Maura Cash – The ASC Industry’s Role in Reducing the Disparity of Care
Here’s what to expect on this week’s episode. 🎙️
🎙️ Does your surgery center screen for social determinants of health (SDOH)? Does your staff know how to identify a patient that may need extra support in order to experience positive outcomes?
In this thought-provoking episode, we explore the crucial topic of reducing the #DisparityofCare for those in our communities. Our guest, Maura Dent Cash, a seasoned nurse with 45 years of experience in the ambulatory surgery world, shares her valuable insights. Here are the key takeaways:
1️⃣ Disparity of care refers to the inequitable access to necessary care and desired outcomes for patients in surgery centers or medical facilities. It encompasses disparities at the access, care, and postoperative levels, highlighting the difference between equality and equity of care.
2️⃣ Social determinants of health, such as discrimination, income, education level, and physical environments, play a significant role in contributing to the disparity of care. These factors impact individuals’ healthcare by affecting their economic stability, social and community context, and access to appropriate care.
3️⃣ Surgery centers can reduce the disparity of care by focusing on education and identifying patients who need additional support. Providing patient education in formats tailored to their needs and implementing #SDOH assessments can help address the unique challenges patients face and improve outcomes.
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 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 Mora cash is the VP
0:33
of clinical strategies here at hsd
0:35
Pathways and she’s here today to talk to
0:38
us about the ASC Industries role in
0:40
reducing the disparity of care
0:42
now if you’re a frequent listener of the
0:45
show you know exactly who Mora is and
0:47
the impact she has had on the ASC
0:49
industry so it should be no surprise
0:52
that she’s bringing us this incredibly
0:54
important information together we cover
0:56
what disparity of care means what the
0:59
most common social determinants of
1:01
Health are how surgery centers come into
1:03
play and most importantly how surgery
1:06
centers can get started in closing the
1:08
chasm of care
1:10
in our news recap we’ll cover the ftc’s
1:13
proposed ban on non-compete laws the
1:16
surgeon suing the state of North
1:18
Carolina over certificate of need laws a
1:21
tiny patch aiming to reduce the need for
1:23
blood work and of course end the new
1:25
segment with the positive story about a
1:28
new blood test that can help identify
1:30
pregnant women who are at high risk of
1:32
developing preeclampsia
1:34
hope everyone enjoys the episode and
1:37
here’s what’s going on this week in
1:38
surgery centers
1:41
[Music]
1:44
hi Maura thanks for joining us today
1:46
thanks for having me
1:49
so you have been on the podcast before
1:51
but just in case our listeners miss that
1:53
episode can you share a little bit about
1:56
yourself and your experience in the
1:58
surgery center world
2:00
sure so I’ve been a nurse for 45 years
2:04
the last 18 years of that was in the
2:08
Ambulatory Surgery world so I’ve had
2:12
every role that you can think of in an
2:15
ASC starting with staff nurse and moving
2:18
all the way up to resource manager for
2:21
all the people Parts and Equipment that
2:23
are in the surgery center
2:25
very cool so obviously with all of that
2:29
experience you are a very sought after
2:32
speaker in the industry right now and
2:34
this topic we’re going to talk about
2:36
today is one that you actually gave at
2:39
ASCA this year and then a few State ASE
2:42
associations have reached out as well so
2:44
due to its popularity and importance we
2:47
wanted to get you on the show to talk
2:49
about the ASC Industries role in
2:51
reducing the disparity of care and I
2:54
think after every time you do this talk
2:56
you and I connect and one thing I think
2:58
that we’re both always surprised about
3:00
is how little people are thinking about
3:02
this topic and how much it is needed so
3:06
at a high level can you share what the
3:09
term disparity of care means
3:13
right so disparity of care is when
3:17
people cannot receive the care that they
3:20
need
3:21
and they cannot get the care that they
3:25
need when they’re at a surgery center or
3:27
any other medical facility and they also
3:31
can’t have an outcome a desired outcome
3:34
from that procedure so the disparity can
3:39
be at the access level it could be at
3:42
the care level and it could be at the
3:45
outcomes level postoperatively so the
3:48
disparity itself is just a term that
3:52
means the equity of care is not being
3:55
delivered and there’s a huge difference
3:57
between equality of care and Equity of
4:01
care so Equity means we all have the
4:05
same potential to reach our full health
4:09
capacity perfect that’s very helpful we
4:13
can’t obviously talk about disparity of
4:14
care without talking about social
4:16
determinants of Health which is another
4:18
phrase that I think we know pretty well
4:20
at this point but it’s interest seeing
4:22
how much education still needs to be
4:23
done in this realm so tell us more about
4:26
what social determinants of Health are
4:28
and how they fit into this disparity of
4:30
care idea
4:32
excellent so according to the Centers
4:35
for Disease Control the social
4:37
determinants of Health are conditions in
4:40
places where people live learn
4:44
work and play that affect a wide range
4:47
of health and quality of life risks and
4:51
outcomes
4:52
so basically they contribute to the
4:55
disparity of care because of social
4:59
environments things like discrimination
5:02
income education level marital status
5:07
and in physical environments such as
5:10
residents overcrowding Transportation
5:13
isolation so covet in the last couple of
5:18
years have really brought this to the
5:20
attention of everyone
5:21
and it’s primarily those physical
5:24
environments the isolation the high
5:27
rents and mortgages the overcrowding the
5:30
immigration issues the living in tents
5:34
shelters that kind of thing it’s brought
5:37
it to a huge head in our country that
5:40
people can’t get care and when they can
5:44
get care they can’t always achieve the
5:46
outcomes that we want for them because
5:49
their social determinants have them
5:52
living in conditions that badly affect
5:56
their outcomes sure yeah and I think how
6:01
you said it originally looking at every
6:03
step of the way like you have the access
6:04
issues then you have the care issues
6:06
then you have the post-op issues as well
6:08
there’s really so many moving parts to
6:11
