Macro Pressures Impacting the ASC Landscape w/ David Howerton

Erik Sunset: [00:00:00] Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy journal. And today we’re joined by David Howerton. Many of you in podcast land will be familiar with David, but for those who aren’t, David’s based in Nashville, Tennessee. He’s a bonafide expert in the ASC space, and I’m not going to let him try to back that down at all.

Erik Sunset: He is a bonafide expert. He’s held executive roles with surgery center tech vendors like HST pathways, simplify ASC. And CSS or med among others. David, thanks for joining us today.

David Howerton: Erik, good morning. Thanks for having me. It’s great to be here and appreciate the opportunity to, to

David Howerton: shoot The breeze with you

David Howerton: today.

Erik Sunset: Oh my gosh. The pleasure is all mine. So bad. We’re so far apart. I’m in Miami. You’re in Nashville. It’s like maybe what, 15 hours of 95 and

David Howerton: So

David Howerton: just a short drive, just a short drive away. All

Erik Sunset: Well, thanks again for joining because we’re really excited to get some of your perspective on the ambulatory surgery [00:01:00] center space it Has been changing and evolving over time really since its inception But the changes seem to be moving much more quickly these days There’s a lot of macro pressure on the ASC space things like private equity investments health system interest consolidation all of the, you know, sort of all the pressures you’re seeing in healthcare now, what do you see, what, what do you view as some of the most important pressures happening on the ASC space?

David Howerton: right. All right. You’re, you’re so right, Erik, so much going on today in the healthcare space. I know we’re going to touch on AI a little bit later on, but I think all of these macro trends, really not just within ASC, but in healthcare in general. So this pocket of, of the healthcare system that we know as outpatient surgery has been to your point in radical change, in my opinion, over the last decade I got involved in the [00:02:00] space around 2015 and the scene was completely different.

David Howerton: The actors were completely different. We still had a an area of the market that was lagging behind hospitals and clinics. squarely focused on meaningful use initiatives in varying degrees. So all of the attention from the investment community from the big technology vendors, all of that was still focused on trying to work out how to make hospitals and physician practices. More efficient and effective with technology. And once that ran its course a little bit more and the market matured, now you start to see this gaze turn upon the surgery center space, a market adjacency that people look down like, gosh, this is right for investment. It’s you know, it’s a beacon of light in the healthcare space with its efficiencies and that natural, uh, the natural tendency is to move into that with, with some of these things that we’re talking about.

David Howerton: today. So, [00:03:00] you know, big picture items that I think about today, obviously, and probably you will hear these from other folks as well. Right now, labor anesthesia. Where are we with the investment? You know, the investments from private equity today. What are the public markets look like? So that consolidation.

David Howerton: So these, these big Trends have, are going to have impacts, you know, throughout the rest of this year and into next year, depending on where we are with the, with the economic climate in the U

David Howerton: S

Erik Sunset: Yeah. I mean, those, those are all huge. And, you know, you’ve heard them here on the DocBuddy journal before as well around labor shortage, and I want to key on that for just a little bit. Obviously the ASC. segment, as it were, was spared by or spared from the meaningful use rules and that high tech act in that A.

Erik Sunset: R. R. A. 2009 law. And that has left a lot of A. S. C. S. Running off paper, you know, universally [00:04:00] or just about universally, there’s a practice management software in place that handles your patients, your scheduling and your billing. And that’s it. And that’s like the extent of the adoption of technology.

Erik Sunset: But I’m seeing and hearing more and more that a We know there’s a better way and we know that it’s technology and we are now beginning to look at that and seriously evaluate it. Why do you think it has taken this long absent a meaningful use type law for that realization to come into focus? I mean, obviously labor shortage is part of it, but why are we getting serious about it now?

David Howerton: think a couple of things are happening here. One, you have platform initiatives coming in from private equity investors, right? You you’ve traditionally back to that 2015 timeframe, you had a small number of technology actors in space. Very few EHR or documentation systems available for surgery centers. You had the hangover that we’re all aware of docs having battled through [00:05:00] uh, sometimes having to put in a second or third system in their clinic, this disruption of their workflows. tHat they were really not expecting. And, and a lot of the unintended consequences from what, you know, should have been an otherwise really good idea to digitize the healthcare community.

