Optimizing Your ASC’s Case Mix, Value Based Care Insights w/ Andrew Lovewell MHA MSHI FACHE

Erik Sunset: [00:00:00] All right. Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy, we deliver healthcare solutions that take the pain and costs out of broken workflows like our OpNote solution, which gives ASCs the power of instantly generated operative reports from the point of care.

Erik Sunset: You can learn more about that and more at docbuddy.com. And today we’ve got a great guest, Andrew Lovewell. Andrew is the CEO of Columbia orthopedic group. Andrew, thanks for joining us.

Andrew Lovewell: Thanks for having me, Erik. I’m really looking forward to our discussion.

Erik Sunset: It’s our pleasure. It’s going to be a fun show. And I know, um, you’ve made some appearances recently on, uh, on Becker’s ASC, uh, this is old hat for you to be able to, to share your expertise on the ASC space and beyond. And sort of setting up our discussion today. I know one of the, one of the points that.

Erik Sunset: You’re passionate about, you find the most interesting right now is finding the right case mix index to both fill your center, [00:01:00] sort of optimize profitability where you can. So give us the low down there.

Andrew Lovewell: Yeah. So that’s a, it’s a great lead in, right? So we have, um, really tried to maximize or optimize our case mix index for our ASC for a multitude of reasons. One of those being, so we’re fully vertically integrated. So we have a anesthesia arm or department of our business as well. Um, and we have to make sure from a payer mix standpoint, that the cases we’re doing are both, um, clinically appropriate, but also financially appropriate. And, you know, most importantly, it’s, it’s assuring that we can provide care on our terms that are going to provide a quality outcome for our patients. And really, when we look at what makes us clinically viable also makes us financially viable in the long run. So we try to assure that the cases we do today, are those cases that are going to yield the [00:02:00] best outcome for both parties, us as a business patient as a patient. And we look at, you know, a varying degree of, um, safety measures to assure that we’re going to do the right case at the right time at the right place. And then financial measures to make sure are we optimizing or at least breaking even on the cases we’re doing, you know, as the margin compression continues to happen on the professional side of services from the Medicare physician pay cuts. Um, you know, you have to assure that you’re examining everything in your ASC as well to make sure you’re really honing in on, you know, your margin per case, your profitability per minute. Uh, what it’s going to look like from the standpoint of every little thing that happens to get to the result you need to be at. So our processes internally are, are really optimizing our block time to assure we’re staffing and scaling our cases at the right time. And then also, is there a way for us to kind of shift cases from site of service from an [00:03:00] OR to a procedure room? Or vice versa to make sure that we’re really making sure every little bit doesn’t go unused because today, you know, one of the things we talk about internally is really the, the cost and salaries, wages, benefits, you know, the time, the efficiency, um, clinical metrics, all of those things are factors that play into what we do every day.

Erik Sunset: When you mentioned optimizing for block times, they’re having anesthesia in house is a tremendous leg up. Uh, that’s a luxury that, that not money have. And, you know, luxury is probably not the right way to phrase that because you’ve structured the business in a way that allows for that. So not, not to take, uh, And you do credit away there, but when you have that anesthesia in house, does that allow you to go deeper into optimizing block times because you don’t have the pressure of managing external anesthesia to go along with it?

Andrew Lovewell: I think the biggest thing that it does by having anesthesia in house is that it really aligns the [00:04:00] incentives. You know, when it used to be a third party independent group, we’ve been with the same group, and in fact, we employed the same group that was with us. Um, they felt tremendous pressure from the outside world when it came to payer contracts, the Medicare reimbursement rate for professional services and anesthesia, and really from a sustainability standpoint of their business, they were paying a pretty high fee for outside revenue cycle billing. And, you know, they could not get to a place where they could scale at the rate we can because when they join us, you know, they’re, they’re on our contracts. All of a sudden, we’re doing the billing. We’re doing the collecting. We can bill and collect a little bit, um, more savvy than they can. You know, our, our percentage that we pay ourselves for the billing and collecting is us, right?

Andrew Lovewell: We’re paying ourselves to do the billing and collecting. So I can hire a coder as opposed to hiring a third party. I can put more resources in my same staff I have to give them, you know, the knowledge set to go ahead and pre collect for things. So I [00:05:00] think the biggest thing that that gave us was probably more, uh, relief than anything. And the anesthesia group as well, because, you know, they didn’t have to necessarily worry about what was going to happen. You know, they’re going to be taken care of a hundred percent. And additionally, when you’re a small little anesthesia group, like they were from a benefit standpoint, like providing health insurance to your staff or a 401k or all those things, you know, joining a 300 plus employee group, that cost burden of that goes way down.

