How to Win With a Lean, Mean, and Paperless ASC w/ Nyleen Flores CPMSM, CPCS, CPCO

Erik Sunset: [00:00:00] All right. Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy, of course, we deliver healthcare solutions that take the pain and cost out of broken workflows. And today we’ve got a really special guest. We’re joined by Nyleen Flores. Nyleen is a long time administrator of medical practices and surgery centers.

Erik Sunset: She is also the chair of the NAMS subject matter expert group. Subcommittee. Mylene, thanks for making a little time for the DocBuddy journal. How are you doing today?

Nyleen Flores: Great. Thanks for asking. Looking forward to a fun filled conversation today.

Erik Sunset: Yeah, so am I. We’ve gotten to chat a little bit offline. You shared that you’re actually going to be speaking at the upcoming ASCA 2024 annual conference in Orlando. Tell us a little bit about what you’ll be doing there.

Nyleen Flores: Yes, I am so looking forward to ASCA this year. ASCA always does a great job and obviously it’s an amazing network [00:01:00] opportunity. Great learning, lots of great speakers this year and always bringing forth new ideas and new ways of doing stuff. And I’m going to be speaking about my favorite thing in the world, which is actually credentialing. My topic is credentialing, who, what, why, and how. And I’m excited to showcase the role that credentialing Actually has in the quality program of an ASC. So it’s a very important piece that a lot of administrators kind of just roll off to a CBO or to someone else. And they don’t understand that there’s a second part of that

Erik Sunset: well, that’s really exciting that you’re going to be a speaker at ASCA. Listeners of the show know that we fly the ASCA flag high and proud. We love our friends over at ASCA. And for those who haven’t yet registered, you still have the chance [00:02:00] to.

Erik Sunset: The event is taking place April 17th through 20th in Orlando. You can get more information from ascasociation. org. And we’ll of course have a link to that in the show notes. We actually had the pleasure and the privilege of hosting Bill Prentice on the podcast last year and he is the the leader of Aska as their CEO.

Erik Sunset: And one of the one of the talking points is that ASCA is driving the awareness of ASC to the broader community, to to those in Washington. This is one of those rare instances in healthcare where it’s a win for patients, a win for providers, and even a win for payers. While awareness is really important on a national scale, at a more localized scale, it’s important to remember that ASCs are actually a business and they don’t just operate themselves.

Erik Sunset: They obviously are in existence to treat patients and provide great outcomes, but they can only do that if they remain profitable. And Eileen, I think you had some thoughts on that.[00:03:00]

Nyleen Flores: Yeah. So I’m all about running a lean and mean center. At an ASC that can do the higher paying cases. Now that does not mean the highest reimbursement because you want. You can do smaller cases that will be more profitable and cost a lot less to perform. Let me give you an example. I can do a Blue Cross carpal tunnel in about five to seven minutes with one circulator, one tech, right? I don’t require the amount of staff or the time than a total knee. Now, if my profit margin is over 2000 per carpal tunnel, and I can do 12 in maybe four hours, you’re talking a lot more money than I would make [00:04:00] just making maybe two total needs because I had to pay a lot more in supplies, a lot more in implants and a lot more in staff.

Nyleen Flores: I, I need at least four or five people in the room. And that’s with an easy surgeon. So you want to be lean and mean when you can to make the most in a very smart way. Not always adding these big cases. Does that translate into higher profits? You have to have a very particular type of surgeon to truly make a total joint program successful. And I know a lot of ASCs right now are pushing things like total shoulders and the total knees, which is great. I’m not saying that’s not a good thing. I’m just saying, The amount of money you’re going to make off of that can sometimes be really upset by working leaner and meaner. So that’s one of the ways [00:05:00] to do it.

Nyleen Flores: The other thing is to me, staffing critically. is extremely important. And that means cross training everyone. I’m not about running a center that tells me I am only a circulator. I refuse to do pre op. Excuse me. I don’t think so. That does not work. You have to cross train your staff because otherwise you’re always going to be short and you’re always going to be scrambling. It’s worth. Investing in your staff, paying someone an extra week or sending them to a program, sending them to the, the resources that are available nationally to get the extra training to be able to cross train and keep your surgery center staff to avoid this temporary staffing issue. And it makes them more marketable in the future.