David Howerton: I’m still behind that. And I think we all would agree interoperability was lacking. As you have money coming into the space, it’s really hard to manage business and prove out your investment thesis. If you’re having to dig into a bunch of on prem systems. that reside across the country. So I think there’s a top down initiative, at least on the billing side, scheduling, billing the practice management that you alluded to. Let’s standardize that. Let’s go ahead and make sure that we’re not having to interject unnecessary human labor into the process of rolling up a quarter’s worth of data. So I think that’s helping move the ball forward. I think [00:06:00] from other health care segments, we’re certainly seeing, you know, advancement in EHR workflow.

David Howerton: We all know epic Cerner, you know, the big you know, the big products out there and how they’re starting to integrate point solutions within design. The actual clinical applications itself. So you have providers that are working in other areas of the healthcare markets, providers that are getting trained. So there’s a different set of expectations today than there was eight or 10 years ago in the surgery center space. And we’re growing. Into that not fast enough. And now you put on top of that, some of the AI potential out there, and you can really kind of chart a course towards something to be highly effective for surgery centers, but there’s a lot of ground to cover

David Howerton: to get

David Howerton: there.

Erik Sunset: Yeah, and we definitely need to dig deep into A. I. And we are going to I want to talk about anesthesia. Anesthesia. Excuse me if I could say it properly just for a little bit as well. You know, when you look at [00:07:00] the broader sort of macro environment for physicians in general, you know, accepting anesthesiologist here.

Erik Sunset: We’re going to run up on a huge shortage of them and we’re really only a handful of years away. A lot of that is due to the dissatisfaction with their career choice. They’re getting burned out. They’re retiring early. Spoke with actually spoke with a physician earlier this week who said, you know, we need to do what we can to keep these guys and gals practicing in the, in the near term so that we can sort of.

Erik Sunset: buffer the shortage, but in doing that and enhancing career satisfaction for providers now, you’re going to then make more of them interested or more potential providers interested in going through medical school residency and their fellowship. And then, you know, you end up with more physicians on the back end of this anesthesia is, you know, under some of the same pressures.

Erik Sunset: But the number one self reported cause, or really the [00:08:00] top three or four self reported causes for burnout are around technology. Certainly anesthesiologists have to use some of this technology as well, but to a different degree. It’s a different type of practice, obviously. We look at this huge shortage of anesthesiologists in the market and we’re opening up, you know, as a country and as states We’re opening up the practice of anesthesia to your mid level anesthesia provider and that’s still not going to be enough.

Erik Sunset: What’s the answer? What do you think should be done?

David Howerton: Yeah, it’s a, it’s a, it’s a big question to tackle Erik. And I think I’d add to that, that you have some, some, at least in the short run, some downstream impacts from no surprises act some reimbursement and payment issues that go along with that. So I, I, I think you, you do have to get you have to make a focused effort to bring more people into into the profession.

David Howerton: We have to do a better job of continuing to recruit, train and, and, and deploy people in the marketplace, especially with an aging population that’s only going to add more [00:09:00] demand into the marketplace. And that’s what we’re seeing today. We’re seeing more demand, but we have reimbursement issues that are getting in the way to the point where you have even some uh, you know, some lawsuits going on with the, you know, I think FTC and some big actors that are in the roll up space.

David Howerton: So there’s a lot of confusion out there that’s having downstream pressures for the independent operators today. And we got to work our way through that. But as we know that stuff doesn’t happen overnight. So methodical. education. I think probably a big picture item around getting better workflows to meet providers within the E.

David Howerton: H. R. I think helps. We’ve got a long way to go there because we’re still building out the community talked about being paper based today. That’s easy. It’s known, it’s efficient, it helps the throughput of the surgery center, but we’re not going to be able to harness all of that information for, for [00:10:00] improvements down the line.

David Howerton: So a myriad of factors get through, and I’m not sure I have a great answer on where we need to go to get this solved in the short, medium and long term. Just keeping it in focus, keeping it on the discussion, you know, in, in the main form of discussion. For everybody to know that this is really what’s unlocked the surgery center world and innovation and anesthesia is what’s allowing more procedures to come online.

David Howerton: It’s allowed for people to improve faster, have better outcomes. So we really need to focus on this and make sure we’re not letting this one

David Howerton: slide.

Erik Sunset: Absolutely, and then to that point One of the one of the key initiatives that Bill Prentice, the CEO of ASCA, shared earlier this year was around awareness that the general population of the United States has no idea what an ASC is, what it is that they do, why it’s a rare win win win in healthcare, too, for the patient, the provider, and the payer, and he came on to say anything we can do to improve our [00:11:00] standing and improve our stature, sort of in the public mind, we need to be doing.

Erik Sunset: Thank you.

