This Week in Surgery Centers: Nader Samii – Preparing for Quarterly Board Meetings

Nader Samii – Preparing for Quarterly Board Meetings

Here’s what to expect on this week’s episode. 🎙️

Every ASC needs to hold a quarterly board meeting in order to stay in compliance and remain accredited. Nader Samii, CEO of nimble, is on the podcast this week to talk through how you can make those meetings as impactful, productive, and engaging as possible.

Nader walks through how to properly prepare, the essential financial metrics you should always include, how to get ahead of potential surprises, and a bunch of other topics so you can look forward to these meetings instead of just going through the motions.

A few topics covered:

🤝 Board Composition: The ideal ASC board should include the CEO or administrator, physician board members, particularly major shareholders and the medical director. It’s beneficial to consider including outside board members with diverse backgrounds such as marketing, sales, customer experience, or hospitality to bring different perspectives and expertise.

🧠 Strategic Focus During Meetings: Board meetings should go beyond routine updates and delve into strategic discussions. Pre-circulating financial and operational data to board members can save time and focus the meeting on strategic problem-solving and big-picture thinking.

👀 Engagement and Preparation: Engaging board members in advance and preparing them with an agenda and necessary materials can lead to more productive discussions. Avoiding surprises, especially negative ones, is crucial in board dynamics.

📈 Important Financial Metrics: Key financial metrics such as revenue per case, cost per case, net revenue percentage, AR days, and denial reasons are critical for assessing past and future performance. Understanding these metrics can guide strategic decisions and operational improvements.

🔄 Continuous Improvement: Regularly assessing and improving the board’s structure and meeting focus can lead to more effective governance and better decision-making for the ASC.

By implementing these strategies, an ASC can leverage its board’s expertise more effectively, leading to improved operational efficiency, strategic growth, and enhanced patient experiences.

Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.

Episode Transcript

01:26.44
Nick Latz / HST Pathways
Nader, welcome the show.

01:42.30
Nader Samii / nimble
Um, thank you Nick really excited to be here. Appreciate you having me.

01:44.17
Nick Latz / HST Pathways
So so to jump in not or if we think about a standard or illustrative board. You know, let’s think about an independent ASC as an example from your experience. What does a typical board composition look like in terms of board members.

02:02.59
Nader Samii / nimble
So I would say typically you would have the CEO or administrator and whoever is running the center absolutely on the board and and an important part of it. Ah you typically would have physician board members. Um. That would that would be part of that tends to be ah the larger shareholders a medical director and other larger shareholders tend to be your board members. Um I think that there are I would say I see it less but I would encourage people to think about bringing. Um. Outside board members into and and joining a board that maybe bring in entirely different perspective. They aren’t in the day-to-day of running surgery centers and aren’t mired and you know the the quagmire of what is healthcare sometimes but getting people who might add value in places that you want value added whether it’s someone.

02:50.54
Nick Latz / HST Pathways
Um, yeah.

02:59.00
Nader Samii / nimble
Who’s got ah you know a patient experience or just a broad you know customer experience background growth orientation marketing orientation something that again brings maybe a different perspective than is on the board. Um I think is really helpful and and advisable to people and just getting ah a completely different. You know lens to in in which they see the world and then I would also say ah depends on again. The the setup of Ac um, you could have health system um management if there’s health system ownership. You could have private equity um board membership if there’s private equity ownership. Um. Or of course management company Asu Management company representation if there’s asu management involved and again depending on majority or minority as to how many seats those different groups have.

03:46.48
Nick Latz / HST Pathways
Sure and I wanted to to touch on the the comment around the outside board members I think that’s a good idea and I’ve seen that less in the ASC industry that i’ maybe seeing other outside industries where it’s more common have have you any backgrounds for outside board members that.

03:56.53
Nader Samii / nimble
Right.

04:05.76
Nick Latz / HST Pathways
And to work well or be a good fit and within ASC space.

04:08.41
Nader Samii / nimble
Like I said I I think you know you’ve got you know plenty of experience with your current. You know, traditional board members that will cover. You know, general healthcare topics quality safety. You know, clinical operations. Financial or revenue cycle operations. There’s plenty of those people that typically already have representation. So I would seek people that would would really help me encourage. Um, you know a different way of thinking that would be growth oriented and so I’m with you I don’t see it very often. Um, but I think it would be really interesting to get people you know community leaders that again come from a sales background a marketing background. Ah, you know, even a hospitality or you know high-end experience background those types of things I think would be really interesting. Um, complement to to do what exists today.

