Marie Yarborough – Top 5 KPIs all ASCs Should be Tracking | This Week in Surgery Centers
Here’s what to expect on this week’s episode. 🎙️
Tracking key performance indicators (KPIs) is the only way to ensure your surgery center is operating at optimal efficiency. But how do you know where to begin?
Marie Yarborough, CASC is the Administrator at Skyway Surgery Center. With four ORs and 600 cases per month, KPIs are her lifeline for understanding her facility’s revenue and success. In this week’s episode, we ask Marie why she started this journey, how she identifies what to track, how she collects her data, and more. Here’s a high level of what she shared.
By measuring KPIs, you’ll be able to:
- Watch historical trends and course-correct before it’s too late
- Access visual representations of your data to draw out insights and make decisions
- Meet and exceed your organization’s goals
Here are the five most important areas to focus on:
- Financial
- Supply & operational costs (ex. Operational costs by case)
- Employee expenses (ex. Average labor cost by case)
- Surgeon utilization (ex. Is volume shrinking?)
- Patient satisfaction
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
0:06
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 guests 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 Marie Yarborough is
0:33
the administrator of Skyway Surgery
0:35
Center in Chico California and she’s
0:38
here today to talk to us about the top
0:39
five kpis that all ASCS should be
0:42
tracking there’s that very popular
0:45
saying you’ve probably heard a million
0:47
times if you can’t measure it you can’t
0:49
manage it and that’s certainly true when
0:52
it comes to surgery centers we get to
0:54
talk with Marie about the top kpis how
0:57
she determines what to measure how she
0:59
collects the data the results she’s seen
1:02
and so much more
1:04
in our news recap we’ll cover the new
1:06
outpatient surgery quality and access
1:08
act the latest on the no surprises act a
1:12
new gastric balloon that does not
1:14
require surgery
1:16
and of course and the new segment with a
1:18
positive story about a couple who fell
1:20
in love after going through heart
1:22
surgery together
1:23
hope everyone enjoys the episode and
1:26
here’s what’s going on this week in
1:27
surgery centers
1:29
[Music]
1:33
Marie welcome to the show
1:35
thank you
1:36
appreciate you appreciate you joining us
1:38
today can you tell me a little bit about
1:40
your background in the ASC industry
1:43
yeah
1:44
um thanks for having me on today my name
1:46
is Marie Yarbrough I live and work in
1:48
Northern California
1:50
which I’ve been a resident of my whole
1:52
life I’m a certified ASC administrator I
1:56
have my degree in business and in a few
1:59
more months I’ll have my MBA
2:02
um I’ve worked in healthcare my whole
2:04
life and I’ve been an ASE administrator
2:06
for 15 years now
2:09
fantastic great background and and
2:11
you’re currently at Skyway surgery
2:13
centers correct yes tell us a little bit
2:16
about Skyway in terms of the type of
2:19
facility you are in specialty areas and
2:21
things like that sure yeah
2:23
um Skyway is a 40r1 procedure room
2:27
multi-specialty facility we perform
2:31
around 600 cases a month and we see
2:34
predominantly Ortho Ophthalmology and GI
2:38
cases
2:39
great and does Skyway have any
2:42
affiliations either with management
2:44
companies or ownership groups or
2:46
anything yes yes
2:50
fantastic
2:52
um and appreciate that background and
2:55
one of the things Marie we’re excited to
2:57
talk to you about today at HST we’re
2:59
we’re big fans of the aska Forum uh you
3:02
know we check in there for time to time
3:03
it’s been a good source of kind of
3:05
learning and knowledge hearing for our
3:07
company over the years and one of the
3:10
one of the posts that we noticed uh
3:12
recently was a post that you made around
3:14
kpi files and kpi sharing and we thought
3:18
that’d be a great topic we’re always
3:20
talking about kpis and data at HST with
3:23
our customers yeah and I thought it’d be
3:25
a great topic for a podcast
3:27
one of a couple of the the kpi
3:30
categories that you posted about and
3:32
