Gavin Fabian – The Case Profitability Conundrum
Here’s what to expect on this week’s episode. 🎙️
Surgery centers often struggle to predict if a case will be profitable before taking it on, especially with complex and high-acuity cases.
Gavin Fabian is the Chief Innovation Officer at HST Pathways, and alongside his team, he decided to tackle this problem head-on and build first-of-its-kind software that would arm ASCs with the data they need to avoid unprofitable cases and take on cases with financial confidence. Here’s what to expect in this week’s episode:
💡 After working closely with surgery centers, they realized the need to develop a tool (HST Profit Forecast) that offers a financial profile of a case, including revenue breakdown based on payer contracts and historical payments, as well as cost breakdown by staff, supplies, implants, and overhead.
🚀 This innovative tool saves centers significant time by automatically generating profitability forecasts for upcoming cases. It enables centers to identify problem cases earlier, allowing for proactive solutions and collaboration with physicians and vendors.
💼 Gavin emphasized the importance of being research-driven and data-informed while also engaging with centers directly to gain a comprehensive understanding of their needs. This approach, combined with being adaptable to customer feedback, has allowed HST to create a valuable solution that aligns with users’ requirements.
📊 Customer feedback has been overwhelmingly positive. Centers have found tremendous value in the time saved, the scalability of knowledge across their teams, and the ability to address problematic cases proactively.
Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.
Episode Transcript
0:00
welcome to this week in surgery centers
0:03
if you’re in the ASC industry then
0:05
you’re in the right place every week
0:08
we’ll start the episode off by sharing
0:10
an interesting conversation we had with
0:11
our featured guest and then we’ll close
0:13
the episode by recapping the latest news
0:15
impacting surgery centers we’re excited
0:18
to share with you what we have so let’s
0:20
get started and see what the industry’s
0:22
been up to
0:23
[Music]
0:27
hi everyone here’s what you can expect
0:29
on today’s episode surgery centers often
0:33
struggle to predict if a case will be
0:35
profitable before taking it on
0:36
especially with complex and high Acuity
0:39
cases Gavin Fabian is the chief
0:42
Innovation officer at hsd Pathways and
0:45
alongside his team he decided to tackle
0:47
this problem head on and build first of
0:49
its kind software that would arm ASCS
0:52
with the data they need to avoid
0:54
unprofitable cases and take on cases
0:57
with financial confidence
0:58
in this episode you’ll learn about the
1:01
development of HSC profit forecast its
1:04
many use cases and what your peers are
1:06
saying thus far
1:07
in our news recap we’ll cover a little
1:10
bit of the CMS 2024 proposed payment
1:13
rule Northwestern Medicine to AI success
1:16
an Ohio physician who lost her license
1:19
and of course and the new segment with a
1:22
positive story about a woman’s
1:24
dedication to receiving her nursing
1:26
license even with 35 years of setbacks
1:30
hope everyone enjoys the episode and
1:32
here’s what’s going on this week in
1:34
surgery centers
1:37
[Music]
1:42
thanks Nick
1:43
Gavin can you tell us a little bit about
1:45
your role here at HST
1:47
sure I’m the chief Innovation officer at
1:49
HST and I effectively build startups
1:53
that leverage all the strengths that HST
1:56
has as a company
1:58
so I think you’ve got one of the most
2:00
interesting roles probably in ASC
2:02
technology right which is you get to
2:05
find problems within the industry
2:06
underserved by technology and decide
2:09
what projects you want to take on tell
2:11
me a little bit about the latest problem
2:14
that you’ve been researching and how it
2:17
came across your radar screen yeah so
2:19
part of my job is just to keep a pulse
2:22
on the bigger unmet needs that surgery
2:24
centers face today and one of those that
2:27
I’ve been hearing consistently over the
2:29
last couple years is the challenge in
2:32
understanding if a case you’re going to
2:34
take on will be profitable or not before
2:37
you do the case
2:38
especially these surgery centers take on
2:40
more complex cases higher Acuity cases
2:42
more implants there’s a lot of
2:45
complexity in trying to figure out what
2:47
you’re going to get paid for that case
2:48
as well as what the costs are going to
2:50
be and at HST we have a lot of the data
2:53
that if analyzed effectively can give
2:55
you the answers to those things so we
2:58
thought that would be a really really
3:00
interesting problem to solve and that we
3:03
were capable of based on the the data we
3:06
have
3:06
got it so focusing in on this problem or
3:10
challenge around case profitability
3:12
and I gotta imagine a bunch of different
3:15
problems or ideas come across your desk
3:18
how did this idea of case profitability
3:20
or this challenge how did you first get
3:23
connected with this how did you first
3:25
find out about it yeah so the way we
3:28
started out on this project was we
3:32
wanted to help centers better understand
3:35
the costs of their implants in advance
3:38
of a case and as we started diving into
3:41
this with facilities we basically the
3:45
solution was a view of our financial
3:47
profile of a case with implants and what
3:51
we heard back from our customers was
3:53
this is awesome I need to see this for
3:56
every case and so it became less of an
3:59
implant focused solution I mean it still
4:02
is very useful for Implant cases but it
4:04
became really a way to look at your
4:06
entire schedule and be able to see
4:09
profitability for upcoming cases yeah
4:11
super interesting so started a little
4:14
narrower and then you’ve kind of
4:16
broadened it from there I found that’s
4:18
how many startups and Innovation focused
4:22
projects begin and end is with you learn
4:26
so much along the way by diving in and
4:28
spending time with your customer and a
4:31
lot of the value creation is being
4:32
Nimble and willing to take a turn and
4:34
let your customer guide you to where the
4:36
value is and this was another case of
4:38
that where what we ended up with is
4:40
different than what we planned on
4:42
starting with same theme but I think a
4:45
lot more valuable to our end users yeah
4:47
and that’s super interesting and I’m
4:50
curious about this kind of startup
4:52
approach you take in general right so
4:54
you know there’s this idea that you guys
4:56
were talking to customers about around
4:58
implant profitability and case
5:01
profitability and so you had a problem
5:03
or an idea what do you then go do to
5:06
validate that you know with others in
5:08
the market or how do you kind of stress
5:09
test that this is a problem that
5:11
resonates with folks yeah I I think you
5:14
have to take a research and data-driven