05:06.36
Nick Latz / HST Pathways
Got it. Um, and so as we think about those those kind of typical board members that you’ve laid out what what do you see in terms of you know the typical goals and objectives of a board member. Um, and does that vary. You know in terms of shareholders versus you know the CEO admin for example.

05:27.46
Nader Samii / nimble
So I think it’s a good question. Um I think again because you have you know a relatively kind of traditional you know board members I would say a lot of times you’ll see board meetings that so so I guess I’ll answer it from the standpoint of what’s happening in a board meeting and then how.

05:43.65
Nick Latz / HST Pathways
So.

05:44.85
Nader Samii / nimble
You know the objective of the board member. So I would say big picture the objective of the board member should be um, really helping the operators of those centers and the physicians of the centers think strategically about how to you know, build grow operate. In the most efficient effective profitable high-end experience type of way. So I think that that probably would be what I would say maybe should be ah the goals I would say a lot of times. Um, every center is different but a lot of times um board meetings and I think it at not just ASCs. But. Companies in general can get very into a um presentation of the facts and updating of what happened ah reporting of again your quality metrics your financial performance all of which is important but when you get this type of audience together for 2 hours trying to find a way to bring much bigger picture strategic, thoughtful discussions to the board where you’re still going through a process. Obviously there’s yeah I would say it’s you know discussions on quality safety clinical you know and financial operations. Our table stakes and that should be in a packet that goes to the board I would pull all that together send that in advance. Let people get updated and then if something is really awry with it either really good or really bad or challenging then then raise it from that perspective as supposed to just kind of going in through and communicating.

06:59.83
Nick Latz / HST Pathways
In a.

07:17.29
Nader Samii / nimble
You know exactly what the numbers were um so looking for at at a board level I think what makes the meetings more productive and powerful and effective is trying to find ways to utilize these board members to help you think through and solve big picture strategic issues and problems to again make you as successful as you can. So. You know there may have been a big drop in you know 1 you higher paying specialties or higher paying type procedures trying to understand what you know is what’s going on you know with that. Um, there could be ah you know challenges I’ve see we’ve all have. You know labor challenges in today’s market you know brainstorming with other leaders in the community. How do you solve some of those types of issues. Um bringing big picture. You know capital allocation type decisions to the board helping you think through investments whether it’s in med techch and biologics. You know, does it make sense to invest in these. Um, types of technologies. What will be the pro and con. Yeah we know the cost and what’s the upside and how can we structure things. Um really thinking through that again. Physician recruitment does that make sense going after you know adding a new specialty expanding your surgery center and again, what’s the capital involved in that. But what’s the ah roi. From that perspective and how would you go about filling up. Um, you know the or and and are you going to be doing it from ah a wise and thoughtful place. It will you know long-term pay off I think those are the things the more that you can go down that direction and again you know think of it as a packet of financial and operational information that goes out.

08:35.37
Nick Latz / HST Pathways
Um.

08:47.49
Nader Samii / nimble
You know it goes to everyone they get that 2 3 days in advance of the board meeting. They’ve reviewed it. You flag any you know, maybe there’s a five ten minute administrator CEO update to kind of level set of one on the financials and then you know have a 5 to 10 page strategy to deck to get you into. Ah, the more that you can get into really this kind of interesting dialogue is where I think you really get value because the bottom line is I think most operators generally know their business and you know to take 2 hours every month or every quarter and to use again. This caliber person’s time to just give a bunch of their you know updates as supposed to really being. Thoughtful about how do we solve big problems and build and grow for the future I would encourage people to do that I would say you see this approach probably less than the traditional approach of just kind of ah you know giving a lot of updates on what’s happened and and you know what’s going to happen next month.

09:38.89
Nick Latz / HST Pathways
Right? And I like that recommended agenda and structure I was going to ask you about that and if I’m I’m kind of hearing you right? It seems like your your recommendation is hey prepare the materials in advance leave sufficient time assume that the board members are going to have reviewed that.

09:44.31
Nader Samii / nimble
Um.

09:57.21
Nick Latz / HST Pathways
Ah, ahead of the meeting and then kind of have the upfront portion more be around questions drilling in abnormalities or things unexpected versus a readout of kind of the standard financial pack right? and then and then if you can do that that that leaves more time.

10:10.57
Nader Samii / nimble
Um, yes, absolutely.

10:15.69
Nick Latz / HST Pathways
Even a bulk of the time at the meeting potentially to discuss the the more strategic the more meaty you know problems or opportunities for for the center.