Nyleen Flores: I mean, the reality is people move around and you’re offering something. They can’t [00:06:00] get somewhere else and in an ASC it’s invaluable to know every role in a surgery center It’s not a hospital where you’re stuck in one role in a surgery center. You have the ability That’s only going to make you more marketable and it’s going to let you grow And if you don’t want to grow that’s great.

Nyleen Flores: At least you can be used in different areas in the surgery center. So those are a couple things that I think make a surgery center really profitable.

Erik Sunset: Let’s talk about cross training for just a second, because if you open up Becker’s ASC any day of the week, there’s a new article about difficulties, hiring difficulties, retaining staff. We hear from some of our clients that, you know, we have a full slate of procedures booked except I don’t have enough surgical techs.

Erik Sunset: So now I’m rescheduling, I’m pushing procedures out, and this is a wasted block of time. I would imagine that that cross training, that for a center that’s well staffed to fairly well staffed, you avoid a lot of these rescheduling and shuffling of the schedule that’s already baked, right?[00:07:00]

Nyleen Flores: Yes. So I almost don’t want to say this out loud, but I had zero turnover last year and I actually had my PRN staff come to me and say, Hey, I really want to move to part time and I had one part timer moved full time. So just saying cross training works having an MA works because those MAs are going to stock your shelves.

Nyleen Flores: They’re going to help a person get dressed. They’re going to help bring supplies to the nurse. They’re going to keep your costs and labor down. There’s no reason why a nurse needs to be transporting or unpaying a nurse’s salary to go take patients around or to help them. Put on some socks. I need an MA to help move the flow and keep things going. As far as [00:08:00] the tech, techs have to process processors. I want them to learn how to be a tech or. Vice versa, everybody has to do everything and I market it as, you know, what’s only better for you. There’s absolutely nothing wrong with, or for example, having an MA and you train them to learn how to process instruments. Everything can be learned as long as it doesn’t require a certification. And if not pay for them to go to get a certification, it’s going to cost you a whole lot less to help them. Get a certification than it is to hire somebody and constantly go through that turnover. So you have to invest in your people. And that’s the way to retain staff. And I’ve been very fortunate to be able to keep the staff that I have, keep them happy [00:09:00] and I want to sum it up by saying it’s not just me. It’s not just how we treat them. It also comes down to your partners. And I know we wanted to talk a lot about physician buy in and what that means financially. And a physician buy in is what’s going to make or break your staff or your center. My main physician never leaves a day without saying thank you to his staff, coming out to the front and saying, thank you. My scheduler has been with the surgery center since the day it opened 30 years ago, my x ray tech has been there for over 20 years.

Nyleen Flores: And my materials manager has been there for 18. My insurance verification person has been there for 12, not because of me, cause I’ve just been there for three years. It’s because of the doctors and how they have made them feel important and invested in the business.[00:10:00]

Erik Sunset: Well, that’s, I mean, that’s positioned by into the highest sense. And we’re talking about ASCs as a business. And we want to lay the, the givens here, the table stakes that we want to give great outcomes for patients. And part of being able to do that is to operate a profitable center and keep the lights on and ensure that you can keep treating patients, because if you can’t do that, then you don’t have a facility to operate in.

Erik Sunset: But that’s, that’s looking at an ASC like a real business. That’s good. HR best practices. And I want to, I want to zoom in on this just briefly, you haven’t had the staffing issues that so many others seem to have. And, you know, I’m on the sidelines. I don’t work in an ASC. I work at DocBuddy. Why do you think there are so, so many longstanding staffing and hiring issues coming out the other end of COVID?

Erik Sunset: Is it a lack of this buy in get people certified, get people, cross trains, treat staff how you [00:11:00]

Nyleen Flores: No, it’s the monster that COVID created. It’s the monster that, that, that, that was created because of the burnout that was happening to the frontline workers, to the staff, to the nurses being demanded to do things they either didn’t feel comfortable with the social kind of change of everything. So you have business staff that now can work from home, so they all want to work from home. The, you have. Nurses who want to make more money because they were getting paid 7, 500 150 I mean crazy amounts of money per hour When you’re talking about medicare reimbursements, going down because we got a penalty even two percent that was held back because of covid so You’re gonna have that problem because at some [00:12:00] point it’s not about the money.