5:17
approach combined with get your hands
5:19
dirty and actually see it yourself and
5:22
get in there with the centers because
5:23
there’s just Things That You Don’t See
5:25
by just looking at Market data like if
5:28
you were to try to look up Market data
5:30
on percentage of cases that come at a
5:34
loss like you really won’t find a lot
5:36
there but when you go into centers and
5:38
you start asking those questions you can
5:39
get a pretty good feel and you can also
5:41
see how they’re actually solving the
5:43
problem today like what are the tools
5:45
they have and maybe the tools they have
5:47
you can’t do any better and you don’t
5:48
know that until you really get in there
5:50
so we spend a lot of time with centers
5:52
and then we look for data to provide a
5:54
macro view of what we’re seeing as well
5:56
got it that makes sense and so for this
6:00
particular challenge around
6:02
case profitability during your
6:04
discussions with customers what are the
6:06
implications of this what are the
6:09
implications of not knowing case
6:10
profitability or getting it wrong or
6:13
being suppressed yeah well if you’re for
6:16
example
6:18
um Facebook it’s probably important to
6:20
you that you know how long users are
6:23
spending on different parts of your
6:26
website right because the parts where
6:28
they’re spending more time those are
6:30
where you’re going to want to sell more
6:31
ads or you’re going to want to optimize
6:32
those parts of the page more across most
6:35
businesses there’s really critical data
6:37
that you need to optimize your business
6:39
and if you’re running a surgery center
6:42
the goal is providing great outcomes at
6:44
a great price that surgery center
6:46
efficiency is such a strategic Advantage
6:49
but if you’re going into cases and you
6:53
don’t really know if the case is
6:55
profitable or not forget how profitable
6:57
or how unprofitable it’s a bit of a
6:59
problem when you’re trying to optimize
7:01
your business model and do cases with
7:04
greater confidence so give that
7:06
visibility so that you’re not Flying
7:08
Blind that what you’re working with
7:09
before you go into the case yeah yeah
7:12
makes sense that a big component of
7:14
overall ASC profitability or Center
7:17
level profitability is the Case
7:19
profitability Case mix and the the
7:22
profitability around those effects got
7:24
it what in your initial conversations
7:26
with customers are there certain types
7:29
of cases that present more of a
7:31
challenge than others yeah I think that
7:34
the centers that are most challenged in
7:37
this area are centers that have large
7:40
variety or diversity of case mix if
7:43
you’re a facility doing a relatively
7:45
small number of Ophthalmology cases you
7:47
can know what you’re getting but most
7:49
centers that have three or more ORS or
7:51
even smaller multi-specialty centers it
7:53
is a real challenge payer contracts are
7:56
exceptionally complex I I cease to be
7:58
amazed by what I find when working with
8:01
customers as far as like how cases are
8:04
paid how implants are paid are there
8:06
caps are the minimum so I think those
8:09
are the centers that are most challenged
8:11
in this area yep yep that makes sense
8:14
and if ASCS could snap their fingers and
8:18
solve this problem and have accurate
8:21
visibility real-time visibility into
8:22
case profitability across all their
8:24
cases
8:26
what could they do with this information
8:27
what would they change if anything in
8:30
terms of the way that they go about
8:31
providing care yeah what we found is
8:35
that when Centers do recognize that a
8:39
case is going to be unprofitable or
8:42
close to unprofitable that there are
8:44
things that you can do to keep that case
8:45
but make it not a negative case for the
8:48
center for example you can reach out to
8:51
your implant vendor and work on getting
8:53
a better price for a product or kind of
8:55
a one-time exception you can work with
8:58
the physician to find ways where you can
8:59
be more cost efficient with that case
9:01
and still take it and the earlier you
9:04
find out about that case the more
9:07
flexibility you have to find a solution
9:10
that makes that case viable that makes
9:12
it workable the challenge that centers
9:14
have is first many centers don’t have a
9:17
process for evaluating the profitability
9:20
of a case in advance and the ones that
9:22
do have a process it’s very very time
9:25
consuming involved is calling multiple
9:27
sources of data into really complicated
9:29
Excel models that like one person at the
9:31
center knows how to look at and by the
9:35
time they actually run it through that
9:37
model usually you’re like two days
9:39
before the case now how much flexibility
9:43
do you have to have a thoughtful
9:44
conversation with your doctor in 48-hour
9:46
notice or your implant rep or maybe you
9:50
need to push the case back but you can’t
9:52
give a patient two days notice so I
9:55
think the impact is that you can take
9:58
the cases that are most problematic for
10:01
your Center financially and resolve them
10:03
figure out a way to make them profitable
10:06
or just be more efficient on the case
10:08
but you have more notice yeah so it
10:11
sounds like it’s not as simple or
10:13
straightforward as hey should we take on
10:15
this case or not it sounds like some of
10:18
the Nuance already the opportunity here
10:19
is okay for cases that tend to be more
10:23
unprofitable it’s getting visibility
10:26
into those with enough time to take
10:28
action on that right 100 and a lot of
10:32
times the staff at the center and again
10:35
I’m speaking from just my experience
10:37
building this and working with say like
10:39
you know 30 40 centers that we’re
10:41
talking to on a regular basis is the
10:44
staff prefer not to move a case a lot of
10:47
times they’re nurses first and they
10:49
deeply care about patient care and so
10:52
they want to find a solution to make it
10:53
work and they take pride in their
10:55
Center’s ability to make
10:57
tough cases work because they’re so
10:59
efficient but oftentimes you need the
11:01
physician and the rep involved in being
11:03
a partner and solving these cases and
11:06
when they have the data like when you
11:08
can show a physician what you’re looking
11:10
at and it’s not very disputable that
11:13
physician becomes a partner much easier
11:15
than if you don’t have the data and the
11:17
conversation is less intimidating for
11:19
the staff member because they’re just
11:20
saying hey this is what I’m looking at
11:22
am I looking at it the wrong way and
11:24
usually it facilitates a conversation
11:26
that makes things better yeah it helps
11:28
with that buy-in process I’m sure
11:30
so you’ve been researching this problem
11:32
and I understand that you’re actually
11:34
launching a product coming up that helps
11:37
centers address this can you tell us a
11:39
little bit about the product that you’re
