← Becker’s Healthcare Podcast
Loading summary
Transcript19 lines
- [00:00]
A
Hello, this is Francesca Matthews with the Becker's ASC Review podcast. I'm thrilled to be joined today by Dr. Randy Robbins, President of Valia Anesthesia Associates. Randy, thank you so much for being here today.
- [00:13]
B
Thanks. It's an honor to be here. Great.
- [00:16]
A
To start us off, could you please introduce yourself and just tell us a little bit about your background?
- [00:21]
B
Sure. Like I said, my name is Randy Robbins. I'm a board certified anesthesiologist in the Dallas Fort Worth Metroplex. I'm the founder and president of Valiant Anesthesia Associates. I found practice back in April of 2013 here in Dallas, one of the most competitive markets in the country for anesthesia with two of us, and we're currently about 40 providers and do probably roughly 15,000 cases a year or so now. I'm also the CEO of Vertex Medical Solutions and online scheduling and software. Scheduling software and charge capture management system that we've got then. I'm the medical director at Baylor Surgical Care Centennial. I'm the chief of staff at Methodist South Lake Hospital and I'm also on city council in South Lake. So that's what I do in my spare time.
- [01:11]
A
All right. Lots of experiences here to kind of inform. Inform your perspective. Yeah, we love when, you know, folks have an array of, of experiences to be able to contribute to our conversations here. Kind of just jumping straight into it. What are the top three trends that you're following in healthcare and ASCS today?
- [01:32]
B
So I think, number one, you know, the elephant in the room for ASCs, especially right now, is anesthesia. It's. It's crazy to have been a part of anesthesia for the last. I finished my residency in 03 and came straight into practice and then having gone through, worked for a couple different groups and now having started my own practice, I think we've seen such a massive transition in anesthesia, especially since COVID I think our specialty was hit especially hard with COVID and I think we lost more providers. Not necessarily from a, you know, a mortality standpoint, but I just think from a physician's choosing to exit the specialty standpoint than a lot of other specialties did. So I think it's changed the face of anesthesia when you look at it from a compensation standpoint, when you look at it from a labor force standpoint. And for the first time, honestly, I feel like in, in decades or maybe forever, we're seeing ASCs really, really struggling to find coverage for anesthesia. So I think that's going to be probably the single biggest piece of anesthesia of ASC concern over the next gosh, decade plus, because I don't see, I don't see that changing much from an anesthesia manpower standpoint. Secondly, I think you look at public policy in health care, you know, what is, what are the different bills going to do? What are the different, you know, politicians going to try to put forth that put pressure on medicine in America? I think we do a great job with providing care to patients. I do think that there's a lot of pressure put on physicians and how they do that and where they cut those, those costs for, for savings standpoint. They seem to always come after the physicians. And I think that's going to continue to put more pressure on physicians. And I think you have to start worrying about physician burnout and what it's going to do and how that's going to affect kind of overall, not just ASC anesthesia specifically, but, but you know, surgeons and primary care and everything across the board, they just can't keep making less working harder. You know, I, I heard a physician today quote that she said, you know, we always have a desire to do more with less. And I kind of challenged that a little bit. I said I don't know that it's a desire to do more with less. I think unfortunately we're just being taught, demanded to do more with less on an almost day to day basis. I think the other thing for me that is a huge piece of just overall success for physicians and for facilities and for ASCs and for everyone in industry and across the board is just kind of physician communication. I think there are very, very few people that speak communicate that speak physician that are not physicians. And I don't think physicians do a very good job speaking anything but physician half the time. And I think that we really are going to have to cultivate some leaders that can stand in the gap and really help communicate what the needs of a physician group are or a physician specialty and communicate to those physicians what the needs of a facility are or what industry are or just kind of what payers need or just really stand in the gap. From a communication standpoint. Then when you look at the number of physicians that are becoming employed by either hospital systems or special, you know, private equity or different, different pieces that have oftentimes, you know, a very dichotomous desire in their goals versus what a physician does, it may not always be patient care that they're most concerned about unless that patient care can generate a better bottom, bottom line for them. So I think that that's a very, very concerning trend in medicine that we're seeing is, is private equity in different places stepping in and maybe causing some concern with, with what we do from a quality standpoint. Overall, I do think, like I said, I think quality of care across the board is pretty strong. I think it's very, very rare that you see dips in quality without red flags that should have been caught before. But those are the three, three or four things that I think are really going to be challenging in the ASC marketplace in the next.
- [05:43]
A
Absolutely. Yeah. Those things definitely ring true. Just thinking about the conversations I have here at Becker's every day, that anesthesia component, I think even those who are optimistic can recognize that you just can't really turn out that many new graduates in a short amount of time. And so a lot of our conversations, I think, have been focused on what we're doing in the meantime at the facility level. And on that note, what. What are you most excited about right now on the other end of this conversation?
- [06:15]
B
Well, you heard that. You know, I do. I wear a lot of different hats. So I, I think that for me, an excitement standpoint is, is where anesthesia is. I think for the first time ever in medicine, anesthesia is at the table with a. With a real investment in the conversation. You know, I think we've anesthesia historically been viewed almost as a commodity, and I think that's changing immensely. And I think people are now realizing that we are an important part of the team, and that piece makes a difference for anesthesia providers across the board. And so I'm excited about finally getting to be a part of the conversation and trying to help facilities understand that there's more to a procedure than just the net rev that comes off that case and what we need to do from an or efficiency standpoint and how we're utilizing that and everything across the board board. So I'm excited about that. I'm excited about physician engagement across the board. I think we have a. I think we have a real vacuum in physician leadership that's kind of led us to where we are in medicine across the board in America. And I think it's. It's going to take some really, really strong leaders to step up and stand in the gap and start having some really difficult conversations potentially with a lot of different folks to really turn the tide in medicine and make a difference in the future.