Nyleen Flores: And the reality is people that are there for the money are not there to take care of patients. They’re there for the money. So that’s not who I want. And I, and when I’m hiring, I tell them, you either want to look work life balance because you’re not going to be a millionaire here. I’ll help you personally.

Nyleen Flores: I’ll help you professionally. I’ll invest in you as a person. I’m not going to pay more than the hospital. I’m just not. So if that’s, if that’s what you want, if you want to work for the money, then go work over there. And my staff is there because, okay. They like the schedule. They kind of like not being on call.

Nyleen Flores: If you want the higher pay, then take what comes with it, but you’ve got to be able to have that real conversation with the staff. Now, sometimes there’s things you can’t control. There’s a fundamental culture problem at your center. And sometimes you can’t do much about it, and if you’re not strong enough to remove that person, that just [00:13:00] continues the culture of nastiness. If you are with a bigger management group, or you are with a bigger healthcare system, the other thing is if you work with other facilities to move staff around is also a way to avoid temporary staffing. Thank you which some groups do well, some so there’s a lot of different ways to do it. I think that the little bit of entitlement of, well, now I’m a nurse, I should be making 95 an hour, just, you know, to, To do what I got to do, then, then if that’s the case, then you need to go where you’re going to make that amount of money, then you’re just about the money. So I, I, I don’t know how to really answer your question without saying it’s really a little bit of both. And it’s just the results of what happened because. They needed it and it was worth that at that time.[00:14:00]

Erik Sunset: I think that’s,

Nyleen Flores: of like the housing market. It goes up and down, right?

Erik Sunset: yeah, right. Well, yeah, we can turn this into a cable news segment. Let’s talk about unemployment. Let’s talk about inflation rates and here’s, here’s all the factors. It’s tough to hire staff. We don’t have to go down that path and maybe we shouldn’t, but you mentioned a couple of things in that, in that passage.

Erik Sunset: So a lot of, a lot of good nuggets in there, the Medicare reimbursement. Going down and going back earlier to something you said, being able to identify the right types of procedures for your center, being knowledgeable about the type of surgeon that you have and type of procedures they, they want to be performing, it seems to me that would be pretty tough to not only have the right staffing in place for a given schedule, but to be able to pick and choose the types of procedures you, you want to be doing.

Erik Sunset: Be awfully tough to do that without technology. And before we started to record, we, we mentioned that the ASC [00:15:00] as a segment is traditionally lagging in electronic health record adoption for a lot of reasons to that, that isn’t to point fingers, but there’s no Medicare penalty, at least at the time of recording to not have an EHR in place.

Erik Sunset: You didn’t have to, would you want to do it anyway, after seeing what happened with meaningful use? And you’ve got a really interesting background that you have seen meaningful use on the practice side and implementing EHRs. Now you see it on the surgery center side. What are some of your thoughts there?

Nyleen Flores: Well, I say subscribe to my religion and go paperless. So I came into the healthcare world when paper charts were still okay. And then government implemented this, you have to move to EHR. So my first EHR was in a nephrology practice and we had an entire room of, of, folders and I [00:16:00] built each one of those folders and my fingers had paper cuts on them and then they tell me, You got to undo all of them and scan them. And at first it’s very overwhelming. And I think that’s part of the problem is because you have to fundamentally understand the build of an EHR to make it work. And it can be very exciting, but you have to have the right people in place with the right mindset. So we went to EHRs and everything is great.

Nyleen Flores: Then I went into the medical staff world and I was able to go paperless for doctors credentialing applications at a healthcare facility. I actually did it at three different hospital systems. So it’s very interesting to teach doctors. How to use an electronic system for doing whatever, whether it’s charting or signing an application or filling out an application. That’s just where the world is going. After you get through that [00:17:00] initial head butting, they are like, Oh, well, that wasn’t that bad. I said, you just had to try it. And sometimes I had. My older docs and they just came to me and were like, I’m so sorry. I can’t figure this out. Can you please help me?