Andrew Lovewell: You know, we could provide health insurance benefits at a cheaper rate. We can provide a better 401k. We can provide more CME dollars. We can do all of the things they were doing. And then some, Because we’ve got the scale to bring them on and really yield a very symbiotic relationship that wins for both parties.

Erik Sunset: That’s pretty indicative of the ASC as a whole, right? You know, it’s the, the rare win win win [00:06:00] in healthcare between the patient, the providers, and their organization, and the payer. One of the, one of the points I’m curious about, Andrew, is it, this may depend on when you brought that anesthesia group in house, but what, did you experience any pre and post no surprises acts?

Erik Sunset: Either education that needed to happen for your revenue cycle operation, or is that just how it’s always been? Uh, again, depending on when they became employed.

Andrew Lovewell: Yeah, so they, they started with us January 1st of this year.

Andrew Lovewell: Um, so it’s a relatively new venture for us. Um, but I would say from the No Surprise Billing Act standpoint, they historically, and even today, were not in network with one of our smaller payers. Um, and I think the challenge there has not been them trying to get a network or even us trying to get them in network for the last nine months. It’s the payer. The payer is very obstructive. They’re not willing to get us on the panel at a rate that’s reasonable. Um, you know, unfortunately, it is [00:07:00] something where we do get challenged by the No Surprise Billing Act because we do alert patients up front and say, Hey, listen, we’re just a non participating provider with this on this part of our business. You know, I’m sorry about that. Here’s the estimate. We’re going to give you the good faith estimate, you know And so we’re assuring that we’re doing our due diligence on that side, even though the payer Didn’t give us any diligence on their side to get us in their panel Or answer our phone calls or do all those things So that’s we could do a whole different podcast on that right we could we

Andrew Lovewell: could have a whole different

Erik Sunset: Oh yeah.

Andrew Lovewell: The obtrusive payers and how they are obstructive to what we’re trying to do.

Erik Sunset: That’ll be part two. That’ll be part two there. And obviously, you know, for anesthesia groups, being in network is now, uh, pretty important, um, employed or not. So when we talk about this optimization of, uh, of block times, we’re just talking about you bring the anesthesia group in house. Being able to measure profitability, uh, both retroactively or looking in a retrospect is one thing, but knowing which [00:08:00] procedures you can schedule and knowing the cost of your implants and the supplies that go into that procedure, and you mentioned, uh, cost down to the minutes.

Erik Sunset: You obviously need a lot of data to make decisions like that. Are you doing anything special to, to collect and then analyze that data or are these just sort of the basics that you’re following?

Andrew Lovewell: Yeah, I think the first step to get there is you’ve you really have to have the right team and right culture in place to Hone down to that level of information Because you have to have people who are motivated to care and you know all of our staff and our asu plus people They’ll care. They all want to make sure they do a good job.

Andrew Lovewell: They want to make sure both financially, they do a good job. Clinically, they do a good job. And I would say, you know, that’s reflected in all of the awards we win year over year over year from Newsweek to local awards to state awards to all these things. So, you know, our, our incentive is to always do the right thing and always make sure we’re putting [00:09:00] our best foot forward. And past that, it comes down to the technology or the data side of things. So we have a pretty robust practice management platform that we use in our ASC. We’ve been on an electronic health record since 2014 in our ASC. Um, and then we had a smaller EHR that we used from about 2011 to 2014. It didn’t have the capability that our, our newer one did in 14. Um, but we recognize the value of being able to track and trend information. Um, so we made a big switch back in 2021. to a new EHR and PM, um, that’s fully integrated and it has all clinical and financial and business operations data tracked. So we can pull infection reports, we can pull, um, time studies, we can pull case costing, we can pull all sorts of stuff and we use it to create internal benchmarks and meetings to where [00:10:00] our physicians have service line meetings and we discuss with them. Hey, here’s how you compare to your peers, both in time, both in surgical outcome, uh, also in cost, uh, associated with your cases. So we benchmark it down to the per CPT level and also per the subspecialty level. So like our sports docs, our benchmarked with our sports docs, our total joint docs are benchmarked with a total joint docs.

