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Ep. 7: Tim Burney – Understanding & Negotiating Implant Costs | This Week in Surgery Centers
Here’s what to expect on this week’s episode. 🎙️
Implants are typically one of the top two drivers of cost for an ASC, but researching, analyzing, and dealing with implants costs can be time-consuming and nuanced.
Tim Burney, Founder, and CEO of Advantien, joins us this week to share how we can effectively better understand and negotiate implant costs to help save a good chunk of money and reduce implant spending. Here are a few ideas.
🤝 Keep an eye on the relationship between the Implant Vendors and Your Surgeons: Vendors are extremely valuable resources to ASCs and provide much-needed support for admins, nurses, and surgeons. But sometimes, vendors and surgeons can build such close relationships that the surgeon stops closely inspecting implant contracts and pricing, and the relationship can be exploited.
📊 Analyzing data = understanding costs: You’re already recording your implant data, but now it’s time to analyze it. Take the raw data, get it into a BI tool or another helpful format, and really dig in. What are you spending per implant per procedure? What is the data telling you?
📍 Negotiate costs locally: National benchmarking data is helpful to an extent, but you cannot rely on it alone. You need local data to ultimately negotiate the best prices. Implant costs vary by state, region, and payer – so find a local database and leverage the most powerful data available.
🏥 And lastly – the surgeons will still be critical: Share the data you’ve found with your surgeons. The decision is ultimately on them, so walk them through the data so they can have all the ammunition they need when they meet with the implant vendors to negotiate the best possible prices based on numbers and facts.
In our news recap, we’ll do a deep dive into the CMS 2023 final payment rule, talk about an uptick in plastic surgery cases, share a much-needed update from YouTube Health, and share the story of two police officers who saved the life of a 1-month-old baby.
Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details!
#Podcast #ThisWeekinSurgeryCenters #TWISC
Episode Transcript
0:00
welcome to this week in surgery centers if you’re in the ASC industry then
0:05
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]
0:27
hi everyone here’s what you can expect on today’s episode we are excited to
0:32
have Tim Bernie as our guest today Tim is the founder and CEO of advantian and
0:38
he’s here to talk to us about how ASCS can better understand and negotiate Fair implant costs implants are typically one
0:46
of the top three drivers of cost for an ASC so Tim has great tips for how you
0:51
can reduce overall costs and how you can get the best price we’ll close the episode with a few news
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stories we’ll start with a deep dive into cms’s 2023 final payment rule talk
1:02
about an uptick in plastic surgery cases share a much needed update from YouTube
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health and of course and the new segment with a positive story about two police officers who saved the life of a
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one-month-old baby hope everyone enjoys the episode and here’s what’s going on this week in
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surgery centers thank you
1:26
Tim welcome to the show hey thanks it’s good to be here appreciate it excited to have you here Tim to talk a little bit
1:32
about implants and before we jump right in can you tell us a little bit about your your background especially as it
1:38
relates to the ASC industry yeah you bet um you know I I grew up really
1:44
interested in uh somehow being in the in the medical uh business I you know as a little kid I was dreamed about being a
1:50
doctor and that sort of thing and and you know life happens and that that plan got derailed but uh I was in the the
1:57
clinical space in the military I was a trained uh combat medic and a surgical assistant and then at some point uh
2:03
after I got out of the military uh I I ended up going into the device business and worked for some other you know the
2:10
larger device companies in spine and mostly um and so I got my uh my knowledge on
2:15
the implant uh side of the business in the in the spine industry mostly As I said working for Medtronic Globus a few
2:22
other companies and then um started working in that space with ASCS in the
2:27
mid 2005 or so when ASCS were in their infancy
2:33
um where they required a lot of support didn’t have a whole lot of uh uh internal people that knew the business
2:38
very well the business meeting plant business and that’s they’ve certainly gotten a lot better at that but there’s
2:44
still a lot of room for better understanding in that space so in 2011 2012 I started a business to address
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some of those uh some of those issues to help support ASCS and better understanding the the implant side of
2:57
the business great and I’m excited to dig in with you on the implant side in particular
3:03
um you know as we all know if you look at the the expenses and the top expense drivers for an ASC up there in the top
3:09
two or three is always implants and so you know one of the things we want to talk about and kind of share some some
3:15
wisdom and get some tips and tricks for you is how to reduce how can ASDS reduce the cost of their implant spend overall
3:23
and what what is this relationship typically look like in terms of implant
3:29
vendors in in the ASC business side and so yeah that’s a good question Nick you know uh the the implant sales reps are a
3:39
valuable resource for hospitals and ASCS especially ASCS they do so much to support individual procedures certainly
3:47
bring in the sets that have the implants in them and then support the nurses and the surgeons during cases and after and
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so they’re a valuable resource for for the facilities for technical as well as
3:58
Logistics physical sort of support from a standpoint and they also by the way have very strong relationships with
4:04
those facilities because they’re they’re intimately involved with them and one of those relationships that’s really important is the surgeon rep
4:09
relationship and uh because they have a lot of impact with the surgeons and and oftentimes that relationship uh can
4:16
actually be exploited uh to maintain higher prices uh ASC people in general
4:22
the administrators Etc respect that relationship and certainly don’t want to upset that so sometimes that can work in
4:28
a negative sense from the standpoint of uh price and implants sure that that makes sense kind of going
4:36
you know the strategy from you know the the rep perspective or from the vendor
4:41
perspective of maybe segmenting out the the purchase decision
4:46
um it can can be beneficial from a from a purchasing power standpoint if
4:52
um if the goal is to understand implant costs right if the goal of an ASC is hey
4:58
we want to understand our implant cost better how can ases approach that in terms of yeah yeah it’s a good question
5:05
they need to dig into the data right most ASCS have really good raw data in their systems uh but the the important
5:12
step is actually analyzing that data right so in particular summarizing the raw data you know in a way that shows
5:18
you you know where your your most your money is going on the implant side where the spend is specific to what types of
5:24
implants are being uh or the are the cost drivers uh breaking it down by implant by procedure and just
5:31
understanding that really well but but the next important part of that is you
5:36
know not just digging into the data but really analyzing that understanding what that data is telling you and that’s
5:42
really an important step so data data is an important really foundational step up and and it’ll lead you to the answers
5:49
yep and I imagine oftentimes that data is in the practice management system right what’s what’s what have you
5:56
found are the best ways to get in there and manipulate it is this reporting yeah it’s HST Envy systems um most ASCS
6:05
that I work with have HST or NV they’re off paper now they’re recording their purchases using those systems uh but
6:12
recording them is not the same as understanding costs right it’s where understanding the cost is where the opportunities are understanding where
6:19
you’re spending your money is is where the opportunities uh are so as I said previously converting that raw data to
6:25
some meaningful summary with uh actionable reports is really the key so the data is there it’s really analyzing
6:33
that data and putting in into a useful sort of format which would be reports and actionable reports benchmarking
6:38
Services another they’ve got you know there’s a service called Equity that does benchmarking and they do it by
6:44
individual implants and you certainly can use that it’ll give you a national average uh it’s better probably for
6:51
hospitals it’s more of a valuable tool for hospitals oftentimes ASCS will have
6:56
more specific uh implants you can find them on Equity but again they’re average they’re average benchmarking and and
7:04
really what’s important is not only to look at the implant itself but also oftentimes there’s Associated
7:10
disposables that are part of that so it’s kind of an overall Global picture of what the spend is right and and you
7:17
want to also understand your savings potential potential specific to the ASC what are the specific opportunities
7:23
based on the products they use again surgery or surgery is done in hospitals oftentimes are different there’s some
7:30
similarity certainly for example you do spine procedures in a in a surgery center you’ll do them in the hospital
7:36
but the complexities are often different therefore the instruments or the implants might be slightly different so
7:41
there’s not always a one-to-one comparison so it’s really important that ASCS look specifically at what they’re
7:47
using particularly the high volume items and look for look at the national benchmarking sure as a starting point
7:53
but you know it’s just a starting point sure and I’m curious on your perspective
7:59
Tim when when ASCS are making the implant purchase decision right whether
8:04
it’s at the physician level or the administrator level do you think the industry overall has a good feel for how
8:12
the specific implant costs are impacting their overall case profitability you know I don’t I think there’s
8:18
definitely a disconnect again the Reps provide a valuable service but it’s very specific to the cases right and and
8:25
um the Reps generally don’t have visibility to those to the sort of
8:31
variables that would help them understand case costs and that sort of thing and quite frankly I mean the whole
8:36
system is set up where you know reps are paid on a commission and you know um uh they’re definitely good partners
8:43
but it’s not their primary focus right and they just don’t have enough information to really help a facility