11:40
launching yeah I think I was alluding to
11:42
it a little bit earlier but basically
11:44
we’ve built a tool that kind of takes
11:48
advantage of all the data that we have
11:50
from the other HST products and in a
11:54
completely automated way when you open
11:57
up the product you see a auto-generated
11:59
uh profitability forecast for all your
12:03
upcoming cases
12:05
um and when you open up the case you can
12:07
see the breakdown of Revenue based on
12:11
your pair contracts but also based on
12:13
historically what you’re getting paid
12:15
for those type of cases and then you can
12:17
look at your costs broken down by staff
12:20
supplies implants overhead Etc and
12:24
there’s a bunch of workflows in there
12:26
where you can have cases flagged if they
12:29
meet certain criteria that need extra
12:30
review I I think in short what the
12:32
product does is it finds the problem
12:35
cases for you so that you have the time
12:38
to go solve them or fix them I think
12:41
what we’ve seen is Center spend so much
12:43
time just trying to find those cases
12:45
they’re left with very little time to to
12:48
do the high value work of resolving the
12:51
problems right right so it sounds like
12:53
your product pulls in a profitability
12:55
snapshot and I assume you’ve got the
12:57
revenue information in there on a
12:59
particular case you’ve got cost
13:01
information in there
13:02
how do you pull in at the revenue side
13:05
of the equation
13:06
yeah so HST has so much data that it can
13:10
pull from based on the products a
13:12
customer has so we look at it as kind of
13:14
levels of data enrichment based on the
13:17
amount of HST products you’re using but
13:20
in the most basic sense for our centers
13:22
that have our HST practice management we
13:25
get the revenue estimate by looking at
13:27
payer contracts and we do a look back on
13:30
every time you’ve scheduled a certain
13:32
procedure with a certain pair what did
13:35
your contract say You’re supposed to get
13:37
paid and not only that what did you
13:40
actually get paid and then we showed
13:42
both of those numbers and sometimes it’s
13:43
pretty interesting that if you are
13:46
supposed to get paid through your
13:47
contract six thousand dollars but you’re
13:49
actually getting paid three thousand
13:51
dollars that has in some cases been a
13:53
cue to dig in and figure out what’s
13:55
going on there yeah okay and so that
13:59
that’s the revenue side so it sounds
14:01
like a mix of the contract effort
14:03
information and what’s actually happened
14:05
historical receivables yeah what about
14:07
the cost side how do you get
14:09
case specific cost information
14:12
yeah so the cost side is something that
14:14
is probably the source of most
14:15
conversation during the implementation
14:18
process because every Center is a little
14:20
bit different and we found that centers
14:23
range from not having good cost data
14:26
that’s useful and having very good cost
14:29
data across those buckets that I
14:31
mentioned staff implants supplies rather
14:34
than taking an approach where we say Hey
14:36
you have to use our products in a way
14:39
that produces useful cost data for
14:41
profit forecast our product but what we
14:44
do is we kind of Meet the center where
14:45
they’re at so maybe they just don’t
14:48
document certain costs on purpose
14:49
because they believe that it’s making
14:51
them more efficient then usually those
14:53
centers will know because they’ve done a
14:55
look back on their cost that hey our
14:56
Ortho cases in general are 18 per or
15:01
minute in staff costs and so we can use
15:03
a rules-based approach where the cost
15:05
data isn’t useful and where the cost
15:07
data is useful in practice management we
15:09
point to that data so either with
15:12
automated it’s just are we using your
15:14
own historical data or are we generating
15:16
some rules that then drive the costs got
15:19
it sounds like there’s a couple
15:20
different ways to get at it yeah exactly
15:25
um okay so I think I’ve got my head
15:26
around how this is working in terms of
15:29
estimating case profitability what
15:32
feedback have you gotten with customers
15:34
that you’ve talked to or customers that
15:36
are using the product already yeah a lot
15:38
of feedback so I think that the initial
15:41
reaction when customers see this is
15:44
almost wow we don’t do this or we don’t
15:46
do this to this level of detail because
15:48
just doing this analysis on one case can
15:51
take a half hour to an hour and now this
15:55
is automatically produced for the next
15:56
you know 250 cases that are on our
15:59
schedule so the time savings or the
16:01
ability to just do this analysis that
16:03
wasn’t possible before is really helping
16:06
centers find problems and go and fix
16:09
those the other is many times the
16:13
centers that do some analysis on this
16:16
are doing it through one or two highly
16:18
tenured employees at the center that
16:21
know their contracts that know the
16:22
vendors like they have really intimate
16:24
knowledge but that knowledge isn’t
16:26
scalable to the rest of the team and so
16:28
Senators have said hey we set this up
16:30
with our most tenured staff member that
16:33
knows all this information but now those
16:35
rules are in there they can educate and
16:37
scale it across the rest of the center
16:39
so it’s given a little breathing room to
16:42
those key staff members that are the
16:43
only people that know this stuff yeah
16:45
and there’s probably some bottlenecks in
16:47
the process I’m sure if only one or two
16:49
folks can operate that right yeah okay
16:52
fantastic for folks that are interested
16:54
in discussing this topic further case
16:57
profitability or the profit forecast
16:59
product that you’re launching what’s the
17:01
best way for them to get more
17:03
information or get in touch I think the
17:05
most straightforward way is just go to
17:07
hscpathways.com book a demo and then we
17:11
can dive into really all the details
17:13
from showing the product having a
17:15
conversation just about what we’ve
17:16
learned in the process we want to be a
17:18
partner and help wherever we can in this
17:20
area
17:21
all right Gavin final question for you
17:23
here we do this with all of our guests
17:24
every week what’s one thing that our
17:27
listeners could do this week to improve
17:28
their surgery centers
17:30
so I think in the centers that we’ve
17:33
spent time with that are the most
17:37
efficient most effective tend to have
17:39
employees that have been there a long
17:40
time a lot of these centers have a
17:42
director of of nursing or a head of
17:45
their or scheduler that they just have
17:47
so much knowledge that they’ve developed
17:49
about the center and they take a lot of
17:52
pride in the facility so really anything
17:54
that you can do to engage employees show
17:58
appreciation up level their skills but
18:01
