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Becker’s Healthcare Podcast
Dr. Shirin Towfigh, Hernia and Laparoscopic Surgery Specialist at Beverly Hills Hernia Center
00:13:54
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- [00:00]
A
This is Alan Condon with the Beckers ASC podcast and I'm delighted to be joined today by Dr. Shirin Tofai, Hernia and laparoscopic surgery specialist at Beverly Hills Hernia Center. Dr. Tofai, pleasure to make your debut appearance with us on the Becker's ASC podcast. He is familiar with you, the work that you do at your surgery center. Do you mind giving us a little bit more insight into your background?
- [00:27]
B
Yes, sure. Thank you very much. I am a board certified general surgeon and I do a lot of minimally invasive surgery, including laparoscopic and robotic surgery. I'm an active member of our own surgical center, which was a great venture that started by physicians and now is partially hospital owned. And it's been a great experience seeing how a surgery center can tee to multiple specialties and then be involved in helping the hospital offload during COVID pandemic times and now start to be kind of one of the premier surgical centers in the nation. I believe we were voted number one in the nation by Newsweek recently.
- [01:18]
A
Wow. What an accomplishment by both your colleagues at your surgery center. So huge accomplishment. Thank you. Conversation A little bit more insight into yourself, your background, your surgery center there, general surgeon, laparoscopic and robotic surgeries, a couple of minimally invasive areas that you really focus in on, but more broadly, I guess two or three kind of key big healthcare trends that you're paying close attention to today. What's on your radar?
- [01:43]
B
Yes, absolutely. I would say that there's definitely a push to which, which has been going on for decades now, to move as much surgical care outside of the main hospital as possible and put it into surgical centers. And that's put the onus on surgical centers to be able to provide hospital level care. In terms of technology, I think the next step is having a broader availability of robotic surgery at surgical centers. It's been something that we really haven't been able to do from a financial standpoint, but that seems to be moving in a direction where collaborating with industry is making it so that we're more likely to be able to offer robotic surgery in the surgical center. And as you may know, the more you offer minimally invasive or robotic surgery, the more likely you are to be able to provide care to patients as an outpatient and not require hospitalization because the pain is pretty well tolerated. Tolerate with those operations. That's number one. I would also say that this idea of, you know, multispecialty surgical centers is becoming better. It used to be, at least, you know, I'm In Los Angeles, Beverly Hills, most of our surgical centers are cash based for cosmetic and plastic surgery. And that's really changing where we're seeing serious operations, whether it's hysterectomies or prostatectomies being performed at an outpatient setting as well. And nurses and surgeons and anesthesiologists are becoming more comfortable offering higher level of care at a surgical center. I would say those are the top two.
- [03:34]
A
So I'm fascinated by both, both of those trends, but I think particularly the first one, I think as it relates to robotic surgery, like you said, one of those key minimally invasive techniques, that's really the onus for a lot of these complex surgeries being driven away from the hospitals to outpatient settings. ASCs, you did mention, we hear so often that the barriers to ASCs for some of these robots was number one. So we so often hear about the cost, the size. Seems like those two barriers are coming down a little bit now. To your point, collaborating with industry is a big thing. I love to hear your insight. Kind of how do you see kind of the future of robotics at ascs? And to your point, collaborating with industry, how does that kind of relate to this whole movement to the ASE outpatient setting with those robots? Sure.
- [04:21]
B
I have a great story to share for you. So when I first got involved with the surgery center back in 2013, robotics for general surgery was just becoming something of interest and mostly was urology. You know, prostatectomies were pretty commonly performed robotically. And my hope was to bring the robotic technology into the surgical center. But at that time, you had to spend $2 million to buy a robot, and the insurance will never provide you payments any differently if you use the robot or didn't use a robot. So there was no way financially to make sense of that. And at that time, industry was also not eager to bring down their pricing to accommodate for a larger volume of surges in the surgical centers. They were still expanding out in the main hospitals, I must say, over time. And partially that's because of interest of industry to penetrate more. And also there's more competition in the robotic field. The price of robotic surgery has reduced and they've come up with a bit more interesting ways. You don't have to buy the robot outright anymore. For example, you can lease it. You can do these what we call pay per click. It's basically you pay each time you use the robot. So it's like leasing a luxury car, right? As opposed to buying your luxury car. It's a little bit More manageable. So kudos to industry for doing that because when we first spoke to their leadership, now it's what, 12 years ago there was zero interest and now there's a lot of interest to work with surgical centers to go in, to enter surgical centers, because they've pretty much done a good job of saturating the market on the hospital side. The problem is the other arm of the finances here, which is insurance, has not kicked in. So as your viewers probably know, there's three tiers of payment by insurance for the same exact operation. If it's done in the main hospital, you get a large amount of money for it. If the same operations performed at a hospital based outpatient surgery center, you get a lesser amount and the least amount is paid to a freestanding surgical center. So it makes no sense financially to do a robotic operation, which is expensive, in a environment such as a freestanding outpatient surgery center that gives you the lowest reimbursement for that operation. So even though industry has kicked in to help on their side, insurance really has not done their job of allowing that to be a feasible financial situation. So that's a major roadblock right now, which is what operations does it make sense to do in an outpatient surgery center if you're the, let's say the hospital or healthcare system and how do.