- [07:41]
A
Absolutely. I also write for our physician leadership line, and there's definitely, I think, kind of a younger generation of physicians that are starting to come in and a lot of those conversations I think are kind of starting to happen about how can we close the gap between where physician leadership maybe is now and where we want it to be in the next 10 years, given the very rapid changes in healthcare, AI, all that. But yeah, how are you?
- [08:10]
B
I think a lot of times you see that younger, that younger generation of physicians that are coming out of training, like they're one of the biggest voids in leadership because of the fact that, you know, you've had the 80 hour workweek limitation. They're so, they're so focused on, you know, this work life balance that sometimes they forget that hey, not everything can be balanced for leaders because leadership is a sacrifice period. And a lot of times, you know, they just don't, they don't. The willingness to sacrifice is, is becoming less and less I think in, in each generation it seems like.
- [08:51]
A
Super interesting you say that. Yeah, yeah, definitely. We'll, we'll kind of keep that in mind going forward in those conversations just for that part of the publication because it's definitely something that, you know, I talked to, when I talk to people, I feel like everybody's at a little bit of a different point in the, the larger picture. So yeah, just super interesting to hear you say that. Pivoting a little bit. How are you thinking about growth over the next 12 months?
- [09:18]
B
Well, it's, it's, it's intriguing. Anesthesia growth is, is for the, is for the first time in a long time. It's, it's really easy to grow if you can find people. You know, I literally have probably got no less than five different facilities currently that would love for me to, you know, put in a bid for their, for their coverage. The problem is not growth. The problem is finding the manpower to cover the growth. And so I think for us the piece we're looking at is how do we find the right people to partner with. And I think we have to go beyond looking at that commodity provision of anesthesia and start looking at how do we partner with facilities and really make a value add. We always hear talk about, you know, clinical quality, but again, I think clinical quality, especially in anesthesia, when you look at, it's pretty strong across the board. We've got, we've made such advances from a monitoring and from a perioperative pain control and post op nausea and everything. We've got so many options now that we're doing such a great job from a clinical standpoint, it really starts to become okay. How can we partner with, with a facility and start making a dent on the revenue piece of this, you know, how do we, how do we step in instead of always saying, okay, you just need to write more checks to me, what can we do to help offset that? And a lot of times, like I said, I think it's looking at or efficiency and looking at or utilization and partnering with the leaders of the facility and saying, hey, yeah, if you want to run flip rooms for six different surgeons and have two hour gaps in each of those rooms, you can do that and maybe the net rev on your side makes sense to just pay for the anesthesia to do that. But if we can consolidate and figure out how to work these surgeons cases the right way, where even if we are doing a flip room, we've got something that goes in that gap there that helps make a difference and helps offset, you know, the expense of that. So I think for us, growth is going to be a lot more about quality than quantity. You know, I think, like I said, I think if Covid hadn't happened, like I said, we're a group of about 40 right now, I think we'd have been close to 100 or more because we were growing 40 to 60% year over year for the first, gosh, seven or eight years of our practice. But Covid just put the brakes on all of that and then you turn around and like I said, you see private equity stepping in and here in Dallas you've got probably 70 plus percent of the anesthetics provided by an equity owned provider. And we've seen the cost of coverage for CRNAs and anesthesiologists, you know, double and triple in a lot of instances and that becomes a crippling finance piece for private practice providers. So I think it's going to be really quality over quantity for us and just really finding the right partners to work with over the next 10 years.
- [12:24]
A
Absolutely. For sure. That quality over quantity piece I think is, yeah, again, very, very felt. Based on the other conversations I have here at Becker's. Is there anything else that I didn't ask about that you want to touch on in this conversation?
- [12:38]
B
No, I think that, that the ASC marketplace in general has, is at a real tipping point. We're seeing such a move to the ASCS that the pieces we used, you know, five years ago to market ASC lifestyle and jobs really has changed. We're now seeing almost a competition from the hospitals saying, well, we may be the better lifestyle now. Yes, we have call, but you know, we're not doing as many cases because they've all been pushed to the ASC. So I. I think that the ASCs are really at a tipping point to find out how are we going to manage the volume of growth and the volume of cases and stuff that we're seeing over the next decade. Because I think it's going to be immense as payers continue to put pressure on patients to have their stuff done in asc. And we see an increase in acuity across the board with what kind of patients we're seeing in an ASC environment. But the problem is that increased acuity doesn't necessarily come with an increased compensation, so it costs more to care for a sicker patient without the provision of that revenue. There. That's going to be a concern and there's going to become a squeeze that's going to be untenable at some point in time.
- [13:53]
A
Absolutely, yeah. Hearing you on the tipping point, well, that is actually all I have for you today. Randy, thank you so much for joining us.
- [14:01]
B
Absolutely. Thank you. I appreciate it and look forward to talking again sometime.
- [14:05]
A
Yeah, it's been a pleasure speaking with you and I look forward to it, too.
- [14:09]
B
All right, thanks.
- [14:10]
A
Yep, have a good one.