Mahoua Ray, CEO and Medical Director, Kansas Surgery Center

Summary

Becker’s Healthcare Podcast: In-Depth Summary of Episode Featuring Mahua Ray

Release Date: July 27, 2025
Host: Grace Lynn Keller
Guest: Mahua Ray, CEO and Medical Director, Kansas Surgery Center
Recording Location: 22nd Annual Spine, Orthopedic and Pain Management Conference, Chicago

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1. Introduction to Mahua Ray and Kansas Surgery Center

In the July 27, 2025 episode of the Becker’s Healthcare Podcast, host Grace Lynn Keller welcomes Mahua Ray, the CEO and Medical Director of Kansas Surgery Center. Mahua Ray introduces herself as an anesthesiologist and pain physician with a diverse background that includes experience in the VA and academia before transitioning to private practice in 2015. She highlights her pivotal role in establishing the surgery center from the ground up, emphasizing her comprehensive responsibilities that span staffing, credentialing, anesthesiology services, inventory management, nursing, and overall staffing.

“I have been instrumental in getting set up as a surgery center just ground up. We built a building ground up, set up our own pain ASC about four or five years ago.”
— Mahua Ray (00:54)

2. Current Industry Trends in Ambulatory Surgery Centers (ASCs)

Mahua Ray delves into the significant trends reshaping the healthcare landscape, particularly focusing on the migration of procedures from hospital settings to Ambulatory Surgery Centers (ASCs). She points out that surgeries like knee, hip, and shoulder replacements, along with minimally invasive spine and pain management procedures, are increasingly being performed in ASCs. This shift is advantageous for ASC owners as it allows for cost savings and more straightforward contract negotiations.

“A lot of the procedures that were traditionally done in the hospital setting have moved to the ASC. For example, knee hip shoulder replacements, minimally invasive spine in pain management.”
— Mahua Ray (01:56)

However, she also notes challenges such as accreditation and compliance, particularly concerning sterilization processes, which are crucial due to narrowing profit margins. Additionally, Mahua emphasizes the importance of evaluating the economic viability of each procedure to ensure that reimbursements are adequate.

Another critical trend she discusses is cost transparency. With the rise of high-deductible health plans, patients demand clearer information about their out-of-pocket expenses to avoid unexpected billing surprises, which have led to negative patient reviews. Mahua underscores the necessity for ASCs to proactively inform patients about costs upfront.

“We don't want any surprises at the end. When patients were used to going to the hospitals, that was something that physicians and ASC owners were not used to dealing with. But I see a lot of bad patient reviews based on billing.”
— Mahua Ray (02:30)

Lastly, Mahua highlights the aging population, particularly baby boomers, who are living longer and facing more health issues. This demographic shift increases the demand for anesthesiologists who can efficiently manage and review patient charts to prevent cancellations of anesthesia cases.

3. Addressing Staffing and Workforce Challenges

Staffing remains a critical concern for ASCs nationwide, with Mahua Ray identifying two primary areas of difficulty: anesthesiology and registered nurse (RN) staffing. She explains that securing reliable anesthesiology staff is increasingly challenging as many Certified Registered Nurse Anesthetists (CRNAs) opt for locum tenens work.

“Most CRNAs are now doing locum work. So what we do is since we have pain and anesthesia both, we have some of our anesthesiologists help out in the operating room.”
— Mahua Ray (04:10)

To mitigate RN shortages, Kansas Surgery Center has adopted several strategies:

1. Utilizing Staffing Agencies: Building strong relationships with RN staffing companies to ensure access to last-minute staffing needs.
2. Expanding Roles: Hiring more Licensed Practical Nurses (LPNs) and medical assistants to support RNs and streamline operations.
3. Optimizing Preoperative Processes: Reducing RN time in pre-op by having all necessary information, such as med lists, readily available to expedite patient preparation.