this and things that need to be
6:13
addressed so that everybody could have
6:15
access to basic human rights like Health
6:18
Care
6:19
okay so how do these I think you gave
6:21
some examples here but how do these
6:23
social determinants of health impact in
6:25
individuals Health Care can you give us
6:27
some specific examples of when they
6:30
might come into play
6:32
sure economic stability is the big one
6:36
right so it’s employment that it
6:39
provides a living wage it’s things that
6:41
support employment like worker
6:43
protections paid sick leave Child Care
6:45
access to reliable transportation and
6:49
affordable housing those economic
6:52
stability things can cause people to not
6:55
even be able to seek the care that they
6:58
need to not be able to afford the care
7:00
that they need and even if they can’t
7:03
afford it and they can’t seek it they
7:05
may not be able to get there they have
7:07
to keep in mind that economic stability
7:09
is a huge player and then we have the
7:12
social and Community context so their
7:16
own communities do they have
7:18
discrimination there are there
7:20
conditions in the workplace that put
7:22
them much higher on the injury scale are
7:25
they in areas where they cannot even get
7:29
out to exercise their environment
7:32
exposes them to very healthy risk
7:34
behaviors those kinds of things that
7:37
affect
7:38
how they can access the care are really
7:42
huge and then the kind of care that’s
7:44
available for them taxes
7:46
sure definitely
7:49
okay let’s talk about the surgery
7:52
Center’s role
7:53
so how can surgery centers and our
7:58
listeners help to start to identify how
8:02
some of these social determinants of
8:03
Health might be impacting their patients
8:05
and then what can they do to lessen the
8:07
disparity of care
8:08
believe it or not
8:10
most important social determinative
8:12
health is not socioeconomic it’s
8:15
education and ASCS can play a huge role
8:19
in educating our patients once we’ve
8:23
identified what their educational needs
8:26
are in that aspect ASCS can certainly
8:30
provide education in a format that best
8:34
suits their patient population if you
8:37
have illiterate patients written
8:40
discharge instructions are really not
8:41
going to help those people if they speak
8:44
a foreign language but they can’t read
8:46
that language you might have some
8:48
trouble educating them beforehand about
8:51
what their procedure is going to entail
8:54
and after the fact what they need to do
8:58
to best recover and have the best
9:01
outcome from those procedures so
9:03
education is a huge piece of this but I
9:07
think the primary thing that ASCS can do
9:10
and we do many things well but one of
9:14
the primary things that we could do is
9:16
identify those people that need a little
9:19
head start to get those best outcomes we
9:23
can do that by asking the right
9:26
assessment questions a lot of doctors
9:29
offices now do social determinants of
9:31
Health questionnaires for all of their
9:34
patients when they send in a request for
9:37
surgery attach that social determinant
9:40
of Health questionnaire so that you
9:42
could see what kind of needs this
9:43
patient might have before you actually
9:46
schedule their procedure
9:48
sure so somebody’s listening and they’re
9:51
ready to do an internal check see if
9:54
they’re doing the necessary things to
9:55
cover the spaces do you think that the
10:00
assessment is the core of being able to
10:03
determine patients who might need an
10:05
extra leg up
10:06
like the pre-assessment questionnaire I
10:08
think the assessment is important but I
10:11
think a lot of people might be reluctant
10:14
to admit that maybe they used their food
10:18
money to buy their post-op meds or maybe
10:22
they don’t have the best diet because
10:25
they can’t afford some quality food so
10:29
maybe they have food insecurities and
10:31
they’re not willing to admit it maybe
10:33
they came into your Center in the dead
10:36
of winter and they only have a sweater
10:37
on and you can observe certain things
10:41
right cleanliness appropriate clothing
10:43
without
10:45
necessarily embarrassing them or judging
10:48
them on these things but still you could
10:51
say it’s really cold out there today we
10:54
have a lot of coats in our lost and
10:55
found maybe you might want to take a
10:58
coat home because keeping your body warm
11:01
is super important for the healing
11:03
process
11:04
so you can tie those things together but
11:07
sometimes assessments are not accurately
11:09
answered and you’ll have to use your
11:12
visual cues and ask the patient in a
11:15
roundabout way to get the answers that
11:17
you need
11:18
yeah and so it sounds like the
11:20
assessment observation and then also
11:23
just building that trust with them and
11:26
making them feel not judged and like
11:28
it’s a safe space for them to
11:32
share whatever it is actually going on
11:34
when the doctor or post-hop nurse shares
11:38
any instructions with them making them
11:40
feel like they can honestly respond and
11:42
say I don’t have access to three meals a
11:45
day or whatever it might be
11:48
yeah
11:50
and I feel your pre-op call nurses and
11:53
your discharge nurses are in such a
11:55
unique position to build that trust and
11:58
show no judgment but just empathy
12:02
and support and give them some tools
12:05
that they can use to better have access
12:10
to what they need to heal after surgery
12:14
yeah and I heard you give this example
12:17
maybe it was at aska I think it was
12:19
primarily around transportation and how
12:21
if a patient calls and needs to
12:24
reschedule or cancels last minute
12:26
obviously it’s frustrating but getting
12:29
to the root cause of why I can’t fill a
12:33
morning appointment and it’s like okay
12:35
maybe the bus schedule doesn’t work like
12:37
that or maybe their significant other
12:39
they share a car and the significant
12:41
other will be taking that car to work
12:42
and just trying to understand with
12:44
empathy why are you unable to follow
12:47
these instructions and things like that
12:50
exactly I mean cancellation is very
12:53
costly for the ASC yeah but also delayed
12:57
treatment is costly for patients right
12:59
so if we ask that second question if
13:03
they just say oh I can’t get their
13:04
transportation like you said maybe they
13:08
only have child care for this window
13:10
maybe they only have ability to take
13:14
them there and bring them home and
13:16
you’ve changed their times two or three
13:18
times and now that neighbor or that
13:21
friendly face at church is not able to
13:23
assist them so we have to be considerate
13:26
of their time and helping them to
13:30