you’re so kind of nice to share your
3:34
final on Words around billion
3:37
collections uh
3:39
when you think about kpis overall across
3:43
Skyway Surgery Center are those
3:45
typically the categories that you’re
3:47
focused on is the the billion collection
3:49
set
3:50
I mean just with my background in
3:52
business
3:54
um yes
3:56
um but the business has so much more to
3:59
it right patient satisfactions
4:02
um
4:03
surgeon utilization there’s so much you
4:07
can focus on
4:10
um but of course the business is my main
4:13
focus
4:15
um as should any administrator
4:19
absolutely Revenue in right how much how
4:22
much money are we making so uh can you
4:24
share what kpis are in general
4:27
and why you think they’re so important
4:29
and helpful sure
4:31
um kpi is an acronym for key performance
4:34
indicators key performance indicators
4:37
measures your facilities performance
4:39
that you can use to quantify levels of
4:43
success it gives you that visual
4:47
representation of key areas of focus I
4:51
use it to watch historical Trends and to
4:54
see if my organization is meeting its
4:57
schools normally you can use this when
5:00
one chard or a graph or a piece of data
5:03
does not provide enough information to
5:06
decide
5:06
kpis are important because you can’t
5:10
manage what you don’t measure
5:12
yep I think it was Peter Peter Drucker
5:15
that said it best so um that’s great
5:17
yeah and how long have you been tracking
5:20
kpis at Skyway
5:22
I’ve been tracking kpis from the
5:24
beginning I’ve quickly learned the
5:27
benefits and feedback a kpi can give to
5:30
determine which one to track is
5:32
individualized the need at Skyway was
5:35
more financially related I needed to be
5:38
able to track how we were doing with
5:40
upfront collections aging billing
5:43
timeliness credit balance levels and
5:45
things of that nature
5:47
got it okay and so the focus on the
5:50
financial side with billing and
5:52
Collections and so you you’ve got your
5:55
key kpis which you track do you do you
5:59
change those on a regular basis or do
6:01
they tend to stay pretty consistent
6:03
month over month quarter over quarter
6:05
yeah more than likely I find I will add
6:08
to my kpis rather than stopping a
6:10
measurement altogether the indicators
6:13
that I choose to follow are important to
6:15
me and there is no Finish Line it’s a
6:18
monthly comparison of a performance that
6:20
I can follow and then learn from
6:22
fantastic
6:25
um and the data side of it is something
6:27
that our customers ask us a lot in terms
6:30
of hey how do we get the right metrics
6:32
in the right way that we want to see it
6:33
what do you guys use for the data
6:36
collection
6:37
uh HST
6:39
I have several reports I run in HST for
6:43
example if I want to follow how well
6:46
registration is doing collecting the
6:48
mounts due at time of surgery I will run
6:51
a report under HST scheduling reports
6:54
called
6:55
sc1000 admission billing schedule this
6:59
report clearly clearly shows the amount
7:02
estimated the patient will owe at the
7:05
time of service which has been given to
7:07
the patient ahead of time and the amount
7:11
collected
7:12
the each month I track their progress or
7:15
decline once I’ve collected this data I
7:18
entered in Excel spreadsheet that I’ve
7:20
created and I’ll follow the changes and
7:23
variables once I started to track the
7:26
numbers I implemented benchmarking
7:28
levels to help
7:29
um motivate change
7:33
fantastic
7:34
uh Marie if you had to choose five kpis
7:39
that every ASC should be focused on what
7:42
five would you choose
7:45
um there’s so many I would say you
7:48
should definitely follow your financial
7:50
numbers this is so important for
7:52
administrators to track when you keep a
7:55
close eye on this you’ll know sooner
7:57
rather than later if numbers start to
7:59
shift
8:01
um I would also track Supply costs or or
8:03
operational costs track those numbers
8:06
either by case or against Revenue volume
8:10
again if you notice a shift what
8:12
happened where where did the shift come
8:14
from how do we fix it what are your
8:16
options in the long run this is going to
8:19
help those financial numbers