Andrew Lovewell: We do it at a level where. It’s meaningful enough where they can get a good sense of, okay, here’s how I stack up from my peers. And you know, what’s important to us, probably the most important piece of that is we still overlay the outcomes on top of that. The outcomes are the most important piece to us.

Andrew Lovewell: So we track all outcomes we have for four plus years now. Um, so we track all outcomes at our ASC and assure that. Everyone is above the national average, um, and we also submit, uh, uh, the registries for joint replacement, spine replacement, where we can trend and track to see how we’re doing just at a national [00:11:00] level with our outcomes. And really, you know, if there’s something that we need to do that moves the needle from an outcomes and quality standpoint and it adds incremental cost, we’re going to do it. Because the reputation we have as being a high quality provider is more important to us than squeezing a little bit out.

Erik Sunset: That’s a really interesting look at it and to, I want to come back to two things. One, one is the culture and another is some of the benchmarking data that you use, but you mentioned something, uh, earlier on being vertically integrated, uh, from the clinic to the surgery center, to your anesthesia team and so on.

Erik Sunset: Are you using the same EHR and the ASC as you do on the clinic side of the house, or are those separate software?

Andrew Lovewell: Right now there’s stuff for software. Um, I will tell you that’s not ideal. You know, we would love to all be on one platform. Um, I think it’s difficult because there are very specific use cases of EHRs today. [00:12:00] I don’t know that anybody has really cracked the code on, on every little thing. I think some of the big players have. Some of the big players think they have, um, but they haven’t. You can’t be every everything to everybody. It’s not possible. So, you know, we’ve looked at, um, we’re going to upgrade our practice EHR here in the next year, uh, to a newer system. And we’ve looked at several different new systems to say, okay, well, here’s, here’s what you have for our practice.

Andrew Lovewell: Yes, it’s good. But can some of that translate to our ASC? And if the answer is no, it’s no, right? But we would love to get to a place where it’s a fully vertically integrated clinical record, not just for our staff, but for our patients, because then they could log into one patient portal, they could get access to everything. You know, from, from an easy use standpoint, there’s significantly less, uh, health information management and release of information we have to do. It makes life very fundamentally different when it’s all one system. And, you know, unfortunately there’s just different stakes from [00:13:00] different vendors. You know, you’ve got your big vendors in the ASC space and you got your big vendors in the ambulatory space and they don’t see eye to eye.

Andrew Lovewell: They don’t have aligned incentives like we do internally. Um, so I’m hoping one of them maybe takes the lead and says, okay, this is what we’re going to do and this is why we’re going to do it, but you know, they’ve got a margin to worry about. Um, And I think that their motivations are different than us as a practice and as an ASC.

Erik Sunset: Yeah, and you know, coming from a background of EHR sales many years ago, you know, it was one or the other. You’re either in the ASC side of things or you’re not. And the two don’t really cross over on the vendor side. And as you said, some will happily tell you, Oh yeah, we do both. But you don’t really do both.

Erik Sunset: Come on, show it to me. Show me how it does both. Um, so that’s, that’s interesting. I wish you good luck on the clinic, uh, EHR search, no drama. Hopefully you’ve got a really good governance board to make that, uh, to [00:14:00] end up with everybody as happy as they can be,

Andrew Lovewell: You know, I think that it’s, uh, it is, it’s luck, right? None of these systems, I mean, if we really want to get down to it, none of them are an A plus student. Like all of them perform at a somewhat adequate level. And it’s whether you can deal with their adequate level or that other person’s adequate level, but none of them are good at everything.

Andrew Lovewell: You know, there’s some of them are really strong on the PM. Some of them are really strong on the EHR. No one’s put it all together yet. Um, and I, I don’t know why it seems like it’s so simple to me. Um, but they don’t, they don’t listen to what I have to say when I give feedback. So it’s so kind of frustrating when you’re looking at picking the best of the worst. You know, cause, cause they’re all going to be cumbersome. They’re all going to be something that creates friction to start with. And it just takes time to get used to it. And unfortunately medicine moves so fast today that like time’s our most valuable product right now. You know, we don’t [00:15:00] have, we don’t have enough time to. dedicate or devote to a gigantic EHR swap, but we still have to do the damn thing. You know, we can’t be in a position where we’re beholden to some old technology that’s not delivering an outcome we want. So it, it’s a, it’s a cumbersome thing to get through, but you just, you got to slog through it, you know?