- [07:34]
A
You make that in your own surgery center? How do you make those decisions, those choices? If you don't mind me asking, a little bit of perspective from your ASC in terms of is this a procedure I'm going to do robotically? Is this something I'm going to do, a traditional method? Just curious to hear your thoughts on that.
- [07:49]
B
I mean, we're very lucky. We're in a very robust outpatient, freestanding surgical center. We're partnered with our major hospital were very high volume. So based on that, we're a bit stronger financially than maybe your standard privately owned surgical center. So we're very lucky with that. And our partnership with the hospital has made it so that there are some efficiencies we can build into running the surgical center. Our hope is that within the next year we will have a robot as we're expanding our surgical center. And honestly, if it were completely up to the business people, it would probably not be a good idea to have a robot. But the demand for robotic surgery is so high. In order to maintain high quality surgeons, you kind of have to offer the technology that's out there. So that's really what I think. That's my impression. I'm not like the CEO of the hospital, I'm one of the surgeons, I'm part of their leadership. But I would say that my impression is that the demands of the surgeons is one that's making it so that we are moving towards getting a robot. But it's now 12 years after I've initially requested a robot. So it's a slow process and hopefully will not be a financially detrimental decision.
- [09:20]
A
No. Fascinating to kind of get your thoughts or insight there kind of more broadly and then also as it affects and relates to your center. Really, really exciting to kind of hear the developments there. Minimum based technology as it relates to general surgery. I'd love to get your perspective. Kind of fantastic surgery center, number one ranked on Newsweek, like you'd mentioned, at the top. How are you thinking about growth over the next 12, 24 months or so? Like you said, you've got a partnership with a hospital. High, high volume center. Is growth adding more physicians, more surgeons, tacking on new specialties kind of. What are your thoughts? There's.
- [09:55]
B
Oh, well, we are very excited about growth. We were the first surgical center for our hospital to partner up with. I believe now they have upwards of 12 or more in the greater Los Angeles county area. It's been because we were such a successful endeavor that they continue to do that. And the key is, and I'll add to you, we are adding a third surgical center in our own in the same facility as the original surgical center that was opened. We went up to two during the pandemic then. Now we're up to three by next year. The volume is there, the interest is there. My patients prefer to be operated on at the surgical center. I have my own team at the surgical center, the same circulating nurse and so on. It's much more efficient and much more likely to get standardized care for my specific patients. So I love working at the surgical center. And the more surgeons we recruit to come to the surgical center and bring their cases as opposed to the bulkier, less efficient, time wise hospital, the more they like to be in the surgical center too. So I would say it's like going to a big box hotel versus to like a boutique hotel. You get better service and potentially nicer options.
- [11:25]
A
And that kind of ties into just the last question I have here. I think it'd be a crime for me not to ask. I mean, such a fantastic surgeon, fantastic leadership. It sounds like Beverly Hills Hernia center for ASC physician owners, ASC administrators listening to this podcast. Obviously it's so, so highly rated. Fantastic achievement by Newsweek. One or Two maybe key tips to really kind of elevate that patient experience care. For surgery centers, you're really looking to booster their position and their market. What advice would you have for them?
- [12:01]
B
I would say proceed with caution. I have a feeling there are many doctors and surgeons who are interested in opening up a surgical center because the payment that you see to a facility is so much more than the typical payment for the surgeon provider. And so from a financial standpoint, they feel that, that it just makes sense to open up your own surgery center. But it's highly regulated, it's a very serious business. Staffing is critical and it really needs to be done with a lot of thought and not just be a reflex of, oh, I can have a one or two bed surgery center and make a lot of money off of it. There's so many surgical centers that fail and, and so many that end up in some type of poor outcome for patients because there have been situations where corners are cut and maybe you don't really have a qualified nurse doing this or you don't have an anesthesiologist. You can't cut corners with patient care. And so if you're just looking at it as a way to make money, that's just not appropriate because you've got patients lives at hand. So I would say proceed with ca, surround yourself with really smart, experienced people and make sure you're doing it with good intentions in mind, I think two.
- [13:34]
A
Fantastic kind of tips and takeaways to round out our podcast today. Dr. To an absolute pleasure speaking to you and catching up here and all about your surgery center. Sounds like a ton of excitement, a ton of growth ahead. Thank you so much for taking the time and look forward to catching up with you down the line.
- [13:49]
B
I appreciate it. Thanks so much.