8:21
and then the employee expenses labor
8:24
expense
8:25
Progressive revenue or
8:27
average labor cost per case what however
8:31
you want to follow and track it it
8:33
doesn’t even have to be a ratio you can
8:36
just follow the numbers
8:38
surgeon utilization using
8:42
who’s using or not using their block and
8:45
why
8:46
or why is their volume shrinking those
8:49
are
8:50
questions you can answer by following
8:54
those numbers lastly patient
8:56
satisfaction what’s the trend do you see
8:58
a decline in satisfaction scores and why
9:01
love it very very encompassing there in
9:04
terms of the different categories of
9:05
operations so appreciate it so final
9:07
question for you Marie and we do this
9:09
every week with our guests what is one
9:11
thing listeners can do this week to
9:13
improve their surgery centers
9:16
I say Empower your employees with
9:19
information these tracings are just not
9:22
for you and the board allow your
9:24
employees to see the changes that are
9:26
happening
9:27
set a benchmark and create a goal for
9:29
them and lastly reward them for a job
9:32
well done because their success is your
9:34
success
9:35
love it all right
9:38
that’s a wrap that’s a wrap okay thank
9:41
you so much
9:42
good night
9:46
as always it has been a busy week in
9:49
healthcare so let’s jump right in our
9:51
first story comes from Becker’s ASC and
9:54
it’s definitely an exciting one four
9:56
lawmakers have reintroduced legislation
9:59
that would eliminate penalties that
10:02
charge Medicare beneficiaries higher
10:04
co-pays for care outside of hospitals
10:07
the four lawmakers are Senator Bill
10:10
Cassidy of Louisiana
10:12
Senator Richard Blumenthal of
10:14
Connecticut
10:15
representative Brad wenstrup of Ohio and
10:18
representative John Larson also of
10:20
Connecticut and the bill is called the
10:23
outpatient surgery quality and access
10:25
Act
10:27
the goal of the bill is to close the
10:29
reimbursement gap between Hospital
10:31
outpatient departments and ASCS
10:33
and co-pay penalties for Medicare
10:36
beneficiaries address barriers to
10:39
Affordable and quality care and increase
10:41
transparency about cms’s procedure
10:43
coverage at ASCS which I know has been a
10:47
long-standing question and issue
10:49
Senator Blumenthal shared that patients
10:52
should shouldn’t be charged more for
10:54
procedure just because it was performed
10:56
by an outpatient provider the current
10:59
restrictions on ASCS are an unnecessary
11:01
burden limiting seniors access to care
11:04
and driving up health care costs I think
11:07
we can all agree with that and honestly
11:10
as a Connecticut resident I am proud of
11:12
how Senator Blumenthal is advocating for
11:14
surgery centers and also the bill is
11:17
endorsed by ASCA which always helps so
11:19
we’ll keep a close eye on how it
11:21
progresses and we’ll make sure to share
11:23
some timely updates
11:25
the next story is kind of wild but the
11:28
United States Department of Health and
11:30
Human Services has paused surprise
11:32
billing arbitration after Texas Court
11:34
decision
11:35
so to understand what this means you
11:38
need to First understand the independent
11:40
dispute resolution process so as we know
11:43
surprise medical bills have been banned
11:45
in America since 2022 since the no
11:49
surprises act went into effect despite
11:51
the law though one in five Americans
11:54
still report receiving surprise bills
11:56
and obviously we all know
11:58
um compliance with the no surprises Act
12:01
is has been completely Hit or Miss
12:03
there’s been so many questions so
12:05
part of the no surprises act allows
12:08
patients to file payment disputes
12:10
through cms’s website and in 2022 they
12:14
opened up the portal for five and a half
12:16
months so from April 15th to September
12:19
30th as kind of a trial and about 90 000
12:22
disputes were submitted in that time
12:25
frame and for perspective the number of
12:28
disputes they’ve received in that
12:30
five-month window surpassed the number
12:32
that they anticipated receiving in a
12:35
full year
12:37
um and since 2022 the Texas Medical
12:39
Association has been extremely vocal and