Erik Sunset: well, and that’s, unfortunately that’s the state of play, uh, class research that’s KLAS research for our listeners that may not be familiar. They release a rating every year. They look at, uh, user reviews and they do some really in depth surveying. They do a good job. I’m a big fan of it. Work the class does, but to your point, Andrew, the best in class winners in the HR are B minus B there’s different categories, so it’ll, it’ll vary.

Erik Sunset: But that’s your very best every year. I don’t think I’ve seen the best in class when they’re better than 86%. I’m sure a listener will correct me if they have, but, um, that begs the [00:16:00] question, why, why, why, why, why, why? Because the PM side. You know, you’ll get some of these very old and now gone systems like mysis tiger, people were using that for 35 years with no complaints.

Erik Sunset: Yeah. You get a little bit different UI if it’s just a flashing, you know, green cursor on the screen, but. That worked fine. What’s going on with the clinical side and I’ll stop talking and give you a chance to rebut in a second, but you look at some of the other data around physician burnout and obviously more broadly than just in the A.

Erik Sunset: S. C. But at the clinic and at the hospital, the number one driver of their burnout, their self reported burnout is the technology If they’re forced to use, so what can we do to fix it? Like, where, where do you start?

Andrew Lovewell: Yeah. It’s, it is, um, it’s one of the most interesting kind of quandaries, right. That happens in the medical field. That’s never going to be solved is, um, you know, No EHR vendor has came out of [00:17:00] really wanting to do right by the patient, in my opinion. And, you know, they all have to meet these federal certified EHR compliance things.

Andrew Lovewell: They have to meet all these hoops to jump through and everything. But I don’t know that anyone has said what is right, what, what is right for us to do for the patient and provider. And really, I don’t know that the federal government has said that either because they put all these obstructive things that get in the way of the patient provider relationship. And, you know, the HR is probably one of the most colossal kind of things that have done that, you know, you, you interrupted a segue of. It was so simple with A to B that it worked. And you know, I get it. I get it. It makes sense from a clinical outcome standpoint, tracking things and doing this and do that. And I mean, I just finished our, our MIPS submission the other day. And like, that is such a cumbersome thing to go through. You know, you’re like, okay, I got to talk about my promoting interoperability and my [00:18:00] improvement activities and my quality and my this and my that. And at the end of the day, you’re like, Why am I doing this?

Andrew Lovewell: Like it’s, it’s, it’s a, it’s a net neutral product from Medicare. They don’t incentivize anybody. They take the money away from the losers and give it to the quote unquote winners.

Andrew Lovewell: But really you spend so much money on meeting the MIPS requirements that like, did you really win? Because I don’t know if I want

Andrew Lovewell: and and then and then you get to end of it.

Andrew Lovewell: You’re like, I had to spend a million dollars on a freaking EHR. So I don’t know. And maybe we’re both on soap boxes at this point, but like, I think it’s, I think it’s a very frustrating thing in medicine that will never be solved.

Erik Sunset: yep. And, uh, at the risk of putting you taking another step onto that soapbox, we can’t forget that. MIPS is a byproduct of meaningful use, not really doing anything. Um, and meaningful use is there to get us to a point where interoperability would be a no brainer. Eh, not so much. We’re not there.

Andrew Lovewell: Well, here is. Here’s what we’ve all [00:19:00] forgot is there is a cost associated with everything today, and it’s not a little cost anymore. It’s a big cost. And when Medicare continues to slash physician payments year over year over year, and the inflationary curve is up 40 plus percent since 2009, just in a short 15 year period, And Medicare reimbursements are down 25%, 30%. The margin just getting driven out of medicine. What, where’s the breaking. Right. And, and like, I’ve talked on this before with Becker’s and been on some panels and other podcasts and like, you know, the, the, Strategic reform of our system is not going to happen anytime soon, and it may not ever happen, honestly, but what people are failing to realize is when you’re operating on a margin that’s so thin that it’s so [00:20:00] fragile that physicians are leaving private practice in droves. in joining private equity groups or being employed by hospitals or not having a seat at the table anymore, I don’t think we’re putting the patient’s best interest in mind. We are really failing seeing what the actual purpose of our mission is. And that is to take care of people. So when we get all this complex stuff in the way of everything else, We are completely forgetting what we were here for. So I think that’s why part of our mission and what we do is do the right thing. And that is treat the patient, take care of what’s in front of us. And we will be fine. We will make, it’s not going to be as much money as we made a year ago, guarantee you, but we will still make good money and we will still get to control our destiny and take care of patients the way we want. And I think that’s what’s meaningful. And I think that’s what will maybe flip the pendulum at some point is people saying, okay, I’ve been mandated to do A, B, and C when [00:21:00] I’m taking care of patients. I don’t want to do A, B, and C. They don’t need that. They need D, E, and F or something different altogether. So I think that to me is the most important piece of everything we talk about is. None of us would be in business. Hospitals, ASCs, surgeons, physicians, whatever. No one would be in business without the patient. That’s really the core fundamental of what we’re doing. It’s taking care of people. So we’re going to get back to that.

