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To learn more about how CareCredit works for you and your patients, visit carecredit.comforward/beccarspodcast. This is Gracelyn Keller with the Becker's Healthcare Podcast, and we are live at the business and operations of ASCs. I am joined right now by Michael Gail, who is the administrative director of Centerra Obici Ambulatory Surgical Center. So, Michael, thanks for joining me today. Would love to have you take a moment to introduce yourself and talk a little bit more about your role in the
industry. Oh, sure. I've been in health care senior leadership, for better than 20 years. Currently, I'm at Sentara Obici, Ambulatory Surgery Centers on the campus of, Sentara's Suffolk Hospital. Sentara is a health care large health core large health care organization that, that is mostly in North Carolina and Virginia, and it also has a health plan. So there's, 8 surgery centers in the region that I participate in. The I'm I'm a director at one of those facilities.
I was recruited from, Southern California where I ran, endovascular surgery corporations. Wonderful. Well, thank you for being here. And let's start our conversation today talking about ASC volume. So this is expected to increase by 16% across the country by the year 2032. With this growth, what is the most pressing challenge to maintaining a positive patient experience? Well, it's it's that's a multifaceted question, with a lot of answers.
I I would say it starts with, ramping up, labor resources for the patient's benefit. And and that means resources for patient patient education as well as counseling for patients on, their financial obligations, pre and post op education, coordination with the referral sources for physical therapy, home health.
There are transportation issues, of course, but most of our resources as a facilitator of surgery, are are dedicated to the day of and preparing getting clearance for those patients to to come to the facility, educating them about what to expect, talking to them about the financial obligations they may have, and coordinating, heavily with the physician surgeon's office to make sure those patients, are able to pass through all those bureaucratic hurdles
without much exposure to them. But I would say, it's already a challenge, across the board in health care, finding competent people, to help shepherd patients through an ever through the ever increasing complexity of, of that experience. A lot of patients, depending on their socioeconomic backgrounds, you know, they they're barely keeping their heads above water, with with, with life.
So it it can be a challenge adding on, you know, complexities of healthcare that have concepts that, are alien to them. Oftentimes, they just want the conversation reduced to what I have what do I have to pay you? And issues that that are more profound that have to do with, on our side,
because we're experts in the field. They have to do with our side, about good clinical outcomes and their proper the proper informed consent process leading up to their their, their surgery, is is oftentimes things that they can't process, are too busy to process, or unwilling to process for all the all the same reasons. Absolutely.
And going along with that, what strategies have worked for your organization to tackle some of these challenges, and what is the recommendation you have for health care leaders to stay ahead of them? Again, another another very good question, very broad. I'll give you a quick example to sort of silo this a little bit, make it more comprehensible. The we started a total joint program this year. So total knees and total shoulders. So, there's a there's a pre and post op
patient education component to that thing. So if you if you're having a total knee surgery, that nurse nursing education, that clinical education you're supposed to get is very important because you don't know what to expect. A lot of these patients are aged. So, you know, they have Medicare. And so these can be as simple as as we may perceive them to be. That education about what comes next through that pre and post experience is very
important. So having, for example, an ambassador, like a nurse ambassador or a nurse and another clinical person like a scrub tech who has experience in those surgeries, intraoperative experience for those surgeries supporting supporting those surgeries, Having those kind of people speak to the families of the patients, before they get there for clearance issues, and then during their stay while they're there, in coordination with the physician surgeons communication with
them, can be very important. So that's one example of how to how to prepare for the transition that Medicare wants us to make, CMS wants us to make, to some of the procedures that are currently done in a hospital setting that can easily be done in an outpatient setting. So when you have a low acuity base, something that's less complicated, less challenging, that has a lower risk factor, and can be done in an outpatient setting, that volume, just by virtue of who's paying for it, the payers,
they're driving that volume to us. So that increase in volume, we have to speak to the challenges of patient education. In addition to all of the other things we already do, we just have to ramp up the game, for what we already do, especially with the communication between us and the physician referral source. Their their office people change a lot, for example.
And we just have to keep that that knowledge bin rotating through that cycle of ever increasing business, more demands on us to to process those imp those patients, without making it seem like it's an assembly line. And you do that with more, labor resources that are trained and competent in communicating with those patients. That's the whole ballgame right there. Because if you treat people like it's an assembly line, they'll react like they're in a factory.
And nameless with a number and just being processed. They're just a paycheck to us. And that's not the case at all. The other issue I would say is, to prepare for this is is all the background stuff that happens, like good clinical out that produce good clinical outcomes. And I know this is like a very boring subject. But, you know, a lot of what a lot of the the the adverse events, the bad things that happen in an in an OR, we keep track of, right? We keep track
of all of them. And a lot of the thing all of the things that happen postoperatively, that are reported to us by the physician surgeons, post operative infections, people had to be hospitalized for it. The corrections that they had, revisions that they had to make on the surgery that they did. Those things are reported to us, too. And the more we keep track of those things, without letting them fall by the wayside, the better able we are to correct and
produce better clinical outcomes. So patients can be assured, sort of, on the back end, that we're minding our own house from a from a quality outcomes point of view. So I would say those kinds of resource dedicating those kinds of labor resources to that process is important. Forming those committees, participating them, in them. Again, as boring as it may sound, it's extremely necessary and it bear it bears results. You have QI, QA studies that you produce from those things.