12:42
has had
12:44
um multiple lawsuits filed with the
12:47
latest one being in September alleging
12:49
that the arbitration process set up in
12:51
the note in the final no surprises rule
12:53
favored payers over providers and a few
12:57
weeks ago a Texas judge ruled in favor
13:00
of the Texas Medical Association
13:03
so what does this mean I’m going to read
13:07
to you what Healthcare dive shared as a
13:09
briefing of what’s Happening next as
13:11
they kind of summed it up perfectly so
13:13
there’s three bullet points here the
13:15
first is that CMS has asked parties
13:18
involved in Surprise billing disputes to
13:21
put payment determinations on hold so
13:23
everything’s kind of on pause
13:26
um the government is currently in the
13:28
process of evaluating and updating
13:30
independent dispute resolution
13:31
resolution guidance systems and
13:34
documents to make them consistent with
13:36
the judge’s decision
13:38
and then the last part here along with
13:41
pausing new determinations Arbiters
13:43
should recall any determinations made
13:46
after February 6 2023.
13:49
so that’s the latest how this will
13:52
continue to play out is still a bit of a
13:54
mystery but we will certainly be staying
13:57
on top of this story
14:00
here’s another fascinating story from
14:03
Med City News allurion Technologies has
14:07
commercialized a gastric balloon in the
14:09
form of a capsule
14:11
unlike traditional gastric balloons that
14:14
are surgically implanted this device is
14:16
meant to be swallowed by the patient
14:18
under the guidance of a clinician of
14:20
course the balloon then inflates in the
14:24
stomach and is checked by an x-ray to
14:26
verify its placement and they say that
14:29
this whole outpatient procedure only
14:31
takes about 15 minutes
14:33
but it doesn’t end there allurion has
14:37
software that helps Physicians collect
14:39
data and monitor the patient and then
14:42
the patient is able to download an app
14:44
that will help them adjust and develop
14:46
new food habits
14:48
the last step is after about four months
14:51
a valve opens and allows the balloon to
14:54
empty and pass out of the body with
14:57
waste
14:59
um kind of crazy so the product has been
15:01
trialled on over a hundred thousand
15:03
patients and is available in Canada
15:05
Mexico India Australia and Brazil but it
15:08
hasn’t been able to get the FDA
15:10
clearance in the U.S that it needs it
15:14
didn’t pass their first attempt and I
15:17
believe they’re going for a second round
15:20
um but overall I would love to hear what
15:23
you think of this technology I feel like
15:25
in theory it could be a real game
15:27
changer
15:28
um and you know not only in providing
15:31
and how the procedure is performed but
15:33
also in helping educate people on
15:35
healthy diet habits and portion control
15:37
but of course would also come with its
15:40
fair share of health risks so if you
15:43
follow HSC pathways on LinkedIn check us
15:46
out
15:46
and leave a comment on this episode to I
15:49
would love to hear your thoughts on what
15:50
you think about this new procedure
15:54
and to end our new segment on a positive
15:57
note in 2011 Colin Cabella and Taylor
16:01
Givens were both recovering from heart
16:03
transplants at Anova Fairfax Hospital in
16:07
Virginia
16:08
during that recovery period they had
16:10
crossed paths a few times but it was
16:12
really on the five-year anniversary of
16:15
their heart transplants when they were
16:17
reunited at the hospital that they
16:19
decided to go get dinner together
16:22
since then they’ve been married for four
16:24
years and have really leaned on each
16:26
other as they recover and continue to
16:29
live their lives so they were able to
16:31
turn a really scary life-altering moment
16:34
into a beautiful love story
16:37
and that news story officially wraps up
16:39
this week’s podcast thank you as always
16:42
for spending a few minutes of your week
16:44
with us make sure to subscribe or leave
16:46
a review on whichever platform you’re
16:48
listening from I hope you have a great
16:50
day and we’ll see you again next week
16:55
[Music]
16:58
why are you keeping me
