Jim Stilley – How Medical Assistants Can Help with Staffing Issues & Reduce Spend | This Week in Surgery Centers
Here’s what to expect on this week’s episode. 🎙️
Almost every surgery center is struggling with two issues right now – staffing shortages and increasing costs. By hiring Medical Assistants, you might be able to tackle both problems at once.
Jim Stilley is the CEO of Great Lakes Orthopaedic Center, which is currently the largest practice north of Grand Rapids. With 20 years of ASC industry experience, he has helped build three ASCs, was formerly the president of MASA, and has experience running very large ASCs with 130+ staff members. He joins us today to share his perspective on how hiring Medical Assistants instead of RNs (where appropriate) will help solve both staffing and spending concerns.
In this episode, we’ll cover the following:
➡️ How #MedicalAssistants or other paraprofessionals can take on the more repeatable, learnable tasks that do not need to be completed by an RN.
➡️ How to evaluate your current processes, identify opportunities, and successfully roll out these changes while balancing experience.
➡️ How to overcome some of the most common concerns, such as patient safety and quality of care.
➡️ The financial benefits you can expect (spoiler: you might just save two-thirds of the spend).
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 if you’re in the ASC industry then
0:06
you’re in the right place every week we’ll start the episode off by sharing an interesting conversation we had with
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our featured guests and then we’ll close the episode by recapping the latest news impacting surgery centers we’re excited
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to share with you what we have so let’s get started and see what the industry’s been up to [Music]
0:28
hi everyone here’s what you can expect on today’s episode so I know everyone is
0:33
always promising solutions for the current Staffing crisis but today we actually have some real advice to share
0:40
that will not only help with Staffing but also help you save some money Jim Stilley is the CEO at Great Lakes
0:47
Orthopedic Center and he’s here to share his perspective on how hiring medical assistants in lieu of RNs where it’s
0:55
appropriate will help with staffing issues while also reducing spend in our news recap we’ll cover how smart
1:02
watches can impact pacemakers the relationship between chat GPT and the
1:08
healthcare industry four ways tablets are transforming patient care and of
1:13
course and the new segment with a positive story about the nurse of the year in Uganda hope everyone enjoys the
1:20
episode and here’s what’s going on this week in surgery centers
1:26
[Music] damn welcome to the show thanks for
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joining us today thanks glad to be here so Jim you’re the CEO of Great Lakes
1:37
Orthopedic Center in Traverse City uh Michigan can you give our listeners kind of a feel for your facility in terms of
1:45
specialty and general size range you did uh we have 14 orthopedic surgeons
1:52
um 11 apps and 10
1:57
Physical Therapy providers and we’re in we’re the largest Practice
2:04
North of Grand Rapids in Michigan great how many ORS do you guys work out
2:11
of um well we have three inner in our ASC and you know we’re looking at
2:18
potentially building more um at another another location we’re pretty geographically remote
2:25
communities up here so we have Physicians that travel quite a bit
2:31
fantastic and so that’s where you’re at now um give us a sense of you know kind of a
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little bit of your overall history with you in the industry um I’ve been in the ASC industry for
2:42
about 20 years I was the president of the Michigan Association twice
2:50
um and I have run very large ASC with 10ors and 130 140 staff
2:58
and I’ve also been vice president of operations for some management companies
3:05
and have helped build three ases
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fantastic so you’ve seen different scenarios in in use cases and different Evolutions
3:16
the industry and so right now everybody’s talking about sapping and spending and expenses as as
3:24
two kind of challenges the facilities are grappling with and I know you have some thoughts around each so I wanted to
3:30
start there um you you kind of described your uh you
3:36
know physician and Staffing mix of your facility if we kind of think of a typical ASE facility kind of mid-size
3:43
multi-specialty ASC facility what do you see in terms of the typical staff makeup
3:49
in terms of types of individuals that work there you
3:54
know the mix between Physicians and RNs and that type of Staffing mix you bet
4:00
and it’s it’s all over the place depending on the sub-specialties and the Specialties that are being utilized but
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um for the most part there’s usually a pre-op and post-op team and they can in
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some of the smaller ASCS be the same folks in larger ASC as they’re completely different divisions
4:23
and then we have or staff and we also have front desk administrative
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staff but one of the things you know with ASC we can spend you know anywhere
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from 20 to 33 percent of our budget on personnel and so we’re always looking
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for ways to kind of reduce some of that expense um you know we always think more cases
4:47
will work our way out of not making enough and when you do a case
4:53
that that money goes to a lot of things it goes to supplies it goes to other things but when you actually save a
5:00
dollar 100 of that money goes right back to the bottom line and so the best way
5:06
we can do um to save money or make money is be as efficient as possible
5:12
sure and so when you think about those different kind of teams or groups within the ASC
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um how many of those fde or Personnel are typically registered nurses well now
5:25
I just see that split working yeah you know in some centers I I’ve seen that where all their clinical staff is
5:32
registered nurses they had a philosophy that a registered nurse can work in
5:40
pre-post and make you know in times of shortage they can even work in the OR and some specialties
5:46
um other places you know it’s a lot broader depending on the number of patients that you’re seeing each day and
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so that’s really the determinant of whether we get outside of an all RN staffed model or we start to get into a
6:01
model that has Nurse directed teams with medical assistance or nurse assistants
6:06
helping that um that that nursing team sometimes I see
6:12
anesthesia assistants helping and
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some of the biggest changes that I’ve ever had to do in my career is changing
