More On Cardio to the ASC, Key ASC Issues

Erik Sunset: [00:00:00] Hey folks. Welcome back. I’m your host, Erik Sunset. You are listening to the DocBuddy journal here at DocBuddy. We deliver healthcare solutions and take the pain and cost out of broken workflows like op note. Which gives ASCs and their affiliated clinics, the power instantly generated operative reports, all approved from the point of care and with images. If you want them. You can learn more about op note and all of our solutions at docbuddy.com.

So today is Friday. November 1st hope everybody had a great Halloween yesterday. Um, I know I had a fantastic time. Treating with my girls. Rolls who are the perfect age? Treat with a, they. I get a big kick out of it, but they also need to be out, uh, till all hours. So it is right in that sweet spot. More important. if you are in Chicago at the Becker’s. Uh, ASC events that to be proper about it, that is the. The 30th annual meeting of the business and operations of AFCs. [00:01:00] Um, happening in Chicago. Uh, hope you had a chance to. To stop by our booth. Hopefully you got a chance to see a op note.

We’ve got both. Uh, Rob and Ashley holding down the Ford’s name as a reminder, this is one. One of the final stops on the dock buddy road show. Four. The 2024. Um, next week we will be. Be into Layla Washington at the Washington ambulatory. Surgery center associations. 2024 annual. Education conference and trade show. Uh, So if you missed us in Chicago at. At Becker’s ASC and you’re not going to be traveling to two Lael up.

Here’s one way. To get in touch with us. So you can go to the website, hit the contact us. Uh, but not the top rates. Send us a note. We can link up with you that way you. I could also email sales@dockbuddy.com and we can get in touch with you. There. So today. Um, we’ve got another solo. So show a for you.

So another little bit [00:02:00] of a break in tendency. Like we talked about last week. Now while we reload our hopper for, for. For great guests and it gets more experts onto the show for. You’re listening enjoyments about for today, wanted to share. There a couple of quick and nice headlines as we wrap up the week. Um, certainly something that those in the ASC space we’ll be keeping it close. Uh, watch on. Um, and with that, let’s get into it.

 the first of two hot topics for us to close out our week with. With, uh, brought to you by Becker’s ASC. There’s no formal relationship there, except that we’re exhibiting. At their event this week, but I’ve got a couple of news items from Becker’s ASC. Becker’s asc.com. Obviously we’ll have a link to the. The articles that are referenced there. Um, but the first two, the new hot. Hot ticket for ASTs similar to the orthopedic boom, a decade. And ago cardiology has emerged as the next major growth opportunity for. ASC growth has these high [00:03:00] acuity cardiac surgeries migrate to the. Outpatient setting. Cardiology is now the big, hot. Ticket for ASC. He says Bruce Feldman administrator Easter. Eastern orange ambulatory surgery center in Cornwall, New York. Uh, who told Becker’s a lot of centers are beginning to do cardiac procedures. Vascular stenting, ICD implants and so forth.

Huge. Huge. Shout out to Bruce friend of the show. We’ve had Bruce on the podcast. And cast and the not too distant past. Excellent episode. Gave you some, a lot of free game for those in the ASC space. So do yourself a favor. Find the doc, but a journal on your favorite podcast. Player. And look for Bruce Feldman.

You’ll be able to find him. Um, but the article continues according to Avanza is 20. 22 key ASC benchmarks and industry figures. Your port cardiology is. The fastest growing ASC specialty, major ASC chains. You’re taking notes. Optum’s ASC arm. Do your field Illinois based SCA. [00:04:00] Health acquired at least two cardiovascular providers in 2020. Three. National cardiovascular partners comprises 21 cardiac. Cardiac catheterization and vascular labs, Ponte Vedra beach, Florida. To based pivotal health care has 11 affiliated practices and 14 location. Stations earlier this year, Marriottsville Maryland based upon score. And compass surgical partners. Partner to build a cardiovascular surgery center. In short pump, Virginia. Despite this trend, Mr.

Feldman. Then said that the you work has not yet approved many cardiology codes for ASC. while 26 other states have moved forward. While he expects outpatient cardiology to become more widely accepted. Soon hospital lobbies are big obstacle in the migration. Quotes. Hospitals don’t want to lose these cases to. The AFCs, these are lucrative cases for the hospital and they’ve spent millions of dollars. Dollars building catheterization labs.

He said, if. All of that volume goes to the AFCs. How could they [00:05:00] backfill those labs? Abs and quotes. This is why much of cardiology ASC. ESY development is in places like the Midwest or California, Bruce. Melvin shared where there’s less consolidation by larger health systems. Bruce continued. Major cities have large healthcare. Their systems who have huge lobbying power in Washington to fight the migration. Of these procedures.