just keeping the team in place seems to
18:03
drive a lot of positive effects for the
18:06
centers that we work with love it it’s
18:08
all about the team Gavin thanks so much
18:10
for joining us today really appreciate
18:11
the conversation cool thanks Nick
18:15
[Music]
18:17
as always it has been a busy week in
18:20
healthcare so let’s Jump Right In as you
18:23
likely have heard CMS released its 2024
18:26
proposed payment rule as the rule in and
18:30
of itself is 963 Pages our clinical
18:33
experts are currently sifting through
18:36
everything that is in the document and
18:38
we are planning a bit of a deeper dive
18:40
into the good and the bad of what has
18:42
been included for next week’s episode
18:44
but for now the biggest update on
18:47
everyone’s mind is the average rate
18:49
update so if the proposed rule were to
18:52
be finalized as drafted ases would see
18:55
on average overall covered procedures an
18:59
effective update of 2.8 percent this
19:03
number is a combination of a three
19:05
percent inflation based on the hospital
19:07
market and a productivity reduction
19:09
mandated by the Affordable Care Act of
19:12
0.2 percent points it is important to
19:15
note though that updates might vary
19:17
significantly by code and Specialty so
19:19
you will want to look closer at the
19:21
document to see how you might be
19:23
impacted and CMS will be accepting
19:26
comments on the proposed rule through
19:28
September 11th and obviously the more
19:30
ASC voices that can be included the
19:33
better so I strongly suggest you take a
19:35
few minutes to share with CMS what you
19:38
think about what they have put forward
19:39
and of course we’re doing the same on
19:42
our end but keep a close eye on what
19:44
aska has to say they have already done a
19:47
great job summarizing a few things and
19:49
put some thoughts together already on
19:51
the feedback they will be providing
19:54
and in this week’s AI news Northwestern
19:58
Medicine
19:59
gastroenterologists achieves a 13
20:02
increase in the detection and removal of
20:05
colorectal polyps with the assistance of
20:08
artificial intelligence during the
20:10
colonoscopy so the research used the FDA
20:13
approved Medtronic GI genius computer
20:17
aided detection system which resulted in
20:20
higher removal rates compared to
20:22
procedures without Ai and for context
20:25
each one percent increase in detection
20:28
rates is associated with a three percent
20:31
decrease in the risk of colon cancer
20:33
within five years so the use of AI in
20:37
colonoscopies could potentially reduce
20:40
future colon cancer diagnoses by up to
20:42
39 percent
20:44
and based on the positive results from
20:46
the research Northwestern Medicine has
20:49
invested in GI genius devices as you can
20:52
imagine intending to equip every
20:54
endoscopy Suite in its nine acute care
20:56
hospitals and four outpatient locations
20:59
in the Chicago suburbs this shows the
21:03
first of many commitments we’ll see to
21:05
using and developing AI technology to
21:08
enhance patient care in the Health Care
21:10
system and of course what we always like
21:12
to share is that this technology is
21:15
being used alongside doctors so it’s
21:18
never intended to be used alone but it
21:20
is intended to be used in tandem to
21:23
enhance and improve what the human eye
21:26
can do
21:27
I was recently on Doc Buddy’s podcast to
21:30
talk about all things Ai and Healthcare
21:33
so I know we’re always sharing AI news
21:35
but if you’re interested in learning
21:36
more about use cases and pros and cons I
21:40
highly suggest checking out doc Buddy’s
21:42
episode
21:44
all right Story three an Ohio plastic
21:48
surgeon who gained popularity on Tick
21:50
Tock for live streaming operations has
21:53
lost her medical license
21:56
Dr Catherine Catherine Roxanne grahr I’m
22:00
probably saying that wrong her last name
22:01
is g-r-a-w-e
22:04
um also known as social on social media
22:06
as Dr Roxy will no longer be able to
22:10
practice medicine in the state of Ohio
22:12
and must pay a forty five hundred dollar
22:15
fine
22:16
so three patients reporting reported
22:20
having complications following
22:22
procedures with Dr Roxy and
22:25
complications that would not normally
22:27
arise during the procedures she was
22:29
performing now that’s a key part of this
22:32
these three patients were forced to seek
22:35
medical attention after their surgeries
22:37
according to Medical Board records with
22:40
some reporting skin tears infections and
22:42
other serious complications
22:44
an attorney representing the state’s
22:47
case against Dr Roxy shared this case
22:49
isn’t about some Antiquated view of
22:52
social media these patients trusted Dr
22:54
Roxy because of what they saw on social
22:57
she made major surgeries with
22:59
potentially life-altering complications
23:02
seemed like one big party
23:05
according to USA Today the secretary of
23:08
the medical board warned Dr oxia at
23:10
least twice in the last four years
23:12
before her license was suspended so this
23:15
did not come out of nowhere for her and
23:18
in September of 2021 she was urged by
23:20
the board to take remedial education
23:22
courses on plastic surgery complications
23:25
but allegedly continued to film and live
23:28
broadcast the procedures you can also
23:31
see in her live streams that she’s
23:33
actively reading comments while actively
23:36
operating which obviously is incredibly
23:39
dangerous
23:40
and I think for me it was so frustrating
23:43
about this case is of course patients
23:45
were put In Harm’s Way for absolutely no
23:47
good reason that’s first and foremost
23:49
but then second social media can be a
23:53
wonderful way to share educational and
23:55
informative Health Care related content
23:57
with your communities and it can
23:59
absolutely be done in a way that causes
24:02
zero harm to patients and stories and
24:05
scenarios like this
24:07
it’s just kind of a classic case of how
24:09
One Bad Apple can spoil the bunch and
24:12
the way the media is writing these
24:14
headlines obviously it makes it look
24:16
like Tick Tock is the problem when it’s
24:19
not it’s the irresponsible use of tick
24:21
tock and other platforms that is the
24:23
problem
24:24
so I wish these three patients well and
24:27
I hope they can fully recover from this
24:29
experience and if you are interested in
24:32
learning more about this case
24:33
specifically and the positives that can
24:36
come with having a social media presence
24:38
Dr grunch will be joining us next on
24:41
next week’s episode to share the success
24:43
that she’s experienced firsthand on Tick
24:46
Tock and other platforms
24:50
and to end our new segment on a positive
24:52
note after 35 years Rhonda Trotter
24:56
fulfilled her lifelong dream of becoming
24:59
a nurse After High School Rhonda’s
25:01
mother told her there were too many
25:03
nurses so she took a job at the Postal
