How to Strengthen the Anesthesia and ASC Relationship w/ Greg Collins DNP CRNA

Erik Sunset: [00:00:00] All right. Hello and welcome back. I’m your host of the DocBuddy journal, Erik. Here at DocBuddy, of course, we deliver healthcare solutions that take the pain and cost out of broken workflows like Op Note, which gives ASCs the power of instantly generated operative reports approved from the point of care. You can learn more about Op Note and our other solutions at DocBuddy.com. And today we’re joined by Dr. Greg Collins. Dr. Collins serves as Assistant Professor of Professional Practice at Texas Christian University, the School of Nurse Anesthesia. He’s operated his CRNA practice since 2006 across various settings. In addition to his civilian career, Dr. Collins has a background in the military, having served as an officer in the U S army reserve. His service record includes downrange deployments in 2008 during operation Iraqi freedom and in 2011 for operation new Don. Dr. Collins, thank you for your service. And thank you for joining the show today.

Erik Sunset: We’re excited to have you here.[00:01:00]

Greg Collins: Yeah, thank you, Erik. I really do appreciate the opportunity to speak with you today.

Erik Sunset: Well, it’s going to be fun. We’re we’re going to have a good time here. Maybe not as good of a time though, as we’re going to have in Orlando next week for the ASCA annual conference, where you are a speaker. And if I’m not mistaken, your speaking slot is titled improving your bottom line. Anesthesia models are the answer.

Erik Sunset: And I think that’s Friday afternoon. So before we don’t want

Erik Sunset: you

Erik Sunset: to. Don’t want to spoil any of your talk there, but give us a taste. What, what can some of the ASCA attendees expect there?

Greg Collins: Yeah, so really what we’re going to be talking about is uh, a concept that, uh, we call the driven anesthesia model. And I think it’s the, the title obviously implies uh, its for an ASC. Um, I kind of want to though, Erik, if I could, by, by kind of briefly uh, introducing you and listeners to uh, or maybe many to, to certified registered nurse anesthetists or CRNAs, because they really do have a [00:02:00] critical role in this efficiency driven model that we’re promoting.

Greg Collins: Um, CRNAs practice nurses. uh, who specialize anesthesia. They’ve been doing so for over 150 years, really since the civil war in the United States. Um, if you look a map, CRNAs are the primary anesthesia providers for about 80 percent plus of rural America. And often, as I can attest to, they’re the sole anesthesia provider in downrange military medicine, work in a variety of practice settings, anywhere where anesthesia is delivered, you’re likely to see a CRNA there on the stool.

Greg Collins: Um, it’s funny, um, reintroducing or maybe uh, uh, uh, what a CRNA is about 25 years ago when I was looking to, to get into this profession, I was handed uh, through some handed a VHS tape and the, the copy of the, the, the title of the VHS tape was called the best kept secret in health care.

Greg Collins: And it was a uh, It was a, think it was nightline expose uh, you know, a little um, um, brief synopsis of what, what CRNAs were. And that title always stuck with me, the best kept secret in healthcare. Um, really that [00:03:00] you know, kind of to their mystique because nobody really knew who they were.

Greg Collins: You know, you’d show up at the hospital and somebody would put you to sleep, but you didn’t really know who that person was or what exactly they did. And I’ll tell you uh, in 25 definitely changed. We can’t call it the best kept secret in healthcare anymore. Um, CRNAs about 50 million anesthetics a year now.

Greg Collins: And if you’ve had an anesthetic, you know, in the last 10 years, it’s a high probability that was a CRNA that provided that.

Erik Sunset: Yeah, I appreciate the primer there. And some of, some of that new familiarity or re found familiarity, and this is obviously an important, an important topic. There’s an ongoing cataclysm, a lack of anesthesiologists and of anesthesiology providers of all levels. So that CRNA is the linchpin that, in my view, is holding it all together for now, as you see this exodus from the career by the anesthesiologists.

Greg Collins: yeah, that’s absolutely true. I think I plan to elaborate a little bit on that in [00:04:00] Orlando on Friday. Um, but it’s a, big market disruption right now. And the provider shortage is a primary driver that market disruption. And um, I really I believe our organization feels strongly that that.

Greg Collins: I appreciate the way you described it being the linchpin. I think that the flexibility of the role of the CRNA really fits well with the current shortage. I know on the education end, you know, we’re ramping up our efforts to create more CRNAs to really get more people in the workforce and, you know, with retirement, with the baby boomer generation creating more demand.