Nyleen Flores: Absolutely. No problem. So then when I got into the ASC world, first thing I did was, okay, no more paper here. Paper is a bad word. We’re going to go paperless. At first I got a lot of resistance. I can’t do it. I can’t treat a patient and document. I can’t do this. I can’t do that. And I was like, okay, everybody, just first, I’m going to know what you do. So I spent a lot of time. I would be working every role I would sit down next to the pre op nurse and they tell her what is wrong with what you do now, what would you like and what would make it as easy as possible. What do you do first, what do you do second. And so I am the back end when we were building the EHR, not only [00:18:00] understood what they needed what their frustrations were, I was able to build it that way. So that made treating the patient and documenting. At the same time, feasible and doable. One of the most important things is how in the world are you accurately reporting anything without electronically documenting everything as an ASC, you have to report your normothermia stats. You have to report how many hair removals you did.

Nyleen Flores: I mean, all this stuff, how are you doing that? You’re literally going to go. We do 4, 000 cases a year. You think I’m going to go through 4, 000 charts and figure out how many times I shaved some guy? Who knows that? So, how are you actually doing that if you have paper? How accurate are those numbers that you’re supposedly reporting? I find it a little hard to believe that you’re actually getting that. I saw one surgery center, four girls, at the end of the day had to [00:19:00] grab their paper. 20 charts and literally sit there and type in from every page. What time the incision time, the room in time, the time out time they’re manually entering.

Nyleen Flores: So not only do you have a nurse doing it in the room. Putting it on a piece of paper, which may or may not be correct, but then you’ve got some poor other person doing it. And then you’re paying another person to scan the record because you have to keep it for X number of years, depending on all the other governmental factors of how long you have to keep records for whatever your policies, plus whatever the national guidelines are.

Nyleen Flores: So you’re have staffing again, you’re wasting money. And then whatever you’re paying for an EHR I can tell you it’s less than paying a salary and benefits of another person to sit there and do medical records all day. Now, I’m all about appropriate staffing and giving jobs to people, but I’d rather waste the money on people that I need to do a surgery and to make [00:20:00] money than sitting there and somebody scanning records because Don’t want to go to EHR. So I am all about moving to EHRs. It’s a lot better reporting, a lot better tracking. I’m going to say a caveat is it has to be built correctly. Things can go really wrong either using paper, but using an EHR too. You have to have people who are invested. It has to be built correctly. You got to understand the, the, the ins and outs, and that may not be your leader.

Nyleen Flores: It may be a younger person in your staff that kind of wants to learn and can be your right hand person. So just my two cents and I tell everybody subscribe to the paperless religion.

Erik Sunset: Well, I’m right there with you. And it comes back to a central theme of our conversation about buy in. You’re serious about [00:21:00] providing the best outcomes, serious about being a high performing center. You can’t. Ensure that the data you’re capturing is correct on paper and they get a lot of grief and I still think rightfully so, especially on the clinic side of things and the hospital side of things, we know it’s a leading cause of burnout for providers and staff is sort of these clunky, probably not correctly implemented softwares or not correctly implemented for a given facility or given practice.

Erik Sunset: Like the devil’s for sure in the details. Don’t you think?

Nyleen Flores: Oh, absolutely. And you try to do your charting as efficiently as possible. But my docs five clicks and they’ve signed off on their chart. They’ve reviewed, seen, clicked, done did their HMP, confirmed their site marking, literally everything is done in one second. I made it as easy as possible for them, but then I also didn’t just make unanimous decisions.

Nyleen Flores: I [00:22:00] tell the nurses all the time. Guys, if something isn’t working and you’re like, Naline, this is driving me crazy because I have to scroll back up to do it. Just let me know. I’ll fix it for you. Oh, can you add so and so to the computer? Because that person isn’t showing up. Absolutely. Naline, this preference card is missing.

Nyleen Flores: We went from betadine to chloroprep. The poor circulator. Was removing beta dine at every case and adding in chloroprep until one day she’s like, I think I’m so tired of doing this. And I said, Oh my goodness, honey, of course it takes me two seconds. I’ll fix the bigger problem and solved her problem in two seconds.

