor side, I hear about some of the work flows from administrators and surgeons and clinicians and think Oh my gosh, you are running your surgery center with a a boatload of post it notes and handwritten things jotted down all over the place and just cannot fathom that that is reality.

Erik Sunset: And you know, I’m obviously joking. There’s some hyperbole there. What are some of the lowest hanging… Oh no, well don’t tell me that. Don’t tell me that.

Katie Pierson: no, there, there, there’s, there’s truth to it for folks though, right? There’s, there’s truth to it for some people that. this, that’s the way they’ve always done it. There’s, that’s the way that it’s always been done. So for them, there’s always this assumption that they’ll work faster with their binders, with their post it notes, with their paper. And the real challenge is helping them Reimagine the way that they work, and that’s [00:05:00] probably been the biggest shift that I’ve come across for some people to say, no, we need to literally start all over again from what you need to accomplish in your day and use the technology. To serve that because I have walked into facilities now who have quote unquote adopted technology and but what they’ve done is taken their piece of paper and turned it into a computer program instead of looking at as You know, what, what is the, what is the program capable of to help me function for the day? That’s, that’s probably been the biggest thing I’ve seen in that mind shift of paper to technology. I just wanted to add that.

Erik Sunset: I’m glad you did. You can have the same type of digital silo as you do like a paper silo to get really into the vendor speak with you. But with, you know, what we’re talking about is efficiency. What are some of the lowest hanging pieces of fruit that you think tech can [00:06:00] bring to an ASC? Just in terms of simple efficiency, getting things done faster.

Katie Pierson: Sure. I think adopting an EMR is is always you know, One of the best things you can do, but also vetting to make sure that your EMR is not a piece of paper that you’re just turning into technology and then building it out to meet the needs of your, your facility and trying to find a program. That’s going to be all encompassing. I know that’s really hard to do, but the, you know, people don’t want to go to 18 different programs to, to complete their job for the day. So really trying to find something that will meet most of your needs. Of course, there’s not like a all. Everything, you know, pretty packaged right now out there.

Katie Pierson: But you know, some of them are, are trying to, to get there. So I think an EMR, if there’s anything that, that would be something I’d say is first because it’s going to benefit so many people. Your physicians, your, your staff, you know, like the, [00:07:00] so many folks will buy into that and, and, and adopt that faster than they will just a single you know, I’m thinking about logs. You know, to turn binders into logs, who does that really benefit at the end of the day? More the administrative folks,

Katie Pierson: you know, so it’ll be harder to get your stakeholders to agree to buy something like that, although it’s usually cheaper to so really, it’s hard to say answer this because it depends on much money do you have to spend? What is it that you’re trying to accomplish and you know, who, who’s excited to adopt the technology, you know, is it your administrator or is it that new nurse that just came from the hospital that’s like, I had an EMR and I need an EMR again, or is it the doctor that says maybe that same concept of I’m at the hospital.

Katie Pierson: All I have to do is click a button and everything is translated for me. So I think it really just depends on who’s, who’s chomping at the bit to get something adopted and then kind of take that and run with it.[00:08:00]

Erik Sunset: want to pick at that a little bit more on the, on the surgeon or on the provider side of things, because you’re, you know, you’re a surgeon, you’ve got an orthopedic practice, or you have your own clinic based practice and Medicare has essentially mandated you to buy and use an electronic health record.

Erik Sunset: They’re not cheap. They don’t save you time. They’re not your favorite thing about your job. And in fact, the data shows it’s usually your least favorite thing about your job as a provider. How do you, how do you get a surgeon excited about technology in the ASC when they’ve been snake bitten, you know, everywhere they’ve turned from their clinic to the hospital.

Erik Sunset: And now the ASC is going, Hey, we want to implement an EHR. What do you tell that doctor?