Greg Collins: It’s tough, and I think that that we’re always looking to to fill those gaps, and I think really the the CRNA is the ultimate model, if you will, to to kind of to fill those gaps.

Erik Sunset: Yeah, how could it not be? And you love to see the states sort of loosening restriction and regulation and, and allowing more independent practice by CRNAs. At least I do.

Greg Collins: For sure, yeah, for sure. Obviously, we advocate for that as well.[00:05:00]

Erik Sunset: To to, to bring us back, I kind of dragged this off topic here Dr. Collins, and it’s a, it’s a great topic. But how does that refresher around CRNAs relate to that efficiency driven anesthesia model?

Greg Collins: Yeah yeah, thank you for asking that. It really the when we. When we talk in terms of the efficiency driven anesthesia model, I’m really talking about a concept that’s built around a collaborative practice between CRNAs and either physician anesthesiologists or surgeons, kind of depending on the facility, depending on the culture and the needs of the facility.

Greg Collins: And the intent of that is to maximize flexibility. It’s really uh, structured to flexibility of the workflow, the surgery schedule um, rather than, you know, forcing the surgery schedule through some uh, arbitrary, uh, uh, anesthesia practice model that, that emphasizes uh, uh, more so than it does uh, patient care Um, and I think when you kind of look at the, the workflow, and I know you guys are familiar with this uh, the daily workflow daily surgery schedule in ASC, There’s always choke points in [00:06:00] the morning and always choke points at the end of the schedule. And this efficiency driven model, I think, has this plug and play type mentality that allows kind of the lessening of that burden of those choke points and allows the work really allows the ASC to dictate that workflow rather than forcing it through that arbitrary anesthesia model where there’s provider redundancies.

Greg Collins: There’s people watching people providing anesthesia, and we’re more interested in helping the facilities really. Uh, uh, allow them to, to, to, to, to promote and to set the tone, if you will.

Erik Sunset: And related to those choke points, do you find those are harder or better or the same when we’re talking about anesthesia that is employed by the center? Or are those choke points really more vicious when we’re talking about external anesthesia to the ASC?

Greg Collins: Well, that’s a good question, and I don’t know that I can answer that completely. I think that That it’s probably a combination of both, you know, it’s, it’s somehow related to both. I think [00:07:00] that uh, the concern is always increasing flexibility. And I think that, that if, if you have uh, ultimate where it’s a next man up mentality, everybody is able to do everything um, monitor room uh, provide, you know, preoperative uh, assessment, and planning, uh, you know, uh, procedures like nerve blocks, things like that.

Greg Collins: I think that. It’s the efficiency driven model really, really operates on this best athlete in the best place, if you will, or next man up mentality.

Erik Sunset: That makes sense. And to kind of expand on my thought there of internal versus external anesthesia for a surgery center, obviously, you know, we’re looking at this through the lens of ASCA, we’ll have many ASC administrators and owners and some surgeons and some anesthesiology providers there, but for those at ASCs where they have a relationship with an external anesthesia provider or group or Groups of different providers.

Erik Sunset: Sometimes that can be a [00:08:00] little bit of a black box to the ASC. You know, we, we have our block times and we just do the very best that we can. But we’re in a world now with shrinking reimbursements. We’re in a world where block times need to be managed pretty ruthlessly, not only for you and your surgeons, but down to the individual case, down to the profitability by the minute for really tightly run ASCs. So from, from your perspective, what would you tell an anesthesia team or an anesthesia group to help build a successful relationship with the patient? The surgery centers in their market.

Greg Collins: I think that that’s all related to transparency. And you mentioned the idea of the black box, the great secrets that each of those groups kind of hold and refuse to share with one another. And I think that, that ultimately eliminating that, those secrets and kind of being transparent, you know, the anesthesia group or whether it’s a management group, whether it’s even internal providers.

Greg Collins: I think there, there needs to be transparency on the side of the anesthesia provider that says, [00:09:00] you know, here is the market salary. Here’s what we have to have to have people sitting on your stools and providing anesthesia. And, uh, And we need in terms of your payer mix. Here’s what we need in terms of, of uh, the way the flow of your, your specialty lines that you offer.

Greg Collins: ASC too, we need transparency. Uh, from an anesthesia standpoint uh, does that intend to grow, add service lines? What’s that going to do to their payer mix? Do they intend to draw down a service line that may have been profitable for the anesthesia group that it’s no longer going to be in existence?

