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Becker’s Healthcare Podcast
Greg Schooler, Chief Operating Officer, Cincinnati GI, CGI Anesthesia Associates, Anderson Endoscopy Center, LLC
00:10:38
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- [00:00]
A
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- [00:36]
B
Is Grace Lynn Keller with the Beckers Healthcare Podcast and we are recording live at the 31st annual Business and Operations of ASCS. I'm currently joined by Greg Schooler who is the Chief Operating Officer at Cincinnati gi CGI Anesthesia Associates and Anderson Endoscopy Center. So thank you for being here, Greg. Let's have us start off by having you share a little bit more about yourself and your work in the ASC space.
- [01:01]
C
Okay. Well I kind of go back to the dawn of ASCs and I've worked for a number of companies including Surgery Center Partners, Endo Center Partners. So I built all kinds of different ASCs, whether it was eye centers, endoscopy centers, multispecialty centers, pain centers. I currently we own a couple centers that I built and we have an endospe center that right now did 13,000 cases last year. It's real busy center, five rooms. I've also worked in private equity and helped roll up the largest nephrology practice in the United states. We had 63 nephrologists and 23 dialysis centers. Well anyway, I've got a long career in a lot of different specialties, neurosurgery, run a urology practice. So long, long time. Almost 35 years in medicine, medical management.
- [01:52]
B
Wonderful. Well, thanks for taking the time to join me today and let's start our conversation regarding the ASC market in the US this is projected to reach $60.8 billion by 2030 and continues to experience strong year over year growth. So from your perspective, what are the most significant trends and market forces driving this expansion and how should ASC leaders be preparing today?
- [02:15]
C
Well, as you know, there's a lot of new centers still being built and I think the insurance industry is driving some of that because they realized what a cost savings they have there and the quality is equivalent or better. So I mean, for example uhc, when we get UHC patients, they will waive the pre cert and the OR and or the prior authorization if they come to an ASE versus going to a hospital. Also, there's no price parity right now, although that's probably going to happen in the future. But right now most of the hospitals, if they have an hopd, for example, are probably bringing in two to three times the money that we get paid for the equivalent procedure. So I think it's a real positive trend for ASCs. And I think the challenge for ASCs going down the road is to avoid being gobbled up, so to speak, by a hospital or by a private equity firm. And I just gave a talk this morning where I gave some really, I think, profound reasons for staying independent and, and some strategies for being able to do that.
- [03:19]
B
And from AI and robotic surgeries to advanced EHR systems, technology remains both a make or break factor and a critical driver of ASC operations at scale. How do you see deeper tech integration shaping the way ASCs deliver care and manage their business over the next few years?
- [03:35]
C
Well, we were one of the first to adopt AI enhanced colonoscopy in the market we're in, in Cincinnati, Greater Cincinnati. We were first to market with, with Medtronic system called GI Genius. And so we did institute that implement that long before the hospital, the university, any of the other practices in town. We also are using AI now to do our charting and it's a good augmentation to our charting. You can walk in the room with your phone or a laptop, talk to the patient. It'll take all that information and what's been collected by the medical assistant or at the front desk, integrate all that into a chart note, which obviously you have editorial control over. But it really saves a lot of time because it does a very good job of doing that. And it helps you pick out your E and m code, the ICD10 code and what level of E and M code you select. So it really helps you also kind of get your billing down right, which I find is kind of a problem for some of our mid level providers, for our NPs or PAs. So those are the things I see in terms of AI and then, you know, in terms of technological innovations. I mean in gi, the quality of the scopes, the imaging, the drivability of the scopes, I mean there is just a ton of things that are improving over the years. So I see a pretty rosy future for technological innovation.
- [04:57]
B
Wonderful. And I guess follow up to that. Is there one technology or innovation in specific that stands out to you as especially transformative?