He said, They did the same thing five years ago with. Joint replacements, but now 95% of joint replacements are done in. At an ASC rather than a hospital. Additionally, private equity. He recently has taken an interest in the specialty due to a low concentration. Of private equity in cardiology. The nation’s aging population. And changes to Medicare and Medicaid rules.

Additionally, cardiovascular procedure. Procedures are less expensive in ASC then in the hospital outpatient department. For example, catheter placement in the coronary artery for coronary. Granary and geography, which is one of the most common procedures. Costs [00:06:00] $382 at an ASC. Versus. $919 at an HOPD. Looking ahead, Mr.

Feldman. Feldman expects cardiology to enter the ASC through single specialty centers. Catheterization labs are very expensive to build. So it’s often. Cost-prohibitive for multi-specialty ASC is to add cardiology. And Bruce. Uh, obviously nails this Bruce’s a as an icon. ICAN in the space. So he knows what he’s talking about. One other person who really. Really knows what they’re talking about with regard to cardiology procedures. Taking place in the ASC is Dr.

Dan Blumenthal, who is. The chief quality officer of CVA USA. Dr Blumenthal. Paul has actually been on the show twice. We’ve been lucky enough to get him twice on. The dock buddy journal. Where we went in depth on. Getting cardiology procedures to the ASC. It’s going to take. To get more of them to the ASC, how you can safely do them, how you select patients. How do you keep patient populations healthy? Uh, healthy enough to have. [00:07:00] There Hertz or, um, And so forth, have a. Procedure happened to them in the ASC. So there’s a lot of moving pieces. Obviously Bruce is talking really heavily around lake. Regulatory and sort of reimbursement, um, based factors. Here, which I agree with there’s there’s not a whole lot else.

You can say there. Dr. Blumenthal though gives a lot of a great. Perspective on what it means for providers. So as a cardiologist, which Dr. Bloom. Blumenthal is so as a cardiologist. Yeah. It’d be great to do procedures. In the ASC, but, um, we’re talking about operating. On the engine room of a human, as it were so highly recommend you check out both of those episodes. With Dr.

Blumenthal. And then also give a look to Bruce Feldman’s episode with us from a little bit earlier this year.

 All right. And our last topic. Of the day. No, I, um, let’s go through the list of. Um, articles seeing what kind of emails I had gotten, you know, I had some interesting. [00:08:00] Stuff for Medscape. Um, but the Becker’s ASC list kind of. Got my eye. One thing in particular. What trends or ASC? See leaders, tired of hearing about. And this. Hit a little. So close to home because it’s almost verbatim what we covered last week. And it’s kind of funny how, how this all works.

That. In the height of COVID. There was a lot of. A lot of articles written about COVID a lot of, uh, sort of twists and Ang. And angles taken on COVID that. You know, in this new. New reality. You know, your revenue cycle has never been more important because we. We need to be able to handle both tele health visits as well as the limited. In offices is that you get, which is true.

Being like everything had this COVID. Good spin on it. And it got to a point where it was just like, man, I’m talking about COVID 24 7. Seven at this point. And early on, like rightfully so. So obviously, but as things kind of stabilized and you know, we got back. Back to normal, to the extent we could.

And I [00:09:00] certainly realized that. That’s different based on where you were in the world and where you were. We’re in the U S. I remember talking to, um, the bad. hospital review folks. Around some content that I was going to place. Place onto, onto their site and said, Hey, like what’s, what’s a hot topic. What are some analytics that you have, you know, to show me where. I can deliver value to your listeners. It’s COVID. And I. I said, really?

You got to be kidding me. I’m looking at COVID all day long. It’s all. COVID all the time. In terms of content and news and coverage and angles, everything. Everything was COVID related. So really we have to do more about COVID and the. The answer was like, yeah. I mean, you can give us whatever content you’d like, but. The hottest topic remains.

COVID. So we’re kind. Of approaching that same level of saturation. It seems like. Like around some of these. Ki headwinds, the ASC. ASEE leaders are tired of hearing about. We’ll shout out a couple of them. I don’t have any, [00:10:00] uh, relationship with these folks, but hopefully we can make. A new, a new friend or two.

So Susie Kingham, she’s the administrator of. Vanced ambulatory surgery center out there in Rancho Cucamonga, California. She says that ASC is needs stronger. Legislative repres. Representation to ensure that we can survive in the future. We’re being squeezed financially. And we’ll not survive if we don’t get equal reimbursements as a . That’s hospital outpatient department as surgery. The centers, we do not get dependent.

Bit of hospital group purchasing organization. And pricing. That’s GPO, nor do we have government help. And a reimbursements are increasing when our costs to operate have increased substantially. While we can and do save insurance companies, incredible amount. Of money and provide more specialized care with better outcomes. We are. We’re paid a percentage of what HBO, PBS. Receive this absolute. Absolutely can’t continue and have us survive.