Erik Sunset: And this lack of technology, which we’re seeing get better, we’re seeing ameliorate, but you need to have data on outcomes as opposed to just patient demos. So I think that’ll help the cause overall. And as they, I see kind of opens up, hopefully you get more provider involvement and it’s more tracked to place for

David Howerton: it’s more attractive. You’re going to see an initiative from CMS to continue to shift procedures outpatient. So it will organically take care of itself, in my opinion, from that capacity availability for procedures. Physicians become more comfortable moving more complicated things in there. We know we’ve got the simple stuff that gets done on the regular. But as we as we open up cardiology as we you know, maybe see more urology. Obviously, ortho msk continues to push into that as as a, you know, I’m a recipient recipient of that [00:12:00] myself recently. So We will see this move more mainstream and I think, you know, ASCA does a nice job of advocating for its members, but it’s, it’s a tough task, right?

David Howerton: It’s a, it’s a hard hard ball to push up hill year over year over year. So kudos to the team for getting the team that helped the legislation push through. They’ve got the new 11 codes passed, including shoulder arthroplasty. So those are wins. It’s incremental, but it’s coming. And I think we’ll have. You know, we’ll have to rethink how, how, what gets done in hospitals over the long haul and that kind of asset light footprint of surgery centers is a fantastic

David Howerton: answer for that.

Erik Sunset: we can talk to the cows come home about spending in the U S on healthcare, it’s percentage GDP, the amount of. fraud, waste and abuse that goes into that spend. And, you know there are much smarter folks than I, that could make good recommendations there. So unless you feel really strongly about any talking points there, [00:13:00] let’s examine something that may help us with the amount that we’re spending on healthcare for a variety of reasons.

Erik Sunset: And that’s, that’s AI, or at least so called artificial intelligence. If it’s not just machine learning and predictive analytics. Do you want to dive into healthcare’s top deck of the Titanic moment or do you want to address it kind of at large before we do?

David Howerton: I’ll follow your lead wherever you want to, wherever you want to start, because I’m just hearing about this AI thing. I think it

David Howerton: sounds, sounds

David Howerton: promising.

Erik Sunset: Well, let’s, let’s, before we look at this, this tweet thread, which listeners will have heard on a prior episode, it’s something that’s been turning over in my head more and more. And the more I think about it, the more I find a lot of it indefensible. We’ll get there. We’ll get there for sure. But AI in general, you know, the advent of chat GPT has sort of revolutionized a lot of workstreams content creation for marketing, for salespeople and their outreach, um, and the integration of [00:14:00] this or the inclusion of chat GPT or LLMs, large language models in actually prominent EHRs is really interesting. For me, from where I sit right now, and I want your take on this, David, sometimes this appears to be a solution in search of a problem.

Erik Sunset: And here’s what I mean. You’re a physician. We’ve already said and we already know that we’re burned out because of all the technology that I have to use that doesn’t really do what I wish it would do, which is help me treat more patients and provide better outcomes to patients as opposed to being my own scribe.

Erik Sunset: From the provider point of view. So now I’m going to be forced to make a choice. I’m either going to create my own documentation, like I have been doing with any number of inputs in my EHR. Maybe I use voice recognition, like something that Docquity provides, or maybe I do have a scribe. And it’s going to say exactly what I want it to say.

Erik Sunset: And when I click save, I’m done with it. The other end of this, the [00:15:00] emerging end, the LLM and the chat GPT side of things is now. I’m going to click a button and I’m going to have the instant generation of the documentation, the communication, whatever it is that I need, but now I need to go edit it because my name’s on it and I’m signing it or I’m sending it to the patient and it’s sort of a six to one, half a dozen to the other type argument.

Erik Sunset: What’s going to take me more or, you know, better, but what’s going to take me less time, the editing and the review or just doing it myself.

David Howerton: We’re, we’re in early innings here, right? Generative AI. The ability to produce something new from a set of data it we’re, we’re in the 1996, 97, 98 timeframe, where we were just sort of opening up the internet. There’s so much activity. It’s overwhelming. It’s, it’s literally everywhere. It’s my feeds are filled with, I can’t keep up with articles or podcasts or insights on where we’re going [00:16:00] with AI and healthcare, but it’s, it’s clear that it’s a radical game changer. It fits into the narrative of what we talked about with provider burnout. So I think point number one is that, you know, for surgery centers or for general practitioners or any, any subspecialties, AI is not a replacement, right? It is to be brought in to help physicians and nurses be better at what they do to practice at top of license.