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that mindset that an all RN team is the best way to go for a certain certain ASC
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and it’s it’s really taken a lot of communication to get those teams to realize the addition of some
6:36
paraprofessional staff can really be helpful to help that RN work at the
6:41
higher end of their license sure and that seems to be kind of more and more
6:46
timely and more and more being contemplated now that um that Staffing is challenging it is um and our ends are
6:53
hard to come by and our ends are hard to come by and so you mentioned medical assistance
6:59
um you know what is a medical assistant and how do they kind of fit into this equation
7:05
well you know every state has a different guideline on what it what it
7:11
allows or it will authorize um in the midwest where I’ve typically
7:17
worked and I’ve also worked in um Nevada and California
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um it is that state that kind of determines what that is and it can be a certified nursing assistant it can be a
7:29
medical assistant there’s lots of different types of credentials for medical assistance but in in the midwest
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in two or three states you’re not required to have a credentialed or a
7:41
certified medical assistant in many cases that RN can delegate authority to
7:47
trained individuals and so we will bring on team members in many of our ASCS and
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train them to help with you know stretcher cleaning and litter
8:00
patient transport helping to bring nourishment to patients it doesn’t have
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to be a certified medical assistant it can be
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pretty much anybody that you train um and I just feel like there’s a lot of
8:17
opportunity in that area and if you really look at your state regulations to
8:22
what you can have in an ASC I think a lot of people would be surprised and that’s just making sure that you have a well-trained team
8:29
got it so so it seems like you’re you’re kind of really in some cases breaking down the tasks
8:35
that are that that are kind of the clinical staff is doing and saying hey is there an opportunity for
8:41
specialization here do we do we need experienced trained RNs for everything or they’re kind of more repeatable
8:48
trainable tasks that you can actually use other folks for right and some you know the most numerous ases are
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Ophthalmology and gastroenterology and they they don’t have they’re not very
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wide on the spectrum of the number of procedures that they perform so they get really technical in what they do and
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they’re not super invasive and high risk and you’re starting to see it it is really how many patients can we move
9:14
through this platform each day and so there are a lot of tasks that having an
9:20
RN move a patient and get them um ambulating and things along those
9:25
lines it’s not really an RN requirement it is a requirement for an RN to take a look at a patient to make sure that
9:31
they’re recovering from anesthesia uh effects of anesthesia appropriately but
9:36
there’s lots of ways that you can skin that cat sure yeah that’s interesting and for the medical assistant in
9:43
particular what’s kind of the typical skill set difference or level of
9:49
training experience difference between a medical assistant and an RN uh it’s it’s night and day
9:55
um the the RN has a lot of things that only an RN can do and that’s what we’re
10:03
really looking for in that ASC when things when things go south you need
10:09
that RN to work at the highest end of their license when it comes to drug reconciliation and you know their their
10:16
years of experience and training but for most of the functions in an ASA
10:22
on an average day when things aren’t going wrong um or incredibly busy you can have
10:28
people that assist that and there’s a wide range of skills there are ma
10:35
programs that that get medical terminology that assist in blood pressures that assist in different
10:43
um phlebotomy skills starting IVs can be delegated to Mas as long as you have a
10:51
training protocol and you have you got proficiencies that have to be demonstrated and supervised
10:59
each state will outline what can be delegated to a paraprofessional
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the non-licensed individual yeah and and you mentioned hey there’s a
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there’s a big difference in terms of credentialing and experience and so is there also a significant
11:17
difference in the cost or salary of you know a medical assistant or versus a full RN you bet
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um like I said you can do anything from somebody that is well intentioned coming off the street that you train yourself
11:31
for certain functions you know like if you just if you’re big enough ASE and you have 40 Striker stretchers and
11:39
somebody needs to clean those and disinfect that well sometimes it makes sense that that’s
11:45
just RNs in between cases when you you don’t have a high volume place
11:51
sometimes you’re so busy that it may make sense to bring that non-trained individual and train them to
11:58
do that and so that that’s the that’s the real trick is finding
12:05
what are the things that a non-trained ma can do and you can train
12:12
what do you want then that pay scale is pretty low
12:17
um and then you know if you go to a CMA or CCNA they’ve done six months of
12:24
school they get a little more medical terminology they can do a little bit more and that’s pay scale is a little
12:31
bit higher but even at the highest end of a pay scale for the CNA or the Mas
12:36
they’re still about a third of the cost of your lowest priced RN hmm
12:44
yeah I you know this is interesting because this opens up the labor pool
12:50
um right in in terms of the clinical staff members people that can operate on the clinical side if you’re willing to
12:57
you know open you know the types of roles and credentials that you’re looking for uh so it opens up the labor
13:04
pool but it also potentially it seems like it puts more of a burden on the center of the facility on training it
13:11
does that right it does and you know what we’re not talking about is just
13:16
making having fewer nurses do more work what we’re talking about is having nurse
13:22
directed teams to have that RN kind of supervising what’s happening in Pre and
13:29
post-op interjecting hit herself or herself into the situation when a
13:34
licensed nurse is needed documenting where appropriately and supervising
13:41
um the the rest of the team to help them accomplish that it does take a little
13:47