Katie Pierson: If you can do it before your center even opens, it’s a lot easier than trying to throw it in there once things are already going. I’ve been a part of both of those sides and I can tell you that, you know, if you’re opening up an ASC, just kind of building it into the day and into the [00:09:00] expectation typically is, is much more appreciated and, and accepted. And and also I hate to say it like this, but I guess it depends on the experience of technology with your physicians to you know, some, some of these newer docs, again, they’ve, they’ve come out of school, they’ve learned on the computer, they’ve only charted in hospitals on the computer. So it’s kind of like nursing too, where now you throw them a piece of paper and they’re like, ah, you know, I don’t know what to do with this because I’ve never learned how to. Dictate or hand write an entire chart. So I think, you know, that that’s kind of dependent on it. But otherwise starting slow is the way to go for those that are a little more apprehensive, you know, maybe just starting off with their op notes or just starting off with, you know, click, click here for your orders or click here for your immediate op notes.

Katie Pierson: I can tell you my guys now, We’re just finally getting to the last pieces of utilizing our [00:10:00] EMR for them. Because, you know, it just, it takes a minute if they’re not utilizing it all right, right from day one.

Erik Sunset: Sure. That that makes total sense. Obviously if you’re de novo facility, just. Buy it and that’s how, that’s how we’re doing it. No question about it. And what about Let’s turn our attention a little bit to the administrative side of the house. Obviously there’s some amount of technology you essentially must have.

Erik Sunset: You have to be able to schedule patients, capture demographics, maybe be able to bill things that you’re doing at the surgery center. So there’s sort of a baseline where the clinicians can maybe get away with more. Or more of a lack of technology, I guess phrase that correctly. What’s going to make an administrator the happiest or most excited in a technology sense of their facility?

Katie Pierson: I don’t think it can be emphasized more that data is king, and it’s really what drives the administration side in all aspects, actually, I was [00:11:00] going to say financially, but, you know, outcome based to determine really what are we going to focus on in the next six months, year. So really any, Any kind of analytical program that you can get going is, is ideal. You know, some of these EMRs have analytics built into them. So it’s also knowing how to use it, you know, because it’s, It’s, it’s one thing to say that you have it, but then to also understand how to use it, how to, how to get the information, what are you looking at making sure that the data is clean, of course which is sometimes a struggle because it’s usually user dependent on the, the data going in for the data coming it’s, it’s. For example, same day cancellations. I’m just going to use that as an example. So on our scheduling system, it was capturing it. But I wasn’t sure if the number was correct. So for a month. [00:12:00] I had to manually track it. I’m like, just for one month, let’s make sure that this is, this is accurate. Because, you know, be careful of trusting all technology as well. You can always double check it, you know, with a manual process there, but anything, anything to, to give you data to help support, you know, your processes to support purchasing, to support you know, cause. a lot of these EMRs too will have, you know, to your point billing in, in it as well. So you can kind of see on a daily basis, what have you collected?

Katie Pierson: What do you need to collect? Cause that’s really what we’re, what we’re held accountable towards is the money coming in. And then from money going out perspective, you know, are you utilizing anything like a QuickBooks or, or something like that to be able to, to track that I can, Go in 10 different directions with that answer.

Katie Pierson: So I’m going to stop there for a second.

Erik Sunset: Yeah. Take, take a [00:13:00] breath. That’s, I mean, that’s that really is a display of your expertise in the field because you’re, you’re, you can go in 10 different directions. I know one of the things I hear often from administrators is concerns around case profitability, and that has many. More layers to it than even I’m consider myself a conversational in, but it goes from the purchasing at a good price.

Erik Sunset: To them making a decision that this is the implant to the device that we want to be using for a blend of outcomes and financial reasons. How do you see data or how do you use data to help drive decisions related to case profitability?

Katie Pierson: Yeah. Historically, that’s been a very piecemealed process. I know one or two of the EMRs out there right now has worked really hard at getting that as a more automatic thing for administrators to be able to see if I do this case, How much money will we make on it? But to your point, it [00:14:00] really just comes down to understanding what are all the costs that are gonna be associated with that, that case, you know, from staff to supplies to the implants, and then, you know, what is that payer gonna pay you depending on what, what that patient has.

Katie Pierson: But honestly, it’s been, that’s, that’s definitely been a challenge out there because to your point, that’s what drives the business is. You know, what are we going to get on this case? We’ll do a hip injection that we’ll get paid 10 on versus a spinal cord stimulator implant that pays like 30 grand, you know?

