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Becker’s Healthcare Podcast
Nathan A. Merriman, MD, MSCE, Interim Senior Medical Director of Surgical Specialties for the Digestive Health Clinical Program at Intermountain Medical Center
00:13:41
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- [00:00]
A
Hello, this is Francesca Matthews with the Beckers ASC Review podcast. I'm thrilled to be joined today by Dr. Nathan Merriman, the interim Senior Medical Director of the Surgical Specialties Digestive Health Clinical Program at intermountain medical center. Dr. Merriman, thank you so much for being here today.
- [00:18]
B
Thank you for having me, Francesca.
- [00:20]
A
Absolutely. To start us off, could you please introduce yourself and tell us a little bit about your background?
- [00:27]
B
Sure. I won't go all the way back to the beginning, but I will say I grew up in healthcare and medicine on the east coast in academics, went to UNC Chapel Hill for medical school and up to Philadelphia at University of Pennsylvania for residency and fellowship, then got a master's in clinical epidemiology with a focus on clinical trial design and had intended to stay in academics. Then my wife and I decided to go into private practice. She's maternal fetal medicine and then for me and GI in Delaware and loved our experience there for 12 years. Learned a ton about the business side of medicine. Also, we had our own endoscopy center, worked with an amsurg partner to help optimize the clinical, operational and financial health of the endosp, and worked with the health system Christiana Care as well to understand teamwork across health systems and private practice partners, and then also worked with startup companies on learning about innovation and how we can actually work together across different partnerships in health care to be better because we can't all be good at everything. And then decided in 2020, my wife and I decided that we would leave our private practices and join the Intermountain Health team. So we moved our four kids out to Utah and have loved every minute of being a part of Intermountain. And I'll just say candidly, I see a lot of collective strength with an Intermountain system because we can take some parts of academics, some parts of private practice, models of care, and then center on our mission, focus on helping patients live their healthiest lives and working together to prevent avoidable suffering across our communities. I can't say enough about how happy I am to be with Intermountain.
- [02:45]
A
Awesome. Yeah, that's. That's great to hear. And I love speaking with folks who have experience in private practice. I write a lot on the physician leadership side of our publication. And yeah, there's definitely. I'm kind of seeing growing movement towards sort of hybrid models of doing things just to kind of respond to the very dynamic healthcare environment today, which kind of transitions into our next question, which I'm, I'm curious what Are the top three trends that you're following in healthcare today?
- [03:14]
B
Yes. I would start with understanding the patient experience and working toward patient centered design and improving access to care. What we're really trying to work on, and I'm following companies both in startups as well as health systems and private practices, is how can we make it easier for our patients to get the right care they need at the right time in the right venue? By far, that's number one. Human centered care design, I think is something we need to all continue to work on. Because I've said this before, I've never done a colonoscopy without a patient's help. I know that sounds basic, but it is fundamentally true. If we leave our patients out of the design of care, we're going to lose them. I think really focusing on patient centered care is number one. Number two is a massive concern about the cost of health care, which is is unsustainable and more and more awareness around this. And I know this has come in waves before, but I think this is one of the biggest waves that we're seeing in true unsustainability. If we keep doing what we're doing currently in terms of the cost of care, then the third big trend is thinking about innovations in team based care model and technology. I am of the opinion that often people use the word innovation referring to technology, but there's so much more to innovation. As we're trying out new ways of working together, we're trying out at Intermountain, we're really focusing on proactive care, which I believe is the right thing to do. How do we get upstream working with patients on identifying health concerns conditions earlier before they progress and get more costly and more harmful to patients. Proactive care I believe is a form of care innovation and so using team based care models to innovate with our patients would be number three.
- [05:25]
A
Absolutely. And what are you most excited about right now?
- [05:32]
B
I think I'm excited about competition and I don't know if that's a popular response or what others say, but I think if we're competing on the right things, we will all help each other to get better faster. Just in the frame in gi, I think the way we're looking at it is how do we compete against colon cancer? Then using that frame, then we start to see each other across academic centers, community health systems and larger groups as well as private practices and startup companies is we're all teammates fighting against colon cancer. I think I'm very excited about competition and how do we collaborate to Compete on the right things. High safety, high quality care, lower cost of care for our patients and then human centered care with a team based approach with every patient as our teammate. I think that's what I'm most excited about is competing on the right things to help make care better and more affordable for our patients.