8:49
make good decisions the facility really needs to drive that process they really need to be the ones that that go to the
8:57
Reps and go to the device companies and using that data that I mentioned before to get to drive that I would not count
9:03
on the rep to understand what their you know what their business looks like and what the opportunities are to drive
9:08
savings uh that’s probably not I’d say it’s definitely not the best place to start
9:14
yeah that makes sense the facility is the only one with the 360 view of hey what’s our Revenue per case as well as
9:20
what’s the other inputs and and costs and uh one more thing I’ll throw in Nick sorry to interrupt you but is is the
9:27
reimbursement side I mean there’s two sides of this right there’s the cost side and the reimbursement side and when
9:32
you when you think about that that’s an area where um oftentimes even ASC struggle to
9:38
understand that’s a pretty complex side of the business so to expect the Reps of the device companies to understand that
9:44
side to have that visibility number one and understand it is probably a bridge too far for you know for that sure and
9:51
on that reimbursement side how much variability is there across
9:56
payors and reimbursement rates yeah so there’s there’s two basic types of payers
10:03
um in the marketplace uh there’s many different payers many different insurance companies when I say insurance companies those are the payers uh
10:09
there’s the global side um the global side is like Medicare right where um implants are not reimbursed on an
10:16
individual basis so uh implant charges are not submitted to Global payers like
10:21
Medicare Medicare pays a capitated or a set rate for a particular procedure and
10:27
in that procedure the facility is expected to cover all of their costs I see all their costs there’s there’s some
10:32
things that slide out of that but basically for sure the um the implant costs are included in that so it’s not
10:38
some separate charge for the implants the other side um is there is where they reimburse for
10:44
implants cost or Cost Plus cost or Cost Plus meaning that they’ll reimburse the facility the facility turns in an
10:51
invoice for the implants whatever charge they paid for them and the facility will
10:56
be reimbursed by those payers based on that that charge so let’s just say for example an implant costs a thousand
11:02
dollars on a cost reimbursement they’d get a thousand dollars back on a Cost Plus oftentimes a payer will build in a
11:08
five or ten or whatever percent additional so on a thousand maybe they get an extra fifty or a hundred dollars
11:13
which you know helps a little bit uh you know adjudicate that that cost
11:19
um and and to collect that money so there’s two types the global and the cost plus that’s important number one and as far as variability I mean it
11:26
varies across the country and it varies from state to state from region to region from payer to payer you know um
11:33
when you look at uh Medicare which is global that usually will take up
11:38
obviously a portion of maybe as much as 50 percent of a of a surgery centers
11:44
um you know parent Network so they’re not being reimbursed for implants so that’s important right because then the
11:49
most important aspect of that of that implant is how low can you get the price because you’re not going to be in
11:54
reimburse so you want to build that margin to to be profitable right as a facility but the other side is that cost
12:01
plus you can have a blue cross that is typically a Cost Plus in a given state or whatever but Aetna may be typically
12:08
Global it just varies a lot what I see mostly is probably about a 50 50 mix and
12:14
again there’s variability there’s some facilities that are 70 Cost Plus and some they’re 20 or whatever it really
12:20
depends on on the area but if to say that there’s a 50 50 on average mix
12:26
between those two types of pairs is probably a a reasonable assumption
12:31
yeah that sounds like a good rule of thumb and on the cost plus side of the equation how much room is there for
12:39
device specific or implant specific negotiations
12:45
yeah well first of all um the negotiations are not separated by the
12:50
payers right so from a standpoint the goal is always to drive down the cost of
12:57
the lowest you know the lowest uh cost you can get I mean on the cost plus side it’s kind of counterintuitive right I
13:03
mean if you’re if your implant is a thousand dollars or your implants 500 you’re going to get reimbursed so you
13:09
can make a case that it really doesn’t matter right but as I said just a moment ago there’s going to be a mix there’s
13:14
going to be a mix of global and there’s going to be a mix of Cost Plus payers so to make sure that you are doing the best
13:20
you can on the global side again depending upon the the mix but uh you’re going to want to drive that uh
13:26
regardless of the of what payers they are because the payers it’s not one price for one pair one price for another
13:32
the cost of that implant that I sort of made up earlier of a thousand dollars is still a thousand dollars regardless of
13:38
what the payer is so generally speaking you’ll see that surgery centers uh
13:44
hospitals for that matter too but Sergey centers specifically want to drive down to the lowest to the lowest cost they
13:50
can regardless of the payers yep and and how often do you see that
13:57
happen do you see do you think the ASC Market is up to date overall on kind of
14:02
latest insights tips and tricks and has the the benchmarking data you know
14:07
readily available that you mentioned to to kind of credibly and effectively you know negotiate those at those rates you
14:15
know I I’d say that most uh centers proactively negotiate
14:20
um again I think that the information is there I mean
14:25
um you know the benchmarking again is a usually an average benchmarking it’s
14:31
important to engage uh professionals that understand that market that that
14:36
have a better benchmarking tools and what I mean by that is as I said earlier when you when you’re talking about a GPO
14:43
that’s usually an average price it’s an average price across the country it’s better than we’ll call it list price
14:49
which by the way is meaningless but it’s better than the list price but it’s it’s kind of an average price you’ll find
14:55
across the country what I’ve seen is that’s what the way it is with gpos it’s better always to negotiate on a local
15:01
level you know the fact is that um you know if you say to the Reps I need to get a better price they’ll say
15:07
things like you’re getting the best price in the country or the best price I can give you might be true it might not
15:13
be but what you need to do is to understand what does that mean and that’s a challenge right I mean it really is a challenge because whether
15:19
you look at equity which is an average price um you know gives you an average price gives you some highs and lows as well
15:24
but again there’s a variable ability from from region to region if there’s a way to and there are ways to access
15:31
databases that have the locally negotiated competitive pricing that’s
15:36
really the key so you take your raw data turn those into actionable sort of comparative reports to understand what
15:43
you’re paying and then access through you know different uh Avenues companies
15:50
that provide this sort of information there are a few that can provide the
15:55
information on a local level to say hey this is the best price that I know what it says over here but really you should
16:01
be able to compare to our database which shows a very competitive locally negotiated sort of
16:07
um you know environment this is where you need to get to so comparative compared to what your raw date is
16:12
compared to a really good Benchmark employ someone that can help you understand what that should be and then
16:19
negotiate off of that yeah that’s that’s that’s good Insight
16:25
um and how how readily available are those local kind of databases that that
16:31
include that pricing information yeah there are um you know there there are a few companies that have them um you know
16:38
they’re the gpos and the equities and things like that are available right
16:44
unfortunately as I said it’s not necessarily the the best pricing because again it’s a national pricing setup and
16:51
it doesn’t always give you you know when you go to your like it’s I don’t know if this is a good analogy or
16:56
not but I think about you know when you go shopping if you go to your local grocery you go to whoever you go to a
17:01
tailor you go to where you buy your suits or dresses or whatever you know you know someone you can stand there
17:07
face to face and have a good negotiation with them and probably do better than you might do if you went somewhere where
17:12
you didn’t know the person I think it’s a similar setup right the other thing is you know the surgeons are the key in
17:18
this whole process quite frankly I mean so so from an administrative standpoint and I know you asked me how readily
17:25
available is it it’s available right but you have to look for it other companies that do it um but at the end of the day it’s really
17:32
a matter of getting this information and going to the surgeons and making a case to the surgeons why it’s important and
17:38
let them be the sort of the impetus to drive the results because they’re ultimately the ones that they use what
17:45
they you know they they’re trained on what they’re comfortable with so it have to stay within those parameters and help
17:50
let the surgeons help Drive the results as well yeah I I like that because that kind of
17:56
speaks to the change management component of it right I think for administrators or others that work in
18:02
the facility if they’re you know suggesting a change based on cost or otherwise and there’s surgeons that are
18:08
used to doing procedures a different way with different materials there’s gonna have to be kind of a change management conversation or at least kind of an
18:15
understanding the why I’m sure and what what have you seen as your experience is the best way to to do that with surgeons
18:22
in particular yeah well again uh we’ll start with data I hate to sound like a broken record but
18:28
but they need to do their homework the ASC needs to do their homework and they know that I you know they would say we
18:34
know that um it’s to take that raw data analyze it you know do the comparative analysis and then sit down with the
18:39
surgeons and and you know keep in mind the surgeons in a surgery center setting and this is really important and it’s
18:45
it’s obvious but it’s really important is that they’re Equity owners most of them almost all of them are Equity owners in that facility right so uh
18:52
where you go into a hospital and they’re basically renting space if you will um and that’s not even 100 accurate but
18:58
you get the ideas that they’re they’re not vested owners in that hospital so you know they want to use what they want
19:04
to use and it’s at the hospitals to negotiate you don’t have the leverage of the surgeon but in the ASC where I