welcome to this week in surgery centers
0:03
if you’re in the ASC industry then
0:06
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 guests 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 Marie Yarborough is
0:33
the administrator of Skyway Surgery
0:35
Center in Chico California and she’s
0:38
here today to talk to us about the top
0:39
five kpis that all ASCS should be
0:42
tracking there’s that very popular
0:45
saying you’ve probably heard a million
0:47
times if you can’t measure it you can’t
0:49
manage it and that’s certainly true when
0:52
it comes to surgery centers we get to
0:54
talk with Marie about the top kpis how
0:57
she determines what to measure how she
0:59
collects the data the results she’s seen
1:02
and so much more
1:04
in our news recap we’ll cover the new
1:06
outpatient surgery quality and access
1:08
act the latest on the no surprises act a
1:12
new gastric balloon that does not
1:14
require surgery
1:16
and of course and the new segment with a
1:18
positive story about a couple who fell
1:20
in love after going through heart
1:22
surgery together
1:23
hope everyone enjoys the episode and
1:26
here’s what’s going on this week in
1:27
surgery centers
1:29
[Music]
1:33
Marie welcome to the show
1:35
thank you
1:36
appreciate you appreciate you joining us
1:38
today can you tell me a little bit about
1:40
your background in the ASC industry
1:43
yeah
1:44
um thanks for having me on today my name
1:46
is Marie Yarbrough I live and work in
1:48
Northern California
1:50
which I’ve been a resident of my whole
1:52
life I’m a certified ASC administrator I
1:56
have my degree in business and in a few
1:59
more months I’ll have my MBA
2:02
um I’ve worked in healthcare my whole
2:04
life and I’ve been an ASE administrator
2:06
for 15 years now
2:09
fantastic great background and and
2:11
you’re currently at Skyway surgery
2:13
centers correct yes tell us a little bit
2:16
about Skyway in terms of the type of
2:19
facility you are in specialty areas and
2:21
things like that sure yeah
2:23
um Skyway is a 40r1 procedure room
2:27
multi-specialty facility we perform
2:31
around 600 cases a month and we see
2:34
predominantly Ortho Ophthalmology and GI
2:38
cases
2:39
great and does Skyway have any
2:42
affiliations either with management
2:44
companies or ownership groups or
2:46
anything yes yes
2:50
fantastic
2:52
um and appreciate that background and
2:55
one of the things Marie we’re excited to
2:57
talk to you about today at HST we’re
2:59
we’re big fans of the aska Forum uh you
3:02
know we check in there for time to time
3:03
it’s been a good source of kind of
3:05
learning and knowledge hearing for our
3:07
company over the years and one of the
3:10
one of the posts that we noticed uh
3:12
recently was a post that you made around
3:14
kpi files and kpi sharing and we thought
3:18
that’d be a great topic we’re always
3:20
talking about kpis and data at HST with
3:23
our customers yeah and I thought it’d be
3:25
a great topic for a podcast
3:27
one of a couple of the the kpi
3:30
categories that you posted about and
3:32
you’re so kind of nice to share your
3:34
final on Words around billion
3:37
collections uh
3:39
when you think about kpis overall across
3:43
Skyway Surgery Center are those
3:45
typically the categories that you’re
3:47
focused on is the the billion collection
3:49
set
3:50
I mean just with my background in
3:52
business
3:54
um yes
3:56
um but the business has so much more to
3:59
it right patient satisfactions
4:02
um
4:03
surgeon utilization there’s so much you
4:07
can focus on
4:10
um but of course the business is my main
4:13
focus
4:15
um as should any administrator
4:19
absolutely Revenue in right how much how
4:22
much money are we making so uh can you
4:24
share what kpis are in general
4:27
and why you think they’re so important
4:29
and helpful sure
4:31
um kpi is an acronym for key performance
4:34
indicators key performance indicators
4:37
measures your facilities performance
4:39
that you can use to quantify levels of
4:43
success it gives you that visual
4:47
representation of key areas of focus I
4:51
use it to watch historical Trends and to
4:54
see if my organization is meeting its
4:57