25:06
Service
25:07
she decided to eventually go to nursing
25:09
school but then while she was there both
25:11
of her parents fell ill so she had to
25:14
leave school to care for them she got
25:16
back to nursing school in January 2019
25:18
and she now works alongside some of the
25:21
doctors who actually helped care for her
25:23
parents so congrats Rhonda on being
25:26
recognized as nurse of the week for your
25:29
resilience and determination in becoming
25:31
a nurse
25:33
and that news story officially wraps up
25:35
this week’s podcast thank you as always
25:38
for spending a few minutes of your week
25:40
with us make sure to subscribe or leave
25:42
a review on whichever platin or platform
25:44
you’re listening from I hope you have a
25:47
great day and we will see you again next
25:49
week
25:54
why are you keeping me
welcome to this week in surgery centers
0:03
if you’re in the ASC industry then
0:05
you’re in the right place every week
0:08
we’ll start the episode off by sharing
0:10
an interesting conversation we had with
0:11
our featured guest and then we’ll close
0:13
the episode by recapping the latest news
0:15
impacting surgery centers we’re excited
0:18
to share with you what we have so let’s
0:20
get started and see what the industry’s
0:22
been up to
0:23
[Music]
0:27
hi everyone here’s what you can expect
0:29
on today’s episode surgery centers often
0:33
struggle to predict if a case will be
0:35
profitable before taking it on
0:36
especially with complex and high Acuity
0:39
cases Gavin Fabian is the chief
0:42
Innovation officer at hsd Pathways and
0:45
alongside his team he decided to tackle
0:47
this problem head on and build first of
0:49
its kind software that would arm ASCS
0:52
with the data they need to avoid
0:54
unprofitable cases and take on cases
0:57
with financial confidence
0:58
in this episode you’ll learn about the
1:01
development of HSC profit forecast its
1:04
many use cases and what your peers are
1:06
saying thus far
1:07
in our news recap we’ll cover a little
1:10
bit of the CMS 2024 proposed payment
1:13
rule Northwestern Medicine to AI success
1:16
an Ohio physician who lost her license
1:19
and of course and the new segment with a
1:22
positive story about a woman’s
1:24
dedication to receiving her nursing
1:26
license even with 35 years of setbacks
1:30
hope everyone enjoys the episode and
1:32
here’s what’s going on this week in
1:34
surgery centers
1:37
[Music]
1:42
thanks Nick
1:43
Gavin can you tell us a little bit about
1:45
your role here at HST
1:47
sure I’m the chief Innovation officer at
1:49
HST and I effectively build startups
1:53
that leverage all the strengths that HST
1:56
has as a company
1:58
so I think you’ve got one of the most
2:00
interesting roles probably in ASC
2:02
technology right which is you get to
2:05
find problems within the industry
2:06
underserved by technology and decide
2:09
what projects you want to take on tell
2:11
me a little bit about the latest problem
2:14
that you’ve been researching and how it
2:17
came across your radar screen yeah so
2:19
part of my job is just to keep a pulse
2:22
on the bigger unmet needs that surgery
2:24
centers face today and one of those that
2:27
I’ve been hearing consistently over the
2:29
last couple years is the challenge in
2:32
understanding if a case you’re going to
2:34
take on will be profitable or not before
2:37
you do the case
2:38
especially these surgery centers take on
2:40
more complex cases higher Acuity cases
2:42
more implants there’s a lot of
2:45
complexity in trying to figure out what
2:47
you’re going to get paid for that case
2:48
as well as what the costs are going to
2:50
be and at HST we have a lot of the data
2:53
that if analyzed effectively can give
2:55
you the answers to those things so we
2:58
thought that would be a really really
3:00
interesting problem to solve and that we
3:03
were capable of based on the the data we
3:06
have
3:06
got it so focusing in on this problem or
3:10
challenge around case profitability
3:12
and I gotta imagine a bunch of different
3:15
problems or ideas come across your desk
3:18
how did this idea of case profitability
3:20
or this challenge how did you first get
3:23
connected with this how did you first
3:25
find out about it yeah so the way we
3:28
started out on this project was we
3:32
wanted to help centers better understand
3:35
the costs of their implants in advance
3:38
of a case and as we started diving into
3:41
this with facilities we basically the
3:45
solution was a view of our financial
3:47
profile of a case with implants and what
3:51
we heard back from our customers was
3:53
this is awesome I need to see this for
3:56
every case and so it became less of an
3:59
implant focused solution I mean it still
4:02
is very useful for Implant cases but it
4:04
became really a way to look at your
4:06
entire schedule and be able to see
4:09
profitability for upcoming cases yeah
4:11
super interesting so started a little
4:14
narrower and then you’ve kind of
4:16
broadened it from there I found that’s
4:18
how many startups and Innovation focused
4:22
projects begin and end is with you learn
4:26
so much along the way by diving in and
4:28
spending time with your customer and a
4:31
lot of the value creation is being
4:32
Nimble and willing to take a turn and
4:34
let your customer guide you to where the
4:36
value is and this was another case of
4:38
that where what we ended up with is
4:40
different than what we planned on
4:42
starting with same theme but I think a
4:45
lot more valuable to our end users yeah
4:47
and that’s super interesting and I’m
4:50
curious about this kind of startup
4:52
approach you take in general right so
4:54
you know there’s this idea that you guys
4:56
were talking to customers about around
4:58
implant profitability and case
5:01
profitability and so you had a problem
5:03
or an idea what do you then go do to
5:06
validate that you know with others in
5:08
the market or how do you kind of stress
5:09
test that this is a problem that
5:11
resonates with folks yeah I I think you
5:14
have to take a research and data-driven
5:17
approach combined with get your hands
5:19
dirty and actually see it yourself and
5:22
get in there with the centers because
5:23
there’s just Things That You Don’t See
5:25
by just looking at Market data like if
5:28
you were to try to look up Market data
5:30
on percentage of cases that come at a
5:34
loss like you really won’t find a lot
5:36
there but when you go into centers and
5:38
you start asking those questions you can
5:39
get a pretty good feel and you can also
5:41
see how they’re actually solving the
5:43
problem today like what are the tools
5:45
they have and maybe the tools they have
5:47
you can’t do any better and you don’t
5:48
know that until you really get in there
5:50
so we spend a lot of time with centers
5:52
and then we look for data to provide a
5:54
macro view of what we’re seeing as well
5:56
got it that makes sense and so for this
6:00