Nyleen Flores: You just remove it from the preference card, add the new one to the preference card, put miraculously everything works. So you can’t just say, this is what it’s going to be. And I’m never going to change it. No, it’s, it’s an evolving, moving. Constantly, you know updating just, it’s, it’s just so beautiful.

Nyleen Flores: Just works beautifully.

Erik Sunset: Oh, it’s [00:23:00] like you said, your, your staff and you see something, say something it’s software, it’s meant to be changed. It’s meant to grow with you. It’s not a static and for a credentialing and revenue rockstar, like yourself, you know, you’re talking about cleaner data, faster processes, how about a second order effect here, get reimbursed faster.

Erik Sunset: If you’re not waiting on a process, that’s driven by paper driven by more manual workflow about get paid faster with a, by being paperless.

Nyleen Flores: Oh, absolutely. Absolutely. And everything. Everything goes in the chart and I get my PO requests with my charges within 15 minutes of the surgery being completed, which means I know what the invoice is going to be within 15 minutes. That invoice for the implants or the supplies or whatever. Then gets uploaded.

Nyleen Flores: So, but within 24 hours, the billing company knows what [00:24:00] the supply charges are, what the bills are, what the costs were associated. You have a copy of the card scanned into the chart. You have a sign attestation at check in with each person verifying their demographic information. And again, everything is scanned in the chart at that time. Every desk has a scanner. And when I first started implementing all of this stuff, the girls in the front were like, Oh my goodness. Oh my goodness. And then the first time that they got a question and they were able to go in the person’s chart and look up, they were like, this is the best thing ever. And I said, yes, because it took you two seconds instead of trying to call the patient.

Nyleen Flores: Oh, I forgot to get scan your Carter. I typed in the Medicare number wrong. Now with all you Crazy digits and numbers of the Medicare numbers have. So absolutely you get paid quicker. You have, everybody knows where to find the information. It’s not hidden in 10 different places. You streamline processes.

Nyleen Flores: You name things exactly the same. A demo is a demo is a demo. A FACI is a [00:25:00] FACI, an ID and insurance. So everybody is named. Everything has a naming convention, everything is put in where it has to go, and everybody knows where to look for it. Doesn’t matter if you work in the front, doesn’t matter if you’re the nurse, everybody knows there’s one repository.

Nyleen Flores: That is the patient’s chart, and that’s where you’re going to find any information. Especially if you’re using a third party billing service, they have to have that information. So you have to be paperless for that to work,

Erik Sunset: There’s a, there’s an article. It’s getting a little long in the tooth now, but it’s, it was titled software is eating the world and think early days of Uber. Like this is kind of the timeframe it was published in. And in 2024 software has already eaten the world except in healthcare and the fix for healthcare.

Erik Sunset: I mean, the other, the other end of the spectrum, what you just described, super efficient, everything’s digitized two seconds to get an answer as opposed to Let me [00:26:00] go flip through some charts and see if we got the data, find where it is. And the point I’m driving at is that you can put more people on that problem to make it faster in a paper based world.

Erik Sunset: But why would you, why would you incur that cost of at least one full time employee to do so maybe two, maybe three. It’s just been the healthcare fix. Just throw people at an issue. That’s a manual process. But you don’t need them at all if you’re digitized.

Nyleen Flores: right? I think in health care where it’s a little difficult to say that and as much as i’m a paperless thing Reality is health care is a touch business and I feel that that’s why it gets so much You know memes that’s why you get all this tiktok videos about the doctor doesn’t pay attention to you because he’s just dictating to get paid The reality is patients want to be touched. We’re moving away from that. So [00:27:00] maybe AI can help with that. Maybe if the doctor is using AI, he can then talk to the patient instead of stopping what he’s doing and typing in front of a patient. So there are, I do understand how that can be perceived as removing the pain. Patient interaction touch the physical touch that is needed in health care because patients do feel I mean, I feel whoever you go into a hospital, it bothers you to see a nurse just sitting there on the computer when you’re like, I’m in pain.

Nyleen Flores: I want you to pay attention to me. I don’t care about your computer. So that’s why I think in health care. There’s been that lag as well.