schools normally you can use this when
5:00
one chard or a graph or a piece of data
5:03
does not provide enough information to
5:06
decide
5:06
kpis are important because you can’t
5:10
manage what you don’t measure
5:12
yep I think it was Peter Peter Drucker
5:15
that said it best so um that’s great
5:17
yeah and how long have you been tracking
5:20
kpis at Skyway
5:22
I’ve been tracking kpis from the
5:24
beginning I’ve quickly learned the
5:27
benefits and feedback a kpi can give to
5:30
determine which one to track is
5:32
individualized the need at Skyway was
5:35
more financially related I needed to be
5:38
able to track how we were doing with
5:40
upfront collections aging billing
5:43
timeliness credit balance levels and
5:45
things of that nature
5:47
got it okay and so the focus on the
5:50
financial side with billing and
5:52
Collections and so you you’ve got your
5:55
key kpis which you track do you do you
5:59
change those on a regular basis or do
6:01
they tend to stay pretty consistent
6:03
month over month quarter over quarter
6:05
yeah more than likely I find I will add
6:08
to my kpis rather than stopping a
6:10
measurement altogether the indicators
6:13
that I choose to follow are important to
6:15
me and there is no Finish Line it’s a
6:18
monthly comparison of a performance that
6:20
I can follow and then learn from
6:22
fantastic
6:25
um and the data side of it is something
6:27
that our customers ask us a lot in terms
6:30
of hey how do we get the right metrics
6:32
in the right way that we want to see it
6:33
what do you guys use for the data
6:36
collection
6:37
uh HST
6:39
I have several reports I run in HST for
6:43
example if I want to follow how well
6:46
registration is doing collecting the
6:48
mounts due at time of surgery I will run
6:51
a report under HST scheduling reports
6:54
called
6:55
sc1000 admission billing schedule this
6:59
report clearly clearly shows the amount
7:02
estimated the patient will owe at the
7:05
time of service which has been given to
7:07
the patient ahead of time and the amount
7:11
collected
7:12
the each month I track their progress or
7:15
decline once I’ve collected this data I
7:18
entered in Excel spreadsheet that I’ve
7:20
created and I’ll follow the changes and
7:23
variables once I started to track the
7:26
numbers I implemented benchmarking
7:28
levels to help
7:29
um motivate change
7:33
fantastic
7:34
uh Marie if you had to choose five kpis
7:39
that every ASC should be focused on what
7:42
five would you choose
7:45
um there’s so many I would say you
7:48
should definitely follow your financial
7:50
numbers this is so important for
7:52
administrators to track when you keep a
7:55
close eye on this you’ll know sooner
7:57
rather than later if numbers start to
7:59
shift
8:01
um I would also track Supply costs or or
8:03
operational costs track those numbers
8:06
either by case or against Revenue volume
8:10
again if you notice a shift what
8:12
happened where where did the shift come
8:14
from how do we fix it what are your
8:16
options in the long run this is going to
8:19
help those financial numbers
8:21
and then the employee expenses labor
8:24
expense
8:25
Progressive revenue or
8:27
average labor cost per case what however
8:31
you want to follow and track it it
8:33
doesn’t even have to be a ratio you can
8:36
just follow the numbers
8:38
surgeon utilization using
8:42
who’s using or not using their block and
8:45
why
8:46
or why is their volume shrinking those
8:49
are
8:50
questions you can answer by following
8:54
those numbers lastly patient
8:56
satisfaction what’s the trend do you see
8:58
a decline in satisfaction scores and why
9:01
love it very very encompassing there in
9:04
terms of the different categories of
9:05
operations so appreciate it so final
9:07
question for you Marie and we do this
9:09
every week with our guests what is one
9:11
thing listeners can do this week to
9:13
improve their surgery centers
9:16
I say Empower your employees with
9:19
information these tracings are just not
9:22
for you and the board allow your
9:24
employees to see the changes that are
9:26
happening
9:27
set a benchmark and create a goal for
9:29
them and lastly reward them for a job
9:32