David Howerton: You, I think that’s a term I’m hearing much more frequently now. I want to practice at top of license. Okay, great. What can we do to backfill that and take away? The things that humans just natally are less effective at than, than a computer system. So there’s so much ground to be made up here. We’re, you know, we’re still trying to figure out how, how is this going to be done on a mass adoption level?

David Howerton: And we’ve got a lot of things happening [00:17:00] in a time compressed manner, probably giving physicians across the board, some pause of like, wait, this is going to happen too quickly. I want to know. Not just sort of the math behind the way this works, but I want it to be a credible thing for me. What clinically, how is this going to help clinically?

David Howerton: And I think I listened to some a talk by John Holopka at Mayo Clinic, and he kind of nailed that down with, we’re going to provide data sets that we can prove to you, physician, that are going to be beneficial to you workflow. Now there, there Way out there in terms of sophistication and budgets and, you know, capabilities that doesn’t necessarily translate today into the surgery center world, because we’re again, we’re eight to 10 years behind where the hospital segment is. But that, that’s, that’s the gap we need to bridge, right? We need to get information in that helps physicians, helps nurses do their jobs so that they’re [00:18:00] not having to quote unquote chart in their pajamas.

Erik Sunset: Yeah, you’re so right. The, the pajama time charting is killing the profession. It’s literally killing the career in front of our eyes. And to be clear, I’m all in favor of technology, augmenting provider workflows. As a patient, I’d love to have the expert opinion of my provider. 10 trillion data points that software can chew up and spit out and say, yeah, you know, we agree with your provider, or maybe this needs to be considered, everybody should want that.

Erik Sunset: It’s, it’s absolutely common sense. And that’s kind of, that’s kind of an easy segue into this healthcare’s top deck of the Titanic moment, uh, thesis, where the thesis is what happens in the next year will define the next century of American healthcare. And basically everyone is ignoring it. And let’s, let’s set the table just a little bit here, because everyone is ignoring it.

Erik Sunset: I’m not so sure. I think Silicon Valley has been [00:19:00] bitten many times by an entry into healthcare. Look at Google look at Apple and all of the data that their wearables produce and physicians say, absolutely not. That’s not a part of my patient record. Too much liability, too much exposure for me, you know, among many other sort of traditional tech

Erik Sunset: monuments the big ones is what I’m trying to get at. So the, the folks that are on the ground in health IT, I don’t think are ignoring it at all, but you know, not to review this line by line once more. But it outlines that due to a scarcity of providers, which I completely agree with the insertion of an insurance payer into the care, the inelastic demand and high trust and then regulatory capture of healthcare, you’re seeing sort of parallel system to the traditional, I have insurance, I use it when I go to the doctor and I get what I need done, versus this other end of the spectrum, which is cash for pay.

Erik Sunset: Where, and this is where I think the thesis becomes indefensible, [00:20:00] where something like an LLM will replace provider responsibility over your care and allow a healthcare organization to scale to infinity. aLl because of the power and leverage of an LLM. Now there’s, there’s more to it than that. But David, thoughts at a surface level here?

David Howerton: Yeah. I mean, I think I agree with your assessment that, you know, a little bit hyperbole, right? Maybe I don’t, I don’t disagree with sort of the backdrop of what’s driving things. I mean, we have any number of issues that we have to work through in the health care system cost regulatory you know, provider training and onboarding and retention. All those things are true. We know that, right? Are we going to leapfrog in one year to some kind of magic singularity? Thank you. That’s not feasible, right? The, I mean, we have a recent executive order from the president of the United States that has a myriad of, of impacts on [00:21:00] how this thing rolls out.

David Howerton: So just when, just by the regulatory environment alone. We know things will slow down. That doesn’t mean the innovation engine slows down. I think that’s going faster than ever today. Tomorrow. We’re going to see things come out and you and I’ll read something or hear something and say, Oh wow, that’s, that’s fascinating. Are those use cases? Applicable today. Maybe, maybe not. It depends on, you know, on, on how they’re connected into the system. And we still have to get around the substrate of the EHR today and EHR today becomes tomorrow’s, you know, data repository. Right? And so all things will live on top of that because we can’t just forget. Get rid of that. That’s a documentation system. It’s there for regulatory purposes. It’s a, you know, legal safety net, all the things that need to happen. Plus, we need to know what goes on during an episode of [00:22:00] care, right? What did, what is, what is going on for the, for the patient, right? So we can record that and draw that out. And then you, you talked about wearables. We have, you know, all kinds of image capture. So many other clinical trials, all these other data sets that sit outside of that. I don’t see it being feasible for us to to just magically get to a position where all of that stuff is brought into some kind of longitudinal record that allows us to make the strides that You know, we need to, will this next year have profound effects on the future of healthcare? Yeah, I think it will. I think that’s a, a, a legit statement because we’re going to compress the learnings from the last 20 years. Down to, to move forward. We know what mistakes we’ve made. We know what we think we should have done. We all work around the technology frameworks that exist today. [00:23:00] It just, it just seems to me like it’s a, it’s a three to five year rollout or more to get across the board, what

David Howerton: we need to get done.