Greg Collins: And so I think that that kind of culture of transparency helps with that and it helps on both sides and, and really allows the. the ASC and the anesthesia management group or group of anesthesia providers to, to kind of align their goals together, that both their financial goals and their practice goals.

Greg Collins: And I think by doing so, by being transparent, kind of eliminating that black box, I think that, that we see uh, and I’ve seen this, in my practice as well. You see um, that there’s both sides, that, that both sides can adjust. Both [00:10:00] sides can uh, can, to, increasing demand, decreasing demand, changes in payer mix.

Greg Collins: And that’s. That’s kind of why I think being transparent is most important.

Erik Sunset: When you’re, you’re kind of blowing a dog whistle in my direction, talking about transparency, talking about payer mix, I would imagine that transparency now, you know, in a post no surprises act world, you know, transparency. And communication, you know, going beyond just being transparent, but at proactively communicating, you know, around where you’re in network, where you’re not, and Hey, you know, Erik is coming in for a scope and, you know, his, he’s out of network for us.

Erik Sunset: What are you going to do about it? Cause I can’t just stick him with this bill anymore. And that’s not the right way to phrase it. That would be how the patient observes the you know, the billing to happen. Not that the anesthesia group would be viewing it that way. So as I hedge my statement there in this post, no surprises act world, how does that transparency and communication change or what, what needs to happen now that didn’t need to happen before?

Greg Collins: Well, some [00:11:00] of it’s being forced by the credentialers, right? And the governing bodies and by the federal government. Sometimes, you know, you have to, for an ASC to have a contract with an anesthesia group, that anesthesia group must show that they’re in network with the payers that are at the ASC. And I think because of the No Surprises Act, because of that, I think that Um, it’s transparency, which I think is a good thing.

Greg Collins: You know, obviously, anesthesia management groups, particularly the big anesthesia management groups, have differing opinions on the No Surprises Act. Um, and I think uh, you know, for, good reason, obviously, but I think that um, uh, I think the playing field that we’re playing on right now.

Greg Collins: And I think that our, our uh, demand, the demand us is to adjust to that playing field. And I, you know, like we mentioned, I think transparency is the answer there.

Erik Sunset: Well, one of the things that is potentially helpful with you know, advancing that transparency and being able to communicate readily and easily as technology. ASCs traditionally lag [00:12:00] pretty heavily in technology adoption compared to their peers at the practice and at the hospital, obviously DocBuddy, we’re pretty well versed in the technology and use at, at ASCs by the ASC. And what we don’t interact with so often though, is the anesthesia, the, the independent anesthesia, anesthesia group, and their interaction with the ASCs technology for better, for worse, or, or something in between. What are your thoughts there on anesthesia building that great relationship with ASC?

Erik Sunset: Is it access to the technology in, in the facility or something else or different technology?

Greg Collins: No, I think it’s access, access is a great opener for sure. I think the access has to be provided there, but I do think it’s, it’s really incumbent on the anesthesia group to trust that technology from the ASC. You know, there’s all the matrix, matrix, matrixes that are built. Sometimes they’re a little bit cumbersome to what our schedule should look like, but I think that, that overall we [00:13:00] have to trust the data.

Greg Collins: We have to trust the technology and I think as the efficiency driven anesthesia model lens make those adjustments, whether it be case starts, whether it be um, you mentioned the the schedule, turnovers, things like that. I think that, that we have to trust that data. We have to uh, uh, trust the, data, but the analyses of the data.

Greg Collins: And I think that, that, that um, that initial relationship with ASC. If you can build trust early. Through transparency, then things like technology, we can embrace those together and make that part of the culture, make it part of the culture to depend on that. As the technology improves, obviously, that it should be more trustworthy, and I think that being able to depend on the ASC to provide that in a fair and equitable manner, and for the anesthesia group to respond appropriately to those analyses with staffing changes, with movement within the staff, so on and so forth.

Erik Sunset: It makes a ton of sense. And I’m really interested in your perspective here because you have a new [00:14:00] push and maybe renewed is the right word here that ASCs are making decisions on which types of cases they’re going to do based on the projected profitability. So you’re looking at your staff costs, your surgeon costs. Your supplies, your implants, all the things that go into a successful procedure. Obviously anesthesia is a part of that. And if anesthesia is a different business than, than your facility, you know, how does that change the equation or what would be your pro tip for anesthesia teams to go into a facility and say, Hey, look, we want to help you be profitable on every case you do, because we’re not going to have any cases to help you with if you don’t keep the lights on.