10:22.47
Nader Samii / nimble
Yeah I I Very much think that and I think if if you play that out a little bit I think you end up with a very engaged and excited board as well because that is more interesting. You know, sitting back Otherwise people can get into a bit of a rote you know. You know process and there’s just constant. You know, update and discussion etc and now someone’s going to go down a rabbit hole of some number that’s in there which you know was it meaningful was it. Not you again, you just do that work for them to kind of Flag. What’s meaningful or not but I I Really do think it makes for yeah, an interesting you know and fun.

10:48.17
Nick Latz / HST Pathways
Crap.

10:59.32
Nader Samii / nimble
An engaged board and again these are these are smart people the more thoughts you can get there really can can can help you know over the long haul you know with your organization.

11:07.84
Nick Latz / HST Pathways
Right? And you you mentioned the the information pack that goes into it who’s typically responsible for preparing that.

11:18.44
Nader Samii / nimble
It’s good question I would say generally that CEO or administrator of the center is typically leading the charge there they may need probably not the source of all the information a lot of this information is going to be and obviously seen in the software system. Um, yeah, and and and being thoughtful about how you set up your um, what data goes into your software in terms of cost the cost side of it for example, um, and ideally deciding what are those kind of ah if if you can automate and have you know the the basic. Reporting type of information you know set up in a way where at the month end you hit print when the month is closed and you’ve got all of the information you need from both the clinical and financial. You know perspective and that goes in a set of here’s the updates and getting a little bit of back and forth between yourself and your board to decide. What level of detail they want and what you know specific reports you want. But I think doing it that way can can make it efficient. But yeah, there’s probably some coordination with you know you know your clinical um you know people who are in charge of the clinical side people in charge of financial side whether it’s a revenue cycle company or you’re internal. Ah, you know Rcm Team there’s probably some work you know to coordinate with that. Um, but again now you know think about quality safety clinical ops financial ops are the kind of the big buckets.

12:41.68
Nick Latz / HST Pathways
Got it and and and so it seems like the the admin CEO is oftentimes quarterbacking that information packet like you said do they do they run point the admin CEO and presenting that out at at the board meeting.

12:53.19
Nader Samii / nimble
Um, absolutely um.

12:59.58
Nader Samii / nimble
That’s in my experience again. Obviously every center and every you know team is a little bit different but my general experiences again if you think about you know and a lot of the physicians are busy running around. Yeah they’re they’re scrambling to get to the board meeting on time. Um, so yeah, the the. CEO or administrator typically leading the charge I’m pulling it together really in the charge on pulling the overall board packet and presentation together. Um and delivering it now depending on what’s happening with the center and how interesting or strategic or what issues are going on. You know there may be ah you for example, the medical director. Maybe there’s some. Yeah, some pre-dialog that happened to be like hey here’s here’s where you know I’m planning to go with the board meeting. Um, you know you’re my board chair. Yeah would I would certainly have my board chair in the loop and and to the extent that other people are engaged and active. Never hurts to you know, ping them in advance and say hey here’s big picture. The agenda you know, maybe maybe send that out a week or 2 in advance here’s the big picture agenda we’re going to cover. Let me know if there’s any other you know, topics or anything you guys want to discuss and we can make sure that gives us a couple weeks to you know pull that together and include it. Um, so I think that that’s good.

13:54.82
Nick Latz / HST Pathways
Yeah.

14:09.76
Nader Samii / nimble
Hygiene and good practice again depending on the level of engagement of your your board members.

14:14.29
Nick Latz / HST Pathways
Yeah, that seems like a great way to ensure alignment between between the center management and the board. Um.

14:19.66
Nader Samii / nimble
yeah yeah I think what it does to Nick and when you’re doing that is you’re really avoiding which is probably the single most important thing in any of these situations is avoiding surprises. Um at least avoiding bad surprises. Good surprises. Are you know, still to avoid them ideally. But you know you can certainly? ah.

14:27.87
Nick Latz / HST Pathways
Right.

14:37.35
Nader Samii / nimble
Okay, getting over a good surprise but you know people you don’t want that meeting people to find out you know something that’s gone wrong or gone bad. Um, and and that’s the first time they’re hearing about it the more you can socialize that run it by. And and not just at that. So at that point by the time you’ve socialized that they’re aware of it. They know you’re working on it by the time the board meeting comes they’re like hey everyone understands here’s this issue we’ve had um and here’s what we’re doing about it here’s our solution and our plan makes you know for for much better. Ah, you know board meeting and overall relationship between. Ah, the leadership and board members.

15:12.44
Nick Latz / HST Pathways
Right? Totally a agree um wanted to shift gears not and ask you a little bit about some of the key financial and and revenue cycle metrics that are often reviewed in a board meeting brought into a board meeting if we think about um.

15:21.37
Nader Samii / nimble
Are.