Erik Sunset: Sure. And I, I think where there is some merit in this top deck of the Titanic moment, it’s not, it’s not explicit, it’s not in this series of thoughts. When you look at the amount it costs whether it’s coming straight out of your paycheck, whether it’s something that you are paying for the amount that health insurance costs without any actual benefit to you at the time you pay for it.

Erik Sunset: And then you go and pay to receive care, whether that’s a co pay or you’re working down your deductible or whatever, you know, whatever that is. I think there probably is a subset of folks that are willing to explore a completely parallel system, whether they’re paying for traditional coverage through their employer, or it’s something they get from CMS or whatever.

Erik Sunset: I think there probably is a subset of people a significant subset, that’s gonna have to go to some cash based [00:24:00] model, you know, 50 bucks at a time, 100 bucks at a time, for some, something that amounts to near emergent care or some type of critical care, you know, think about a bad case of the flu. That’s not something that you can just kind of like sit on your couch and write out every time.

Erik Sunset: So there’s, there’s probably something to this, but I don’t think that it’s that technology is going to drive us or let me rephrase that. It’s not going to be that LLMs drive us to this parallel system of care. It’s going to be economic pressure on individuals.

David Howerton: Right. I agree with that. I mean, when we talk about. Large language models. We, they have to be trained and tuned that costs money. It’s time. We have to work through the ethics and the bias of those. There’s a lot to process there. Is that, is that going to be a state where we can effectively help providers deliver care?

David Howerton: Yes, but to your point, Getting to what’s going to happen in the interim, you know, maybe away from the surgery [00:25:00] center world, advanced primary care Amazon’s announcing, you know, low cost low cost insurance to, you know, to prime members, there will be disruptive forces out there that help access to care at a primary care level, but that doesn’t translate into the more costly world of surgery centers.

David Howerton: Right. We got it. We still have that. You can’t deliver low cost surgery today beyond what is already being done in the outpatient setting, which is, you know, it’s phenomenal. What’s done today

David Howerton: versus what’s done in the hospital.

Erik Sunset: Oh yeah, I mean that, that is the low cost care, right? The low cost

David Howerton: That’s right.

Erik Sunset: care.

David Howerton: That’s right.

Erik Sunset: Well, we kind of meandered, we meandered around a bunch pressures on the ASC space, LLMs, healthcare’s so called top deck of the titanic moment, which I think you can make the case for the last 35 years we’ve had the top deck of the titanic moment with spend just kind of waiting for the band to stop playing, I guess.

Erik Sunset: But on a little bit more proactive note, a little bit more rosy of a note, [00:26:00] as we’re looking towards a new calendar year, and I’ll, I’ll say the cliche, it’s hard to believe it’s, you know, the week before Thanksgiving that we’re recording this already. But as we’re looking towards 2024, two pronged question here.

Erik Sunset: What do your surgery center administrators need to be doing now to get ready for 24? And then is there anything different that an owner or an owner slash operator slash physician should be looking at for 2024?

David Howerton: Yeah. I think you know, we’ve touched on a lot of things. So the first, first part of the question, you know, end out the year right now, everybody’s heads down. and you know, in hair on fire mode because patients are coming in to exhaust deductible. So the, the end of the year is always hectic and patient focused.

David Howerton: It’s always patient focused, but the volume really kind of takes, I think it puts extra pressure on the administrators and staff at the surgery centers to prepare for the next year. So there’s a little bit of a post [00:27:00] holiday regroup to get ready for 2024. And I know they’re all in board meetings and planning.

David Howerton: So I think probably a lot of it is just, let’s get through, let’s get our, let’s get our procedures done. And then looking into the new year, what are some other things we haven’t touched on? I mean, I think Yeah. One that continues to pop up, I think, is cyber security. I think we’re getting into a world with a lot more bad actors. So, you know, top of mind for me would be how do we prevent unwanted activity? How do we protect our patient information? Are we training? Are we getting the people the right you know, the right just ongoing oversight so that they don’t unintentionally do something? I think the majority of Breaches are just innocent mistakes, but they can be incredibly costly, and we hear time and time again that a surgery center is shut down because they can’t access their information.