Erik Sunset: So it’s very clearly a alignment of incentives. What would be your recommendation to anesthesia teams there?

Greg Collins: Yeah, well, I think that the ASC’s understanding of how an anesthesia provider bill is generated is important. I think the more they understand about that, the more they understand that, you know, we’re beholden to whatever [00:15:00] CMS or private payer allows for this particular case. There may be a delta there.

Greg Collins: There may be a delta on what it costs the person to sit on the stool versus what they’re being reimbursed to sit on that stool. And that’s, again, where that relationship is so important because if it’s profitable for the ASC. Maybe not so profitable for the anesthesia provider. Then that that the meeting of the minds has to happen to how are we going to do this?

Greg Collins: How are we going to continue to provide this service? Who’s going to make up the delta? How are we going to make up the delta and and how are we going to move forward? Um, it’s you reimbursements being cut. That’s a big part of the market disruption. Um, those just be slashed.

Greg Collins: In the face of uh, this increase demand, decrease in providers, and salaries going through the roof. Salaries now are at an all time high, and so um, all that gap between what we’re, what we’re paid to sit there, and, and, and uh, what it costs to provider on the stool.

Erik Sunset: Where do you think it breaks and what do you do to fix it after it does break? Cause it’s not sustainable.

Greg Collins: That’s the million dollar question [00:16:00] that that’s the actually I should say that’s the multimillion dollar question, right? I think that uh, I mean, heard it forecasted that the end is near and then I’ve also heard it I’ve also heard the forecast of their prediction that that who knows, you know, we’re continuing in this up cycle I don’t think the anesthesia market will settle at any time within the next 10 years.

Greg Collins: I would like to see that happen I would like to see it happen just for stability Um, but at the same time, we can’t do much to dictate the market. We’re putting providers out there in as many numbers as we can. But uh, you know, demand, the increase in demand, it, it is what it is, and it’s, it’s upon the, the, the providers, the facility providers, the hospitals and the ASCs to, to make those changes and also to understand what that means for, for the, for the anesthesia groups.

Greg Collins: What that means for the, the provision of anesthesia in your location and what that means for the addition of a service line, the drawout of a service line.

Erik Sunset: What it seems to me, and I’m, you know, I’m a lay person here. There isn’t really a [00:17:00] magic wand. Like you said, you can’t, what can you do to impact market forces either as a group, even if it’s a very big group, you know, you’re still beholden to broader macroeconomic factors. But those much wiser than me have, have shared that the place to start is to get more people interested in going to medical school, first of all, and then, you know, secondarily interested in becoming an anesthesia provider. Is there anything you can really do beyond that? And I, I won’t ask you, how do you, how do you do that? What would be your pro tip there? Cause I, you knew you, you wouldn’t be telling me you’d be in Washington, but. Is that a reasonable place to start? Just more anesthesia providers is the step one here.

Greg Collins: I think that’s foundational. I really do. I think that’s foundational because the demand’s not going anywhere, you know, we, we try to make predictions in the market, but. I can, I can boldly predict that demand, the demand will just continue to increase. Um, you know, uh, training and education of, of MD anesthesiologists of, of CRNAs is uh, uh, it can [00:18:00] So. Um, you know, I work at and I understand what that means to us here locally, but, you know, we can only fill so many seats. We, we, we’re, we’re limited uh, as is everybody with the, the, the, the seats. There are uh, nurses now, know uh, uh, I mentioned nurse and that’s just being advanced practice nurses.

Greg Collins: There are nurses now. post ICU that are making money that uh, that to be a pretty good CRNA school. And they’re making money now that, that uh, they never have made And that’s, that’s a little bit of a detractor. And so um, on the education side, we’ve looked at kind of what that might mean to us in the next five years and 10 years uh, see less applicants.

Greg Collins: And I’ll tell you that at our program specifically, and I think this is true across the nation, that, that the application process hasn’t slowed down. I think again, it’s just unfortunately demand that’s outpacing supply.