19:09
mentioned earlier about that surgeon rep relationship and how important that is and it is it’s a very important relationship for many reasons it’s a
19:16
valuable one um you know you have to be able to go to that that doctor and give them a reason
19:22
why you know he needs to maybe confront the rep who’s such a valuable resource to him that he him or her that they
19:30
um that they rely on and why do I need to push this he’s telling me he’s given me the best price so you need to go to
19:36
that surgeon who is an equity owner who really cares about the cost structure of the surgery center right there are parts
19:42
of negotiating oftentimes most times with the with the bigger equipment that sort of thing and given as you said when
19:48
you open the this the set the the implants are the top one two or three
19:54
usually the top one or two uh expenses in a facility that that’s an important
19:59
obviously uh Target for everyone including the surgeon so get the data get the comparative analysis basically
20:06
get all your ducks in a row so that when you go to the surgeon and you say hey look here’s where we’re spending here are the opportunities what do you think
20:13
you feel like we should go after what do you think are the best opportunities here to drive to drive the results and
20:19
if we do this we’re going to save this or we’re going to do this or whatever the case might be and that’s that’s is really the important part of that I like
20:26
that it’s the it’s the show them the data and then the ask versus versus the tell like you’re here’s the dollars what
20:33
what lever should we pull yeah it’s you know see it’s very simple really uh in the sense that it you know it seems like
20:40
the obvious pathway but again it’s a different setup than it is in a hospital and sometimes you know you lose sight of
20:47
that and and sometimes you know administrators you know they want to please the doctors and do what’s best
20:52
they’re also focused on what’s doing what’s best in the ASC but really their ammunition and to to help the doctors
20:59
with those decisions to help them achieve the outcomes they need they want to achieve which is you know the best a
21:05
highest quality patient care at the best cost and with the least amount of expense you know you want to make sure
21:12
you you include the surgeon obviously don’t just go to the store to say hey we can save 10 why do we where can we what
21:19
can we do help me understand what you want to do to drive that right it makes sense I think and and it does work it
21:25
does work sure sure and and you mentioned the hospitals and I wanted to touch on hospitals for just a second
21:31
because I you know I have heard um some administrators some facilities
21:36
on the ASC side say hey you know we we partner with our hospital
21:42
system or we partner with a local hospital to get their implant rates right and they’ve got you know the
21:48
hospital’s got a purchasing team they’ve got more people on it and so we feel pretty comfortable if we’re working with the hospital we’re going to get the best
21:54
implant rates possible is that does that hold water based on your experience
22:00
yeah well it depends I mean sometimes that’s the case but you know the general
22:05
assumption is that what you just said right that well we’ve got Hospital pricing and that’s the best pricing well
22:12
um I would definitely challenge that okay um there are instances where uh potentially if there is let’s say a
22:18
contract with synthes that is a that is a very aggressive contract I’m not saying you never get the best price but
22:25
again it there are going to be instances where you know it’ll be a good price or it’ll be the best but in most instances
22:32
you can do better right and and that again is where you know you can take that as a benchmark right take the
22:39
hospital pricing as a benchmark and in those cases where you compare you know the data and you compare you know the
22:46
other information that I’ve spoken about we’ve spoken about together that’ll give you an idea I mean it’ll it’ll lead you
22:52
down the right path right I mean to have that as part of your your data that
22:58
you’re going to do this analysis on it’ll give you an opportunity not only to compare your pricing to what you
23:04
might be able to negotiate locally but also against the pricing that is readily available to you from the hospital but
23:10
my experience is that with exceptions you can always do better by negotiating locally with the local reps especially
23:18
the Reps will go to their companies but with the local reps because that’s where the relationships are right that’s where
23:24
the relationships and again that’s this is a setting where the surgeons have the
23:30
most interest in the outcome of those of where that pricing is and those negotiations so
23:36
um they they’re going to be very aggressive and very supportive of a an administrator of a surgery center of the
23:43
staff that has that comparative analysis yes we’re getting great pricing here at the hospital but we can do better in
23:49
those areas so that’s a long answer the short answer is there’ll be instances where the the implants are are
23:54
competitive in price but many instances where you can do better got it so I like that so it’s
24:00
you know kind of the theme I hear is use it as a data point use it as one of your benchmarks right so you use the hospital
24:06
pricing if you’ve got it use the local databases as you’ve got it but also
24:12
going back to the beginning of the conversation compare that to the other expenses that
24:17
are going into the certain procedure types and the revenue is associated with those procedure types and then kind of
24:24
work with the rep work with your implant or up to make a you know winning procedure that’s that’s profitable for
24:30
everybody absolutely and by the way I want to make it clear that the the implant reps want
24:35
to keep the business they do want to be good partners right yeah it’s just the incentive to have them be the ones to
24:41
push that result um is not the best strategy right but to bring them on board and and they too
24:47
react to data right they’re going to react to mostly to what the surgeon wants to do but yeah you put all that
24:53
together and I agree yeah that’s the that’s the best formula fantastic so final question for you here
25:00
Tim we do this every week with all of our guests um what is one tip our listeners can do
25:06
this week at their Surgery Center to improve results yeah and I’ve kind of touched on it
25:11
already but I’m gonna gonna drive it home uh because it’s so important right and that is I present the surgeons with
25:18
the data right that that is probably the most important thing you can do obviously you do your homework ahead of
25:23
time but put in the time and effort to Summer summarize your raw implant purchase history and and to an easy
25:30
understanding list of you know comparing Apples to Apples you know the the same
25:36
products that you’ve got there to to the same products that are you know that you benchmarked against the usage the CPT
25:43
codes by the way and and the reimbursement which we talked about earlier put all of that together and
25:50
talk about how that sort of affects the whole business outcome but you start with presenting the surgeons with data
25:56
you start with putting the data together in reports but start with sitting down with your surgeons after you’ve done the
26:01
homework and talk to them you know they’re going to appreciate it as I said their owners in the business they want the best outcomes they’re going to make
26:08
the best decisions for their patients and for their Center but I would do that I would go to the to the data get the
26:14
data from your whatever you’ve got in your facility of hstmv or whatever you’re using and and do the other
26:20
homework do that and then go to your surgeons and um you know make a plan with your surgeons and and do it as a
26:26
team and I think that’s the best way to and and one of the things that that all surgery centers if they’re not doing it
26:32
this week they should plan for in my opinion love it that’s great insight
26:38
Tim thanks so much for joining us this week we really enjoyed the conversation thanks Nick it’s been fun talking to you
26:43
I appreciate the opportunity to talk to you [Music]
26:50
as always it has been a busy week in healthcare so we will jump in but first I wanted to acknowledge that it is
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peri-operative Nurses Week so to all the perioperative nurses out there thank you
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for your hard work and expertise and making sure patients are safe and well taken care of hope you all get a chance
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to celebrate all right first story as promised last week we are going to share a bit of a
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deeper dive into the 2023 final medicare payment rule a huge thank you to more
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cash hst’s VP of clinical strategies and aska for helping summarize what’s going
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on here so let’s start with the positive the final rule taking into account a 4.1
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percent inflation and a required reduction of 0.3 percent mandated by the
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Affordable Care Act CMS finalized an effective update of 3.8 percent while
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it’s not as good as we hoped It’s actually an increase of 1.1 percent from the proposed rule so that in and of
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itself is a win and then with regards to the ambulatory Surgical Center Quality Reporting
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program CMS finalized its proposal to suspend the mandatory adoption of ASC 11
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which is cataract’s Improvement in patients visual function within 90 days
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following cataract surgery so this will remain voluntary in 2023.
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and then moving on to the not so positive we mentioned this last week but unfortunately CMS only added four new
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procedures to the ASC covered procedures list even though aska advocated for 47.
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so we’ll include the four they added in the episode notes if you wanted to check those out and lastly just a really interesting
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call out in the proposed rule CMS actually sought comment to explore how
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ASCS are implementing Tools in their facilities towards the goal of interoperability
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they’re considering the usefulness of electronically submitted quality measures in ases to Aid in delivering