particular challenge around
6:02
case profitability during your
6:04
discussions with customers what are the
6:06
implications of this what are the
6:09
implications of not knowing case
6:10
profitability or getting it wrong or
6:13
being suppressed yeah well if you’re for
6:16
example
6:18
um Facebook it’s probably important to
6:20
you that you know how long users are
6:23
spending on different parts of your
6:26
website right because the parts where
6:28
they’re spending more time those are
6:30
where you’re going to want to sell more
6:31
ads or you’re going to want to optimize
6:32
those parts of the page more across most
6:35
businesses there’s really critical data
6:37
that you need to optimize your business
6:39
and if you’re running a surgery center
6:42
the goal is providing great outcomes at
6:44
a great price that surgery center
6:46
efficiency is such a strategic Advantage
6:49
but if you’re going into cases and you
6:53
don’t really know if the case is
6:55
profitable or not forget how profitable
6:57
or how unprofitable it’s a bit of a
6:59
problem when you’re trying to optimize
7:01
your business model and do cases with
7:04
greater confidence so give that
7:06
visibility so that you’re not Flying
7:08
Blind that what you’re working with
7:09
before you go into the case yeah yeah
7:12
makes sense that a big component of
7:14
overall ASC profitability or Center
7:17
level profitability is the Case
7:19
profitability Case mix and the the
7:22
profitability around those effects got
7:24
it what in your initial conversations
7:26
with customers are there certain types
7:29
of cases that present more of a
7:31
challenge than others yeah I think that
7:34
the centers that are most challenged in
7:37
this area are centers that have large
7:40
variety or diversity of case mix if
7:43
you’re a facility doing a relatively
7:45
small number of Ophthalmology cases you
7:47
can know what you’re getting but most
7:49
centers that have three or more ORS or
7:51
even smaller multi-specialty centers it
7:53
is a real challenge payer contracts are
7:56
exceptionally complex I I cease to be
7:58
amazed by what I find when working with
8:01
customers as far as like how cases are
8:04
paid how implants are paid are there
8:06
caps are the minimum so I think those
8:09
are the centers that are most challenged
8:11
in this area yep yep that makes sense
8:14
and if ASCS could snap their fingers and
8:18
solve this problem and have accurate
8:21
visibility real-time visibility into
8:22
case profitability across all their
8:24
cases
8:26
what could they do with this information
8:27
what would they change if anything in
8:30
terms of the way that they go about
8:31
providing care yeah what we found is
8:35
that when Centers do recognize that a
8:39
case is going to be unprofitable or
8:42
close to unprofitable that there are
8:44
things that you can do to keep that case
8:45
but make it not a negative case for the
8:48
center for example you can reach out to
8:51
your implant vendor and work on getting
8:53
a better price for a product or kind of
8:55
a one-time exception you can work with
8:58
the physician to find ways where you can
8:59
be more cost efficient with that case
9:01
and still take it and the earlier you
9:04
find out about that case the more
9:07
flexibility you have to find a solution
9:10
that makes that case viable that makes
9:12
it workable the challenge that centers
9:14
have is first many centers don’t have a
9:17
process for evaluating the profitability
9:20
of a case in advance and the ones that
9:22
do have a process it’s very very time
9:25
consuming involved is calling multiple
9:27
sources of data into really complicated
9:29
Excel models that like one person at the
9:31
center knows how to look at and by the
9:35
time they actually run it through that
9:37
model usually you’re like two days
9:39
before the case now how much flexibility
9:43
do you have to have a thoughtful
9:44
conversation with your doctor in 48-hour
9:46
notice or your implant rep or maybe you
9:50
need to push the case back but you can’t
9:52
give a patient two days notice so I
9:55
think the impact is that you can take
9:58
the cases that are most problematic for
10:01
your Center financially and resolve them
10:03
figure out a way to make them profitable
10:06
or just be more efficient on the case
10:08
but you have more notice yeah so it
10:11
sounds like it’s not as simple or
10:13
straightforward as hey should we take on
10:15
this case or not it sounds like some of
10:18
the Nuance already the opportunity here
10:19
is okay for cases that tend to be more
10:23
unprofitable it’s getting visibility
10:26
into those with enough time to take
10:28
action on that right 100 and a lot of
10:32
times the staff at the center and again
10:35
I’m speaking from just my experience
10:37
building this and working with say like
10:39
you know 30 40 centers that we’re
10:41
talking to on a regular basis is the
10:44
staff prefer not to move a case a lot of
10:47
times they’re nurses first and they
10:49
deeply care about patient care and so
10:52
they want to find a solution to make it
10:53
work and they take pride in their
10:55
Center’s ability to make
10:57
tough cases work because they’re so
10:59
efficient but oftentimes you need the
11:01
physician and the rep involved in being
11:03
a partner and solving these cases and
11:06
when they have the data like when you
11:08
can show a physician what you’re looking
11:10
at and it’s not very disputable that
11:13
physician becomes a partner much easier
11:15
than if you don’t have the data and the
11:17
conversation is less intimidating for
11:19
the staff member because they’re just
11:20
saying hey this is what I’m looking at
11:22
am I looking at it the wrong way and
11:24
usually it facilitates a conversation
11:26
that makes things better yeah it helps
11:28
with that buy-in process I’m sure
11:30
so you’ve been researching this problem
11:32
and I understand that you’re actually
11:34
launching a product coming up that helps
11:37
centers address this can you tell us a
11:39
little bit about the product that you’re
11:40
launching yeah I think I was alluding to
11:42
it a little bit earlier but basically
11:44
we’ve built a tool that kind of takes
11:48
advantage of all the data that we have
11:50
from the other HST products and in a
11:54
completely automated way when you open
11:57
up the product you see a auto-generated
11:59
uh profitability forecast for all your
12:03
upcoming cases
12:05
um and when you open up the case you can
12:07
see the breakdown of Revenue based on
12:11
your pair contracts but also based on
12:13
historically what you’re getting paid
12:15
for those type of cases and then you can
12:17
look at your costs broken down by staff
12:20
supplies implants overhead Etc and
12:24
there’s a bunch of workflows in there
12:26
where you can have cases flagged if they
12:29
meet certain criteria that need extra
12:30
review I I think in short what the
12:32
product does is it finds the problem