Katie Pierson: So it really, it does make a big difference and it’s something that all administrators need to be Very privy to when they’re looking at their schedule and seeing, you know, what, you know, what does this day make sense from a profitability standpoint and you know, it really depends on what technology you have available to you to, to get it. So if you’re creating spreadsheets to say, typically we get paid this because this is our implant [00:15:00] cost, you know, that might have to be where you, where you go right now, because I don’t know of any. outside of an EMR system that really helps you determine that. And maybe we can put something together and make a billion dollars, you know?

Erik Sunset: Sign me up. it’s that easy too. Yeah. No, but you know, this might be a little bit more of a philosophical point and put you on a soapbox, which I’m trying to do here. But in terms of trends with payers, when you, when you look at the ASC, you’ve got the very rare win, win, win. for the providers and their facility, the patient, and then the payer, you have a cost savings versus inpatient care, we’re not getting care at all, and then you end up with very good outcomes, how, how dare a payer pay next to nothing and risk profitability for cases, which obviously we We in healthcare don’t want to be [00:16:00] too shy to talk about profitability because without it, you don’t get to turn the lights on.

Erik Sunset: You don’t get to open up your facility every morning and treat patients. It has to make money. So how dare a payer risk putting you into the red on a procedure that a patient needs done.

Katie Pierson: Well, I guess that kind of brings us full circle from the beginning of our conversation where I said in hospitals, I always see technology and then I come into the ASU setting and it looks like I’m back in the 1980s and I can only imagine that part of that is driven by the fact that they don’t get the same reimbursement as hospitals on many cases. You know, I mean, let’s be honest. Politics are big driver into this. Hospitals have a huge thumb down on the payers and there’s a lot of work. There’s a lot of lobbying that’s being done to get the ASC procedures better reimbursed. [00:17:00] I’m very excited about the CMS rule that just got passed.

Katie Pierson: Was that last week? That, you know, that approved 11 procedures instead of just that one dental case. So I think we are making a little bit of headway. However, you know, we’re definitely still way behind in the times. And unless you have folks that. really understand it and then can take the action to the pay or see.

Katie Pierson: We’re also still such a small component of health care, so they’re going to spend their time and money and energy on the bigger areas like the hospital systems. And until until we keep fighting or, you know, make, I don’t know, until we all band together, it’s still very segmented in that respect to, you know, that even the each state is so different in the way that they’re handling how to approach the payers and how they’re approaching you know, the federal government on getting reimbursed.

Katie Pierson: Because again, it depends on your relationship with [00:18:00] hospital systems. Some ASCs are. partnered with hospital systems. So they have to be very careful in how they’re navigating those conversations because they don’t want to lose out on some of the benefits of being a partner with them. So really, I mean, yeah, it can, it’s going to take a minute.

Erik Sunset: Yeah. And you, you hit on one of the keys. We had the ASCA CEO Bill Prentice on earlier this year, and he shared that the biggest challenge facing the ASC industry is just visibility and recognition. So I’ll I want to share a plug for our friends over at ASCA, which is the Ambulatory Surgery Center Association.

Erik Sunset: If you want to get involved at least with the annual conference. They are going to host in Orlando in 2024 visit, visit ASC association. org because they are fighting a good fight for our, all of our friends in the ASC space.

Katie Pierson: Yeah, it’s really exciting to hear about those 11 approved procedures. Hearing Bill just speak last month [00:19:00] about it at the Becker’s conference and how, you know, they’ve done a lot of work to try to help CMS understand the importance of getting those procedures approved. So I’m very grateful for their work that they’re doing. And Cara Newberry too, of course, is always such a great resource there as well. She’s fighting the good fight.

Erik Sunset: Yeah. Thank you to our friends at ASCA national and for all of the state ASC contingents as well. let’s change gears a little bit. We’ve talked a lot about technology and technology should be a way to ease folks workload, but it isn’t always. So, Katie, in your experience and in your estimation, how can technology help combat things like physician burnouts, staff burnouts, and just a general healthcare sort of malaise that’s fallen over the industry post COVID?