bit more thought but I would I guess I would put it out there if you’re in all RN team and
13:52
you’re doing a lot of volume and you don’t have any paraprofessionals working with you then there you should be asking
13:58
yourself well what could we do if we had you know some of these team members we
14:05
could spend more time with patients on the things that nurses need more time to
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do because the nurses are still running around giving nourishment they’re still running around doing gait training that
14:16
could be delegated to a medical assistant to do certain things at different surgery centers for that
14:24
specialty right absolutely and you mentioned earlier that there’s hesitation in some
14:31
cases uh there’s change management required to think about the model differently to think about Staffing
14:37
Staffing differently than an RN clinical team yes um why do you why do you think
14:43
that is well I’ve had some nurses tell me that I’m giving away their favorite part of their job at times even a warm
14:50
blanket from the blanket warmer to a patient and see that smile on their face when they’re freezing and you give them
14:56
that warm blanket can be what many nurses actually came into the profession for
15:02
um to have that interaction with depration but if you’re in a busy Surgery Center and you know you start to
15:08
separate tasks based on licensure and the ability to find team members I can
15:16
see where you know parts of those you will never see Parts the lower end of that license
15:22
ever being done by those nurses again many times they they regret that and and
15:29
so ASE is a different animal anyway there’s Clinic nurses there’s Hospital
15:34
nurses there’s ASC nurses yeah even nurses from pre and post-op working in
15:41
in the or are different type of nurses they
15:46
and we’ve just got to be sensitive to what makes that nurse love his or her
15:53
job and not take that from them but realize that there are team members that
15:59
can help them do the things that they can’t do it all themselves you know take it I mean we’re taking patience to the
16:05
parking lot why should an RN and our all RN team do that if they didn’t have to
16:11
take would take that patient to the wheelchair to the parking lot to get in and out of their car that’s 15 minutes
16:18
in some cases to help an elderly patient get in and out of their car that nurse is gone for that period of time and so I
16:25
just urge people to start thinking about that it doesn’t mean that we’ll have less RNs but what it it may mean is you
16:34
may not have to look for more RNs when volume goes up because there’s a team that allows that one RN to do more
16:42
yeah yeah and and the role specialization model makes makes a lot of sense to me and and carving up those
16:49
those tasks and saying what skill sets do we need for the different tasks um could could someone that wanted to
16:55
poke holes in this model or take a contrarian approach say hey but what about patient safety doesn’t this leave
17:01
us more exposed for patient safety issues and what have you seen uh in
17:06
practice in terms of folks that have rolled out a more specialized model how
17:11
have they taken those maybe precautionary steps around patient safety well it was always the thing that was the main opponent when I would bring
17:19
this into a new center was that it’s the risk you know we we like to have an orn
17:25
team um you know we’re not good at some of these things that you want us to do like setting up protocols setting up
17:32
um proficiencies supervision of paraprofessionals you know we like the
17:39
one-on-one nursing aspect of what we do and
17:44
I would say yes if it wasn’t executed correctly you could open yourself up to some risk and to some safety issues but
17:51
for we’re not asking these paraprofessionals to you know to give medications that’s not that’s not what
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we’re doing um what we’re really talking about is helping figure out what functions
18:03
absolutely have to be done by a nurse what functions do not have to be done by a nurse and
18:10
then there’s that gray area and that’s where the more experienced Ma you get can be trained to do a urinalysis
18:18
pregnancy and record the results and it’s perfectly legal and it’s perfectly
18:23
safe as long as you’ve done the training and you know you do the protocols that’s
18:29
not something that an RN has to do and so I I just I when I get those the pushback
18:37
on the safety I say show me show me the documentation where in any of our state
18:43
regulations or where in the CMS um where within a orn or aspan does it say
18:52
that this has to be done by an RN yeah exactly well I I like this gym I
19:00
think ASCS are uh are challenged with Rising expenses I think it’s on top of
19:07
everybody’s mind in terms of rising expenses and the impact on profitability and at the same time everybody’s
19:13
challenged with Staffing and and Staffing up and retaining team members and hiring new ones and so I think
19:20
you’re giving our listeners a model to think about that that addresses both of those and for some people it’s probably
19:26
not a good fit for but uh but it’s certainly something for for everybody to kind of think about the applicability to their centers and it does require it’s
19:33
hard on the it’s hard on the administrators it’s hard on the clinical coordinators to make sure that they have
19:39
the right balance of a team because now you’re not just thinking okay you know this nurse can do this in the morning
19:46
and can do this in the afternoon and I’m well set but in a larger Center you do
19:51
have to think about different types of skill sets and I think
19:57
one of the the carrots if you will is if I’m saving like I said two-thirds of the
20:04
the price of salary that two-thirds saving doesn’t all have to go
20:10
back to the bottom line in order to distributions it can go to increase
20:16
salaries for nurses um so I I kind of let them know if we
20:23
have 20 nurses and we need we’re going to grow by 10 do I really need to pick up another two or three nurses or do I
20:30
need to pick up four Mas that can help these nurses and still Bank
20:36
a significant amount of that savings to put back into salaries for growth in our
20:42
end salaries which are historically lagging in Asus yeah three invest some some of those
20:49
dollars in retention around kind of your clinical team leaders that can help operate a model
20:55
like this right because a model like this probably does depend on having strong clinical team leaders to manage
21:01
it correct Jim final question for you and we asked
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this of all our guests every week what’s one thing our listeners can do this week to improve their Surgery Center
21:16
wow um I think maybe just take a time out and
21:22
realize that I mean the staff in my office in the practice are just overwhelmed because nobody’s getting
21:29
paid more anymore I mean we’re all getting paid less and we’re required to do more and I think just I know we do a