Andrew Lovewell: That’s our core function.

Erik Sunset: Andrew, I want to try to phrase this, um, succinctly and in a, in a meaningful way here. Related, related to value based care. You know, there, we talked about some of the obstructions to just treating the patient. There are, there’s a data collection effort that we call MIPS and you’re submitting to registries and other specialties are submitting to their registries.

Erik Sunset: You then have an influx of private equity money. As you said, they see an opportunity to invest and make an ROI on their [00:22:00] investment. If there was a switch that you could flip that we’re going to move everybody to value based care and fee for service is dead and gone, does that remove some of the invest, what could be, and I’m not saying it is, but could that remove some of what could be interpreted as obstruction by investment in healthcare by outside entities.

Erik Sunset: And if you can bypass just the simple data collection that we’re doing. Like your smoking status, sir. You’re here for a flu shot today. What do you smoke? Yes or no. There’s maybe value in that. Maybe not. Like, does it matter for my flu shot or, or what?

Andrew Lovewell: Yeah,

Erik Sunset: Trying to get back to being succinct here, failing miserably.

Erik Sunset: Does it move to value based care? If you could just flip the switch, does that fix some of this to putting the focus back on the patient and helping reduce the costs? Or is that just the same thing by a different name?

Andrew Lovewell: a my opinion on value based care is that it’s a great concept that none of us can define You know, I [00:23:00] think we can all I think we can all agree that value is good But if we can’t define what value is it’s not real, you know I grew up on a big farm in northern, Missouri And my grandpa growing up all the time was like if you can’t see it touch it feel it It ain’t real. It’s the same thing with value based care. If I can’t define it and you and I can’t share a definition of what it is, is it real? And I don’t know, I’m not an anti value based care guy by any means. I’m a value based care guy defined with rules, regulations, guidelines, and something for me to go off of.

Andrew Lovewell: Right? So if you tell me what the rules are, I’m going to figure out how to win. You know, I don’t like, I don’t like to lose. Our group doesn’t like to lose. Okay. You know, we will figure it out, but you got to define what the rules are. You know, we’ve done several of the value based care bundle initiatives with some of the big payers.

Andrew Lovewell: We did one of the very first ones in the country with one of the big [00:24:00] bukas and they kept changing the rules. Every time I turn around, they’re like, Oh, well now this is included in the bundle or this is included in the definition. I’m like, wait a second. We started out with saying we want to provide really high quality access and care to our members, which are my patients, and you want to compensate for that. And I was willing to take a pay cut for my ASC, my physicians, and my anesthesia to do that for you four years ago. And then you changed the rules and said, we don’t want to pay you the same thing we were paying you when we assigned the contract. And now we’re saying, all these other things are included. You need to go pay for lab. You need to go pay for therapy. You need to go do this. And like, we got to the end of it and we’re going, wait a second. Who’s defining this value? Because if it’s a return on the stock market for you, that’s not value to me. That’s not actually value to the member or patient either. So, what are we really accomplishing here? Now, it’s not to say I don’t believe in some type of [00:25:00] mechanisms with the accountable care. Act or some kind of aco type model or capitation conceptually could work It depends on one the trust you have and who’s regulating it. Let’s face it. The federal government has no idea what happens with medicine Secondarily who’s really the one defining the value?

Andrew Lovewell: It should be the patient at the end of the day Not, not even us, honestly, because I’m going to view it as a skewed lens because I’m gonna say I’m really good no matter what. And then secondarily, or tertiary to that is really, it’s like, until we can have a shared nomenclature or definition of what value is. It’s a really irrelevant conversation and maybe that’s the wrong stance. I will tell you when value based care first came out four or five years ago, I was the first guy out there going, we’re going to do bundles. We’re going to do direct to consumer. We signed big national employers to send people here.