12:35
cases for you so that you have the time
12:38
to go solve them or fix them I think
12:41
what we’ve seen is Center spend so much
12:43
time just trying to find those cases
12:45
they’re left with very little time to to
12:48
do the high value work of resolving the
12:51
problems right right so it sounds like
12:53
your product pulls in a profitability
12:55
snapshot and I assume you’ve got the
12:57
revenue information in there on a
12:59
particular case you’ve got cost
13:01
information in there
13:02
how do you pull in at the revenue side
13:05
of the equation
13:06
yeah so HST has so much data that it can
13:10
pull from based on the products a
13:12
customer has so we look at it as kind of
13:14
levels of data enrichment based on the
13:17
amount of HST products you’re using but
13:20
in the most basic sense for our centers
13:22
that have our HST practice management we
13:25
get the revenue estimate by looking at
13:27
payer contracts and we do a look back on
13:30
every time you’ve scheduled a certain
13:32
procedure with a certain pair what did
13:35
your contract say You’re supposed to get
13:37
paid and not only that what did you
13:40
actually get paid and then we showed
13:42
both of those numbers and sometimes it’s
13:43
pretty interesting that if you are
13:46
supposed to get paid through your
13:47
contract six thousand dollars but you’re
13:49
actually getting paid three thousand
13:51
dollars that has in some cases been a
13:53
cue to dig in and figure out what’s
13:55
going on there yeah okay and so that
13:59
that’s the revenue side so it sounds
14:01
like a mix of the contract effort
14:03
information and what’s actually happened
14:05
historical receivables yeah what about
14:07
the cost side how do you get
14:09
case specific cost information
14:12
yeah so the cost side is something that
14:14
is probably the source of most
14:15
conversation during the implementation
14:18
process because every Center is a little
14:20
bit different and we found that centers
14:23
range from not having good cost data
14:26
that’s useful and having very good cost
14:29
data across those buckets that I
14:31
mentioned staff implants supplies rather
14:34
than taking an approach where we say Hey
14:36
you have to use our products in a way
14:39
that produces useful cost data for
14:41
profit forecast our product but what we
14:44
do is we kind of Meet the center where
14:45
they’re at so maybe they just don’t
14:48
document certain costs on purpose
14:49
because they believe that it’s making
14:51
them more efficient then usually those
14:53
centers will know because they’ve done a
14:55
look back on their cost that hey our
14:56
Ortho cases in general are 18 per or
15:01
minute in staff costs and so we can use
15:03
a rules-based approach where the cost
15:05
data isn’t useful and where the cost
15:07
data is useful in practice management we
15:09
point to that data so either with
15:12
automated it’s just are we using your
15:14
own historical data or are we generating
15:16
some rules that then drive the costs got
15:19
it sounds like there’s a couple
15:20
different ways to get at it yeah exactly
15:25
um okay so I think I’ve got my head
15:26
around how this is working in terms of
15:29
estimating case profitability what
15:32
feedback have you gotten with customers
15:34
that you’ve talked to or customers that
15:36
are using the product already yeah a lot
15:38
of feedback so I think that the initial
15:41
reaction when customers see this is
15:44
almost wow we don’t do this or we don’t
15:46
do this to this level of detail because
15:48
just doing this analysis on one case can
15:51
take a half hour to an hour and now this
15:55
is automatically produced for the next
15:56
you know 250 cases that are on our
15:59
schedule so the time savings or the
16:01
ability to just do this analysis that
16:03
wasn’t possible before is really helping
16:06
centers find problems and go and fix
16:09
those the other is many times the
16:13
centers that do some analysis on this
16:16
are doing it through one or two highly
16:18
tenured employees at the center that
16:21
know their contracts that know the
16:22
vendors like they have really intimate
16:24
knowledge but that knowledge isn’t
16:26
scalable to the rest of the team and so
16:28
Senators have said hey we set this up
16:30
with our most tenured staff member that
16:33
knows all this information but now those
16:35
rules are in there they can educate and
16:37
scale it across the rest of the center
16:39
so it’s given a little breathing room to
16:42
those key staff members that are the
16:43
only people that know this stuff yeah
16:45
and there’s probably some bottlenecks in
16:47
the process I’m sure if only one or two
16:49
folks can operate that right yeah okay
16:52
fantastic for folks that are interested
16:54
in discussing this topic further case
16:57
profitability or the profit forecast
16:59
product that you’re launching what’s the
17:01
best way for them to get more
17:03
information or get in touch I think the
17:05
most straightforward way is just go to
17:07
hscpathways.com book a demo and then we
17:11
can dive into really all the details
17:13
from showing the product having a
17:15
conversation just about what we’ve
17:16
learned in the process we want to be a
17:18
partner and help wherever we can in this
17:20
area
17:21
all right Gavin final question for you
17:23
here we do this with all of our guests
17:24
every week what’s one thing that our
17:27
listeners could do this week to improve
17:28
their surgery centers
17:30
so I think in the centers that we’ve
17:33
spent time with that are the most
17:37
efficient most effective tend to have
17:39
employees that have been there a long
17:40
time a lot of these centers have a
17:42
director of of nursing or a head of
17:45
their or scheduler that they just have
17:47
so much knowledge that they’ve developed
17:49
about the center and they take a lot of
17:52
pride in the facility so really anything
17:54
that you can do to engage employees show
17:58
appreciation up level their skills but
18:01
just keeping the team in place seems to
18:03
drive a lot of positive effects for the
18:06
centers that we work with love it it’s
18:08
all about the team Gavin thanks so much
18:10
for joining us today really appreciate
18:11
the conversation cool thanks Nick
18:15
[Music]
18:17
as always it has been a busy week in
18:20
healthcare so let’s Jump Right In as you
18:23
likely have heard CMS released its 2024
18:26
proposed payment rule as the rule in and
18:30
of itself is 963 Pages our clinical
18:33
experts are currently sifting through
18:36
everything that is in the document and
18:38
we are planning a bit of a deeper dive
18:40
into the good and the bad of what has
18:42
been included for next week’s episode
18:44
but for now the biggest update on
18:47
everyone’s mind is the average rate
18:49
update so if the proposed rule were to
18:52
be finalized as drafted ases would see
18:55