21:37
good job of it in the surgery center industry but I think just taking a time out and making sure all the employees
21:43
know that you rely on them that they’re incredibly important in value and that
21:48
they feel that stress just like we all do of this metronome of productivity just increasing and increasing them when
21:55
will it end and it may not but what they also have to understand is we’re Relentless I know my peers in the
22:03
industry are Relentless at looking at ways to make their jobs easier not harder to find help to help them in
22:10
these processes and to let them know that we care about them we understand that they’re stressed and we’re working
22:15
every day to make sure that they’re less stressed and we can’t that we just value our team great this is a great
22:22
conversation Jim thanks so much for joining us today thank you I appreciate it
22:28
[Music] as always it has been a busy busy Healthcare so let’s Jump Right In
22:35
today’s first burning question is could a smart watch it possibly interfere with
22:41
a pacemaker according to a new study reported by U.S News the answer is yes
22:46
smart watches Rings or scales that emit electrical currents can interfere with
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implantable heart devices even causing them to malfunction the wearable devices that cause
22:58
confusion in problems are ones that use bio impedance which I had to look this
23:04
up is the response of a living organism to an externally applied electric current the study found that even the
23:11
slight electrical currents from these gadgets can potentially cause problems and even cause a pacemaker to send an
23:18
unnecessary shock to the heart if it mistakenly thinks the heart needs to be restored to a regular rhythm
23:24
now I will say given the fact that all these Technologies involved are relatively new there is a lot of unknown
23:32
here and it’s hard to say with certainty what the risk is and the probability of
23:37
something going wrong additional studies are obviously needed but for now if you or someone you know does have a
23:44
pacemaker it’s probably a good idea to avoid smart watches and other gadgets of that sort or at the very least have a
23:52
discussion with your doctor our second story comes from Med City News and one AI expert is sharing their
23:59
concerns about the relationship between chat GPT and the healthcare industry chat GPT has been dominating the
24:06
headlines lately but if you’re not familiar with it it’s basically an automated intelligence tool that
24:13
analyzes language to answer questions and produce written content that humans
24:18
can understand so for example I can go to chat GPT and
24:23
type in something fun like write me a poem about my cat and the
24:28
dishwasher and within 20 seconds the poem is written or I can type in something more serious like why is my
24:35
surgical site red and swollen and it will also produce an answer now conversations around where and how
24:43
Ai and automation fit into the healthcare world can definitely get heated some welcome it looking for ways
24:49
to save money save time solve for staffing issues and other benefits but others don’t welcome it simply out of
24:56
concern for for patient safety and the quality of patient care the AI expert interviewed in this
25:02
article is Matt Hollingsworth and he is the CEO of Carta Healthcare which
25:08
develops AI software to reduce the amount of time clinicians spend on mundane tasks so it’s interesting that
25:15
even as someone selling Healthcare AI tools he is quoted saying this about chat GPT
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I think it is an awesome advancement there’s a bunch of really cool things that it can do but it’s a tool a hammer
25:29
can be used to build a house or bludgeon somebody to death it’s all about how you use the tool that matters which I think
25:35
is a good perspective for everybody um but to summarize his primary concerns
25:41
chat GPT is accessible to all and it’s built to produce convincing sounding
25:48
content even if it’s 100 wrong people already turn to sources like Reddit and
25:54
Tick Tock when they have a medical concern or looking for medical advice so adding chat GPT into the mix could start
26:03
to cause problems the reality though is that tools like this are obviously not going anywhere and the more you know the
26:10
better so if you haven’t already definitely give it a try so you can become familiar with it and start to
26:16
make your own decisions about the role something like this might play in your world both personally and professionally
26:25
and Switching gears to our third story Healthcare dive shared an article about four ways tablets are transforming
26:32
patient care and four ways they can be used at the point of care if you’re not
26:38
using tablets in your surgery center right now you are really missing out on a lot of benefits like increased
26:43
efficiency productivity and just overall collaboration between the patients and
26:49
the entire uh care team so let’s review the four use cases that they shared
26:55
the first is EHR access so by using tablets a few benefits include
27:00
significant Time Savings for both nurses and doctors improved documentation reduced errors better patient care
27:07
lighter workloads and the list goes on because by charting in real time the
27:13
benefits are really endless when you compare it to the paper process
27:18
the second is virtual patient observation this allows patient care teams to check in and monitor their
27:25
patients remotely and in this scenario a tablet can be mounted on a patient
27:30
observation cart and trained staff members can observe their patients health conditions and behaviors from a
27:36
distance the third use case is telemedicine imagine you’re in pre-op or post-op and
27:45
you need to Loop in a specialist or another member of The Care team who is off-site using a tablet you can call
27:52
them turn the cameras on and they’re immediately with you in that room I know
27:57
we’re all familiar with virtual doctors visits from you know with your PCP
28:02
um from the covid days and some of that has continued I believe I just had a
28:09
dermatologist appointment virtually but now that we have these options available
28:14
to us providers are continuing to think out of the box and how they can be used
28:21
and then last but not least the fourth use case is called video remote interpreting which is kind of just a
28:28
fancy way of saying a translator but um I can imagine many scenarios where this is helpful if you have a patient
28:35
that is hearing impaired or uh English is their second language finding local
28:40
translators can be challenging and super expensive and most likely will cause
28:46
care delays if you’re not prepared so something like VRI can bring an expert
28:52
translator right into the room with you so those are just four examples of how
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tablets can impact how you care for your patients in an influential way and in a way that is