understand why it was important to
13:32
change the time of their surgery but
13:35
also dig a Little Deeper like you said
13:37
and ask those follow-up questions to see
13:39
if maybe we can assist them in part of
13:43
that transportation yeah and another
13:46
thing too is I feel like we always talk
13:48
about how important it is for surgery
13:50
centers to be members of their community
13:52
and to
13:54
not necessarily partner with other
13:56
businesses but be aware build
13:58
relationships and Community Education
14:00
and it also seems like it would be a
14:03
great idea if they’re not doing it
14:04
already for surgery centers to keep a
14:06
list of resources on hand so here are
14:09
Transportation options here are food
14:11
delivery services whatever it might be
14:14
exactly and there’s so many services in
14:17
our communities that we often don’t
14:20
think about taking advantage of because
14:22
ases in particular have always lived in
14:25
these sort of separate little bubble
14:27
where our patients are elective
14:29
surgeries and they usually have
14:33
insurance or pay in advance or if they
14:35
made a arrangements for the payment for
14:38
that surgery and they’re usually in and
14:40
out in a day so we don’t typically think
14:44
of their social determinants of Health
14:48
affecting their care and that we could
14:51
do much to help their situation but the
14:54
truth is there’s so many agencies
14:56
locally and there’s an awful lot of
14:59
philanthropic associations like the
15:03
Lions Club and sororities and
15:05
fraternities and those kind of things
15:08
that offer services that we never tapped
15:11
into because our patients have always
15:13
been outside of the usual Fray of
15:18
hospital care but more and more
15:20
procedurally brought to the ASC more and
15:24
more of those patients are of sick or
15:27
chronic Health maybe or additional
15:29
conditions and their bigger surgeries
15:31
that sometimes require longer length of
15:34
stay we are getting some patient
15:37
populations that we never tapped into
15:39
before and we need to think about these
15:42
social determinants of Health if we want
15:44
to provide best care that we can yep I
15:47
agree so if somebody is listening that
15:51
would like to again get started in this
15:53
world we talked about the assessments we
15:55
talked about observation what else can
15:58
they do to start going down this path
16:01
Google is your friend here if you Google
16:05
assessments for social determinants of
16:07
Health you’re going to get hundreds of
16:10
hits you’re going to be able to read
16:12
some of those and say oh this is exactly
16:14
what we would want to ask our GI
16:16
patients or our cataract patients or our
16:20
Orthopedic patients because Orthopedic
16:23
is a great example right if they can’t
16:24
do the follow-up exercises because they
16:28
live in overcrowding conditions or they
16:29
live alone they don’t have anyone to
16:31
help them get down and up off the floor
16:33
these are important things to know
16:36
rather than just give discharge
16:38
instructions so asking the right
16:40
questions up front will help meet their
16:42
needs truly and Google will also give
16:46
you if you type in food assistance
16:48
you’ll get all kinds of hits for it
16:51
there’s a sorority in North Carolina I
16:55
believe that provides nutritious
16:57
carryout bags for patients leaving high
17:01
protein high carb good nutritional value
17:04
to help them in those first couple of
17:06
days get off to a really good start and
17:09
just say hey we have these great food
17:11
bags for anybody who would like to have
17:14
them on discharge that’s a huge thing if
17:17
you have a grade school who’s collecting
17:19
coats and hats and mittens you can have
17:23
a little collection there and hand them
17:25
out we give out the winter in Minnesota
17:27
we give out free scarves hats and
17:30
mittens to our clients those things are
17:32
important to have available and it’s
17:35
such a simple thing that you could do
17:37
and get your neighborhoods and
17:39
communities involved in that kind of
17:41
activity
17:42
perfect
17:46
people we can get talking about this the
17:48
better and I love that you’re
17:49
spearheading this in the industry making
17:51
sure that everybody knows the importance
17:53
of this and also easy ways to get
17:55
started with it as well these are doing
17:58
so much Erica
18:01
that we just need to continue to fight
18:03
the fight we offer excellent here at
18:07
lower prices and we need to Market
18:09
ourselves out there to let people know
18:12
there is an affordable option for you
18:14
and we also need to use our a collective
18:18
force in Washington and make sure that
18:21
the same deductible cap that’s applied
18:24
to hospitals for Medicare patients is
18:26
applied to ASCS and that they have full
18:29
access to asc’s at the federal level
18:32
because that will make a huge difference
18:34
we already do so many things for our
18:37
patients and our potential patients but
18:40
we don’t advertise it enough we don’t
18:42
get that message out it’s a great
18:45
opportunity for us to even that playing
18:48
field and make sure that people who have
18:52
some issues with the social determinants
18:55
of care know that they do have access to
18:58
ASCS
19:00
beautiful perfectly said
19:02
all right so we do this every week with
19:05
our guests what is one thing our
19:07
listeners can do this week to improve
19:09
their surgery centers
19:11
so sticking with this topic there’s one
19:14
thing that we ask every single patient
19:16
that we see and that is when was the
19:19
last time you had anything to eat or
19:21
drink
19:22
if we rephrase just that one question
19:25
and maybe added a writer and what was
19:28
that meal or when was your last
19:32
substantial meal and what was that meal
19:35
we have great food insecurity in this
19:39
country and it’s hidden it’s a hidden
19:41
little gem because the beautifully
19:44
quaffed woman who comes in for a
19:46
cataract surgery may not have bought any
19:51
substantial food so that she could pay
19:53
for her post-op care or her eye drops so
19:57
we want to make sure that we’re asking
19:59
the right questions and that is such a
20:01
simple question to expand on and maybe
20:05
get a hint that there may or may not be
20:07
food insecurity in this person
20:11
perfect that is great advice thank you
20:14
Maura appreciate you as always my
20:16
pleasure bye
20:20
[Music]
20:21
as always it has been a busy week in
20:24
healthcare so let’s Jump Right In
20:26
the Federal Trade Commission has
20:29
proposed a ban on non-compete causes and
20:32
employment contracts aiming to eliminate
20:34