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effective safe efficient patient-centered Equitable And Timely care
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a few specific topics they were looking for comment on were any current barriers
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to interoperability in the ASC setting the impact of Health I.T the ability of
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ASCS to participate in interoperability or any EHR based Qi activity and then
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just general perceived benefits and risks of interoperability in an ASC setting
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so in the final rule they publish some of the feedback that they received and as expected there was concern around the
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financial and administrative burden of implementing an EHR and also the lack of
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federal financial incentive one commenter suggested that CMS conducts a scan to assess the current
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adoption of ehrs in the ASC setting which personally I think is long overdue
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a few commenters recommended the development and use of Health I.T expanding past dhrs in order to create a
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place where Digital Data can be shared across all patient care experiences to provide access to a complete and
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Comprehensive Health Care record there was a bunch more feedback as you can imagine and CMS shared that they
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would take all comments under consideration for future rulemaking but it’s definitely telling and exciting
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to see EHR so prominently discussed this of course doesn’t guarantee anything
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will happen but certainly increases the odds and there’s so much more to the ruling
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um so please check out the episode notes for a link to learn even more details
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in a story shared by outpatient surgery magazine a plastic surgeon in Maryland
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has experienced an increase in demand for his procedures and he believes the
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pandemic strongly influenced this uptick more patients than ever have been
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reaching out for breast reconstruction tummy tucks and cosmetic plastic surgery
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of the face and body and here are three reasons he’s cited first the inability to travel and
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continued safety concerns with travel means patients have longer stretches of downtime at home
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the second and the beginning of the pandemic most people were experiencing some extra money associated with PPP
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loans or stipends being an unusual amount of cash flow was available
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and lastly A Renewed interest in mental health and self-care he believes has led
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people to not only want to improve what’s going on in the inside but also the outside uh now this was just one doctor’s
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experience and we love to see uh anything kind of driving
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um case volume to surgery centers but for ASCS that specialize in Plastics I’d
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love your feedback as well if you’ve seen an increase in case volume over the last two years
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why do you think that is do you think it’s related to the pandemic or more cultural shifts and acceptance of
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plastic surgery um for elective reasons or any of the above or something totally different
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definitely let us know in the comments on LinkedIn you know this was one doctor and I’m curious to see if others are
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experiencing the same foreign gears to our third story Dr Garth Graham
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the global head of YouTube Health shared that credible medical professionals are
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now able to apply for a special verification on YouTube NBC News shares
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that this is an effort to combat medical misinformation online and make it easy
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for viewers to identify reliable sources now as a consumer in a patient I
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personally think this is a wonderful new feature when something’s wrong it’s so
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tempting to go to the Internet for information instead of calling your doctor and we all know that the internet
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is typically wrong or very Doom and Gloom about things and as a healthcare
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professional I’m sure you have plenty of stories where patients call you and say my surgical site is red and Google tells
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me I’m dying that seems to always be the outcome whatever you do search for some reason so this is a great first step to
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try to weed out YouTube accounts who give medical advice without proper certifications
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one other thing for ASCS to consider is bringing more video into the mix in 2023
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if your ASC does not provide any videos right now for prospective or current
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patients you’re missing out on a great way to reach your community and educate
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patients you can do facility tours interviews with Physicians educational
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videos on the services you provide you know kind of what to expect videos and
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so much more and now you can be verified on YouTube which will add even more to
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your credibility and you don’t need a production company to do this you know with the quality of smartphones now you
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can record these videos yourself at a very low Financial cost so just
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something to think about and then even more so that you can kind of be certified on YouTube is a huge one
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and to end our new segment on a positive note two police officers in Kansas City
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saved a one-month-old baby who stopped breathing due to RSV the entire incident
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is caught on body cam footage and while it is of course intense to watch it’s
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actually really helpful to see how the officer performs CPR on such a small baby just in case you ever find yourself
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in a similar situation the officers were able to get the baby breathing again
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before transporting her to a local hospital and I’m happy to share that baby kamiya is doing just fine thanks to
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officer Richard dushane and officer Charles Owen uh we’ll include include a link to the story in the episode notes
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as always to The Today Show article so you can see the footage of their life-saving efforts
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and that news story officially wraps up this week’s podcast thank you as always
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for spending a few minutes of your week with us make sure to subscribe or leave a review on whichever platform you’re
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listening from I hope you have a great day and we’ll see you again next week
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[Music]
welcome to this week in surgery centers if you’re in the ASC industry then
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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]
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hi everyone here’s what you can expect on today’s episode we are excited to
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have Tim Bernie as our guest today Tim is the founder and CEO of advantian and
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he’s here to talk to us about how ASCS can better understand and negotiate Fair implant costs implants are typically one
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of the top three drivers of cost for an ASC so Tim has great tips for how you
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can reduce overall costs and how you can get the best price we’ll close the episode with a few news
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stories we’ll start with a deep dive into cms’s 2023 final payment rule talk
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about an uptick in plastic surgery cases share a much needed update from YouTube
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health and of course and the new segment with a positive story about two police officers who saved the life of a
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one-month-old baby hope everyone enjoys the episode and here’s what’s going on this week in
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surgery centers thank you
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Tim welcome to the show hey thanks it’s good to be here appreciate it excited to have you here Tim to talk a little bit
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about implants and before we jump right in can you tell us a little bit about your your background especially as it
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relates to the ASC industry yeah you bet um you know I I grew up really
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interested in uh somehow being in the in the medical uh business I you know as a little kid I was dreamed about being a