29:03
impactful and can produce real change and results and to end our new segment on a positive
29:10
note a nurse in Uganda was recognized as nurse of the Year by the country’s
29:15
Health Minister after she was seen climbing up an incredibly dangerous ladder in order to bring and administer
29:22
vaccines to children in a remote area Agnes nambot namboso is her name and you
29:29
have to go to the episode notes so you can see the article and check out this video for yourself whatever you’re picturing in your head The Climb this
29:36
nurse is making is 10 times more dangerous um than what you’re picturing it’s kind
29:42
of hard to tell for sure but she has a backpack like box strapped to her back presumably filled with the supplies and
29:50
the latter looks to be hand built with tree branches and looks to be at least a few stories high at least from where the
29:57
angle of the camera is so the commitment that Miss nomboso has to taking care of
30:04
her community is so inspiring and her nurse of the Year title is well deserved
30:10
and that news story officially wraps up this week’s podcast thank you as always
30:15
for spending a few minutes of your week with us make sure to subscribe or leave a review on whichever platform you’re
30:21
listening from I hope you have a great day and we will see you again next week
30:27
[Music] foreign
welcome to this week in surgery centers if you’re in the ASC industry then
0:06
you’re in the right place every week we’ll start the episode off by sharing an interesting conversation we had with
0:11
our featured guests and then we’ll close the episode by recapping the latest news impacting surgery centers we’re excited
0:18
to share with you what we have so let’s get started and see what the industry’s been up to [Music]
0:28
hi everyone here’s what you can expect on today’s episode so I know everyone is
0:33
always promising solutions for the current Staffing crisis but today we actually have some real advice to share
0:40
that will not only help with Staffing but also help you save some money Jim Stilley is the CEO at Great Lakes
0:47
Orthopedic Center and he’s here to share his perspective on how hiring medical assistants in lieu of RNs where it’s
0:55
appropriate will help with staffing issues while also reducing spend in our news recap we’ll cover how smart
1:02
watches can impact pacemakers the relationship between chat GPT and the
1:08
healthcare industry four ways tablets are transforming patient care and of
1:13
course and the new segment with a positive story about the nurse of the year in Uganda hope everyone enjoys the
1:20
episode and here’s what’s going on this week in surgery centers
1:26
[Music] damn welcome to the show thanks for
1:31
joining us today thanks glad to be here so Jim you’re the CEO of Great Lakes
1:37
Orthopedic Center in Traverse City uh Michigan can you give our listeners kind of a feel for your facility in terms of
1:45
specialty and general size range you did uh we have 14 orthopedic surgeons
1:52
um 11 apps and 10
1:57
Physical Therapy providers and we’re in we’re the largest Practice
2:04
North of Grand Rapids in Michigan great how many ORS do you guys work out
2:11
of um well we have three inner in our ASC and you know we’re looking at
2:18
potentially building more um at another another location we’re pretty geographically remote
2:25
communities up here so we have Physicians that travel quite a bit
2:31
fantastic and so that’s where you’re at now um give us a sense of you know kind of a
2:36
little bit of your overall history with you in the industry um I’ve been in the ASC industry for
2:42
about 20 years I was the president of the Michigan Association twice
2:50
um and I have run very large ASC with 10ors and 130 140 staff
2:58
and I’ve also been vice president of operations for some management companies
3:05
and have helped build three ases
3:11
fantastic so you’ve seen different scenarios in in use cases and different Evolutions
3:16
the industry and so right now everybody’s talking about sapping and spending and expenses as as
3:24
two kind of challenges the facilities are grappling with and I know you have some thoughts around each so I wanted to
3:30
start there um you you kind of described your uh you
3:36
know physician and Staffing mix of your facility if we kind of think of a typical ASE facility kind of mid-size
3:43
multi-specialty ASC facility what do you see in terms of the typical staff makeup
3:49
in terms of types of individuals that work there you
3:54
know the mix between Physicians and RNs and that type of Staffing mix you bet
4:00
and it’s it’s all over the place depending on the sub-specialties and the Specialties that are being utilized but
4:08
um for the most part there’s usually a pre-op and post-op team and they can in
4:15
some of the smaller ASCS be the same folks in larger ASC as they’re completely different divisions
4:23
and then we have or staff and we also have front desk administrative
4:29
staff but one of the things you know with ASC we can spend you know anywhere
4:36
from 20 to 33 percent of our budget on personnel and so we’re always looking
4:41
for ways to kind of reduce some of that expense um you know we always think more cases
4:47
will work our way out of not making enough and when you do a case
4:53
that that money goes to a lot of things it goes to supplies it goes to other things but when you actually save a
5:00
dollar 100 of that money goes right back to the bottom line and so the best way
5:06
we can do um to save money or make money is be as efficient as possible
5:12
sure and so when you think about those different kind of teams or groups within the ASC
5:19
um how many of those fde or Personnel are typically registered nurses well now
5:25
I just see that split working yeah you know in some centers I I’ve seen that where all their clinical staff is
5:32
registered nurses they had a philosophy that a registered nurse can work in
5:40
pre-post and make you know in times of shortage they can even work in the OR and some specialties
5:46
um other places you know it’s a lot broader depending on the number of patients that you’re seeing each day and
5:53
so that’s really the determinant of whether we get outside of an all RN staffed model or we start to get into a
6:01
model that has Nurse directed teams with medical assistance or nurse assistants
6:06
helping that um that that nursing team sometimes I see
6:12
anesthesia assistants helping and
6:18
some of the biggest changes that I’ve ever had to do in my career is changing
6:23
that mindset that an all RN team is the best way to go for a certain certain ASC
6:29
and it’s it’s really taken a lot of communication to get those teams to realize the addition of some
6:36
paraprofessional staff can really be helpful to help that RN work at the
6:41
higher end of their license sure and that seems to be kind of more and more
6:46
timely and more and more being contemplated now that um that Staffing is challenging it is um and our ends are
6:53
hard to come by and our ends are hard to come by and so you mentioned medical assistance