on average overall covered procedures an
18:59
effective update of 2.8 percent this
19:03
number is a combination of a three
19:05
percent inflation based on the hospital
19:07
market and a productivity reduction
19:09
mandated by the Affordable Care Act of
19:12
0.2 percent points it is important to
19:15
note though that updates might vary
19:17
significantly by code and Specialty so
19:19
you will want to look closer at the
19:21
document to see how you might be
19:23
impacted and CMS will be accepting
19:26
comments on the proposed rule through
19:28
September 11th and obviously the more
19:30
ASC voices that can be included the
19:33
better so I strongly suggest you take a
19:35
few minutes to share with CMS what you
19:38
think about what they have put forward
19:39
and of course we’re doing the same on
19:42
our end but keep a close eye on what
19:44
aska has to say they have already done a
19:47
great job summarizing a few things and
19:49
put some thoughts together already on
19:51
the feedback they will be providing
19:54
and in this week’s AI news Northwestern
19:58
Medicine
19:59
gastroenterologists achieves a 13
20:02
increase in the detection and removal of
20:05
colorectal polyps with the assistance of
20:08
artificial intelligence during the
20:10
colonoscopy so the research used the FDA
20:13
approved Medtronic GI genius computer
20:17
aided detection system which resulted in
20:20
higher removal rates compared to
20:22
procedures without Ai and for context
20:25
each one percent increase in detection
20:28
rates is associated with a three percent
20:31
decrease in the risk of colon cancer
20:33
within five years so the use of AI in
20:37
colonoscopies could potentially reduce
20:40
future colon cancer diagnoses by up to
20:42
39 percent
20:44
and based on the positive results from
20:46
the research Northwestern Medicine has
20:49
invested in GI genius devices as you can
20:52
imagine intending to equip every
20:54
endoscopy Suite in its nine acute care
20:56
hospitals and four outpatient locations
20:59
in the Chicago suburbs this shows the
21:03
first of many commitments we’ll see to
21:05
using and developing AI technology to
21:08
enhance patient care in the Health Care
21:10
system and of course what we always like
21:12
to share is that this technology is
21:15
being used alongside doctors so it’s
21:18
never intended to be used alone but it
21:20
is intended to be used in tandem to
21:23
enhance and improve what the human eye
21:26
can do
21:27
I was recently on Doc Buddy’s podcast to
21:30
talk about all things Ai and Healthcare
21:33
so I know we’re always sharing AI news
21:35
but if you’re interested in learning
21:36
more about use cases and pros and cons I
21:40
highly suggest checking out doc Buddy’s
21:42
episode
21:44
all right Story three an Ohio plastic
21:48
surgeon who gained popularity on Tick
21:50
Tock for live streaming operations has
21:53
lost her medical license
21:56
Dr Catherine Catherine Roxanne grahr I’m
22:00
probably saying that wrong her last name
22:01
is g-r-a-w-e
22:04
um also known as social on social media
22:06
as Dr Roxy will no longer be able to
22:10
practice medicine in the state of Ohio
22:12
and must pay a forty five hundred dollar
22:15
fine
22:16
so three patients reporting reported
22:20
having complications following
22:22
procedures with Dr Roxy and
22:25
complications that would not normally
22:27
arise during the procedures she was
22:29
performing now that’s a key part of this
22:32
these three patients were forced to seek
22:35
medical attention after their surgeries
22:37
according to Medical Board records with
22:40
some reporting skin tears infections and
22:42
other serious complications
22:44
an attorney representing the state’s
22:47
case against Dr Roxy shared this case
22:49
isn’t about some Antiquated view of
22:52
social media these patients trusted Dr
22:54
Roxy because of what they saw on social
22:57
she made major surgeries with
22:59
potentially life-altering complications
23:02
seemed like one big party
23:05
according to USA Today the secretary of
23:08
the medical board warned Dr oxia at
23:10
least twice in the last four years
23:12
before her license was suspended so this
23:15
did not come out of nowhere for her and
23:18
in September of 2021 she was urged by
23:20
the board to take remedial education
23:22
courses on plastic surgery complications
23:25
but allegedly continued to film and live
23:28
broadcast the procedures you can also
23:31
see in her live streams that she’s
23:33
actively reading comments while actively
23:36
operating which obviously is incredibly
23:39
dangerous
23:40
and I think for me it was so frustrating
23:43
about this case is of course patients
23:45
were put In Harm’s Way for absolutely no
23:47
good reason that’s first and foremost
23:49
but then second social media can be a
23:53
wonderful way to share educational and
23:55
informative Health Care related content
23:57
with your communities and it can
23:59
absolutely be done in a way that causes
24:02
zero harm to patients and stories and
24:05
scenarios like this
24:07
it’s just kind of a classic case of how
24:09
One Bad Apple can spoil the bunch and
24:12
the way the media is writing these
24:14
headlines obviously it makes it look
24:16
like Tick Tock is the problem when it’s
24:19
not it’s the irresponsible use of tick
24:21
tock and other platforms that is the
24:23
problem
24:24
so I wish these three patients well and
24:27
I hope they can fully recover from this
24:29
experience and if you are interested in
24:32
learning more about this case
24:33
specifically and the positives that can
24:36
come with having a social media presence
24:38
Dr grunch will be joining us next on
24:41
next week’s episode to share the success
24:43
that she’s experienced firsthand on Tick
24:46
Tock and other platforms
24:50
and to end our new segment on a positive
24:52
note after 35 years Rhonda Trotter
24:56
fulfilled her lifelong dream of becoming
24:59
a nurse After High School Rhonda’s
25:01
mother told her there were too many
25:03
nurses so she took a job at the Postal
25:06
Service
25:07
she decided to eventually go to nursing
25:09
school but then while she was there both
25:11
of her parents fell ill so she had to
25:14
leave school to care for them she got
25:16
back to nursing school in January 2019
25:18
and she now works alongside some of the
25:21
doctors who actually helped care for her
25:23
parents so congrats Rhonda on being
25:26
recognized as nurse of the week for your
25:29
resilience and determination in becoming
25:31
a nurse
25:33
and that news story officially wraps up
25:35
this week’s podcast thank you as always
25:38
for spending a few minutes of your week
25:40
with us make sure to subscribe or leave
25:42
a review on whichever platin or platform
25:44
you’re listening from I hope you have a
25:47
great day and we will see you again next
25:49
week
25:54
why are you keeping me
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