Andrew Lovewell: We have a freaking hotel we built where people were flying in and having surgery. Like, I’m not kidding. [00:26:00] We were all after it. You know, we were scrambling to get ahold of it. And we did we launched I thought what was probably the most impressive attempt at scaling value based care in a meaningful way We did two two of the bukas. We did their first national bundle programs here And they were a freaking failure out of the gate not on our part But on the part of they couldn’t adjudicate the claims. They were still paying individual separate payments They didn’t know how to define quality post surgery. Like, well, how do you define that?

Andrew Lovewell: Is it readmissions? Is it outcomes? Is it, is it just simply cost? Cause that’s not quality. You know, how, how do we actually define that? So when we got to the end of the one year contract, we signed with them. We’re like, this isn’t working. This is not a good program. And they shut it. We didn’t even shut it down.

Andrew Lovewell: Cause we went back to the table and we’re like, let’s define the rules. And they’re like, we can’t define the rules. I’m like, what? That’s the whole point of this.

Andrew Lovewell: Like this is the whole point of this to deliver better care and [00:27:00] say that we’re doing in a meaningful way. So I think it’s like, it’s like anything else in medicine, right?

Andrew Lovewell: You got to try stuff and some stuff’s not going to work and some stuff is going to work and the stuff that works, let’s do more of it. The stuff that lowers the total spend, we should do more of it. That’s like, you know, in our market, one of the big payers has came out and said, we only approve these 250 codes at an ASC. And then in an asterisk below that, they say, if you have access to an ASC and I’m like, well, wait a second, that doesn’t accomplish anything. If the big competition I have doesn’t have an ASC, they’re still going to do stuff in their HOPD. They’re still going to get paid a higher rate. Like you’re not creating a level playing field,

Andrew Lovewell: you know, capitalism.

Erik Sunset: the words out of my mouth. That’s, that’s the incentive to close the ASC. We’re going back to that, to our HOPD. We don’t need an ASC anymore. We can get hospital

Andrew Lovewell: Right. Yeah. Capitation is built off competition or consumerism is built off competition. People want [00:28:00] competition. It’s good for outcomes. So if we don’t have a level playing field and they say you have to do them at an ASC period, what did they accomplish? All they did was force me to do that because I have an ASC. They didn’t force my competition to do it, which don’t, don’t get me wrong. Like I love the competition I have because we’re incredibly thankful to be in the market we’re in with the competition we have because we’re pretty damn good at what we do. And like if I could get steerage out of these payers or out of employers or out of any type of model to send me stuff based on true outcomes, based on functional assessments of patients, based on cost, I’d win every day. Every day I’d win.

Erik Sunset: Would I want to go back to something you mentioned? This is, this is my, uh, my favorite segue trick, Andrew, if you haven’t figured that out yet. We’re talking about value based care and you rightly point out that like define it, like, what are we actually talking about, because depending on who you ask, maybe something completely different, or even if it is written [00:29:00] down with your payer example, you gave, they may change your mind, uh, after everything’s submitted.

Erik Sunset: But you did say something that I keyed in on, which was that you should be asking the patient what’s valuable to them. And this is, this is a thought exercise that we can spend the rest of the day through, and I would gladly do so. But what, what do you think the average patient would say? I mean, you’re closer to it than me.

Erik Sunset: I’m a guy working at a health IT, uh, software shop. You’re in Columbia Orthopedic Group. What would the average patient say is value or good value, or, you know, if reimbursement was tied to their satisfaction, what would they want?

Andrew Lovewell: Yeah. So I think when we look at value as a provider led, we look at it on cost outcomes. Um, and then, um, you know, kind of quality, which ties in the outcome. That’s how we define the value equation. But it’s actually a lot longer than that. And really the [00:30:00] numerator gets bigger, not necessarily the denominator because the denominator is probably always going to be costs, honestly. Um, so when we look at the value from a consumer led standpoint, it’s, it’s very akin to other subsects of our economy, right? So the most disruptive things that have happened in the last four or five years for other segments of our economy, right? Uber, right? You can get a cab, a cab now, which is not a cab anymore. Um, yellow taxis got to be pissed at those guys. Right? Because everybody uses Uber. Everybody uses like VRBO or Airbnb. The hotel industry was on their heads trying to figure that out. You know, now you can get Grubhub or Uber Eats or all these things delivered. So like it’s, you know, It’s came down to access, right?