non-competes entirely for Physicians
20:37
this would be a huge change for the
20:39
industry so of course it’s getting a ton
20:42
of attention and as you can imagine lots
20:44
of attorneys are raising concerns and
20:46
chiming in about the potential
20:48
disruption it could cause to existing
20:50
physician employer relationships and
20:53
also raising this question does the FTC
20:56
have the authority to implement such a
20:58
rule
20:59
so if passed this would really upset the
21:02
status quo and they recognize that the
21:05
FTC and they’re arguing that
21:07
non-competes currently depress worker
21:09
wages limit competition and result in
21:12
higher health care costs and they’re
21:14
suggesting that by eliminating
21:15
non-competes it actually opens up a
21:18
potential annual health care cost
21:19
Savings of up to 148 billion dollars now
21:24
I’m not exactly sure where they got that
21:26
specific number from so I’m going to
21:28
take that with a grain of salt but that
21:30
is what they are sharing the last piece
21:32
of this is actually around
21:33
non-solicitation agreements as well so
21:36
the proposed rule targets non-competes
21:39
but it does allow for Meaningful
21:41
restrictions through non-solicitation
21:43
agreements which would prevent
21:44
Physicians from soliciting former
21:46
patients or colleagues from joining them
21:49
if they do leave their place of current
21:51
employment
21:53
so as expected lots of people chiming in
21:56
lots of pros and cons on each side and
21:58
while the elimination of non-competes
22:00
could bring about increased competition
22:02
higher earnings potential cost savings
22:05
the disruption to establish physician
22:08
employee relationships and again the
22:09
uncertainties around the ftc’s legal
22:12
Authority kind of remain those two key
22:14
concerns so we will definitely be
22:16
keeping a close eye on this story as it
22:18
develops
22:21
in our second story from Becker’s ASC we
22:24
are circling back to North Carolina’s
22:26
certificate of need law a few weeks ago
22:29
we’ve reported a story recapping the
22:31
states that are actively trying to
22:33
change the certificate of need laws and
22:35
North Carolina is kind of at the
22:37
Forefront right now we now know more
22:39
about the man behind the most well-known
22:41
lawsuit and it is Dr J Singleton who
22:45
owns an Ophthalmology practice now he is
22:47
suing because of the state’s laws
22:49
stating that he simply can’t perform
22:51
procedures at his ASC
22:54
under the current law Dr Singleton can
22:56
only perform an incidental number of
22:59
surgeries at the center and he must
23:01
instead perform procedures at nearby
23:03
hospital Carolina East which charges
23:06
substantially more per procedure for
23:08
patients
23:09
he also can’t begin the certificate of
23:11
need application process because state
23:13
regulations have determined already that
23:15
the community doesn’t need another
23:17
Center so he’s kind of stuck here Dr
23:19
Singleton sued North Carolina in April
23:22
of 2020 but the North Carolina court of
23:25
appeals unanimously dismissed the case
23:27
so now the case is pending before the
23:29
North Carolina Supreme Court Jamie
23:32
Kavanaugh
23:33
but in the meantime the state treasurer
23:35
Dale Falwell has filed a brief in
23:38
support of reforming certificate of need
23:40
laws in the state which does give Dr
23:42
Singleton some hope for his case I
23:45
thought this was interesting Dale
23:46
folwell shared a statement basically
23:48
saying that certificate of need laws
23:50
contribute to Consolidated Health Care
23:53
monopolies in North Carolina by
23:55
distorting market power in favor of
23:57
large institutional hospitals which is
24:00
pretty powerful
24:01
so same as always we’ll be watching how
24:03
the story develops and I hope for Dr
24:05
Singleton and his community that he
24:07
comes out on top
24:10
in our third story from Medscape a tiny
24:13
patch May someday do your patient’s lab
24:16
work we’re used to things like smart
24:18
watches being able to tell us a lot
24:20
about a patient’s Health but there’s
24:22
still a need to rely on blood work for
24:24
the bigger things the hope is that a
24:27
wearable patch could replace the need
24:28
for blood work and doctors would be able
24:30
to track markers
24:33
interstitial fluid under the skin
24:36
so thinking about different use cases
24:37
for this it really reminds me of my
24:40
grandma who in her last few years was
24:43
constantly going to the doctor’s office
24:45
for blood work in order to maintain some
24:48
of her prescriptions and it was so much
24:50
work getting her safely out of the house
24:52
into the car into the office back in the
24:55
car and so on it was really exhausting
24:58
and overwhelming for her so a wearable
25:00
patch like this maybe could have reduced
25:02
the need for all of those visits and I’m
25:04
sure there are a ton of other use cases
25:07
like that as well
25:08
but anyway how does it work interstitial
25:11
fluid leaks from tiny blood vessels and
25:14
it carries nutrients too and removes
25:16
waste from your skin so to capture this
25:19
fluid each monitor has either a tiny
25:22
wire or an array of less than a
25:24
millimeter long micro needles that
25:26
penetrate the skin for days weeks or
25:28
however long you wear it the micro
25:31
needles or wires are made from a polymer
25:33
that sucks up the fluid which flows to a
25:36
biochemical sensor targeting the marker
25:39
you want to measure
25:40
now that certainly sounds like a lot but
25:43
doctors are saying you wouldn’t even
25:45
feel it and you wouldn’t even know all
25:46
of that was going on ideally this
25:49
technology would help manage chronic
25:51
disease monitor prescription drugs
25:53
measure stress and hormone levels
25:55
measure athletic performance and more
25:58
however while early Studies have been
26:00
promising the doctors cited in the
26:02
article do believe we are still a few
26:04
years out from this being approved and
26:07
available maybe even looking at another
26:09
decade hopefully it’ll come sooner than
26:12
that but it is still very exciting
26:14
progress there
26:15
to end our new segment on a positive
26:18
note a blood test has been approved by
26:20
the FDA that can help identify pregnant
26:23
women who are at high risk of developing
26:25
preeclampsia which is a serious
26:27
complication that can be
26:29
life-threatening Dr Doug Walkers a
26:32
professor of Maternal Fetal Medicine
26:34
told the New York Times it’s
26:36
revolutionary it’s the first step
26:39
forward in preeclampsia Diagnostics
26:41
since 1900 when the condition was first
26:45
defined the new test measures the ratio