David Howerton: And I think… My understanding is a lot of times they’re having to pay to get out [00:28:00] of it. Cybersecurity insurance is getting harder, right? Insurance companies are way ahead of this. They’ve got all the data in the world they need to to make things more difficult on the operating entities. So be mindful of that, think forward and how you’re going to pull together. If you have to have more sophisticated governance and controls in place, that that’s something that I’d want to spend some time on at an executive level to make sure that we’re not caught flat footed and we have to go renew. And it’s a, it’s a, you know, it’s either a massive hike or it’s a no. So I would, I would be spending time on that. If I were, you know, at a, whether you’re an independent or, or a management company and I imagine that the larger the organization, the more Time they have available to that. So that, that’d be one area of thoughts on that. Do you guys see

David Howerton: some same

David Howerton: trends and.

Erik Sunset: So cybersecurity is massive and massively overlooked. Everybody knows they need to be managing it, but [00:29:00] this is much more than having a firewall at your data center. It amounts to a large amount of humans investing their time and learning what they need to be doing and what they can, cannot do.

Erik Sunset: Because to your point, that’s generally a small mistake that costs a healthcare organization or any. Organization, a lot of time and a lot of money. It isn’t that there’s a hyper sophisticated group of hackers that are probing for weaknesses in your network. And Oh, I’m in, you know, you’ve got the guy typing, got sunglasses on in front of his monitor.

Erik Sunset: It’s sending a phishing email. Oh, your password was reset, or we need you to verify X, Y, Z piece of information. You’re pointed to a page that looks like what you’d expect it to be. And then you just hand over your credentials. It’s not that the NSA or pick your spy agency is after your data and there are incredibly gifted technicians working to hack you.

Erik Sunset: They’re just asking you to give them your credentials. And a lot of times that’s all that it is. Phishing [00:30:00] email. Somebody is unaware that that is a

David Howerton: It’s a phone call. You know, I mean, Vegas was brought to its knees

David Howerton: by a phone call. And if I get through Vegas, I can assure you that the independent centers out there are vulnerable because people are busy. People are wearing multiple hats and it just, it seems legit. You know, I have to tell my parents, you know, because they get 1000 emails a week asking for some ridiculous thing. Look at the email address. Does that make sense to you? Is that, is that a legit business? Or is it some nonsensical, weird, garbled thing? And if it doesn’t look right, then

David Howerton: don’t click on it. Don’t respond to that. Don’t respond to that text. Just delete it. If somebody really needs you, they’ll

David Howerton: call you on the phone.

Erik Sunset: that’s right.

David Howerton: But, if they call you on the phone, be willing to take a, you know, step aside and go ask the right questions. to supervisor, to an owner, whatever is this, is this legit? So I hope we can [00:31:00] find some common sense approaches to weed this out because it’s just it’s time and money and you’re losing procedures and you’re, you’re actually having to come out of pocket cash to get out of this predicament that nobody intended to be in.

David Howerton: But I know how maddening it is for folks. And that does kind of, I think. unintentionally bleed over into technology adoption because it’s, it’s perceived as a technology based problem. Um, maybe, maybe not right. Sometimes it is, sometimes it isn’t. So I would, I would say You know, just be on guard

David Howerton: all day, every day.

Erik Sunset: It’s, it’s especially tricky because the technology aspect of it, you can solve that problem with a swipe of an Amex. Like if you don’t already have the right hardware in place, you don’t have the right technical expertise, just buy it, pay for it, and then you move on. It’s the, you know, in the business, they call it social engineering for somebody trying to get you to give them their credentials.

Erik Sunset: That’s an HR [00:32:00] problem. That’s a training problem. And sure, that may be under the compliance umbrella, but that’s a human resource knowledge gap. If people don’t know that they need to be aware of that.

David Howerton: You said something that’s I think that’s, that’s an important thing. It’s it’s go ahead and pay for it, budget it, think about it, be mindful of what needs to come down the road. And, you know, I know, I know the surgery centers are strapped. I know there’s some dynamics around, you know, the ownership models, but I think spend. Is important, not because I’m a technology vendor or at least, you know,

David Howerton: I used to be,

Erik Sunset: easy for us to say, go ahead and

David Howerton: yeah, and, and I think, you know, and this sort of leads into one other thing that I, and maybe I would like to see, it’s not really a trend or things that I think have to be top of mind, but I, I really believe in the modern consumer What’s Retail experience.