Andrew Lovewell: Like we’ve been able to access things in a more meaningful way that have produced more meaningful results. Or maybe the same result, but it’s just easier for me to do [00:31:00] it. So one of the pillars that we believe in is access. So coming up, actually May 1st, we’re opening a walk in orthopedic clinic. You can walk right in and we’ll see you. Period. You don’t have to call us. You don’t have to do anything. We don’t care what’s wrong. We don’t care what your insurance is. Just walk in. Walk right in. We’ll take care of you. We don’t, we don’t care what’s wrong. Just come on in. Don’t call us. Just show up. We’ll give you the ultimate access and boom, there it is. Second thing to that is really what it comes down to for patients and their families. is they want to know more, more patients now than ever vote with their wallet. They have to know what it’s going to cost. Well, if I’m running an orthopedic urgent care or clinic in a place of service 11 or a physician office, I’m automatically four to five times more valuable than an ER or an urgent care is

Andrew Lovewell: a traditional,

Erik Sunset: Oh, yeah.

Andrew Lovewell: because my cost. is so much [00:32:00] less. So we’re, we’re trying to address a two fold problem here by saying, okay, your cost is lower and your access is higher. How would you not win on that? Right? How do you not do better, Mr Patient? Well, they do because it’s aligned care, right? They get experts immediately. They’re in the door.

Andrew Lovewell: They know what’s wrong. We can see them take care of them, have a physician take care of them. It is the ultimate end all be all for a patient because you’re not stuck in some loop of calling and voicemail and this and that it’s one of the people I’ve heard give talks at a national level has said, if I can’t book an appointment as easy as I can order my pizza for delivery, it’s not working.

Erik Sunset: And for healthcare stay to play that that can be a pretty tall order.

Andrew Lovewell: It’s tough, right? Because when we look at like our physicians, the bibles they use to kind of screen patients coming in our practice. We’ve had a couple of them who have said, just get rid of it, get rid of my [00:33:00] protocols altogether. Just have them come right in. I’ll take care of them. And those physicians are now like drowning in patients. And they’ve realized the value of just casting a wider net because every patient wants to see them. I mean, I’ve got four or five guys in my group now who do that, and we’re launching this big orthopedic urgent care hub, basically. We call it ouch, actually. We’re launching. Ouch. May 1st. So if you’re hurt, boom, show up.

Andrew Lovewell: Ouch. Show up. Don’t

Andrew Lovewell: care. Move on it.

Erik Sunset: Great. Good branding.

Andrew Lovewell: So for us, it’s, it’s really trying to create an ecosystem that doesn’t exist in our market yet because everybody else in the market has been able to do that outside of healthcare. They’ve said, okay, we’ve got Uber, we’ve got Airbnb, we’ve got VRBO, we’ve got Grubhub, we’ve got, um, all of these disruptive things that have now become the norm. This is going to just become the norm in our market. It’s going to be the normal thing.

Erik Sunset: Yeah. And to your point, you’re giving, you’re giving the patient what they want, which is [00:34:00] access. Um, I would imagine there’s some level of, uh, price transparency being put into play here as well to really serve the patient and. You know, to bring us home here on, on the value. Um, I’m not sure I have anything to add and I’m not sure that my addition would be valuable anyway, uh, being that you, uh, you’re on the front lines and you see it.

Erik Sunset: My concern, I was trying to lead you down the path of the, you know, the average patient may, may be happy with really great, you know, Care in the sense of the, the staff was nice to me and my insurance ran without an issue. Maybe my outcome wasn’t so great, but you know, I’m happy because they treated me nice.

Erik Sunset: Like, is that, is that really helping your outcome? No, you feel good at the time, but it doesn’t help you longterm.

Andrew Lovewell: You have to think about it from A to Z, right? As a patient, when you walk in, you know, who do you spend the least amount of time with when you get in to see the doctor, the doctor, [00:35:00] you traditionally spend the least amount of time with those who you’re there to actually see the most. So what we are trying to do is really kind of crush that whole myth of saying. We can spend as much time as we need because you have to align the care, not every, and this maybe is not the right thing to say, right, but not every patient needs to see an orthopedic surgeon immediately. You just don’t need that.

Andrew Lovewell: You know, if your shoulders hurt right now, why do you need to go see an orthopedic surgeon?