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doctor and that sort of thing and and you know life happens and that that plan got derailed but uh I was in the the
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clinical space in the military I was a trained uh combat medic and a surgical assistant and then at some point uh
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after I got out of the military uh I I ended up going into the device business and worked for some other you know the
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larger device companies in spine and mostly um and so I got my uh my knowledge on
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the implant uh side of the business in the in the spine industry mostly As I said working for Medtronic Globus a few
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other companies and then um started working in that space with ASCS in the
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mid 2005 or so when ASCS were in their infancy
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um where they required a lot of support didn’t have a whole lot of uh uh internal people that knew the business
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very well the business meeting plant business and that’s they’ve certainly gotten a lot better at that but there’s
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still a lot of room for better understanding in that space so in 2011 2012 I started a business to address
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some of those uh some of those issues to help support ASCS and better understanding the the implant side of
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the business great and I’m excited to dig in with you on the implant side in particular
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um you know as we all know if you look at the the expenses and the top expense drivers for an ASC up there in the top
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two or three is always implants and so you know one of the things we want to talk about and kind of share some some
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wisdom and get some tips and tricks for you is how to reduce how can ASDS reduce the cost of their implant spend overall
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and what what is this relationship typically look like in terms of implant
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vendors in in the ASC business side and so yeah that’s a good question Nick you know uh the the implant sales reps are a
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valuable resource for hospitals and ASCS especially ASCS they do so much to support individual procedures certainly
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bring in the sets that have the implants in them and then support the nurses and the surgeons during cases and after and
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so they’re a valuable resource for for the facilities for technical as well as
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Logistics physical sort of support from a standpoint and they also by the way have very strong relationships with
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those facilities because they’re they’re intimately involved with them and one of those relationships that’s really important is the surgeon rep
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relationship and uh because they have a lot of impact with the surgeons and and oftentimes that relationship uh can
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actually be exploited uh to maintain higher prices uh ASC people in general
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the administrators Etc respect that relationship and certainly don’t want to upset that so sometimes that can work in
4:28
a negative sense from the standpoint of uh price and implants sure that that makes sense kind of going
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you know the strategy from you know the the rep perspective or from the vendor
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perspective of maybe segmenting out the the purchase decision
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um it can can be beneficial from a from a purchasing power standpoint if
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um if the goal is to understand implant costs right if the goal of an ASC is hey
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we want to understand our implant cost better how can ases approach that in terms of yeah yeah it’s a good question
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they need to dig into the data right most ASCS have really good raw data in their systems uh but the the important
5:12
step is actually analyzing that data right so in particular summarizing the raw data you know in a way that shows
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you you know where your your most your money is going on the implant side where the spend is specific to what types of
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implants are being uh or the are the cost drivers uh breaking it down by implant by procedure and just
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understanding that really well but but the next important part of that is you
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know not just digging into the data but really analyzing that understanding what that data is telling you and that’s
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really an important step so data data is an important really foundational step up and and it’ll lead you to the answers
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yep and I imagine oftentimes that data is in the practice management system right what’s what’s what have you
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found are the best ways to get in there and manipulate it is this reporting yeah it’s HST Envy systems um most ASCS
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that I work with have HST or NV they’re off paper now they’re recording their purchases using those systems uh but
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recording them is not the same as understanding costs right it’s where understanding the cost is where the opportunities are understanding where
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you’re spending your money is is where the opportunities uh are so as I said previously converting that raw data to
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some meaningful summary with uh actionable reports is really the key so the data is there it’s really analyzing
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that data and putting in into a useful sort of format which would be reports and actionable reports benchmarking
6:38
Services another they’ve got you know there’s a service called Equity that does benchmarking and they do it by
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individual implants and you certainly can use that it’ll give you a national average uh it’s better probably for
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hospitals it’s more of a valuable tool for hospitals oftentimes ASCS will have
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more specific uh implants you can find them on Equity but again they’re average they’re average benchmarking and and
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really what’s important is not only to look at the implant itself but also oftentimes there’s Associated
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disposables that are part of that so it’s kind of an overall Global picture of what the spend is right and and you
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want to also understand your savings potential potential specific to the ASC what are the specific opportunities
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based on the products they use again surgery or surgery is done in hospitals oftentimes are different there’s some
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similarity certainly for example you do spine procedures in a in a surgery center you’ll do them in the hospital
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but the complexities are often different therefore the instruments or the implants might be slightly different so
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there’s not always a one-to-one comparison so it’s really important that ASCS look specifically at what they’re
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using particularly the high volume items and look for look at the national benchmarking sure as a starting point
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but you know it’s just a starting point sure and I’m curious on your perspective
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Tim when when ASCS are making the implant purchase decision right whether
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it’s at the physician level or the administrator level do you think the industry overall has a good feel for how
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the specific implant costs are impacting their overall case profitability you know I don’t I think there’s
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definitely a disconnect again the Reps provide a valuable service but it’s very specific to the cases right and and
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um the Reps generally don’t have visibility to those to the sort of
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variables that would help them understand case costs and that sort of thing and quite frankly I mean the whole
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system is set up where you know reps are paid on a commission and you know um uh they’re definitely good partners
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but it’s not their primary focus right and they just don’t have enough information to really help a facility
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make good decisions the facility really needs to drive that process they really need to be the ones that that go to the
8:57
Reps and go to the device companies and using that data that I mentioned before to get to drive that I would not count
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on the rep to understand what their you know what their business looks like and what the opportunities are to drive
9:08
savings uh that’s probably not I’d say it’s definitely not the best place to start
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yeah that makes sense the facility is the only one with the 360 view of hey what’s our Revenue per case as well as
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what’s the other inputs and and costs and uh one more thing I’ll throw in Nick sorry to interrupt you but is is the
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reimbursement side I mean there’s two sides of this right there’s the cost side and the reimbursement side and when