26:48
of two proteins produced by the placenta
26:51
and can determine with up to 96 percent
26:53
accuracy whether a woman with symptoms
26:56
will develop preeclampsia within the
26:58
next two weeks having that information
27:00
would be able to keep mom and baby much
27:03
safer rather than waiting to find out
27:05
the hard way so very cool development
27:08
there
27:09
that news story officially wraps up this
27:11
week’s podcast thank you as always for
27:14
spending a few minutes of your week with
27:16
us make sure to subscribe or leave a
27:18
review on whichever platform you’re
27:20
listening from I hope you have a great
27:22
day and we will see you again next week
27:29
why are you keeping me
27:32
[Music]
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 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 Mora cash is the VP
0:33
of clinical strategies here at hsd
0:35
Pathways and she’s here today to talk to
0:38
us about the ASC Industries role in
0:40
reducing the disparity of care
0:42
now if you’re a frequent listener of the
0:45
show you know exactly who Mora is and
0:47
the impact she has had on the ASC
0:49
industry so it should be no surprise
0:52
that she’s bringing us this incredibly
0:54
important information together we cover
0:56
what disparity of care means what the
0:59
most common social determinants of
1:01
Health are how surgery centers come into
1:03
play and most importantly how surgery
1:06
centers can get started in closing the
1:08
chasm of care
1:10
in our news recap we’ll cover the ftc’s
1:13
proposed ban on non-compete laws the
1:16
surgeon suing the state of North
1:18
Carolina over certificate of need laws a
1:21
tiny patch aiming to reduce the need for
1:23
blood work and of course end the new
1:25
segment with the positive story about a
1:28
new blood test that can help identify
1:30
pregnant women who are at high risk of
1:32
developing preeclampsia
1:34
hope everyone enjoys the episode and
1:37
here’s what’s going on this week in
1:38
surgery centers
1:41
[Music]
1:44
hi Maura thanks for joining us today
1:46
thanks for having me
1:49
so you have been on the podcast before
1:51
but just in case our listeners miss that
1:53
episode can you share a little bit about
1:56
yourself and your experience in the
1:58
surgery center world
2:00
sure so I’ve been a nurse for 45 years
2:04
the last 18 years of that was in the
2:08
Ambulatory Surgery world so I’ve had
2:12
every role that you can think of in an
2:15
ASC starting with staff nurse and moving
2:18
all the way up to resource manager for
2:21
all the people Parts and Equipment that
2:23
are in the surgery center
2:25
very cool so obviously with all of that
2:29
experience you are a very sought after
2:32
speaker in the industry right now and
2:34
this topic we’re going to talk about
2:36
today is one that you actually gave at
2:39
ASCA this year and then a few State ASE
2:42
associations have reached out as well so
2:44
due to its popularity and importance we
2:47
wanted to get you on the show to talk
2:49
about the ASC Industries role in
2:51
reducing the disparity of care and I
2:54
think after every time you do this talk
2:56
you and I connect and one thing I think
2:58
that we’re both always surprised about
3:00
is how little people are thinking about
3:02
this topic and how much it is needed so
3:06
at a high level can you share what the
3:09
term disparity of care means
3:13
right so disparity of care is when
3:17
people cannot receive the care that they
3:20
need
3:21
and they cannot get the care that they
3:25
need when they’re at a surgery center or
3:27
any other medical facility and they also
3:31
can’t have an outcome a desired outcome
3:34
from that procedure so the disparity can
3:39
be at the access level it could be at
3:42
the care level and it could be at the
3:45
outcomes level postoperatively so the
3:48
disparity itself is just a term that
3:52
means the equity of care is not being
3:55
delivered and there’s a huge difference
3:57
between equality of care and Equity of
4:01
care so Equity means we all have the
4:05
same potential to reach our full health
4:09
capacity perfect that’s very helpful we
4:13
can’t obviously talk about disparity of
4:14
care without talking about social
4:16
determinants of Health which is another
4:18
phrase that I think we know pretty well
4:20
at this point but it’s interest seeing
4:22
how much education still needs to be
4:23
done in this realm so tell us more about
4:26
what social determinants of Health are
4:28
and how they fit into this disparity of
4:30
care idea
4:32
excellent so according to the Centers
4:35
for Disease Control the social
4:37
determinants of Health are conditions in
4:40
places where people live learn
4:44
work and play that affect a wide range
4:47
of health and quality of life risks and
4:51
outcomes
4:52
so basically they contribute to the
4:55
disparity of care because of social
4:59
environments things like discrimination
5:02
income education level marital status
5:07
and in physical environments such as
5:10
residents overcrowding Transportation
5:13
isolation so covet in the last couple of
5:18
years have really brought this to the
5:20
attention of everyone
5:21
and it’s primarily those physical
5:24
environments the isolation the high
5:27
rents and mortgages the overcrowding the
5:30
immigration issues the living in tents
5:34
shelters that kind of thing it’s brought
5:37
it to a huge head in our country that
5:40
people can’t get care and when they can
5:44
get care they can’t always achieve the
5:46
outcomes that we want for them because
5:49
their social determinants have them
5:52
living in conditions that badly affect
5:56
their outcomes sure yeah and I think how
6:01
you said it originally looking at every
6:03
step of the way like you have the access
6:04
issues then you have the care issues
6:06
then you have the post-op issues as well
6:08
there’s really so many moving parts to
6:11
this and things that need to be
6:13
addressed so that everybody could have
6:15
access to basic human rights like Health
6:18
Care
6:19
okay so how do these I think you gave
6:21
some examples here but how do these
6:23
social determinants of health impact in
6:25
individuals Health Care can you give us
6:27
some specific examples of when they
6:30
might come into play
6:32
sure economic stability is the big one
6:36
right so it’s employment that it
6:39
provides a living wage it’s things that
6:41
support employment like worker
6:43
protections paid sick leave Child Care
6:45
access to reliable transportation and
6:49
affordable housing those economic
6:52
stability things can cause people to not
6:55
even be able to seek the care that they
6:58
need to not be able to afford the care
7:00