- [05:04]
C
Well, I think AI is, I mean, you know, we're tracking the ADR rate, they call it adenoma detection rate, and we're not finding a huge bump. If you're a good endoscopist, you're not going to increase that terribly. But if you're a younger guy in training or somebody who's maybe a less skilled provider, it's wonderful. I mean, Dr. Rex at IU is extremely strong on this and he's one of the guys that frankly invented endoscopy. You know, Doug Rex is somebody that almost any GI doctor would say, oh, yeah, I know Dr. Rex. So. So I really think that's probably going to be the biggest driver, which it is in a lot of areas. You know, really nothing in instrumentation change in our specialty, but I mean, there's always innovations. My ex wife is a neurosurgeon and some of the things I've seen happen in neurosurgery over the years are amazing. You know, frameless stereotaxy and some of the new gamma knife stuff. So I, you know, as long as they fund the research, we're going to continue to improve the technology.
- [06:07]
B
Absolutely. And with 60% of health systems considering ASC joint ventures and many ASCs already partnering with systems in their communities, what opportunities do you see for collaboration, whether with other providers or vendors, to strengthen patient care and operational efficiency?
- [06:24]
C
Well, I'm not a fan of collaboration, actually. To be blunt, I think there's a lot of lot to be said for being an independent practice because when you look at the studies and they look at market penetration of private equity and they look at market penetration of employed hospital physicians, it really, the per capita cost for healthcare is higher when there's a higher market penetration of PE or hospital ownership. So I think that's rule one from my point of view for why it's important to try and stay independent. If you already are, there are reasons you might want to sell your practice. If you have an aging physician population, you have a very busy center and you want to monetize that, well, I'm okay with that. But I think if you have a center with, with a profile of physicians throughout their career, where they're at in their careers, and you're doing a healthy volume, I think there's plenty of things you can do to keep that center independent. I talked about some of those this morning at a talk I gave. But I think one of the things you can do, and I do enjoy relationships with hospitals in the Cincinnati market. We're in the P. HO for one and an ACO for another. And that brings in patients. The pho brings in an additional 243,000 covered lives that we take care of. So the ACO that we belong to in that hospital system does all our mips, macra, which saves us at least a full time employee because it's an awful lot of work. So I think there's a lot of opportunity for collaboration. But in terms of actual selling, I think if you sell 51%, there's a government governance issue. If you sell less than that, you know, you still have a cultural mismatch there necessarily. I can recall one time I brought some nurses from a hospital system that wanted us to manage their center, which was a hospital outpatient department center. And I brought the nurses down to our center and I had to tell them frankly, it was a busy Monday. Monday and Friday are the busiest days in a in endo center. I said please don't stand in one place too long or you're going to get run over. And they were, jaws were open because everybody was moving around so fast. And I find that in the hospital there's not that morale maybe or concern for how fast you get things done. But our efficiency is pretty amazing in a private center. So I see a lot of reasons. The care is great. Our center, four years running has been the Newsweek statista highest rank quality wise. And they use publicly available data like CMS in the whole state of Ohio. So I mean doing a lot of cases is also a key. The more you do, the better you do. That's true in almost any specialty. So I, I really think, you know, efficiency is important, Good care is more important, but you can do both those things.
- [09:06]
B
Is there anything else we didn't touch on or any final thoughts you'd like to share as we wrap up our conversation today?
- [09:12]
C
Well, I, I gotta say I think the, I mean I've been doing this a long time and I think the key to all the success you have with any center, I don't care if it's an eye center or endocenter or ortho center or a pain center or whatever it is, is the employees you have working there. Your nurses, your anesthetists. We use a lot of CRNAs. We have our own anesthesia company. That is the key. You know, I, I was once offered a center and I can't remember which one of the big guys it was. Uspi, sca, whoever it was, they literally offered me a center for nothing. And I went and looked at it. It was a four room center. It was really nice. It was in a real nice office building. They I, they left. They said you can have all the OR equipment. I looked through all that. It was all great. I needed some new OR lights. That was about it. The furniture and we'll give you $300,000. And I said no. You know why? Because I didn't have any doctors to put there. That center is worth nothing. Literally. They were just getting rid of their low hanging fruit, you know, and if somebody would take it under one condition and that was sign the long term lease, they just wanted it off their books. So I mean that's just one simple example of what I'm saying. You know, the key to success is having great employees and creating an. So those people will be recruited and retained?
- [10:24]
B
Absolutely. Well, thanks so much for joining me today on the Becker's Healthcare Podcast to share these insights. Again, we are recording live at the 31st annual business and operations of ASCS.
- [10:34]
C
Thank you very much.