A lot of times, licensure, the people that license you to do this do this work on an outpatient setting require you anyway to have, those kinds of QA studies? Why not base them on something that's real instead of something you go in search of? Base it on the real challenges you have every day. There's plenty of them. Yes. Absolutely. Well, thank you for those insights. And I'm gonna shift gears a little bit
here toward the financial side. So how can leaders ensure that their staff are well equipped to handle patients navigate financial aspects of care, and how does this benefit patient provider relationships? So it it's it's easy to say that to tell a patient or their relatives that they always that they owe you money. The hard thing is is doing it in a constructive way, in a way that inspires conversation and compromise about how to settle that obligation. We don't do things for free.
And we have contractual obligations that require us with some of the payers, to collect that money. So if if I were to decide, for example, just because of what the insurance company pays me, that whatever the patient obligation is is superficial and unnecessary, I would I could be in violation. I probably am in violation, of the of the clause in the contract that says if they have a co pay, if they have a deductible coinsurance, a share of cost, I have to make a good
faith reasonable effort to collect it. I can't just let it go. Now, a lot of times, with because of the shifting market of insurance, the the expense of it, the higher expense of it, people are choosing higher deductible plans. And so their share of cost is not some superficial thing any longer. It could be very substantial. So their their their their total, allowance for the year as a share of cost could be could be 4 or $5,000. And if they have a family, could be
even higher than that. So the point is that having a conversation with patients well in advance of surgery, making them aware of this, and making them aware that you have payment plans and that there are options. There are options like CareCredit, the sponsors of your program. We use them, by the way, as I mentioned earlier. That's that's that long term payment option, at a low interest rate is often a a a deal breaker or a deal maker sometimes.
I, for example, am willing to take payments over 6 months, up to 6 months. But I don't carry anything over $2,000, to give you a concrete example. So no matter what you owe me, I'm gonna divide it by 6 months at most. And then it's gonna go to a collections company, if you haven't settled it by then. But I'll I'll get that understanding with you in advance. And as long as you're transparent, you say, here's what happens at this stage, I'll trust you for this at this stage, I won't at this stage.
Here are the consequences that could happen if you don't pay altogether. You could be refused service if you show up day of surgery and and you're not true to the arrangements that we made. You don't bring in the the the down payment, so to speak, for that surgery of the day, no matter how minor it is. If you don't keep your word from the very beginning, it could be a problem. All of these things go to patient education.
And many times you have to refer the patient back to their their insurance company for that more elaborate explanation of why they owe that money. Sometimes they don't know. They legitimately don't know, like, they have other priorities in life. Now how does that help the how does that help our relationship with the physician's office? Easy.
When the patients don't understand why we're asking them for a couple of $1,000, they're gonna go back to their physician surgeon's office and say, why are you making me go over to this place that wants money that I don't have? It might as well have been $1,000,000. I can't pay $2,000. So if you didn't take the time to reason through this with somebody and be reasonable, it gets back to the physician's office. They have to call me because I'm just a facilitator of the surgery. I don't in my
case, I don't own the docs. They're not my employees. Now I have had owned docs, but I'm speaking to the current situation. It gets back to them, they have to get involved, and then they catch all the grief. Mhmm. Because in the patient's perceptive perception, it's the doctor who set them up for for that that surprise, that big financial surprise that they can't afford. And then there's the humiliation of it. There's the embarrassment.
You know, it people have pride. You don't wanna speak to peep these are your patients. And and they and they're emotional about it because they need the surgery. I mean, what are you supposed to do? You need the surgery. You know you need the surgery. You're gonna say whatever you have to do on the phone call. If you don't have the money to get to the place, get the surgery done, and worry about everything later. Right?
So you might as well have an honest conversation with people upfront and not put them in that place. Absolutely. Well, thank you for sharing your insights today. Is there any parting words you'd like to share on the podcast before we wrap up? I I would just like to say that we are reception people in in nursing clearance. All of the people that have an interaction with the patient intraoperatively, the pre op nurses, the post op nurses in a surgery center setting, and in health care in general.
If we treat people like we would wanna be treated, I know it's an old adage, it's an old saying, It's it's rather cliche. But if we were to treat people like they have common sense, like they have, like they're middle class people with other competing priorities in their lives, especially when they have to take off a day of work or something at surgery, they they have to manage all this all of the things they're going through in healthcare
in addition to just surviving life. And if we were to have more sympathy for the for people in the practical sense, speak to them in the practical sense, considering those issues that they have to deal with, allowing for us to have a conversation that's maybe a little bit broader than just the issue of the day with the surgery of the day.
And hearing them, it will go a long way to helping people to for them to be more open minded and less fearful, not just about what procedure they're having that might save their lives and the necessity of it, But just about what's gonna happen to them afterwards, is that is the other shoe to drop some big thing that's in and of itself unmanageable? You know, with home health or all the
complexities of health care now. We're getting better at what we do, more technologically advanced, for surgical procedures. And as we do, we have to explain how beneficial that that is going to be for them from a from a quality of life perspective. We we have to start being human beings in that conversation so that their minds can be open to the process. Absolutely. Well, thank you for taking the time to join me on the Becker's healthcare podcast
and share these insights on this topic. Again, we are live at the business and operations of ASCs. Thank you.