15:28.60
Nick Latz / HST Pathways
Good KPIs or metrics on the financial side that speak to kind of past performance of of the center I’ll ask you for for a couple metrics. You’d call out and also kind of more of the future League indicator Metrics are there a couple metrics. You’d call out there as it relates to.

15:32.24
Nader Samii / nimble
I. Are. Get.

15:46.73
Nick Latz / HST Pathways
Yeah, feature leading indicators.

15:48.70
Nader Samii / nimble
Yeah, yeah, no doubt um I’ll mention a couple that are a little bit of clinical. Um, which maybe we as an organization spend a little less time on um, but looking at you know your ah you know, average wait time. Um, average time. Yeah, in the operating room every time kind of per surgery utilization of your or staffing costs. Um and any quality issues I think those are things that would also come into play you know in a board meeting that are important but kind of shifting to the to the financial. Ah. I think it’s important to have a strong understanding of your obviously baseline level of what’s your overall typical volume cash collections. You know what’s your write-outs were like basic financial metrics. Of course you should always be looking at and I like to look at that on a trailing thirteen month basis so you can look at. You know seasonality from a year ago too. Um, but when you’re getting into the actual metrics revenue per case is really important and and taking that and breaking that down by specialty and by payer as well as interesting ways to look at it even by provider.

16:59.17
Nader Samii / nimble
And that starts to give you some real information on what’s coming in. You know if you’re doing total. You know you were a sports med group and now you brought in a total joint surgeon um, or you were pain and eyes in gi um, and now you’re looking. You know you’ve got capacity. You go add again, let’s say orthopedics comes with that. The profile is going to be very different. You might be generating you know $4000 cash per case on an oro case and maybe that takes an hour and a half um and in pain. Yeah, it might have been thousand bucks or $1200 ah, but you get through more. Doing the math so that’s your revenue but also of course now looking at your cost per case to get you to your profit margin per case I would say that is at the top of the list where some groups will look at some don’t I think it should be looked at more and more consistently it almost lead with those things and again.

17:50.69
Nick Latz / HST Pathways
I can.

17:55.67
Nader Samii / nimble
Thinking about it by specialty by payer by provider um is is super helpful. Um, and and understanding. You know the volume shifts right? If you’ve got orthopedics or Spine Or Etc Cardiology bigger paying procedures. And now you’ve had a big drop in volume because a lot of people say well look. My volume is 300 cases every single month and that’s great, but not all 300 are made the same and so like you know there will be a thought process if it’s 300 I made $1000000 last month. Why don’t I always do that. Um, if the if the mix of the payer mix and the procedure type mix and and. Specialty mixes are staying the same then sure that makes sense. But if you had you know 50 total joints one month and 6 the next month for whatever reason that’s you know so might pay you know 10 to $15000 per procedure is going to move your needle pretty aggressively so really understanding. What’s happening within that. And couple other metrics that say average charges per case helps flag some of that too or again it sort of gives an indication if you’re doing higher acuity type procedures or not um, net revenue. Um you know percentage. So what are you collecting of what your established net revenue is what is your actual collections coming in and then you have.

19:02.54
Nick Latz / HST Pathways
Um, right.

19:07.60
Nader Samii / nimble
Your basic kind of ar over ninety a r days is credit balances but I think another one that is harder for some people to track but really important if you can find a way to come up with the system to be able to kind of roll up There’s so many different reasons for denials but identify you know, kind of the rollups that you can really be like what are them 5 main fundamental reasons we’re getting denials that is as I would say that with the revenue and in cost per case to get to profit margin per case probably the most important because what’s causing your denials gives you the information to see what can you do to fix things on the you know. Wherever? whatever’s causing it whether it’s you know, pre-auth issues or yeah improper documentation or billing issues. Whatever is the cause of it. You are now in position to go. You’ve got root cause and you can go solve it and um, that’s pretty powerful information. Um. And like it allows you to really change how you’re running your organization because you get those denials consistently at some point if you’re not staffed properly. You know this backlog of denied claims and someone gets behind and they don’t follow up within the timely appeal timeframe. Um, then people run into issues with losing those dollars and losing you know, especially if you’re in bigger, especially you’re going to lose the implant dollars were hard costs too. Plus the cost of procedure and your staffing so it can be pretty powerful to get all that right.