6:59
um you know what is a medical assistant and how do they kind of fit into this equation
7:05
well you know every state has a different guideline on what it what it
7:11
allows or it will authorize um in the midwest where I’ve typically
7:17
worked and I’ve also worked in um Nevada and California
7:22
um it is that state that kind of determines what that is and it can be a certified nursing assistant it can be a
7:29
medical assistant there’s lots of different types of credentials for medical assistance but in in the midwest
7:35
in two or three states you’re not required to have a credentialed or a
7:41
certified medical assistant in many cases that RN can delegate authority to
7:47
trained individuals and so we will bring on team members in many of our ASCS and
7:54
train them to help with you know stretcher cleaning and litter
8:00
patient transport helping to bring nourishment to patients it doesn’t have
8:06
to be a certified medical assistant it can be
8:12
pretty much anybody that you train um and I just feel like there’s a lot of
8:17
opportunity in that area and if you really look at your state regulations to
8:22
what you can have in an ASC I think a lot of people would be surprised and that’s just making sure that you have a well-trained team
8:29
got it so so it seems like you’re you’re kind of really in some cases breaking down the tasks
8:35
that are that that are kind of the clinical staff is doing and saying hey is there an opportunity for
8:41
specialization here do we do we need experienced trained RNs for everything or they’re kind of more repeatable
8:48
trainable tasks that you can actually use other folks for right and some you know the most numerous ases are
8:56
Ophthalmology and gastroenterology and they they don’t have they’re not very
9:02
wide on the spectrum of the number of procedures that they perform so they get really technical in what they do and
9:07
they’re not super invasive and high risk and you’re starting to see it it is really how many patients can we move
9:14
through this platform each day and so there are a lot of tasks that having an
9:20
RN move a patient and get them um ambulating and things along those
9:25
lines it’s not really an RN requirement it is a requirement for an RN to take a look at a patient to make sure that
9:31
they’re recovering from anesthesia uh effects of anesthesia appropriately but
9:36
there’s lots of ways that you can skin that cat sure yeah that’s interesting and for the medical assistant in
9:43
particular what’s kind of the typical skill set difference or level of
9:49
training experience difference between a medical assistant and an RN uh it’s it’s night and day
9:55
um the the RN has a lot of things that only an RN can do and that’s what we’re
10:03
really looking for in that ASC when things when things go south you need
10:09
that RN to work at the highest end of their license when it comes to drug reconciliation and you know their their
10:16
years of experience and training but for most of the functions in an ASA
10:22
on an average day when things aren’t going wrong um or incredibly busy you can have
10:28
people that assist that and there’s a wide range of skills there are ma
10:35
programs that that get medical terminology that assist in blood pressures that assist in different
10:43
um phlebotomy skills starting IVs can be delegated to Mas as long as you have a
10:51
training protocol and you have you got proficiencies that have to be demonstrated and supervised
10:59
each state will outline what can be delegated to a paraprofessional
11:05
the non-licensed individual yeah and and you mentioned hey there’s a
11:10
there’s a big difference in terms of credentialing and experience and so is there also a significant
11:17
difference in the cost or salary of you know a medical assistant or versus a full RN you bet
11:25
um like I said you can do anything from somebody that is well intentioned coming off the street that you train yourself
11:31
for certain functions you know like if you just if you’re big enough ASE and you have 40 Striker stretchers and
11:39
somebody needs to clean those and disinfect that well sometimes it makes sense that that’s
11:45
just RNs in between cases when you you don’t have a high volume place
11:51
sometimes you’re so busy that it may make sense to bring that non-trained individual and train them to
11:58
do that and so that that’s the that’s the real trick is finding
12:05
what are the things that a non-trained ma can do and you can train
12:12
what do you want then that pay scale is pretty low
12:17
um and then you know if you go to a CMA or CCNA they’ve done six months of
12:24
school they get a little more medical terminology they can do a little bit more and that’s pay scale is a little
12:31
bit higher but even at the highest end of a pay scale for the CNA or the Mas
12:36
they’re still about a third of the cost of your lowest priced RN hmm
12:44
yeah I you know this is interesting because this opens up the labor pool
12:50
um right in in terms of the clinical staff members people that can operate on the clinical side if you’re willing to
12:57
you know open you know the types of roles and credentials that you’re looking for uh so it opens up the labor
13:04
pool but it also potentially it seems like it puts more of a burden on the center of the facility on training it
13:11
does that right it does and you know what we’re not talking about is just
13:16
making having fewer nurses do more work what we’re talking about is having nurse
13:22
directed teams to have that RN kind of supervising what’s happening in Pre and
13:29
post-op interjecting hit herself or herself into the situation when a
13:34
licensed nurse is needed documenting where appropriately and supervising
13:41
um the the rest of the team to help them accomplish that it does take a little
13:47
bit more thought but I would I guess I would put it out there if you’re in all RN team and
13:52
you’re doing a lot of volume and you don’t have any paraprofessionals working with you then there you should be asking
13:58
yourself well what could we do if we had you know some of these team members we
14:05
could spend more time with patients on the things that nurses need more time to
14:10
do because the nurses are still running around giving nourishment they’re still running around doing gait training that
14:16
could be delegated to a medical assistant to do certain things at different surgery centers for that
14:24
specialty right absolutely and you mentioned earlier that there’s hesitation in some
14:31
cases uh there’s change management required to think about the model differently to think about Staffing
14:37
Staffing differently than an RN clinical team yes um why do you why do you think
14:43
that is well I’ve had some nurses tell me that I’m giving away their favorite part of their job at times even a warm
14:50
blanket from the blanket warmer to a patient and see that smile on their face when they’re freezing and you give them
14:56
that warm blanket can be what many nurses actually came into the profession for