well done because their success is your
9:34
success
9:35
love it all right
9:38
that’s a wrap that’s a wrap okay thank
9:41
you so much
9:42
good night
9:46
as always it has been a busy week in
9:49
healthcare so let’s jump right in our
9:51
first story comes from Becker’s ASC and
9:54
it’s definitely an exciting one four
9:56
lawmakers have reintroduced legislation
9:59
that would eliminate penalties that
10:02
charge Medicare beneficiaries higher
10:04
co-pays for care outside of hospitals
10:07
the four lawmakers are Senator Bill
10:10
Cassidy of Louisiana
10:12
Senator Richard Blumenthal of
10:14
Connecticut
10:15
representative Brad wenstrup of Ohio and
10:18
representative John Larson also of
10:20
Connecticut and the bill is called the
10:23
outpatient surgery quality and access
10:25
Act
10:27
the goal of the bill is to close the
10:29
reimbursement gap between Hospital
10:31
outpatient departments and ASCS
10:33
and co-pay penalties for Medicare
10:36
beneficiaries address barriers to
10:39
Affordable and quality care and increase
10:41
transparency about cms’s procedure
10:43
coverage at ASCS which I know has been a
10:47
long-standing question and issue
10:49
Senator Blumenthal shared that patients
10:52
should shouldn’t be charged more for
10:54
procedure just because it was performed
10:56
by an outpatient provider the current
10:59
restrictions on ASCS are an unnecessary
11:01
burden limiting seniors access to care
11:04
and driving up health care costs I think
11:07
we can all agree with that and honestly
11:10
as a Connecticut resident I am proud of
11:12
how Senator Blumenthal is advocating for
11:14
surgery centers and also the bill is
11:17
endorsed by ASCA which always helps so
11:19
we’ll keep a close eye on how it
11:21
progresses and we’ll make sure to share
11:23
some timely updates
11:25
the next story is kind of wild but the
11:28
United States Department of Health and
11:30
Human Services has paused surprise
11:32
billing arbitration after Texas Court
11:34
decision
11:35
so to understand what this means you
11:38
need to First understand the independent
11:40
dispute resolution process so as we know
11:43
surprise medical bills have been banned
11:45
in America since 2022 since the no
11:49
surprises act went into effect despite
11:51
the law though one in five Americans
11:54
still report receiving surprise bills
11:56
and obviously we all know
11:58
um compliance with the no surprises Act
12:01
is has been completely Hit or Miss
12:03
there’s been so many questions so
12:05
part of the no surprises act allows
12:08
patients to file payment disputes
12:10
through cms’s website and in 2022 they
12:14
opened up the portal for five and a half
12:16
months so from April 15th to September
12:19
30th as kind of a trial and about 90 000
12:22
disputes were submitted in that time
12:25
frame and for perspective the number of
12:28
disputes they’ve received in that
12:30
five-month window surpassed the number
12:32
that they anticipated receiving in a
12:35
full year
12:37
um and since 2022 the Texas Medical
12:39
Association has been extremely vocal and
12:42
has had
12:44
um multiple lawsuits filed with the
12:47
latest one being in September alleging
12:49
that the arbitration process set up in
12:51
the note in the final no surprises rule
12:53
favored payers over providers and a few
12:57
weeks ago a Texas judge ruled in favor
13:00
of the Texas Medical Association
13:03
so what does this mean I’m going to read
13:07
to you what Healthcare dive shared as a
13:09
briefing of what’s Happening next as
13:11
they kind of summed it up perfectly so
13:13
there’s three bullet points here the
13:15
first is that CMS has asked parties
13:18
involved in Surprise billing disputes to
13:21
put payment determinations on hold so
13:23
everything’s kind of on pause
13:26
um the government is currently in the
13:28
process of evaluating and updating
13:30
independent dispute resolution
13:31
resolution guidance systems and
13:34
documents to make them consistent with
13:36
the judge’s decision
13:38
and then the last part here along with
13:41
pausing new determinations Arbiters
13:43
should recall any determinations made
13:46
after February 6 2023.