- [06:52]
A
That's really interesting framing. I think that sometimes you said, I don't know if that's a popular response. I think most people think about competition in a different way. But what you said, we're competing against colon cancer. This is a collaborative thing and we're, we're competing on the same team. I think that's, that's a really, you know, poignant note there. How are you in your, your center thinking about growth over the next 12 months?
- [07:21]
B
Oh, great. Great question. So, and one thing I should step back and share. When I came to Intermountain in 2020, we had no ambulatory endoscopy centers. And that was very surprising to me because I was a physician, investor and co owner and co manager in one previously and I knew about the value proposition of ambulatory endoscopy centers. And so over the last five years we've worked together at Intermountain to then initiate having ambulatory endoscopy centers in Utah. And we've merged with SEL Health. And so they also, now we're, we're one big Intermountain team of teams. They have three ambulatory endospeed centers in the Denver area that are joint ventures with a very strong aligned private practice partner, Gastroenterology of the Rockies. Now I think as we started up the Altaview ASC which is multi specialty with ent, ophthalmology and gi and next week actually we have the ribbon cutting for our first ever fully ambulatory endoscopy center in Utah with intermountain health at McKaydy. That's very exciting as we then start up and convert our HOPD facility at Riverton Hospital. This is to me fascinating, Francesca, is we are disrupting ourselves by saying we have a hospital based facility and, and we're going to convert that into an asc, an endoscopy at Riverton. And so we're actually going to be making less money. The cost of care for our patients is going to go down as we make that disruption and it's the right thing to do. So going from the McKay Ambulatory Endoscopy center opening next week to Riverton Hospital hopd conversion to an ambulatory endoscopy center in I believe summer of 2026, that is the big growth currently. And then thinking ahead in early 2027, we have a St. George ambulatory endoscopy center we're opening as well. I think I'll share if it's okay. The excited about that growth and understand the challenge in moving a lot of patients out of the hospital based facilities in endospwy we have at Intermountain into these lower cost of care settings is going to be a challenge and I'm really excited about that because we're going to be able to work with our physician partners at each center and then connect the centers to each other to optimize safety, quality, efficiency in the patient experience at every center. That's been a nice benefit of working with surgery partners across our sites in Utah for the surgery ASCs as well as the EndoSp ASES. They're connecting us on a shared platform of who's doing things the best. How can we learn from each other? It's really the intermountain way of working together to improve safety quality, operational efficiency and the human experience for our patients.
- [10:59]
A
Absolutely. And that is so interesting the way you kind of phrase, you know, the, the disrupting yourselves and moving out of the hopd, you know, I think that, I wonder if that's something that we'll see across more systems and you know, ASC organizations as, you know, just kind of the, the migration to outpatient kind of continues and I think that, that the lower cost setting will just kind of continue to prevail is sort of what I'm hearing from sources, but that's definitely super interesting. Anything else to add here? Asked about so far.
- [11:33]
B
The one other thing I'll share is traditionally, and it had been said in a meeting several months ago too is oh, Intermountain doesn't really do ambulatory endoscopy centers. And so we're changing that. And that was the historic perspective. It's really helped connect and align with our GI physician partners because they're also investing in the centers and part owners in the centers. And that's the private practice model I had experienced before. And to be open, that's helped with recruiting. It's helped with also physicians being very engaged and aligned on operational efficiency, working together with our anesthesia, our nursing partners, our surgery partners team to bring out the best in each center. And I think that's going to be exciting to continue to do. And to be honest, it's a unique value proposition I think we have as a health system to have physicians being able to invest and buy into these, both on the surgery ASC side as well as the endospe ASC side.
- [12:46]
A
Absolutely. And we'll have to continue to follow up with y' all to hear more about that, because certainly is very resonant over here. As like I mentioned earlier, just as healthcare kind of evolves, I feel like I'm hearing more and more about just kind of new and, you know, for lack of better term, creative, innovative ways that people are thinking about investment and ownership. So, yeah, that's that's all I have for you today, though. Dr. Merriman, thank you so much for joining us.
- [13:11]
B
Thank you, Francesca.
- [13:13]
A
Absolutely. It's been a pleasure speaking with you, and I look forward to connecting with you again in the future.
- [13:19]
B
Sam.