Erik Sunset: Let’s that had never occurred to me that non anesthesia nursing [00:19:00] salaries were so competitive now with, with that advanced practice degree that it would detract from, from the interest. But the other, the other second half of what you said, the demand is just so great that supply can’t ever meet it. So coming back to our, to our main theme, you know, having said all that, there’s a, there’s a lot happening in anesthesia, the world of anesthesia. What do you wish ASCs would have a better understanding of as it relates

Greg Collins: Well, I think uh, I wish they better understanding of uh, the, the disruption, and I think I intend to, to introduce that significantly in Orlando, but um, I that many times you mentioned that kind of disconnect between An anesthesia management group, anesthesia providers, and, and ASCs, and I kind of wish that they understood that the, the, they see a number many times on a budget line of salary and, and what will equate to eventually a budget line of subsidy for the, the ASC, and, and that’s difficult for them to, to comprehend, and it, it, [00:20:00] it creates a little bit of uh, will, and I think that that if they could truly understand the market disruption, truly understand uh, the, the disruption and also the forecasted market disruption, I, I would like that more than anything else, because um, we are in peculiar position with that.

Greg Collins: And I think that. Um, we uh, succeeding of, of profitability, but that’s just related to salaries. You know, anesthesia management groups, they’re also eating those salaries, they’re the ones paying those salaries, and so they’re the ones that are having to go back to the facilities and negotiate, how are we going to cover this, you know.

Greg Collins: Um, mention this on Friday, but a subsidy or an anesthesia subsidy or a stipend, that used to be a word that didn’t exist in the ASC community. There was just no such thing. The ASC payer mix was always great, the ASC flexibility, the schedule, the types of cases that were done there really allowed an anesthesia management group to come in.

Greg Collins: And operate that just solely based on provider reimbursement and with reimbursement being cut with [00:21:00] those demands picking up and with salaries now going through the roof, that’s great for the, the, the CRNA or the anesthesiologist that’s sitting on the stool providing anesthesia, but that’s really putting a pinch on the anesthesia management group.

Greg Collins: And I think that’s what’s generated things like this efficiency driven model. They’re looking for ways as well, the anesthesia management groups are looking for ways as well to kind of. Uh, uh, little bit, if you will, that, that, that fall of, of subsidy and that going back continuously to the facility and saying, look, in this job market, the, the salaries are continuing to increase.

Greg Collins: Our reimbursement is continuing to decline. We can’t keep people in your facility if, if, if we don’t do something about it in terms of a subsidy. And so that, that is a word that, that uh, ASC providers are, are, definitely learning a lot about in the last few years.

Erik Sunset: what, like the way I’m kind of looking at this, and maybe this isn’t the right mental model, but if you’re a surgeon at a, at an ASC, like your very first step. Is to be credentialed with [00:22:00] the payers, whose members you want to do procedures for number one, you have to have that part that much of the revenue cycle intact, and this is tongue in cheek and maybe a little bit of a flippant comment, but like, if I need my knee worked on, I’m not doing it without anesthesia. So, as a surgeon, being credentialed and being on somebody’s panel, and then having anesthesia that you can rely on, like, those are the two things that you have to have, otherwise, you’re not treating any patients at all. That’s the setup for, where does this road lead? Does this road lead to surgery centers doing, only the very most profitable cases and obviously profitability being squeezed for them where we’re only doing the cases for big bucks and like, Oh, Erik, sorry, your, your elbow hurts.

Erik Sunset: Well, why don’t you go try the ER and see if they’ll treat you? Like, where do we go?

Greg Collins: Well, that’s a good question. And I think that that’s something that that ASCs in particular haven’t had to consider before is, you know What is the number for anesthesia reimbursement in this [00:23:00] particular given case? You know, what what is the anesthesia provider being paid for this? What does that mean then for our subsidy or our budget line on anesthesia in our facility?

Greg Collins: And I think that that may be part of that transparency. That may be part of the transparency we mentioned earlier is They know what they’re making. They know what the facility charges are, the facility reimbursements. They probably have a good idea about what the surgeon is making. Many, many times there’s surgeon owners or surgeon partners in those groups and so they understand that.

Greg Collins: But what they haven’t had to look at is, you know, what’s the reimbursement for anesthesia here? I think that that’s kind of why Uh, I want to introduce bit in Orlando to kind of show that this is something that they have to pay attention to. Um, and, from the Anesthesia Management Group in terms of, of, you know, here’s what we’re going to make.

Greg Collins: If you give us this, this, you know, here’s your list of procedures, here’s your list of, of payer mix. And this is what we’re going to make. That has to be transparent. And, and, and that will allow them, hopefully the ASC to, to understand um, do it without [00:24:00] anesthesia. That’s kind of the ultimate crux of this, right?