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you when you think about that that’s an area where um oftentimes even ASC struggle to
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understand that’s a pretty complex side of the business so to expect the Reps of the device companies to understand that
9:44
side to have that visibility number one and understand it is probably a bridge too far for you know for that sure and
9:51
on that reimbursement side how much variability is there across
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payors and reimbursement rates yeah so there’s there’s two basic types of payers
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um in the marketplace uh there’s many different payers many different insurance companies when I say insurance companies those are the payers uh
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there’s the global side um the global side is like Medicare right where um implants are not reimbursed on an
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individual basis so uh implant charges are not submitted to Global payers like
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Medicare Medicare pays a capitated or a set rate for a particular procedure and
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in that procedure the facility is expected to cover all of their costs I see all their costs there’s there’s some
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things that slide out of that but basically for sure the um the implant costs are included in that so it’s not
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some separate charge for the implants the other side um is there is where they reimburse for
10:44
implants cost or Cost Plus cost or Cost Plus meaning that they’ll reimburse the facility the facility turns in an
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invoice for the implants whatever charge they paid for them and the facility will
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be reimbursed by those payers based on that that charge so let’s just say for example an implant costs a thousand
11:02
dollars on a cost reimbursement they’d get a thousand dollars back on a Cost Plus oftentimes a payer will build in a
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five or ten or whatever percent additional so on a thousand maybe they get an extra fifty or a hundred dollars
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which you know helps a little bit uh you know adjudicate that that cost
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um and and to collect that money so there’s two types the global and the cost plus that’s important number one and as far as variability I mean it
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varies across the country and it varies from state to state from region to region from payer to payer you know um
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when you look at uh Medicare which is global that usually will take up
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obviously a portion of maybe as much as 50 percent of a of a surgery centers
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um you know parent Network so they’re not being reimbursed for implants so that’s important right because then the
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most important aspect of that of that implant is how low can you get the price because you’re not going to be in
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reimburse so you want to build that margin to to be profitable right as a facility but the other side is that cost
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plus you can have a blue cross that is typically a Cost Plus in a given state or whatever but Aetna may be typically
12:08
Global it just varies a lot what I see mostly is probably about a 50 50 mix and
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again there’s variability there’s some facilities that are 70 Cost Plus and some they’re 20 or whatever it really
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depends on on the area but if to say that there’s a 50 50 on average mix
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between those two types of pairs is probably a a reasonable assumption
12:31
yeah that sounds like a good rule of thumb and on the cost plus side of the equation how much room is there for
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device specific or implant specific negotiations
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yeah well first of all um the negotiations are not separated by the
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payers right so from a standpoint the goal is always to drive down the cost of
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the lowest you know the lowest uh cost you can get I mean on the cost plus side it’s kind of counterintuitive right I
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mean if you’re if your implant is a thousand dollars or your implants 500 you’re going to get reimbursed so you
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can make a case that it really doesn’t matter right but as I said just a moment ago there’s going to be a mix there’s
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going to be a mix of global and there’s going to be a mix of Cost Plus payers so to make sure that you are doing the best
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you can on the global side again depending upon the the mix but uh you’re going to want to drive that uh
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regardless of the of what payers they are because the payers it’s not one price for one pair one price for another
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the cost of that implant that I sort of made up earlier of a thousand dollars is still a thousand dollars regardless of
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what the payer is so generally speaking you’ll see that surgery centers uh
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hospitals for that matter too but Sergey centers specifically want to drive down to the lowest to the lowest cost they
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can regardless of the payers yep and and how often do you see that
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happen do you see do you think the ASC Market is up to date overall on kind of
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latest insights tips and tricks and has the the benchmarking data you know
14:07
readily available that you mentioned to to kind of credibly and effectively you know negotiate those at those rates you
14:15
know I I’d say that most uh centers proactively negotiate
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um again I think that the information is there I mean
14:25
um you know the benchmarking again is a usually an average benchmarking it’s
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important to engage uh professionals that understand that market that that
14:36
have a better benchmarking tools and what I mean by that is as I said earlier when you when you’re talking about a GPO
14:43
that’s usually an average price it’s an average price across the country it’s better than we’ll call it list price
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which by the way is meaningless but it’s better than the list price but it’s it’s kind of an average price you’ll find
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across the country what I’ve seen is that’s what the way it is with gpos it’s better always to negotiate on a local
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level you know the fact is that um you know if you say to the Reps I need to get a better price they’ll say
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things like you’re getting the best price in the country or the best price I can give you might be true it might not
15:13
be but what you need to do is to understand what does that mean and that’s a challenge right I mean it really is a challenge because whether
15:19
you look at equity which is an average price um you know gives you an average price gives you some highs and lows as well
15:24
but again there’s a variable ability from from region to region if there’s a way to and there are ways to access
15:31
databases that have the locally negotiated competitive pricing that’s
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really the key so you take your raw data turn those into actionable sort of comparative reports to understand what
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you’re paying and then access through you know different uh Avenues companies
15:50
that provide this sort of information there are a few that can provide the
15:55
information on a local level to say hey this is the best price that I know what it says over here but really you should
16:01
be able to compare to our database which shows a very competitive locally negotiated sort of
16:07
um you know environment this is where you need to get to so comparative compared to what your raw date is
16:12
compared to a really good Benchmark employ someone that can help you understand what that should be and then
16:19
negotiate off of that yeah that’s that’s that’s good Insight
16:25
um and how how readily available are those local kind of databases that that
16:31
include that pricing information yeah there are um you know there there are a few companies that have them um you know
16:38
they’re the gpos and the equities and things like that are available right
16:44
unfortunately as I said it’s not necessarily the the best pricing because again it’s a national pricing setup and
16:51
it doesn’t always give you you know when you go to your like it’s I don’t know if this is a good analogy or
16:56
not but I think about you know when you go shopping if you go to your local grocery you go to whoever you go to a
17:01
tailor you go to where you buy your suits or dresses or whatever you know you know someone you can stand there
17:07
face to face and have a good negotiation with them and probably do better than you might do if you went somewhere where
17:12
you didn’t know the person I think it’s a similar setup right the other thing is you know the surgeons are the key in
17:18
this whole process quite frankly I mean so so from an administrative standpoint and I know you asked me how readily
17:25
available is it it’s available right but you have to look for it other companies that do it um but at the end of the day it’s really
17:32
a matter of getting this information and going to the surgeons and making a case to the surgeons why it’s important and
17:38
let them be the sort of the impetus to drive the results because they’re ultimately the ones that they use what
17:45
they you know they they’re trained on what they’re comfortable with so it have to stay within those parameters and help
17:50
let the surgeons help Drive the results as well yeah I I like that because that kind of