“We have tried to hire more LPNs and medical assistants that can at least help expedite what an RN does. We have also tried to be good with our preoperative process so that the RN time is reduced in the pre-op.”
— Mahua Ray (04:50)

4. The Evolving Role of Orthopedics, Spine, and ASCs in Healthcare

Looking ahead, Mahua Ray is optimistic about the future of outpatient care within ASCs. She observes a growing volume of orthopedic, spine, and pain management procedures transitioning to outpatient settings, which bodes well for ASC owners.

“The future looks bright here because of more and more procedures that are moving from the hospital to the ASC.”
— Mahua Ray (05:11)

However, she acknowledges that ASCs are still adjusting to handle the increased volume and complexity of cases. Networking platforms like Becker’s have been instrumental in helping her center discover new technologies and artificial intelligence (AI) solutions to enhance efficiency and patient care.

5. Training Teams for Financial Conversations with Patients

A significant portion of the discussion centers on how Kansas Surgery Center manages financial transparency and patient billing, especially important as more patients are enrolled in high-deductible plans. Mahua Ray outlines several initiatives aimed at improving financial communication:

1. Dedicated Staff: Hiring a patient account manager and an additional billing specialist to handle complex billing issues.
2. Advanced Billing Software: Implementing software that can generate good faith estimates to provide patients with accurate cost projections.
3. Comprehensive Training: Regularly training frontline staff on billing procedures, differentiating between co-pays, deductibles, and out-of-pocket expenses, and facilitating payment plans for patients.
4. Use of AI: Exploring AI-driven solutions to automate and improve the accuracy of cost estimates, although this is still under consideration.

“We are using a software that has helped us. It's also a billing software that will help us do a good faith estimate. I think that's very, very important.”
— Mahua Ray (06:20)

She emphasizes the importance of continuous education by recording training sessions and allocating time for staff to stay updated on billing practices. Despite challenges, these efforts are crucial to maintaining patient satisfaction and minimizing billing-related complaints.

Conclusion

The episode offers a comprehensive look into the current state and future direction of Ambulatory Surgery Centers, particularly within the orthopedic, spine, and pain management specialties. Mahua Ray provides valuable insights into managing industry trends, overcoming staffing challenges, and enhancing financial transparency—all while ensuring high-quality patient care. Her strategies and experiences serve as a valuable guide for other healthcare leaders navigating similar landscapes.

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Transcript

[A]

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[B]

Is Grace Lynn Keller with the Becker's Healthcare Podcast and we are recording live at the 22nd annual Spine, Orthopedic and Pain Management Conference. I'm currently joined by Mahua Ray who is the CEO and Medical Director at Kansas Surgery Center. Thank you for being here and let's start off by having you share a little bit more about yourself, your role and your organization.

[C]

Good afternoon everybody. Beautiful day in Chicago. Here we are at the Riverside at the Swiss Hotel in Chicago. So my name is Mahua Ray. I am an anesthesiologist and a pain physician that was initially out working in the VA and with academia and then returned to private practice in about 2015. I've been instrumental in getting set up as a surgery center just ground up. We built a building ground up, set up our own pain ASC about four or five years ago. I'm currently the Medical Director. I'm invol in all aspects from staffing to being on top of the service lines such as credentialing, anesthesiology services, inventory, nursing and staffing. And I have learned a lot from Beckers and I hope that I can contribute through this podcast.

[B]

Wonderful. Well, thank you for being here and let's start the conversation with what trends and shifts you're seeing right now in the industry that you think are most important for leaders to pay attention to.