Greg Collins: Is that, and I think the, the government and the, the payers have figured that out as well, that um, if we need we can cut uh, uh, because I Eventually someone will have to pay for it. And unfortunately, many times that’s going to be the facility.

Erik Sunset: That just sets up the wrong incentive chain that that’s going to get. the incentives flowing to those high ticket procedures and nothing else. And then, you know, what happens to outcomes for patients who are immobile when a simple procedure would fix that. And that’s just a silly example, but that doesn’t seem like a good place to go.

Greg Collins: No, I agree. And I, I hope, and I trust that, that, you know, the leaders in the anesthesia organizations and the leaders in the ASC space, you know, are having those big picture meetings because um, I’m not sure that’s going to get any better anytime real soon.

Erik Sunset: On a slightly rosier topic here, and we can certainly revisit [00:25:00] this path to a not good place with poor intentions, but a little bit rosier topic, AI and healthcare is huge. You cannot throw a stone without hitting somebody talking about artificial intelligence or, you know, So called artificial intelligence and healthcare. What are you seeing on the anesthesia front specifically? What are you seeing more broadly that excites you as a provider yourself? Like what, what is going through your head with AI and health care?

Greg Collins: Well, I’m a, unfortunately, or fortunately, maybe I’m a casual observer at this at the moment. And so I can’t really wait to see where this goes. I think we mentioned the, the, uh, the earlier in terms of analyzing efficiency in terms of uh, you know, when to schedule cases, how to schedule those cases.

Greg Collins: I think that that’s the perfect setup for AI. That’s the perfect setup for these. Uh, a large models able to take that data and really quickly spit it out. Um, it’s incumbent on, as I mentioned, us, but also on the facilities and the surgeons to trust that data and, and, and say, you know, if, if it’s better for [00:26:00] me to do uh, orthopedics on, this particular day, because uh, the, the, model suggests that that’s the case, that there’s going to be more flexibility in our schedule, that, that we’re going to have more people here, you know, so on and so forth.

Greg Collins: I think that we have to trust that. I’ll tell you uh, where I am a little bit familiar with AI is in the practice of anesthesia, and it is blowing up. I mean, I’ve, I’ve heard uh, we just had a, research symposium here with our doctoral students, and, and some of the things that they brought up and, and kind of teased out of the current literature was fascinating.

Greg Collins: You know, there’s, there’s large models now that, that will monitor patients vital signs and, and these different data points uh, assessment data points throughout. And, you know, Warren, the anesthesia provider of an impending, you know, untoward event. Um, we at our facility, Where we train CRNAs, we have AI that’s built into ultrasound machines that can identify muscles and nerves, that can give some quantitative physiologic data in terms of, I can put an ultrasound, and speaking of upgrades and technology, that ultrasound machine that used to cost [00:27:00] 80, 000, I can spend a couple of thousand dollars, plug it into my phone, put it on the patient’s chest.

Greg Collins: And get a rough uh, Now that’s not a diagnostic tool. That is just a quick assessment thing. And AI has played heavily into that. I think that, that gosh, as this moves along, I’m really fascinated. Don’t know about much about where it’s going in the business space, but gosh, on the practice front, it’s extraordinary.

Greg Collins: And I really can’t wait to see how this plays out. Luckily, I’m still young enough, if you will, to be in practice, to see this happening.

Erik Sunset: Yeah, that is cool. And this is like the first time in in my career that healthcare has gone so quickly towards something new in a, in a tech sense. So I don’t think we’ll have, I don’t think we’ll have a long to wait to see where we end up. So move it. It’s kind of a hammer in search of a nail, but some of it really is pretty cool and making a real impact.

Greg Collins: Indeed. And something I think we. We have to embrace. I don’t think we can, you know uh, because you mentioned, the hammer [00:28:00] analogy um, if we don’t we’re going to be the nail really quickly. So I think we need to make sure we embrace that and, and learn how to use it to benefit everybody.

Erik Sunset: it’s a literal Pandora’s box scenario. You need to control what’s coming out of that box or it might end up controlling you and not in a Terminator Skynet sense, but put it to use for you. Don’t get competed out of the market.

Greg Collins: Indeed.