And because we don’t have. The deep pockets, we aren’t able to get adequate representation, honestly. [00:11:00] Honestly, there’s nothing more important at this point in time. It should be. The topic of conversation. So for Susie, probably tired. Hearing about it. Um, but not tired of the action. That’s needed and the action that’s taken place. You know, I would just. Recommend Susie can continue to support Casa.

I assume since. You’re based in California. Uh, that you do support. Uh, the California ambulatory surgery. And ssociation. Uh, Casa, April Ladenburg, uh, Bethel. that whole team you. Continue to support Casa and then support. ASCA nationally as well, to help continue to have these more legislative and. More PAC driven conversations. Cause you’re right.

Like. We talked about last week, something’s got to give something has got to change because ASTs are getting. I put in this sort of untenable position, it’s an unwinnable position. To uh, where reimbursement is down. Supply. It costs way up. Uh, and if [00:12:00] nobody steps in. And picks up the mantle and fights for the ASC.

It isn’t going. To make business sense for a whole lot longer to continue doing procedures there. Next Dr. James O’Leary. CEO. A real doc speaks on something that he’s tired of hearing about. Quotes, there continues to be a large discrepancy in reimbursement. Between ASC and HOPD. The AFCs are paid. About half, he says 53% of what HOPD is, are paid under. Medicare.

I’m tired of hearing politicians justify the significant. Pay differential for the same procedure. offering. Much better patient experience and value for patients and health plans. We need site neutral payments and the regulatory structure encouraging. Physician entrepreneurship. And providing the value of quality. and innovation patients deserve.

Well said, what else can I say, Dr.

O’Leary, uh, With the slam dunk [00:13:00] there. Wholeheartedly agree, doc. Next Patrick McEnany is CEO of Northern Illinois foot and ankle. All specialists up there in crystal lake, Illinois. I think we’re all. All tired of hearing about anesthesia shortages. It is a serious issue. In the surgical realm, there are surgery centers that are not. Functioning at full capacity because of this, I’ve also seen block times pulled. Away from docs because of lack of anesthesia. There needs to be a concerted efforts to fix the anesthesia problem by the. Medical community.

It is a knife in the heart to an ASC when cases. I have to be turned down from lack of anesthesia. And similar to our last response. What else can I say there? Uh, Patrick you are completely correct. And when we talked to experts. Spurts on this show about what do we need to do? They get more medical school. School, uh, throughput or medical student throughput into medical. School into their residency, into their fellowship, blah, blah, blah, blah, all the way down. [00:14:00] The line there’s really no magic wand. To be waived here. This is going to be. Uh, sort of a brick by brick effort. To rekindle a, an interest and a desire to get kids. Kids into medical school.

Um, Man and. At stuff. Uh, we had a more, no more recent Fs episode. We had a doctor on and, uh, she had a child, uh, following. In her footsteps to become a doctor. You know, her family members. And people in our community are saying, oh, that’s great. You know, your daughter’s going to keep doing. And, uh, you know, it’s like the family business, she’s going to continue in your footsteps. And the guests on the show while she absolutely supported. Her daughter, you know, unequivocally. Part of it was, I wish. What I wish you would go into some other line of work and a. Unfortunately, that’s the case.

You look at the rates of burnout. That’s a big factor. So, you know, Patrick, if you’re, if you’re out there. Uh, we certainly need [00:15:00] to get more kids. Kids interested in being anesthesiologists and CRNs. Um, but you gotta do what you can right now to. At ease, burnouts, whether that’s software driven, whether. That’s lack of autonomy driven with that’s lack of other types of staffing driven.

We’ve. Covered all these metrics in great detail in the past. You have to fix all the things wrong with the profession now, so you can hopefully keep. Keep some of these anesthesiologists and keep these physicians employed. As they currently are and hopefully retain them in their career. And instead of letting them retire early and mass, which is what’s happening now, as we all. No. Um, once you can fix the professor. things that are broken with the profession now. Uh, currently you’ll see more interest in that medical school throughput. Um, but the reality is when you look at earning potential, of an anesthesiologist, you know, it’s up there.

Um, Certainly. Up there. [00:16:00] If that’s not enough, or if the burnout’s so bad. Uh, that you’re keeping people away from the profession. Something fundamentally wrong with. It goes without saying I won’t step onto that. So POCs. For this particular episode. Uh, so with that, I hope everybody. He had a very happy Halloween and a great October and the start of Q4. Obviously calendar quarter four. Uh, You can catch us next week in Washington.

So if you’re a ProLiant surgeon or. You’re a, uh, otherwise out Washington way. We’ll see you into Layla up. Until next time. And on. Behalf of the entire dock buddy team owned a thank you for listening. Be sure you’re subscribed on apple podcast, Spotify and YouTube. So you always get the newest. Episodes of the show.

And until then, I’m your host, Erik, talk to you saying right.