Andrew Lovewell: It might not be a torn rotator cuff that needs operative care. It might not be a, um, shoulder replacement after arthritis of years and years of wear and tear. You might not need those things. But you do need somebody to have access to, to assure that it’s not those things, and if it is, they’ve got to get you to that place, right? So, you know, I think that that is one thing that we have to do better as a medical community, is aligning the care. with the actual issue. [00:36:00] Because if you think about the number of emergency medical admissions, um, in our country over the last year, two years, whatever it is, right? How many of those were actually emergent issues that needed to be dealt with?

Andrew Lovewell: Whereas they could have been dealt with in a primary care PCP setting. If they would have been medical management differently. Right. So you have to really hone in on like, what is the best course of action to deliver the best result at the best time. And really at the best cost. And I think what happens is we forget so many times over how complicated medicine is because we’re in it that we don’t think about how the patient or the consumer thinks about it. And I think that is really where we have to get is we got to kind of take off this provider led or, or CEO led hat or whatever and think, okay, what do my patients want? And that’s really where I think things have to [00:37:00] head is. Nobody ever wanted to refer to patients as consumers, and that’s really what they are.

Andrew Lovewell: You know, if you think about, I can give you an example of, uh, here’s a question for you. Who do you think I collected the most money from last year? Let’s say I collected a hundred dollars. What portion of it came from, uh, who, who gave me the largest portion of that?

Erik Sunset: Um, you’re leading me down a path here that I should, I’m going to say Medicare and it’s not going to be Medicare.

Andrew Lovewell: The, the patient,

Andrew Lovewell: the patient with high effectable health plans, co pays, everything else. That was my largest payer. That’s where our economy is at today. People have kind of care avoidance after COVID because their health plans have gotten so dang expensive. And we really saw our numbers drop for a while, but then that care avoidance is all caught up now. But like my number one payer, if I’m [00:38:00] collecting a hundred dollars in total is going to be the patient. Now it’s not going to be by tens of thousands of percentages. It’s going to be by a small percentage over Medicare. But like the patient is the number one payer in our medical economy today. And that I think is what’s really, really crazy is like, we have said, let’s go purchase these crazy insurance policies.

Andrew Lovewell: We’re going to, we’re going to provide insurance. But really what they’ve turned into more than anything is catastrophic policies now

Andrew Lovewell: because they don’t cover Nearly as much as what they did 5 10 15 years ago. So we’ve put all the onus on the patient

Erik Sunset: you’re, you’re blowing a dog whistle for me that, you know, more people than ever are insured and like less people than ever are actually utilizing their insurance because they can’t afford to do anything with it. So like, yeah, you got insurance, but what’s the point? You don’t use it because you can’t afford it.

Andrew Lovewell: Right, right.

Erik Sunset: Well, Andrew, this has been fantastic and we definitely need to take the opportunity to get you back on [00:39:00] the show if you’re up for it. But in between now and that, that future date, where can listeners of the show find you? Big on any social medias.

Andrew Lovewell: Yeah, i’m on uh, linkedin Um quite a bit i’m active on there um, i’ve got uh, several things that I publish in beckers or just out on the internet anywhere, um, You We are probably going to launch our own podcast here pretty soon internally about just the messed up medical world we live in today. Um, and a lot of it’s going to be on just education around what insurance and medical care actually is, um, have varying different guests on kind of similar to what you guys do. But I think a lot, a lot of people just really have lost kind of sight on. You know, they say I have insurance, right? And they show up with this card and you’re going, well, you know, you don’t actually have the insurance you need to do this or this or that. So I think, you know, for us, it’s a way to educate and improve the health literacy of people. [00:40:00] Um, cause I think that’s really important. I’m pretty passionate about people understanding what they have and what they don’t have. Um, so really it’s, it’s LinkedIn online, Google me anytime. Um, Kind of say what I think and which sometimes that’s looked at in the medical community of being a little bit of a charlatan But you know, that’s okay.

Erik Sunset: We need guys like you out there, Andrew, fighting the good fight.

Andrew Lovewell: Awesome. Well, thank you so much for having me

Erik Sunset: It’s our pleasure to have you here, Andrew. Good luck with the opening of your new ouch, uh, network, the launch of the podcast and on behalf of the entire DocBuddy team, we want to thank you for listening and be sure you’re subscribed on Apple pods, Spotify, and YouTube. So you always get the newest episodes until next time.

Erik Sunset: We’ll talk to you again soon.