20:36.67
Nick Latz / HST Pathways
Yeah that’s a good tip to focus in on the denials in particular um, wanted to ask you a little bit you mentioned some of these metrics whether it’s you know revenue per case by specialty or you know denial percentage. Um, or you know AR days collection days if you think about those metrics you know I would think about a center that’s part of a management company part of the value. The management company can provide is hey we’ve got 5 10 15 other centers and so we can kind of help you. Quickly understand where are you out of kind of range of what you’d expect versus where you inrange and what what are the potential problem areas. Ah but for independent facilities right? That don’t necessarily have that management view or len do you feel like those centers have good. Benchmark data have a good understanding of where they should be in terms of those metrics.

21:36.73
Nader Samii / nimble
I would say no generally they don’t and it’s it’s almost It’s very difficult to expect them to I mean for example, yeah, there are other third party whether it’s vmg or other third party sources of data. Um, but then you have to understand like really okay, what. Was that comprised over those big management company centers. Is it a different region etc. So there. There are some third -party sources that you can use. But again, um, there’s so many variables that make that either applicable or not to you so having I would say having someone who’s got expertise.

21:56.60
Nick Latz / HST Pathways
That.

22:12.47
Nader Samii / nimble
Whether it’s on your team or externally um, who has a sense of ah essentially what? really what should managed care contract rates look like what is a reasonable sensible good deal for what you’re doing and where you’re doing it and then you know. And then having someone kind of guide you through like what are these metrics we and whether you’re doing it in-house or out outside. It doesn’t matter. Um, you’ve got to find someone who has the expertise because this is the fundamental problem and challenge with healthcare and especially these independent groups. Even if you’re not an independent group. You’re part of a big management company still look at who you’re competing against so you know an independent group of 4 or 5 or 6 surgeons or and an ASC and doing 300 cases a month ah their adversary is optum blue cross blue shield ciga. You know multibillion dollar extremely sophisticated companies with data scientists left and right is just no way that you can line up so like I said it’s David versus Goliath and David has a low-winning percentage over the history of time. So um.

23:09.62
Nick Latz / HST Pathways
Right? yeah.

23:24.25
Nick Latz / HST Pathways
Um, affect.

23:25.19
Nader Samii / nimble
David’s do I should say so it’s it’s ah it’s really difficult and so you got to try your best to find ways to level that playing field from an information standpoint.

23:32.67
Nick Latz / HST Pathways
Got it final question for you now. Do we do this each episode with our guests. What’s 1 thing our listeners can do this week to improve their surgery centers.

23:44.37
Nader Samii / nimble
So I am a big and I and I have had the unfortunate experience of like I believe my entire family spends most of their time at orthopedic ASCs or ah, having surgeries performed or at physical therapy afterwards. So um, and we’re in Charlotte. So. We fund ortho carolina Annually and great group. But um, what I would say is really focusing on the patient experience I think healthcare in general. Tries to but still gets very transactional in its nature and so I think you know again I mentioned hospitality terms in terms of a board member I think it’s a really interesting approach I think it’s not hard to differentiate yourself in a world where things are so transactional in nature and finding.

24:20.51
Nick Latz / HST Pathways
There.

24:29.21
Nick Latz / HST Pathways
Um I.

24:38.45
Nader Samii / nimble
Experiential things that don’t necessarily cost a ton but that you’re really being thoughtful about from the time that patient you know makes the decision at their at the surgical practice to come to your ASC how how does every point of contact from that point forward. You know, handled including on the backend you know through the entire billing process too. Is it all handled wells at the end that they’re feeling and having a great experience. I’ve had a great clinical experience where then the patient follow up. You know they got denials. They didn’t get pre-off. Yeah, they didn’t do the pre-auth process correctly and start sending me $40000 bills and yeah, so you’re probably sending it to the wrong person because this is not my issue and it’s not going to be my issue but they kept sending it and eventually it got all but it took a year and a half and that created annoyance and nuisance and um.

25:23.21
Nick Latz / HST Pathways
Um, yeah, yeah.

25:32.67
Nader Samii / nimble
Yeah, you don’t want to create some stress for people getting $40000 bills that they don’t want to have and are necessary and I’m lucky enough that I happen to know this business. But imagine if you didn’t so you could have had a great surgical experience and you have a bad experience in the backend or you could have not had great point of contact some of that software too. Really wonderful software Experience. You know, easy for people to Maneuver. You know, get through the system so you know almost take a little bit of a spa or hospitality approach to you know?? Ah and maybe flip yourself around have heavier one of your surgeons. Go you know pretend to be a patient through the process and what is that experience. For them and is it what they would want to have and I think that’s lost a lot in this industry.

26:14.78
Nick Latz / HST Pathways
Love it. That’s good perspective Nader. Thanks so much for joining us here today. Appreciate it all right.

26:19.66
Nader Samii / nimble
My pleasure. Thanks for having me Nick.