Katie Pierson: I have to a really good question because [00:20:00] really depending on how you’re utilizing the technology, it can help you or hurt you. I have had the opportunity. to experience it in both capacities in that by clicking a button, most of my work gets done, you know, it’s automated. I just have to fix anything that’s not right and I can move on with my day. Whereas I’ve used another system where I have to click into 15 different areas and it’s just so convoluted and it honestly doesn’t make any sense. So sometimes I wonder Who comes up with this stuff? Because I’m like, we’re utilizing technology but not in the way that it should be utilized. And it gets really frustrating as a frontline worker because you’re trying, you’re working towards the computer instead of towards the patient.

Katie Pierson: So I think anything we can do to make it easy, right? Make it, keep it simple, make it [00:21:00] easy, make it so, you know, most fields are already populated and you only have to Chart by except, you know, chart, chart things that aren’t actually there or whatever. The more that you can do that, the more your end users are going to be open to utilizing the technology. Other than, you know, otherwise having to type an entire paragraph out for each section doesn’t make any sense these days. Make it clickable, make it easy. I use my phone, I use apps for everything. Everything’s pushed towards me. I’m not pushing towards it. So, that’s, that’s, That’s probably what you want to be looking for, at least in utilizing technology, otherwise people are going to get angry very quickly.

Erik Sunset: Well put. And, you know, speaking again on the vendor side of things, You used to hear, Oh, my doctors aren’t good with tech. They they’re tech illiterate. They’re afraid of the computer. It wasn’t true a decade ago. And it’s even less true now. Everybody wants [00:22:00] technology to help them. Nobody wants bad technology though.

Erik Sunset: Why would you? Because once you’ve, once you’ve seen and used good tech, that’s the way it should be for everything. So looking at

Katie Pierson: expect. We expect good tech. So you put a piece of tech in front of us that looks like it’s from 1990 and we are complaining about it, whining about it, trying to get rid of it as soon as humanly possible. So yeah, we are, we’re very needy in that respect now that we, we like to have the latest and greatest because it’s, it is always evolving and now even more rapidly every day, right?

Katie Pierson: It just gets. It’s faster, it gets easier to use in so many other aspects of our life. So you hear of programs now that are trying to emulate Amazon for supply management, right? So it’s, it’s anything you can do to try to make our work world function similarly to our personal health care technology world.

Katie Pierson: So that’s what I’m. [00:23:00] Seeing for sure,

Erik Sunset: that company, you just better hope Amazon doesn’t get interested in supplies for ASCs because that one.

Katie Pierson: because

Erik Sunset: Potentially be revolutionary.

Katie Pierson: I mean, Amazon started off as a bookstore, right? So who

Katie Pierson: knows what, what they’re, they’re capable of anything. I’m convinced of that.

Erik Sunset: Yeah. Incredible logistics there. Well, let’s, let’s get out the crystal ball here, Katie. We’re going to get out the crystal ball, light a few candles. We’re going to try to look into the future here. What do ASCs absolutely need to be doing right now? to prepare for

Katie Pierson: If you haven’t already adopted a electronic health record or medical record, you should have already been doing that, hopefully. Because Whether you like it or not, it’s here and it’s here to stay. And it’s what your staff, your physicians, your [00:24:00] patients and hopefully to the government will be expecting very soon.

Katie Pierson: So it’s just, it’s here. It’s here to stay. It’s, it’s, you rip the bandaid off

Erik Sunset: 2024. Fair enough. And hard to argue with that. As a patient, you know, we’re all patients to some extent, or we at least know a patient, even if you are, you know, outside of the healthcare system as a patient, my provider, my hospital, my surgery center, it really better have an EHR just for my own safety, you

Katie Pierson: Right. Yeah. Yeah. It kind of makes you feel more warm and fuzzy when you know that they’re utilizing it. Actually, it’s funny. I was checking in a patient yesterday and we have them sign on a, on an electronic signature pad. Just to be clear, we have them sign five times on an electronic signature pad and he was complaining that he couldn’t already have clicked something prior to clicking it, so that’s why. checking in to have already had done all of that [00:25:00] work. So there is, it’s absolutely expected to make it easy for everybody.

Erik Sunset: That is that’s my new favorite patient story.

Katie Pierson: I

Erik Sunset: That’s fantastic.

Katie Pierson: was like, we have technology. It’s just to your point, not where everyone’s expecting it to be because I have my app on my phone that I can just click, click, click, click, click on so many other things. So,

Erik Sunset: Yeah, exactly. Exactly.