[C]

So there are certain trends that all of us know about, including that a lot of the procedures that were traditionally done in the hospital setting have moved to the asc. For example, knee hip shoulder replacements, minimally invasive spine in pain management. That's a big field. So that is really good news for ASC owners because it's a very easy negotiation point for getting contracts set up because you can save a lot of money for it to be done in an outpatient setting. It does come with a lot of accreditation and compliance that you have to follow, especially with regards to sterilization because of our profit margins going down. We also have to look into the future to see what procedures or surgeries are lucrative to do in the ASC because some of them might not make any sense given the reimbursements. So we just have to make sure that every procedure the healthcare economics has worked out. The second thing is that the cost transparency, I think the patients have to be well informed ahead of time about the cost transparency as more and more patients move towards high deductible plans and we don't want any surprises at the end. When patients were used to going to the hospitals, that was something that physicians and ASC owners were not used to dealing with. But I see a lot of bad patient reviews based on billing, you know, and not having transparency. So that is something we are focusing on in the future. The third thing in the shift is that the population, the baby boomers, have become a lot older. The population has gotten sicker and older. So there's a critical role of having MD anesthesiologists who can review charts in order to prevent cancellation of anesthesia cases. So that's that third one.

[B]

Absolutely. And let's also touch on staffing and workforce challenges as these continue to be concerns across healthcare. So how is your organization navigating these pressures and what strategies have you seen work?

[C]

Well, so there are two main parts of ASC staffing that is a problem all through the country. One is the anesthesiology or anesthesia staffing and the second is RN staffing. RN staffing was really difficult during asc. It has gotten better. A whole lot of small business have opened for RN staffing. So we use like a few companies out there that are able to supply us RN on last minute. You have to make sure you have relationship with them with the understanding that you might be in need of an RN at last minute notice for the, for the anesthesiology shortage. There's not much you can do. Most CRNAs are now doing locum work. So what we do is since we have pain and anesthesia both, we have some of our anesthesiologists help out in the operating room. The other thing that we have done for RN shorting is we have tried to hire more LPNs and medical assistants that can at least help expedite what an RN does. We have also tried to be good with our preoperative process so that the RN time is reduced in the pre op. Everything is printed out for her. She has all the med list and everything available. So just utilizing the staff that we have, giving them a lot of help so we can get by with fewer staff.

[B]

And as outpatient care continues to grow, how do you see the role of orthopedics, spine and ASCs evolving with the broader healthcare ecosystem?

[C]

So I think the future looks bright here because of more and more procedures that are moving from the hospital to the asc. I think if I was speaking in a hospital space, I wouldn't be happy at this time. It is coming with growing pains. I don't think ASCs were ready to handle all this orthopedic spine and pain volume and you know, places like Becker helped for us to network and find new technologies and AI to help. So I think the future looks bright.

[B]

Absolutely. And as we wrap our conversation, I'd love to touch on how you train your team. So whether that's clinical or front office, how do you train your teams to have conversations around healthcare costs, insurance coverage and financial responsibility in a way that feels clear and supportive for patients? And why do you see this as important?

[C]

So that's a really good question and something that we struggled as a surgery center in the last few years. You know, you bill the patient and then after a few statements you send them to collections and the patients are upset. So we actually had to hire a patient account manager. We also had to hire an additional billing person in house that first of all understands the difference between co pays and deductibles and out of pocket at expenses. We are using a software that has helped us. It's also a billing software that will help us do a good faith estimate. I think that's very, very important. It's not ideal. Sometimes the estimate is a little bit off and patients might be surprised, but it's within 10% of what is we are going to ask the patient to pay every once a month. All the front office are trained, retrained on how to collect ahead, how to collect an estimate, how to collect a balance, what software we can use to help the patients do payment plans. Very difficult topic actually because as more and more patients are moving to high deductible plans, a surgery center that's dependent on in network has to make sure that proper information is given. The lastly, also what we are doing in the training sessions is that we are recording some of these training sessions and we are allotting free time to our employees to retrain on these things because it's become extremely hard to find front office with billing backgrounds. We are also looking into AI software which we have not yet purchased if that could help and maybe automatically calculate the estimates. Until then we are doing it through the help of a software.

[B]

Yes. Wonderful. Well, thank you so much for joining me today on the Beckers Healthcare Podcast. Again, we are recording live at the 22nd annual Spine Orthopedic and Pain Management Conference.

[C]

Thank you.