15:02
um to have that interaction with depration but if you’re in a busy Surgery Center and you know you start to
15:08
separate tasks based on licensure and the ability to find team members I can
15:16
see where you know parts of those you will never see Parts the lower end of that license
15:22
ever being done by those nurses again many times they they regret that and and
15:29
so ASE is a different animal anyway there’s Clinic nurses there’s Hospital
15:34
nurses there’s ASC nurses yeah even nurses from pre and post-op working in
15:41
in the or are different type of nurses they
15:46
and we’ve just got to be sensitive to what makes that nurse love his or her
15:53
job and not take that from them but realize that there are team members that
15:59
can help them do the things that they can’t do it all themselves you know take it I mean we’re taking patience to the
16:05
parking lot why should an RN and our all RN team do that if they didn’t have to
16:11
take would take that patient to the wheelchair to the parking lot to get in and out of their car that’s 15 minutes
16:18
in some cases to help an elderly patient get in and out of their car that nurse is gone for that period of time and so I
16:25
just urge people to start thinking about that it doesn’t mean that we’ll have less RNs but what it it may mean is you
16:34
may not have to look for more RNs when volume goes up because there’s a team that allows that one RN to do more
16:42
yeah yeah and and the role specialization model makes makes a lot of sense to me and and carving up those
16:49
those tasks and saying what skill sets do we need for the different tasks um could could someone that wanted to
16:55
poke holes in this model or take a contrarian approach say hey but what about patient safety doesn’t this leave
17:01
us more exposed for patient safety issues and what have you seen uh in
17:06
practice in terms of folks that have rolled out a more specialized model how
17:11
have they taken those maybe precautionary steps around patient safety well it was always the thing that was the main opponent when I would bring
17:19
this into a new center was that it’s the risk you know we we like to have an orn
17:25
team um you know we’re not good at some of these things that you want us to do like setting up protocols setting up
17:32
um proficiencies supervision of paraprofessionals you know we like the
17:39
one-on-one nursing aspect of what we do and
17:44
I would say yes if it wasn’t executed correctly you could open yourself up to some risk and to some safety issues but
17:51
for we’re not asking these paraprofessionals to you know to give medications that’s not that’s not what
17:57
we’re doing um what we’re really talking about is helping figure out what functions
18:03
absolutely have to be done by a nurse what functions do not have to be done by a nurse and
18:10
then there’s that gray area and that’s where the more experienced Ma you get can be trained to do a urinalysis
18:18
pregnancy and record the results and it’s perfectly legal and it’s perfectly
18:23
safe as long as you’ve done the training and you know you do the protocols that’s
18:29
not something that an RN has to do and so I I just I when I get those the pushback
18:37
on the safety I say show me show me the documentation where in any of our state
18:43
regulations or where in the CMS um where within a orn or aspan does it say
18:52
that this has to be done by an RN yeah exactly well I I like this gym I
19:00
think ASCS are uh are challenged with Rising expenses I think it’s on top of
19:07
everybody’s mind in terms of rising expenses and the impact on profitability and at the same time everybody’s
19:13
challenged with Staffing and and Staffing up and retaining team members and hiring new ones and so I think
19:20
you’re giving our listeners a model to think about that that addresses both of those and for some people it’s probably
19:26
not a good fit for but uh but it’s certainly something for for everybody to kind of think about the applicability to their centers and it does require it’s
19:33
hard on the it’s hard on the administrators it’s hard on the clinical coordinators to make sure that they have
19:39
the right balance of a team because now you’re not just thinking okay you know this nurse can do this in the morning
19:46
and can do this in the afternoon and I’m well set but in a larger Center you do
19:51
have to think about different types of skill sets and I think
19:57
one of the the carrots if you will is if I’m saving like I said two-thirds of the
20:04
the price of salary that two-thirds saving doesn’t all have to go
20:10
back to the bottom line in order to distributions it can go to increase
20:16
salaries for nurses um so I I kind of let them know if we
20:23
have 20 nurses and we need we’re going to grow by 10 do I really need to pick up another two or three nurses or do I
20:30
need to pick up four Mas that can help these nurses and still Bank
20:36
a significant amount of that savings to put back into salaries for growth in our
20:42
end salaries which are historically lagging in Asus yeah three invest some some of those
20:49
dollars in retention around kind of your clinical team leaders that can help operate a model
20:55
like this right because a model like this probably does depend on having strong clinical team leaders to manage
21:01
it correct Jim final question for you and we asked
21:08
this of all our guests every week what’s one thing our listeners can do this week to improve their Surgery Center
21:16
wow um I think maybe just take a time out and
21:22
realize that I mean the staff in my office in the practice are just overwhelmed because nobody’s getting
21:29
paid more anymore I mean we’re all getting paid less and we’re required to do more and I think just I know we do a
21:37
good job of it in the surgery center industry but I think just taking a time out and making sure all the employees
21:43
know that you rely on them that they’re incredibly important in value and that
21:48
they feel that stress just like we all do of this metronome of productivity just increasing and increasing them when
21:55
will it end and it may not but what they also have to understand is we’re Relentless I know my peers in the
22:03
industry are Relentless at looking at ways to make their jobs easier not harder to find help to help them in
22:10
these processes and to let them know that we care about them we understand that they’re stressed and we’re working
22:15
every day to make sure that they’re less stressed and we can’t that we just value our team great this is a great
22:22
conversation Jim thanks so much for joining us today thank you I appreciate it
22:28
[Music] as always it has been a busy busy Healthcare so let’s Jump Right In
22:35
today’s first burning question is could a smart watch it possibly interfere with
22:41
a pacemaker according to a new study reported by U.S News the answer is yes
22:46
smart watches Rings or scales that emit electrical currents can interfere with
22:52
implantable heart devices even causing them to malfunction the wearable devices that cause