17:56
speaks to the change management component of it right I think for administrators or others that work in
18:02
the facility if they’re you know suggesting a change based on cost or otherwise and there’s surgeons that are
18:08
used to doing procedures a different way with different materials there’s gonna have to be kind of a change management conversation or at least kind of an
18:15
understanding the why I’m sure and what what have you seen as your experience is the best way to to do that with surgeons
18:22
in particular yeah well again uh we’ll start with data I hate to sound like a broken record but
18:28
but they need to do their homework the ASC needs to do their homework and they know that I you know they would say we
18:34
know that um it’s to take that raw data analyze it you know do the comparative analysis and then sit down with the
18:39
surgeons and and you know keep in mind the surgeons in a surgery center setting and this is really important and it’s
18:45
it’s obvious but it’s really important is that they’re Equity owners most of them almost all of them are Equity owners in that facility right so uh
18:52
where you go into a hospital and they’re basically renting space if you will um and that’s not even 100 accurate but
18:58
you get the ideas that they’re they’re not vested owners in that hospital so you know they want to use what they want
19:04
to use and it’s at the hospitals to negotiate you don’t have the leverage of the surgeon but in the ASC where I
19:09
mentioned earlier about that surgeon rep relationship and how important that is and it is it’s a very important relationship for many reasons it’s a
19:16
valuable one um you know you have to be able to go to that that doctor and give them a reason
19:22
why you know he needs to maybe confront the rep who’s such a valuable resource to him that he him or her that they
19:30
um that they rely on and why do I need to push this he’s telling me he’s given me the best price so you need to go to
19:36
that surgeon who is an equity owner who really cares about the cost structure of the surgery center right there are parts
19:42
of negotiating oftentimes most times with the with the bigger equipment that sort of thing and given as you said when
19:48
you open the this the set the the implants are the top one two or three
19:54
usually the top one or two uh expenses in a facility that that’s an important
19:59
obviously uh Target for everyone including the surgeon so get the data get the comparative analysis basically
20:06
get all your ducks in a row so that when you go to the surgeon and you say hey look here’s where we’re spending here are the opportunities what do you think
20:13
you feel like we should go after what do you think are the best opportunities here to drive to drive the results and
20:19
if we do this we’re going to save this or we’re going to do this or whatever the case might be and that’s that’s is really the important part of that I like
20:26
that it’s the it’s the show them the data and then the ask versus versus the tell like you’re here’s the dollars what
20:33
what lever should we pull yeah it’s you know see it’s very simple really uh in the sense that it you know it seems like
20:40
the obvious pathway but again it’s a different setup than it is in a hospital and sometimes you know you lose sight of
20:47
that and and sometimes you know administrators you know they want to please the doctors and do what’s best
20:52
they’re also focused on what’s doing what’s best in the ASC but really their ammunition and to to help the doctors
20:59
with those decisions to help them achieve the outcomes they need they want to achieve which is you know the best a
21:05
highest quality patient care at the best cost and with the least amount of expense you know you want to make sure
21:12
you you include the surgeon obviously don’t just go to the store to say hey we can save 10 why do we where can we what
21:19
can we do help me understand what you want to do to drive that right it makes sense I think and and it does work it
21:25
does work sure sure and and you mentioned the hospitals and I wanted to touch on hospitals for just a second
21:31
because I you know I have heard um some administrators some facilities
21:36
on the ASC side say hey you know we we partner with our hospital
21:42
system or we partner with a local hospital to get their implant rates right and they’ve got you know the
21:48
hospital’s got a purchasing team they’ve got more people on it and so we feel pretty comfortable if we’re working with the hospital we’re going to get the best
21:54
implant rates possible is that does that hold water based on your experience
22:00
yeah well it depends I mean sometimes that’s the case but you know the general
22:05
assumption is that what you just said right that well we’ve got Hospital pricing and that’s the best pricing well
22:12
um I would definitely challenge that okay um there are instances where uh potentially if there is let’s say a
22:18
contract with synthes that is a that is a very aggressive contract I’m not saying you never get the best price but
22:25
again it there are going to be instances where you know it’ll be a good price or it’ll be the best but in most instances
22:32
you can do better right and and that again is where you know you can take that as a benchmark right take the
22:39
hospital pricing as a benchmark and in those cases where you compare you know the data and you compare you know the
22:46
other information that I’ve spoken about we’ve spoken about together that’ll give you an idea I mean it’ll it’ll lead you
22:52
down the right path right I mean to have that as part of your your data that
22:58
you’re going to do this analysis on it’ll give you an opportunity not only to compare your pricing to what you
23:04
might be able to negotiate locally but also against the pricing that is readily available to you from the hospital but
23:10
my experience is that with exceptions you can always do better by negotiating locally with the local reps especially
23:18
the Reps will go to their companies but with the local reps because that’s where the relationships are right that’s where
23:24
the relationships and again that’s this is a setting where the surgeons have the
23:30
most interest in the outcome of those of where that pricing is and those negotiations so
23:36
um they they’re going to be very aggressive and very supportive of a an administrator of a surgery center of the
23:43
staff that has that comparative analysis yes we’re getting great pricing here at the hospital but we can do better in
23:49
those areas so that’s a long answer the short answer is there’ll be instances where the the implants are are
23:54
competitive in price but many instances where you can do better got it so I like that so it’s
24:00
you know kind of the theme I hear is use it as a data point use it as one of your benchmarks right so you use the hospital
24:06
pricing if you’ve got it use the local databases as you’ve got it but also
24:12
going back to the beginning of the conversation compare that to the other expenses that
24:17
are going into the certain procedure types and the revenue is associated with those procedure types and then kind of
24:24
work with the rep work with your implant or up to make a you know winning procedure that’s that’s profitable for
24:30
everybody absolutely and by the way I want to make it clear that the the implant reps want
24:35
to keep the business they do want to be good partners right yeah it’s just the incentive to have them be the ones to
24:41
push that result um is not the best strategy right but to bring them on board and and they too
24:47
react to data right they’re going to react to mostly to what the surgeon wants to do but yeah you put all that
24:53
together and I agree yeah that’s the that’s the best formula fantastic so final question for you here
25:00
Tim we do this every week with all of our guests um what is one tip our listeners can do
25:06
this week at their Surgery Center to improve results yeah and I’ve kind of touched on it
25:11
already but I’m gonna gonna drive it home uh because it’s so important right and that is I present the surgeons with
25:18
the data right that that is probably the most important thing you can do obviously you do your homework ahead of
25:23
time but put in the time and effort to Summer summarize your raw implant purchase history and and to an easy
25:30
understanding list of you know comparing Apples to Apples you know the the same
25:36
products that you’ve got there to to the same products that are you know that you benchmarked against the usage the CPT
25:43
codes by the way and and the reimbursement which we talked about earlier put all of that together and
25:50
talk about how that sort of affects the whole business outcome but you start with presenting the surgeons with data
25:56
you start with putting the data together in reports but start with sitting down with your surgeons after you’ve done the
26:01
homework and talk to them you know they’re going to appreciate it as I said their owners in the business they want the best outcomes they’re going to make
26:08
the best decisions for their patients and for their Center but I would do that I would go to the to the data get the
26:14
data from your whatever you’ve got in your facility of hstmv or whatever you’re using and and do the other
26:20
homework do that and then go to your surgeons and um you know make a plan with your surgeons and and do it as a
26:26
team and I think that’s the best way to and and one of the things that that all surgery centers if they’re not doing it
26:32
this week they should plan for in my opinion love it that’s great insight
26:38
Tim thanks so much for joining us this week we really enjoyed the conversation thanks Nick it’s been fun talking to you
26:43
I appreciate the opportunity to talk to you [Music]
26:50
as always it has been a busy week in healthcare so we will jump in but first I wanted to acknowledge that it is
26:57
peri-operative Nurses Week so to all the perioperative nurses out there thank you
27:02
for your hard work and expertise and making sure patients are safe and well taken care of hope you all get a chance
27:08
to celebrate all right first story as promised last week we are going to share a bit of a
27:15
deeper dive into the 2023 final medicare payment rule a huge thank you to more
27:20
cash hst’s VP of clinical strategies and aska for helping summarize what’s going
27:26
on here so let’s start with the positive the final rule taking into account a 4.1
27:33
percent inflation and a required reduction of 0.3 percent mandated by the
27:39
Affordable Care Act CMS finalized an effective update of 3.8 percent while
27:45
it’s not as good as we hoped It’s actually an increase of 1.1 percent from the proposed rule so that in and of
27:52
itself is a win and then with regards to the ambulatory Surgical Center Quality Reporting
27:58
program CMS finalized its proposal to suspend the mandatory adoption of ASC 11
28:04
which is cataract’s Improvement in patients visual function within 90 days
28:10
following cataract surgery so this will remain voluntary in 2023.