Erik Sunset: This

Erik Sunset: is a little bit out of left field at you. So obviously with the medications that you use for anesthesia patients There’s a little bit of risk there, you know, general anesthesia, you’ve got it down to a science, no doubt, but still makes me a little uneasy as a patient to know that that’s going to happen to me. I’ve heard this said this is kind of a long walk for a short drink of water. Dr. Collins, I’ve, I’ve heard it said on this show that one of the things that we’re going to look back on in 10 years or 20 years or something, kind of near term future. Is how insane [00:29:00] it is that not everybody is utilizing personalized medicine and by that sequencing your genes, and let’s forget about the privacy aspect of this for just a second, but being able to sequence somebody’s genes. To say you don’t give them this medicine. It’s not going to work or it’s harmful. And you wouldn’t know it until it’s too late versus this is super effective. This’ll, you know, they will not feel groggy upon upon waking. Do you have any thoughts on on that side of medicine?

Greg Collins: I do. In fact, one of my closest colleagues who happens to be president of our professional organization right now, he’s a CRNA with a PhD in pharmacogenomics, and so he and I can sit and talk about this all day long. And I think that the implications there, we’re already seeing some implications in anesthesia with that.

Greg Collins: In terms of uh, susceptibility opioids, in terms of susceptibility to other drugs, the genetic identifiers there that are present. And I don’t think we’re very far away from, from uh, you, Erik, showing to have your scope you’ve been talking [00:30:00] about and handing them, handing the anesthesia provider a sheet that, that it’s not a recipe by any stretch of the imagination, but it is a set of guardrails that’s really going to allow me as an anesthesia provider To provide exactly what’s best for you, to avoid what’s not best for you, and, and to, to, to really customize uh, your experience. Uh, I think that only is that going to save uh, a lot of untoward but that, I think, has the potential to save money for facilities. I think it has the potential to save money for, for pharmacies, if you will. I think that the, the, uh, really the are unlimited with that. I’m, I’m anxious to see where that goes.

Greg Collins: I’d love to hear him talk about that, because I think that Um, just the or just the thought of it, uh, it it, a, it’s a huge push, and I think that, that um, man, in that market, and I think that hopefully we’ll, as with AI, that’s going to be something that, that hopefully we will embrace.

Erik Sunset: I I’m with you. I think that’s really exciting. I mean, that’s you know, not to be too lighthearted or tongue in cheek, but that’s like Jetson’s [00:31:00] level of future technology, personalized medicine, that’s really cool. But just like we’re talking about Pandora’s box with, with AI, whether it’s in healthcare or in the broader consumer world, You know, there’s no real regulation around it.

Erik Sunset: There’s nothing that protects patients from the use of AI in their care. Yeah, there will be there’s not even anything for regular consumers. At least not at federal level. Certain states are contemplating it. Just, I don’t know. My listeners get all whipped up that I’m wrong about that. But with personalized medicine, the fear, if I’m not mistaken, is that like, what if my insurance company gets this information?

Erik Sunset: They know I’m going to die in a year or sooner than I should, what happens to my coverage? So how do you, how do you navigate that? And I know I’m really throwing a meaty questions at you, but would love your thoughts. Cause that’s the fear for me. Like that’s my genes. And then somebody else has that information.

Erik Sunset: Yeah,

Greg Collins: That is maybe, uh, maybe the ethical dilemma that we’re marching towards [00:32:00] there, right? Um, and don’t know. I think that, you know, I have difficulty really depending on the federal government to come up with things like that. I think that hopefully the people that are in that space that are kind of developing that technology, we need to rely on them to say, Hey, okay, now how do we How do we uh, shade this from people that don’t need to see it?

Greg Collins: How do we allow uh, the people it access to it? Um, but then how that to the patient? That’s going to be the ultimate thing, right? I think that that’s, uh, gosh, that’s wish I could answer, Erik. I uh, confident that’s well above my pay grade at the moment, but, but I share your concern.

Erik Sunset: yeah, I’m, I’m picturing sort of an a la carte menu, like, give me my give me my NSAIDs, my, my best NSAIDs, give me my best anesthesia medicine, and like, that’s it. I don’t want to be, I don’t want to know any predispositions to any horrible, you know, uncurable illness. Just keep that to yourself, their

Greg Collins: would agree with you, but there are some that won’t. So what do we do with those people? You know.

Erik Sunset: [00:33:00] You, you know what? I’m a, I’m a free market guy. I said let them pay for it and give it to them, but don’t come crying when you get something you don’t like, so.