22:58
confusion in problems are ones that use bio impedance which I had to look this
23:04
up is the response of a living organism to an externally applied electric current the study found that even the
23:11
slight electrical currents from these gadgets can potentially cause problems and even cause a pacemaker to send an
23:18
unnecessary shock to the heart if it mistakenly thinks the heart needs to be restored to a regular rhythm
23:24
now I will say given the fact that all these Technologies involved are relatively new there is a lot of unknown
23:32
here and it’s hard to say with certainty what the risk is and the probability of
23:37
something going wrong additional studies are obviously needed but for now if you or someone you know does have a
23:44
pacemaker it’s probably a good idea to avoid smart watches and other gadgets of that sort or at the very least have a
23:52
discussion with your doctor our second story comes from Med City News and one AI expert is sharing their
23:59
concerns about the relationship between chat GPT and the healthcare industry chat GPT has been dominating the
24:06
headlines lately but if you’re not familiar with it it’s basically an automated intelligence tool that
24:13
analyzes language to answer questions and produce written content that humans
24:18
can understand so for example I can go to chat GPT and
24:23
type in something fun like write me a poem about my cat and the
24:28
dishwasher and within 20 seconds the poem is written or I can type in something more serious like why is my
24:35
surgical site red and swollen and it will also produce an answer now conversations around where and how
24:43
Ai and automation fit into the healthcare world can definitely get heated some welcome it looking for ways
24:49
to save money save time solve for staffing issues and other benefits but others don’t welcome it simply out of
24:56
concern for for patient safety and the quality of patient care the AI expert interviewed in this
25:02
article is Matt Hollingsworth and he is the CEO of Carta Healthcare which
25:08
develops AI software to reduce the amount of time clinicians spend on mundane tasks so it’s interesting that
25:15
even as someone selling Healthcare AI tools he is quoted saying this about chat GPT
25:22
I think it is an awesome advancement there’s a bunch of really cool things that it can do but it’s a tool a hammer
25:29
can be used to build a house or bludgeon somebody to death it’s all about how you use the tool that matters which I think
25:35
is a good perspective for everybody um but to summarize his primary concerns
25:41
chat GPT is accessible to all and it’s built to produce convincing sounding
25:48
content even if it’s 100 wrong people already turn to sources like Reddit and
25:54
Tick Tock when they have a medical concern or looking for medical advice so adding chat GPT into the mix could start
26:03
to cause problems the reality though is that tools like this are obviously not going anywhere and the more you know the
26:10
better so if you haven’t already definitely give it a try so you can become familiar with it and start to
26:16
make your own decisions about the role something like this might play in your world both personally and professionally
26:25
and Switching gears to our third story Healthcare dive shared an article about four ways tablets are transforming
26:32
patient care and four ways they can be used at the point of care if you’re not
26:38
using tablets in your surgery center right now you are really missing out on a lot of benefits like increased
26:43
efficiency productivity and just overall collaboration between the patients and
26:49
the entire uh care team so let’s review the four use cases that they shared
26:55
the first is EHR access so by using tablets a few benefits include
27:00
significant Time Savings for both nurses and doctors improved documentation reduced errors better patient care
27:07
lighter workloads and the list goes on because by charting in real time the
27:13
benefits are really endless when you compare it to the paper process
27:18
the second is virtual patient observation this allows patient care teams to check in and monitor their
27:25
patients remotely and in this scenario a tablet can be mounted on a patient
27:30
observation cart and trained staff members can observe their patients health conditions and behaviors from a
27:36
distance the third use case is telemedicine imagine you’re in pre-op or post-op and
27:45
you need to Loop in a specialist or another member of The Care team who is off-site using a tablet you can call
27:52
them turn the cameras on and they’re immediately with you in that room I know
27:57
we’re all familiar with virtual doctors visits from you know with your PCP
28:02
um from the covid days and some of that has continued I believe I just had a
28:09
dermatologist appointment virtually but now that we have these options available
28:14
to us providers are continuing to think out of the box and how they can be used
28:21
and then last but not least the fourth use case is called video remote interpreting which is kind of just a
28:28
fancy way of saying a translator but um I can imagine many scenarios where this is helpful if you have a patient
28:35
that is hearing impaired or uh English is their second language finding local
28:40
translators can be challenging and super expensive and most likely will cause
28:46
care delays if you’re not prepared so something like VRI can bring an expert
28:52
translator right into the room with you so those are just four examples of how
28:57
tablets can impact how you care for your patients in an influential way and in a way that is
29:03
impactful and can produce real change and results and to end our new segment on a positive
29:10
note a nurse in Uganda was recognized as nurse of the Year by the country’s
29:15
Health Minister after she was seen climbing up an incredibly dangerous ladder in order to bring and administer
29:22
vaccines to children in a remote area Agnes nambot namboso is her name and you
29:29
have to go to the episode notes so you can see the article and check out this video for yourself whatever you’re picturing in your head The Climb this
29:36
nurse is making is 10 times more dangerous um than what you’re picturing it’s kind
29:42
of hard to tell for sure but she has a backpack like box strapped to her back presumably filled with the supplies and
29:50
the latter looks to be hand built with tree branches and looks to be at least a few stories high at least from where the
29:57
angle of the camera is so the commitment that Miss nomboso has to taking care of
30:04
her community is so inspiring and her nurse of the Year title is well deserved
30:10
and that news story officially wraps up this week’s podcast thank you as always
30:15
for spending a few minutes of your week with us make sure to subscribe or leave a review on whichever platform you’re
30:21
listening from I hope you have a great day and we will see you again next week
30:27
[Music] foreign
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