28:16
and then moving on to the not so positive we mentioned this last week but unfortunately CMS only added four new
28:23
procedures to the ASC covered procedures list even though aska advocated for 47.
28:28
so we’ll include the four they added in the episode notes if you wanted to check those out and lastly just a really interesting
28:36
call out in the proposed rule CMS actually sought comment to explore how
28:42
ASCS are implementing Tools in their facilities towards the goal of interoperability
28:48
they’re considering the usefulness of electronically submitted quality measures in ases to Aid in delivering
28:55
effective safe efficient patient-centered Equitable And Timely care
29:00
a few specific topics they were looking for comment on were any current barriers
29:06
to interoperability in the ASC setting the impact of Health I.T the ability of
29:12
ASCS to participate in interoperability or any EHR based Qi activity and then
29:19
just general perceived benefits and risks of interoperability in an ASC setting
29:25
so in the final rule they publish some of the feedback that they received and as expected there was concern around the
29:33
financial and administrative burden of implementing an EHR and also the lack of
29:38
federal financial incentive one commenter suggested that CMS conducts a scan to assess the current
29:45
adoption of ehrs in the ASC setting which personally I think is long overdue
29:51
a few commenters recommended the development and use of Health I.T expanding past dhrs in order to create a
29:59
place where Digital Data can be shared across all patient care experiences to provide access to a complete and
30:05
Comprehensive Health Care record there was a bunch more feedback as you can imagine and CMS shared that they
30:12
would take all comments under consideration for future rulemaking but it’s definitely telling and exciting
30:18
to see EHR so prominently discussed this of course doesn’t guarantee anything
30:24
will happen but certainly increases the odds and there’s so much more to the ruling
30:30
um so please check out the episode notes for a link to learn even more details
30:37
in a story shared by outpatient surgery magazine a plastic surgeon in Maryland
30:42
has experienced an increase in demand for his procedures and he believes the
30:48
pandemic strongly influenced this uptick more patients than ever have been
30:53
reaching out for breast reconstruction tummy tucks and cosmetic plastic surgery
30:59
of the face and body and here are three reasons he’s cited first the inability to travel and
31:07
continued safety concerns with travel means patients have longer stretches of downtime at home
31:13
the second and the beginning of the pandemic most people were experiencing some extra money associated with PPP
31:20
loans or stipends being an unusual amount of cash flow was available
31:26
and lastly A Renewed interest in mental health and self-care he believes has led
31:31
people to not only want to improve what’s going on in the inside but also the outside uh now this was just one doctor’s
31:38
experience and we love to see uh anything kind of driving
31:44
um case volume to surgery centers but for ASCS that specialize in Plastics I’d
31:50
love your feedback as well if you’ve seen an increase in case volume over the last two years
31:56
why do you think that is do you think it’s related to the pandemic or more cultural shifts and acceptance of
32:03
plastic surgery um for elective reasons or any of the above or something totally different
32:09
definitely let us know in the comments on LinkedIn you know this was one doctor and I’m curious to see if others are
32:15
experiencing the same foreign gears to our third story Dr Garth Graham
32:22
the global head of YouTube Health shared that credible medical professionals are
32:27
now able to apply for a special verification on YouTube NBC News shares
32:33
that this is an effort to combat medical misinformation online and make it easy
32:38
for viewers to identify reliable sources now as a consumer in a patient I
32:44
personally think this is a wonderful new feature when something’s wrong it’s so
32:50
tempting to go to the Internet for information instead of calling your doctor and we all know that the internet
32:56
is typically wrong or very Doom and Gloom about things and as a healthcare
33:01
professional I’m sure you have plenty of stories where patients call you and say my surgical site is red and Google tells
33:08
me I’m dying that seems to always be the outcome whatever you do search for some reason so this is a great first step to
33:16
try to weed out YouTube accounts who give medical advice without proper certifications
33:22
one other thing for ASCS to consider is bringing more video into the mix in 2023
33:28
if your ASC does not provide any videos right now for prospective or current
33:35
patients you’re missing out on a great way to reach your community and educate
33:40
patients you can do facility tours interviews with Physicians educational
33:47
videos on the services you provide you know kind of what to expect videos and
33:52
so much more and now you can be verified on YouTube which will add even more to
33:57
your credibility and you don’t need a production company to do this you know with the quality of smartphones now you
34:03
can record these videos yourself at a very low Financial cost so just
34:09
something to think about and then even more so that you can kind of be certified on YouTube is a huge one
34:16
and to end our new segment on a positive note two police officers in Kansas City
34:22
saved a one-month-old baby who stopped breathing due to RSV the entire incident
34:28
is caught on body cam footage and while it is of course intense to watch it’s
34:33
actually really helpful to see how the officer performs CPR on such a small baby just in case you ever find yourself
34:40
in a similar situation the officers were able to get the baby breathing again
34:45
before transporting her to a local hospital and I’m happy to share that baby kamiya is doing just fine thanks to
34:53
officer Richard dushane and officer Charles Owen uh we’ll include include a link to the story in the episode notes
34:59
as always to The Today Show article so you can see the footage of their life-saving efforts
35:06
and that news story officially wraps up this week’s podcast thank you as always
35:11
for spending a few minutes of your week with us make sure to subscribe or leave a review on whichever platform you’re
35:17
listening from I hope you have a great day and we’ll see you again next week
35:24
[Music]
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