David Howerton: And I think health care lacks that across the board, right? [00:33:00] Some, there’s some pockets of excellence, not that the people aren’t great. It’s not a people thing. It’s just a, it’s a process. How do you onboard a new patient? How do you bring them into your clinic? How do you, how do you communicate with them?

David Howerton: And that’s a spend thing. The intentionality of the staff is there, right? More often than not, you walk away from these. Nurse interactions. You’re like, I love that person. She’s, she’s awesome. He’s great. We, you know, I’m, I’m, I’m entrusted, you know, I trust in the care that they’re gonna bribe for me, but I have to go do something in triplicate now.

David Howerton: And it’s just, it’s, it’s a, it’s time to go ahead and, and move into a world that that opens up. Right. We talked earlier about how do you get patients coming to a surgery center, make it easy for them, make it dead simple. Make it so attractive that people already don’t want to go to a hospital. coming through COVID. That’s where sick people go. Like, let’s, let’s go to the, let’s go to the areas that are there for preventive care. And obviously we’re fixing problems [00:34:00] in, in, in the surgery center world. We know what we’re fixing, but just make it easy for them. Make, make the paperwork seamless, make it so attractive to me that, that I want to be there, have, have the environment that for, for those of us. You know, maybe apprehensive about our procedure. It’s more than just, you know, empathy from the staff. And again, they’re fantastic at doing that and allaying fears. But it’s, it’s the environment as well. So I’d love to see a move as maybe impractical as it is to make these facilities more welcoming

David Howerton: where they can.

Erik Sunset: I think that’s a really interesting point, and not to drag us way off on the tangent talking about PrEP for 2024, but there’s almost, there’s almost a push and a pull there, that healthcare seems to know that this is a good thing, we want to do it how do we do it? I don’t know. I think it comes down to paying as you said.

Erik Sunset: You have to have technology in place or at least a baseline of technology to even have [00:35:00] a true consumer experience at your facility or at your organization. So we’re going towards that as an industry, but then the push towards it is with the Gen Z population kind of coming into its own and needing to be responsible for its own care as it goes to college and You know, grows up, there’s a level of convenience now with, with anything that’s not just expected, but if it isn’t met, then they’re just not going to do it.

Erik Sunset: And you know, we’re speaking broad generalities

David Howerton: For sure.

Erik Sunset: tolerance of a bad process is going to fall off a cliff as baby boomers sort of, you know, finish their run, great run, obviously, but as they kind of fade away and their healthcare is dictated or managed by others and their family. There’s not going to be a, Oh, I had to call three times for an appointment.

Erik Sunset: It’s going to be, I couldn’t get an appointment on their website. So I’m not going

Erik Sunset: there.

David Howerton: Right, and, and I know the spend is there, so if I can’t get. Have a clean experience. [00:36:00] And I have this big chunk of my disposable income going towards this thing. That, that seems like a detractor in the long term generation. I see it in my kids and their apprehension to do things is just not turnkey. And I think that will, as they, they’re, you know. Spending increases on things that are less entertainment based for at least for my older, older Children, there is going to be a demand on that. So maybe that that’s what drives it. And you’ll have innovators that come through and create different models of care delivery, not episodes of care, but value based care, right?

David Howerton: How are we? How are we going to go about this? You know, bundle of, you know, of care versus just transactional. So and that may be something else we’d be Thinking about surgery center levels is how do we participate in those? What’s a responsible participation in value based care? How can we do that effectively without losing our shirts, right?

David Howerton: Because there are factors outside of our control that, [00:37:00] you know, we, we just, we have to live through to figure out how this works best.

Erik Sunset: No, my gosh. I know we’re coming up on time. That brings another, another thought to the forefront is managing the profitability of cases. The administrators I’ve spoken with over the last six months are being, this isn’t the right way to phrase it exactly, but being held to a higher standard by their physicians and by their owners, where it’s like, what do you mean?

Erik Sunset: You know, this implant cost me this much. This guy only paid that much for his and you might even be in the same facility. So that is for sure a thought for 24, making sure that all your cases remain in the black.

David Howerton: That’s right. Yeah. Being, being good about, you know upfront uh, how do we evaluate? You know, on a proforma basis, what do we do? I think there’s some tools hitting the market that can be really helpful with that. I think the sophisticated administrators do stay on top of this and, you know, you have implants, you have contracts, you have different variables in there that always that trip people up.

David Howerton: But [00:38:00] yes, that that’s something that I think To bring back A. I. Into this over time gets really effective because you’re you’re getting out of just the pure documentation. Let’s just say whether it’s paper or E. H. R. The basic structured data that gets captured, right? That’s that’s what an E. H. R. Does. It captures times.