Greg Collins: very good. Yes.

Erik Sunset: So as we as we kind of get to the end of our chat here today, which has been fantastic what are you hoping to gain out of your, your talk in Orlando, what do you want your, your audience members to gain there? You know, what’s, what’s the big takeaway you’re hoping for next week?

Greg Collins: Well, I think kind of the big takeaway and the way I’d like to wrap this up is is really um, we’re gonna in Orlando talking about this efficiency driven model, kind of break it down, talk about the specifics uh, that that aspect of it, if you will. Um, but want to leave you today kind of emphasizing again the role of C.

Greg Collins: R. N. A. In that Um, I think our, our, our training and our, our background in nursing um, I, I wholeheartedly believe that, that CRNA is typically practiced with the heart of a servant. And, and I think that um, believe it or not, know uh, and many of my colleagues would [00:34:00] shudder at this statement, but anesthesia is a customer service business.

Greg Collins: We have customers and our, our patient is obviously our primary and, and obviously most important customer. The one that we care about, the one that we train, you know, decades for to, to, to take care of. best care of. But uh, you know, that surgeon is also a customer. When I’m providing uh, anesthesia for that surgeon, I’m providing that in a way that allows that surgeon to practice, allows that surgeon to do what he needs to do for his customer, the patient, but also to maximize his success.

Greg Collins: And I think ultimately Uh, probably a VIP customer is an ASC, and I think that, that uh, anesthesia need to realize that, and I, I hope that, that, I don’t hope, I trust that most of my, my colleagues, my CRNA colleagues understand that, and understand this customer service aspect. Um, I really think gosh, if you get the right group of anesthesia providers, In the right facility um, that rise in waters that will eventually float all these boats, including the surgeons, including the, the, the, the, the ASC itself and, and also the [00:35:00] anesthesia groups that, that manage these things.

Greg Collins: I think that uh, it’s ultimately in the culture that can be built between or within that relationship, I think that just makes the ASC more profitable for patients and more, more um, I’m sorry, uh. Attractive patients, more attractive for surgeons to come provide their care and more attractive for payers to be honest with you.

Greg Collins: If you’re doing something efficiently, then then payers are likely to pick up on that. They’re going to pick up on that. I think that that that allows, you know, a good rise in water and hopefully, you know, everybody is successful. I think that. Rather than, than uh, black boxing that anesthesia group, rather than black boxing those, those anesthesia providers, I, I think that, that generally we want to be part of the culture.

Greg Collins: We want to contribute to it. We want to help everybody be successful because we know if that’s the case. We know if more surgeons are operating with a better payer mix in a nicer facility, We’re going to ultimately benefit from that as well, and I want ASCs to know that that that’s kind of the the paradigm of [00:36:00] CRNA practice, but of all anesthesia provider practice.

Greg Collins: We stray away from that sometimes. We do things sometimes that are you know, seem to be more engaged in profitability. But I think at the end of the day, you know, we’re a customer service business and we want to treat the facility like that.

Erik Sunset: Really well put and the ASC is setting a good example for the rest of healthcare, as you pointed out, great for patients, great for providers, even great for our friends at the payers, which sometimes you know, I don’t always get a fair shake. But it’s an important example for healthcare because where else does that happen at the same time?

Erik Sunset: It just doesn’t. So as a wrap up, Dr. Collins, where can listeners connect with you? Are you big on any social medias?

Greg Collins: I’m easy to find on LinkedIn uh, easy to You can search my name and, and uh, TCU school anesthesia pop right up there uh, on, I’m uh, Collins at Collins CRNA on X uh, I do want to your listeners uh, if you have any leading up to the ASCA, I look forward to meeting [00:37:00] everybody there, obviously as well.

Greg Collins: Um, I, I’m going to our uh, a couple of and an email that, that will allow you to, to maybe get some information ahead of time and develop some questions. Uh, the best email uh, to, to immediately questions answered is help, H E L P at A A N A dot com. And you can visit anesthesia facts dot com.

Greg Collins: There’s a litany of information there. I plan on really teasing that up to uh, next week in Orlando.

Erik Sunset: That’s fantastic. And listeners of the show will know they can expect those links in the show notes in the description area. And on behalf of the entire DocBuddy team, thank you for listening. Be sure you’re subscribed on Apple Podcasts, Spotify, and YouTube. So you can always get the newest episodes of the show. And until next time, I’m your host, Erik. Talk to you again soon.