Erik Sunset: This is really a micro point, Nyleen, but you know, you go in for your annual [00:28:00] physical, your doctor walks in the room, and they got to scribe with them. The entire time you’re talking to the doctor, it’s click, click, click, click, click, click, click. How many windows they’re going through? How many fields are they filling out?

Erik Sunset: To me, that speaks more to, again, a not so proper or robust implementation that You know, and I’m I’m coming at this from what used to be for me, the EHR side of the world, you sell them used to run an EHR software company. And, you know, you should be doc, you need to be documenting by exception. There’s no reason for you to type out an entire note when there are tools that let you say all these are normal.

Erik Sunset: Let’s drop those in. And we’re not talking about a chart fraud machine that allows you to, you know, bloat your coding. That’s not what I mean at all, but you’re doing the right kind of documentation. Let’s talk about the exceptions, not the normal. That’s where I just think there’s a better way. There’s a better way than having a scribe in there.

Erik Sunset: And that’s [00:29:00] by properly implementing your software or using the right tools. If it’s not the right tool, get a better

Nyleen Flores: And building, building it correctly, the doctor has to spend the time and say, if I’m a specialist, particularly because I deal with specialists, so primary care is a little bit different because primary care, you’re going to really see everything. So unfortunately, I’m sorry, primary care docs, but for a specialist, right. We’ve gotten to the point where we’re so specialized that a knee surgeon is only going to see knee patients, right? If you really have three or four good templates, the patient’s either coming in for something broken, something torn or something hurting. So if you have those three templates and the notes, you have the same thing.

Nyleen Flores: If it’s built correctly, the doctor should just have a template, be able to pull up that template and all you’re putting in is what you said. The exceptions, you’re documenting why the problem, what you’re going to do about the problem, what can be done about the problem, what the plan, that’s it. What happened, [00:30:00] what’s, you examine the patient, everything is okay, and what you’re going to do about it.

Nyleen Flores: So,

Erik Sunset: Well put. And we’ll, we’ll move on from this. I’ll just say that with an intelligent implementation. You don’t have to degrade that relationship with the patient. You don’t have to have your nose in the computer the entire time. You’re, you’re speaking to them or with them. You mentioned a dog whistle, Nyleen, AI and healthcare, and that takes on a lot of forms.

Erik Sunset: We talked a little bit about it before we hit record. There are LLMs like chat GPT being embedded in EHRs. There is AI that’s taking handwritten or even very old typewriter notes. and extracting meaningful insights from a paper chart. There are robotic processes now that are being used for pathology and identifying bad tissue.

Erik Sunset: Where do you see AI going in healthcare? Where do you think it will be most useful?[00:31:00]

Nyleen Flores: is going to be the way doctors chart and document moving forward. I think that. You know, the same way that when I was growing up, we had the old projectors and now there’s smart boards and we used to have a book and now there’s only eBooks available, you’re just, it’s just going to be the way of the future.

Nyleen Flores: And it’s going to be the way things are. If you want to include virtual reality, I’m seeing all over LinkedIn, these new virtual reality, doctor surgeon things where they put on the goggles and whatever. And then all you have all these sim labs, which all this high technology. So, I mean, I I think that that’s, that’s where it’s going.

Nyleen Flores: Does it make people better clinicians? I don’t know. We’ll have to see if truly walking into a room and activating a microphone [00:32:00] and a doctor saying key words. To be able to document in the chart is really worth it. Or does it just lead to errors and Ultimately someone is listening. So it’s really scary But our phones are always listening to so I I don’t know. I know that we have to be careful, but I think it’s the way of the future.

Erik Sunset: I do too, and I think it’s a matter of time. You mentioned, does this make anyone a better clinician? You know, I can speak to my opinion on this, that if I have the opportunity to have care provided, And there’s a hundred million pieces of data going into my care being guided by the physician. I’m pretty good with that.

Erik Sunset: I don’t mind that at all. The state of play for something like chat GPT or the more specialized LLMs, or even like, let’s stress it down, artificial intelligence. I [00:33:00] think it’s a misnomer today. We’re talking about predictive analytics and machine learning. Really? There’s, in my view, there isn’t really AI out there.