that they need and even if they can’t
7:03
afford it and they can’t seek it they
7:05
may not be able to get there they have
7:07
to keep in mind that economic stability
7:09
is a huge player and then we have the
7:12
social and Community context so their
7:16
own communities do they have
7:18
discrimination there are there
7:20
conditions in the workplace that put
7:22
them much higher on the injury scale are
7:25
they in areas where they cannot even get
7:29
out to exercise their environment
7:32
exposes them to very healthy risk
7:34
behaviors those kinds of things that
7:37
affect
7:38
how they can access the care are really
7:42
huge and then the kind of care that’s
7:44
available for them taxes
7:46
sure definitely
7:49
okay let’s talk about the surgery
7:52
Center’s role
7:53
so how can surgery centers and our
7:58
listeners help to start to identify how
8:02
some of these social determinants of
8:03
Health might be impacting their patients
8:05
and then what can they do to lessen the
8:07
disparity of care
8:08
believe it or not
8:10
most important social determinative
8:12
health is not socioeconomic it’s
8:15
education and ASCS can play a huge role
8:19
in educating our patients once we’ve
8:23
identified what their educational needs
8:26
are in that aspect ASCS can certainly
8:30
provide education in a format that best
8:34
suits their patient population if you
8:37
have illiterate patients written
8:40
discharge instructions are really not
8:41
going to help those people if they speak
8:44
a foreign language but they can’t read
8:46
that language you might have some
8:48
trouble educating them beforehand about
8:51
what their procedure is going to entail
8:54
and after the fact what they need to do
8:58
to best recover and have the best
9:01
outcome from those procedures so
9:03
education is a huge piece of this but I
9:07
think the primary thing that ASCS can do
9:10
and we do many things well but one of
9:14
the primary things that we could do is
9:16
identify those people that need a little
9:19
head start to get those best outcomes we
9:23
can do that by asking the right
9:26
assessment questions a lot of doctors
9:29
offices now do social determinants of
9:31
Health questionnaires for all of their
9:34
patients when they send in a request for
9:37
surgery attach that social determinant
9:40
of Health questionnaire so that you
9:42
could see what kind of needs this
9:43
patient might have before you actually
9:46
schedule their procedure
9:48
sure so somebody’s listening and they’re
9:51
ready to do an internal check see if
9:54
they’re doing the necessary things to
9:55
cover the spaces do you think that the
10:00
assessment is the core of being able to
10:03
determine patients who might need an
10:05
extra leg up
10:06
like the pre-assessment questionnaire I
10:08
think the assessment is important but I
10:11
think a lot of people might be reluctant
10:14
to admit that maybe they used their food
10:18
money to buy their post-op meds or maybe
10:22
they don’t have the best diet because
10:25
they can’t afford some quality food so
10:29
maybe they have food insecurities and
10:31
they’re not willing to admit it maybe
10:33
they came into your Center in the dead
10:36
of winter and they only have a sweater
10:37
on and you can observe certain things
10:41
right cleanliness appropriate clothing
10:43
without
10:45
necessarily embarrassing them or judging
10:48
them on these things but still you could
10:51
say it’s really cold out there today we
10:54
have a lot of coats in our lost and
10:55
found maybe you might want to take a
10:58
coat home because keeping your body warm
11:01
is super important for the healing
11:03
process
11:04
so you can tie those things together but
11:07
sometimes assessments are not accurately
11:09
answered and you’ll have to use your
11:12
visual cues and ask the patient in a
11:15
roundabout way to get the answers that
11:17
you need
11:18
yeah and so it sounds like the
11:20
assessment observation and then also
11:23
just building that trust with them and
11:26
making them feel not judged and like
11:28
it’s a safe space for them to
11:32
share whatever it is actually going on
11:34
when the doctor or post-hop nurse shares
11:38
any instructions with them making them
11:40
feel like they can honestly respond and
11:42
say I don’t have access to three meals a
11:45
day or whatever it might be
11:48
yeah
11:50
and I feel your pre-op call nurses and
11:53
your discharge nurses are in such a
11:55
unique position to build that trust and
11:58
show no judgment but just empathy
12:02
and support and give them some tools
12:05
that they can use to better have access
12:10
to what they need to heal after surgery
12:14
yeah and I heard you give this example
12:17
maybe it was at aska I think it was
12:19
primarily around transportation and how
12:21
if a patient calls and needs to
12:24
reschedule or cancels last minute
12:26
obviously it’s frustrating but getting
12:29
to the root cause of why I can’t fill a
12:33
morning appointment and it’s like okay
12:35
maybe the bus schedule doesn’t work like
12:37
that or maybe their significant other
12:39
they share a car and the significant
12:41
other will be taking that car to work
12:42
and just trying to understand with
12:44
empathy why are you unable to follow
12:47
these instructions and things like that
12:50
exactly I mean cancellation is very
12:53
costly for the ASC yeah but also delayed
12:57
treatment is costly for patients right
12:59
so if we ask that second question if
13:03
they just say oh I can’t get their
13:04
transportation like you said maybe they
13:08
only have child care for this window
13:10
maybe they only have ability to take
13:14
them there and bring them home and
13:16
you’ve changed their times two or three
13:18
times and now that neighbor or that
13:21
friendly face at church is not able to
13:23
assist them so we have to be considerate
13:26
of their time and helping them to
13:30
understand why it was important to
13:32
change the time of their surgery but
13:35
also dig a Little Deeper like you said
13:37
and ask those follow-up questions to see
13:39
if maybe we can assist them in part of
13:43
that transportation yeah and another
13:46
thing too is I feel like we always talk
13:48
about how important it is for surgery
13:50
centers to be members of their community
13:52
and to
13:54
not necessarily partner with other
13:56
businesses but be aware build
13:58
relationships and Community Education
14:00
and it also seems like it would be a
14:03
great idea if they’re not doing it
14:04
already for surgery centers to keep a
14:06
list of resources on hand so here are
14:09
Transportation options here are food
14:11
delivery services whatever it might be