13:49
so that’s the latest how this will
13:52
continue to play out is still a bit of a
13:54
mystery but we will certainly be staying
13:57
on top of this story
14:00
here’s another fascinating story from
14:03
Med City News allurion Technologies has
14:07
commercialized a gastric balloon in the
14:09
form of a capsule
14:11
unlike traditional gastric balloons that
14:14
are surgically implanted this device is
14:16
meant to be swallowed by the patient
14:18
under the guidance of a clinician of
14:20
course the balloon then inflates in the
14:24
stomach and is checked by an x-ray to
14:26
verify its placement and they say that
14:29
this whole outpatient procedure only
14:31
takes about 15 minutes
14:33
but it doesn’t end there allurion has
14:37
software that helps Physicians collect
14:39
data and monitor the patient and then
14:42
the patient is able to download an app
14:44
that will help them adjust and develop
14:46
new food habits
14:48
the last step is after about four months
14:51
a valve opens and allows the balloon to
14:54
empty and pass out of the body with
14:57
waste
14:59
um kind of crazy so the product has been
15:01
trialled on over a hundred thousand
15:03
patients and is available in Canada
15:05
Mexico India Australia and Brazil but it
15:08
hasn’t been able to get the FDA
15:10
clearance in the U.S that it needs it
15:14
didn’t pass their first attempt and I
15:17
believe they’re going for a second round
15:20
um but overall I would love to hear what
15:23
you think of this technology I feel like
15:25
in theory it could be a real game
15:27
changer
15:28
um and you know not only in providing
15:31
and how the procedure is performed but
15:33
also in helping educate people on
15:35
healthy diet habits and portion control
15:37
but of course would also come with its
15:40
fair share of health risks so if you
15:43
follow HSC pathways on LinkedIn check us
15:46
out
15:46
and leave a comment on this episode to I
15:49
would love to hear your thoughts on what
15:50
you think about this new procedure
15:54
and to end our new segment on a positive
15:57
note in 2011 Colin Cabella and Taylor
16:01
Givens were both recovering from heart
16:03
transplants at Anova Fairfax Hospital in
16:07
Virginia
16:08
during that recovery period they had
16:10
crossed paths a few times but it was
16:12
really on the five-year anniversary of
16:15
their heart transplants when they were
16:17
reunited at the hospital that they
16:19
decided to go get dinner together
16:22
since then they’ve been married for four
16:24
years and have really leaned on each
16:26
other as they recover and continue to
16:29
live their lives so they were able to
16:31
turn a really scary life-altering moment
16:34
into a beautiful love story
16:37
and that news story officially wraps up
16:39
this week’s podcast thank you as always
16:42
for spending a few minutes of your week
16:44
with us make sure to subscribe or leave
16:46
a review on whichever platform you’re
16:48
listening from I hope you have a great
16:50
day and we’ll see you again next week
16:55
[Music]
16:58
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