Erik Sunset: So at what point would you have the potential to replace a physician? I think that’s a pretty long ways away, but I think the AI assisting clinical decision supports or even something that isn’t AI at all, like precision medicine, being sure that you get the right The right drugs, the right prescriptions based on your genome.

Erik Sunset: I think that’s closer than people think being being widely adopted, but the replacement of a physician with software, I don’t think patients will be happy with

Nyleen Flores: No, I don’t see that No, I can’t. I don’t want a robot coming in the room

Nyleen Flores: saying, oh, call for me, oh, it’s RSV. No, I don’t know if I want

Nyleen Flores: that.

Erik Sunset: no, that’s a little too Jetsons probably not in our lifetimes.

Nyleen Flores: Yeah,

Erik Sunset: Well, Nylee, before we before we put a bow on this [00:34:00] show, is there, is there anything else that we want to share? Or, or maybe what is the number one thing that you wish more ASC administrators knew?

Nyleen Flores: that is a good question. I I think that I think that Wish they knew how they can really be the person who holds the key to everything working. You are the hub of everything and that includes, and I’ll tie back to my love of my life, which is credentialing and peer review. Doctors have to be held accountable [00:35:00] for what they do. You have to know what to do with that and whether they’re an owner or not, especially in a surgery center, since we’re talking about surgery centers, hospitals is a whole nother monster in a surgery center.

Nyleen Flores: Things get really sticky when a physician is an owner, but if you have bad behavior. That should not be tolerated. That’s going to infect your staff. It’s going to lead to shortages of staff members. Have to really understand that ongoing monitoring And I’m going to talk about how the ongoing matters.

Nyleen Flores: Ongoing reviews matters. Know what your doctors are doing in the OR. Get in the OR. Watch the surgeries. I’m not saying you’re there to critique. Their technical skills on how they did that. You know, anchor I’m talking about, how did they treat? The staff. I’m talking about how. [00:36:00] how they acted during a surgery.

Nyleen Flores: I’m talking about real things that can really hurt patients because your staff needs to know that, you know, what’s going on. Are they talking to your patients in pre op? Are they talking to your patients in post op? How is anesthesia treating the patient? Are they hurting people? I mean, you have to be aware.

Nyleen Flores: So to me is learn what that means. Learn what to do about it. Know that you have resources available and requirements to keep patients safe. You don’t have to be the one necessarily You know, I don’t have to be a nurse because a lot of things people say, Oh, it’s because you’re not a nurse and you’re not a nurse and you’re not a nurse. I don’t have to be a nurse to know what a nurse does. And I don’t have to be a physician to know what a physician has to do or should do or behave. So I study [00:37:00] what a nurse does to know what she’s supposed to do.

Nyleen Flores: I know what the regulations are. I know what they’re what they need to do. Step number one, two, three. I know what the requirements are and I know how to keep a patient safe. So to me is being in the front lines, be there, know what to do. And if you don’t know what to do, find out. And that’s why you should go to the conferences like Aska. And that’s why you should educate yourself. And that’s why I’m a big promoter, not only in staff, but invest in yourself. Get certifications, like, don’t just sit there, keep growing personally. There’s, to me, that’s how you do it. And if you’re not, then maybe you need to change your job and you need to go somewhere else. You don’t love what you do. Don’t stay there, you know, invest in yourself, grow as a person and invest in others. [00:38:00] And that’s kind of all that I have, I think is learn, always learn. Healthcare is always changing. That’s what’s so beautiful about it.

Erik Sunset: Love how you tied it back to the upcoming ASCA annual conference. Again, we’ll have the link to check that out in the show notes. It’s April 17th, 20th in Orlando at the Gaylord Palm. So they picked a great venue. I’m speaking a little bit selfishly. I’m only going up from Miami. I know many will travel for much further away than that.

Erik Sunset: Nyleen, thank you so much for sharing all of your, your hard earned wisdom with listeners of the show.

Nyleen Flores: Thank you for having me.

Erik Sunset: And on behalf of the entire DocBuddy team, thank you for listening. Be sure you’re subscribed on Apple YouTube. So you can always get the newest episodes of the show until next time. I’m your host, Erik. Talk to you soon.