14:14
exactly and there’s so many services in
14:17
our communities that we often don’t
14:20
think about taking advantage of because
14:22
ases in particular have always lived in
14:25
these sort of separate little bubble
14:27
where our patients are elective
14:29
surgeries and they usually have
14:33
insurance or pay in advance or if they
14:35
made a arrangements for the payment for
14:38
that surgery and they’re usually in and
14:40
out in a day so we don’t typically think
14:44
of their social determinants of Health
14:48
affecting their care and that we could
14:51
do much to help their situation but the
14:54
truth is there’s so many agencies
14:56
locally and there’s an awful lot of
14:59
philanthropic associations like the
15:03
Lions Club and sororities and
15:05
fraternities and those kind of things
15:08
that offer services that we never tapped
15:11
into because our patients have always
15:13
been outside of the usual Fray of
15:18
hospital care but more and more
15:20
procedurally brought to the ASC more and
15:24
more of those patients are of sick or
15:27
chronic Health maybe or additional
15:29
conditions and their bigger surgeries
15:31
that sometimes require longer length of
15:34
stay we are getting some patient
15:37
populations that we never tapped into
15:39
before and we need to think about these
15:42
social determinants of Health if we want
15:44
to provide best care that we can yep I
15:47
agree so if somebody is listening that
15:51
would like to again get started in this
15:53
world we talked about the assessments we
15:55
talked about observation what else can
15:58
they do to start going down this path
16:01
Google is your friend here if you Google
16:05
assessments for social determinants of
16:07
Health you’re going to get hundreds of
16:10
hits you’re going to be able to read
16:12
some of those and say oh this is exactly
16:14
what we would want to ask our GI
16:16
patients or our cataract patients or our
16:20
Orthopedic patients because Orthopedic
16:23
is a great example right if they can’t
16:24
do the follow-up exercises because they
16:28
live in overcrowding conditions or they
16:29
live alone they don’t have anyone to
16:31
help them get down and up off the floor
16:33
these are important things to know
16:36
rather than just give discharge
16:38
instructions so asking the right
16:40
questions up front will help meet their
16:42
needs truly and Google will also give
16:46
you if you type in food assistance
16:48
you’ll get all kinds of hits for it
16:51
there’s a sorority in North Carolina I
16:55
believe that provides nutritious
16:57
carryout bags for patients leaving high
17:01
protein high carb good nutritional value
17:04
to help them in those first couple of
17:06
days get off to a really good start and
17:09
just say hey we have these great food
17:11
bags for anybody who would like to have
17:14
them on discharge that’s a huge thing if
17:17
you have a grade school who’s collecting
17:19
coats and hats and mittens you can have
17:23
a little collection there and hand them
17:25
out we give out the winter in Minnesota
17:27
we give out free scarves hats and
17:30
mittens to our clients those things are
17:32
important to have available and it’s
17:35
such a simple thing that you could do
17:37
and get your neighborhoods and
17:39
communities involved in that kind of
17:41
activity
17:42
perfect
17:46
people we can get talking about this the
17:48
better and I love that you’re
17:49
spearheading this in the industry making
17:51
sure that everybody knows the importance
17:53
of this and also easy ways to get
17:55
started with it as well these are doing
17:58
so much Erica
18:01
that we just need to continue to fight
18:03
the fight we offer excellent here at
18:07
lower prices and we need to Market
18:09
ourselves out there to let people know
18:12
there is an affordable option for you
18:14
and we also need to use our a collective
18:18
force in Washington and make sure that
18:21
the same deductible cap that’s applied
18:24
to hospitals for Medicare patients is
18:26
applied to ASCS and that they have full
18:29
access to asc’s at the federal level
18:32
because that will make a huge difference
18:34
we already do so many things for our
18:37
patients and our potential patients but
18:40
we don’t advertise it enough we don’t
18:42
get that message out it’s a great
18:45
opportunity for us to even that playing
18:48
field and make sure that people who have
18:52
some issues with the social determinants
18:55
of care know that they do have access to
18:58
ASCS
19:00
beautiful perfectly said
19:02
all right so we do this every week with
19:05
our guests what is one thing our
19:07
listeners can do this week to improve
19:09
their surgery centers
19:11
so sticking with this topic there’s one
19:14
thing that we ask every single patient
19:16
that we see and that is when was the
19:19
last time you had anything to eat or
19:21
drink
19:22
if we rephrase just that one question
19:25
and maybe added a writer and what was
19:28
that meal or when was your last
19:32
substantial meal and what was that meal
19:35
we have great food insecurity in this
19:39
country and it’s hidden it’s a hidden
19:41
little gem because the beautifully
19:44
quaffed woman who comes in for a
19:46
cataract surgery may not have bought any
19:51
substantial food so that she could pay
19:53
for her post-op care or her eye drops so
19:57
we want to make sure that we’re asking
19:59
the right questions and that is such a
20:01
simple question to expand on and maybe
20:05
get a hint that there may or may not be
20:07
food insecurity in this person
20:11
perfect that is great advice thank you
20:14
Maura appreciate you as always my
20:16
pleasure bye
20:20
[Music]
20:21
as always it has been a busy week in
20:24
healthcare so let’s Jump Right In
20:26
the Federal Trade Commission has
20:29
proposed a ban on non-compete causes and
20:32
employment contracts aiming to eliminate
20:34
non-competes entirely for Physicians
20:37
this would be a huge change for the
20:39
industry so of course it’s getting a ton
20:42
of attention and as you can imagine lots
20:44
of attorneys are raising concerns and
20:46
chiming in about the potential
20:48
disruption it could cause to existing
20:50
physician employer relationships and
20:53
also raising this question does the FTC
20:56
have the authority to implement such a
20:58
rule
20:59
so if passed this would really upset the
21:02
status quo and they recognize that the
21:05
FTC and they’re arguing that
21:07
non-competes currently depress worker
21:09
wages limit competition and result in
21:12
higher health care costs and they’re
21:14
suggesting that by eliminating
21:15
non-competes it actually opens up a
21:18