Erik Sunset: Well, Katie, one of my favorite things to ask guests, it’s a hot topic on the pod too, is AI in healthcare, or so called AI in healthcare. What’s your sentiment towards using things like chat GPT or artificial intelligence in the care of patients?

Katie Pierson: yeah, it has been such a buzz thing to talk about and an exciting thing to talk about because again, anything that can make our lives easier, we’re gonna Always navigate towards that or, you know, go towards that. [00:26:00] However, as you mentioned on your last podcast, and I read an article recently too about the two chat, chat GPT versions being so different whereas the latest one actually is, is failing more math questions than the first version. I would definitely say to be Cautious, very, very cautious about utilizing it, implementing it at least anytime soon. Let them work out the bugs, let them figure out, you know, what’s the best methods to use it or, you know, what’s the best algorithms out there? And I hope that we continue to use it more as a resource, more as a adjunct to practice versus actual practice.

Katie Pierson: However, I can also appreciate that as healthcare is continuing to see a decrease in staffing availability resources in, you know, remote areas, [00:27:00] you name it, I can see how it’s going to be a bigger drive in those. And I hope that folks are just being smart about it and not doing it because it’s easy.

Erik Sunset: Yeah, well put, well put. I’m generally one of the last people to ask for regulation around industry, but this seems like an area where somebody needs to really put their foot down. Maybe it’s the AMA to say, here’s, here’s how you can use AI, but here’s where you need a physician or a clinician or.

Erik Sunset: Somebody with some actual expertise to weigh in as opposed to firing up a chat prompt for an answer, but that’s just my opinion.

Katie Pierson: I agree.

Erik Sunset: It seems kind of reasonable, but you know, we’re, we’re moving really quickly with with AI or so called AI.

Katie Pierson: Well, it’s, it’s, it’s, it’s been useful for so many folks in so many avenues now that the trust is actually gaining on [00:28:00] it because it’s, It’s helped some people in some arenas, you know, and I mean, and I guess in health care too, but I get also, let’s be smart.

Erik Sunset: Yeah. Yeah. And to be clear, I’m not at all opposed to the use of these things. They are very helpful or they can be helpful, but they’re also not perfect. They’re far from it. And. You know, you just an ounce of… Caution is worth a pound of prevention or somebody help me out with that one. You can scream at your car listening to this.

Erik Sunset: He didn’t get the saying right.

Erik Sunset: So Katie, with all that to say, we really appreciated your expertise on tech and the ASC, AI and healthcare. Is there anything else you want to share with listeners of the pod?

Katie Pierson: I know technology can be a really scary thing if it’s something you’re not comfortable with. So if that is the case for you, find your friend that is comfortable with it and [00:29:00] have them do it. Because I promise you that if you use it, right. It can help your day instead of hurt it. You just have to know how to use it and be open to changing some of your ways.

Katie Pierson: I I’d have to say that’s probably the biggest thing I’ve, I’ve come up against with all of this. Yeah.

Erik Sunset: words have ever been spoken there. If if anybody needs a shoulder to lean on, where can the listeners connect with you? Can they find you on LinkedIn or Twitter?

Katie Pierson: Yeah, I am on LinkedIn. You know, I have, I’m, I haven’t signed into Twitter in a long time. I have one, but it’s been a minute. Or now what, is it called X, right? And so,

Erik Sunset: Yeah. Great. Excuse me,

Katie Pierson: right. And and I, I refuse to get a TikTok because I feel like my life would, would just be consumed in it. But you know, I’m on, I am on LinkedIn.

Katie Pierson: Absolutely. You can find me at Katie Pierson D N P R N O N C C A [00:30:00] C A S C.

Erik Sunset: Oh yeah. Yeah. Rock them. You were, those achievements are hard earned.

Katie Pierson: Yeah. Thank you.

Erik Sunset: Well, on behalf of the DocBuddy team, thank you for listening to this episode of the DocBuddy Journal. If you’re not already, be sure you’re subscribed on Apple Podcasts, Spotify, and YouTube as well. So you can always get the freshest episodes of the pod.

Erik Sunset: Until next time, I’m your host, Erik Sunset. We’ll talk to you again soon.