David Howerton: It captures medications. It captures allergies. It captions. What? What happens on game day? But we need to fold in Rich data, whether that’s, you know, GI images or whatever it is, wearables, all this super set of information that gives a more comprehensive view of. Why provider X and provider Y have differing outcomes that there’s some really, really, really exciting stuff on the forefront.

David Howerton: So being mindful of that in 2024 is education. Stay on top of this. Don’t let this trend get away from you. You hear pundits and people that put, you know, tweet storms out don’t get [00:39:00] left behind and there’s some truth in that it’s, it’s time to. It’s time to be educated on technology because it is a force multiplier for you in a surgery center. If we think the labor shortage is going to persist in some part for a period of time, whether we like that or not, we have to find a way to bring technology back behind providers to make them more effective. We’ve got to take some of the administrative burdens or all of the administrative burdens off their plate. So they can pay attention to the patients. That’s what I want. I’m a patient. You’re a patient. We don’t want somebody sitting there staring at a computer screen, typing in an app and ask us a series of questions. Click, click, click, click. And the providers don’t want that either. It takes away from the experience and

David Howerton: we should do better.

Erik Sunset: Yeah, it’s time. It’s time to to grow up as, as an industry. And I’m speaking to the healthcare organizations out there. You can’t hire FTEs. You can’t throw people problems anymore. These technology be doing what you should have been doing 10 years ago. [00:40:00] It exists now,

David Howerton: And as technology vendors, we’ve got to find a way to do that in a cost effective manner, right? Because you can’t soak these entities with Subscription after subscription, after subscription, after subscription, it’s overwhelming. So I, I, you know, I’m empathetic to the buyer who has to weed through all these things to say. Is this really better for me? I mean, I love what this does, but in how does this fit into a holistic picture for me? And I realized that. So we, we have to be better at connectivity, right? If meaningful use had been more mindful of interoperability, I think we’d be in a different place. Would have should have could have.

David Howerton: Okay. So now here we are. And as vendors, it’s, it’s hard to allocate resources to that connectivity because we all have our own agendas to move forward. So it’s a, it’s tricky and it, But it needs to be solved there. I know there are intermediaries that help and companies out there that are [00:41:00] thriving by creating this connectivity.

David Howerton: And that’s great. Let’s just continue to make it easy, continue to be open, move to an API infrastructure and get clean data exchange that’s de identified in a way that we can Use it for betterment of care.

Erik Sunset: what else can you say to that? Thanks for picking me up on my very vendor centric point and for providing the balance there, that was really well put because it’s true. There’s a vendor, 10 vendors out there for every one problem. Some good, some not so good, some in the middle and you do have to make the right choice with limited resources.

Erik Sunset: So very much understand that. David, where can folks connect with you? Are you active on any social medias or anything else that you’d want our listeners to know about what you’re doing?

David Howerton: Thanks, Erik. I appreciate it. I’m, I’m, I’m not terribly active, but I do you know, LinkedIn would be the best place to start. And I can, if you have show notes or something, I can flip over my profile. But that that’s, that’s about [00:42:00] where I, where I live. I don’t really get too much outside of that. For fear of crossing paths with my kids and having them terrified of, of, of, of dad kind of stooping on them.

David Howerton: So I’ll send you my, my profile link and yeah, I’d love to continue conversations. Obviously it’s, it’s, it’s a pleasure to talk to you always. And appreciate having the opportunity to sit down with you and, and you know, thanks to the DocBuddy team for making this available to. Public more information, more awareness you know, more general discussion, I think is, is better.

David Howerton: And so creating a, you know, short form piece that you know, the surgery center world can benefit from or other health care segments as needed I think is a great thing. So kudos to continue to do this and thanks for letting me hang out with you for a

David Howerton: short period of time.

Erik Sunset: Oh, loved it. Love chewing the fat with you. Thanks for sharing your expertise. And we said this before we started to record it’d be really easy to do this and just record a [00:43:00] commercial every week. Not only is that bad content though, we’re very serious about flying the flag for physician workloads.

Erik Sunset: Reducing burnout. We fly the ASC flag as high as anybody out there. Except with the exception, maybe of Aska since we’re not going to the Capitol and they’re doing any lobbying ourselves, but we we’re, we’re totally invested until we bought into making healthcare better in our own little way,

David Howerton: good stuff.

David Howerton: Thanks for doing that.

Erik Sunset: our pleasure. And on behalf of the entire DocBuddy team, thanks for listening. We will catch you on the next episode of the DocBuddy journal.