potential annual health care cost
21:19
Savings of up to 148 billion dollars now
21:24
I’m not exactly sure where they got that
21:26
specific number from so I’m going to
21:28
take that with a grain of salt but that
21:30
is what they are sharing the last piece
21:32
of this is actually around
21:33
non-solicitation agreements as well so
21:36
the proposed rule targets non-competes
21:39
but it does allow for Meaningful
21:41
restrictions through non-solicitation
21:43
agreements which would prevent
21:44
Physicians from soliciting former
21:46
patients or colleagues from joining them
21:49
if they do leave their place of current
21:51
employment
21:53
so as expected lots of people chiming in
21:56
lots of pros and cons on each side and
21:58
while the elimination of non-competes
22:00
could bring about increased competition
22:02
higher earnings potential cost savings
22:05
the disruption to establish physician
22:08
employee relationships and again the
22:09
uncertainties around the ftc’s legal
22:12
Authority kind of remain those two key
22:14
concerns so we will definitely be
22:16
keeping a close eye on this story as it
22:18
develops
22:21
in our second story from Becker’s ASC we
22:24
are circling back to North Carolina’s
22:26
certificate of need law a few weeks ago
22:29
we’ve reported a story recapping the
22:31
states that are actively trying to
22:33
change the certificate of need laws and
22:35
North Carolina is kind of at the
22:37
Forefront right now we now know more
22:39
about the man behind the most well-known
22:41
lawsuit and it is Dr J Singleton who
22:45
owns an Ophthalmology practice now he is
22:47
suing because of the state’s laws
22:49
stating that he simply can’t perform
22:51
procedures at his ASC
22:54
under the current law Dr Singleton can
22:56
only perform an incidental number of
22:59
surgeries at the center and he must
23:01
instead perform procedures at nearby
23:03
hospital Carolina East which charges
23:06
substantially more per procedure for
23:08
patients
23:09
he also can’t begin the certificate of
23:11
need application process because state
23:13
regulations have determined already that
23:15
the community doesn’t need another
23:17
Center so he’s kind of stuck here Dr
23:19
Singleton sued North Carolina in April
23:22
of 2020 but the North Carolina court of
23:25
appeals unanimously dismissed the case
23:27
so now the case is pending before the
23:29
North Carolina Supreme Court Jamie
23:32
Kavanaugh
23:33
but in the meantime the state treasurer
23:35
Dale Falwell has filed a brief in
23:38
support of reforming certificate of need
23:40
laws in the state which does give Dr
23:42
Singleton some hope for his case I
23:45
thought this was interesting Dale
23:46
folwell shared a statement basically
23:48
saying that certificate of need laws
23:50
contribute to Consolidated Health Care
23:53
monopolies in North Carolina by
23:55
distorting market power in favor of
23:57
large institutional hospitals which is
24:00
pretty powerful
24:01
so same as always we’ll be watching how
24:03
the story develops and I hope for Dr
24:05
Singleton and his community that he
24:07
comes out on top
24:10
in our third story from Medscape a tiny
24:13
patch May someday do your patient’s lab
24:16
work we’re used to things like smart
24:18
watches being able to tell us a lot
24:20
about a patient’s Health but there’s
24:22
still a need to rely on blood work for
24:24
the bigger things the hope is that a
24:27
wearable patch could replace the need
24:28
for blood work and doctors would be able
24:30
to track markers
24:33
interstitial fluid under the skin
24:36
so thinking about different use cases
24:37
for this it really reminds me of my
24:40
grandma who in her last few years was
24:43
constantly going to the doctor’s office
24:45
for blood work in order to maintain some
24:48
of her prescriptions and it was so much
24:50
work getting her safely out of the house
24:52
into the car into the office back in the
24:55
car and so on it was really exhausting
24:58
and overwhelming for her so a wearable
25:00
patch like this maybe could have reduced
25:02
the need for all of those visits and I’m
25:04
sure there are a ton of other use cases
25:07
like that as well
25:08
but anyway how does it work interstitial
25:11
fluid leaks from tiny blood vessels and
25:14
it carries nutrients too and removes
25:16
waste from your skin so to capture this
25:19
fluid each monitor has either a tiny
25:22
wire or an array of less than a
25:24
millimeter long micro needles that
25:26
penetrate the skin for days weeks or
25:28
however long you wear it the micro
25:31
needles or wires are made from a polymer
25:33
that sucks up the fluid which flows to a
25:36
biochemical sensor targeting the marker
25:39
you want to measure
25:40
now that certainly sounds like a lot but
25:43
doctors are saying you wouldn’t even
25:45
feel it and you wouldn’t even know all
25:46
of that was going on ideally this
25:49
technology would help manage chronic
25:51
disease monitor prescription drugs
25:53
measure stress and hormone levels
25:55
measure athletic performance and more
25:58
however while early Studies have been
26:00
promising the doctors cited in the
26:02
article do believe we are still a few
26:04
years out from this being approved and
26:07
available maybe even looking at another
26:09
decade hopefully it’ll come sooner than
26:12
that but it is still very exciting
26:14
progress there
26:15
to end our new segment on a positive
26:18
note a blood test has been approved by
26:20
the FDA that can help identify pregnant
26:23
women who are at high risk of developing
26:25
preeclampsia which is a serious
26:27
complication that can be
26:29
life-threatening Dr Doug Walkers a
26:32
professor of Maternal Fetal Medicine
26:34
told the New York Times it’s
26:36
revolutionary it’s the first step
26:39
forward in preeclampsia Diagnostics
26:41
since 1900 when the condition was first
26:45
defined the new test measures the ratio
26:48
of two proteins produced by the placenta
26:51
and can determine with up to 96 percent
26:53
accuracy whether a woman with symptoms
26:56
will develop preeclampsia within the
26:58
next two weeks having that information
27:00
would be able to keep mom and baby much
27:03
safer rather than waiting to find out
27:05
the hard way so very cool development
27:08
there
27:09
that news story officially wraps up this
27:11
week’s podcast thank you as always for
27:14
spending a few minutes of your week with
27:16
us make sure to subscribe or leave a
27:18
review on whichever platform you’re
27:20
listening from I hope you have a great
27:22
day and we will see you again next week
27:29
why are you keeping me
27:32
[Music]
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