Hello and welcome to another episode of SurgiSnacks

My name is Al Norweb.

I’m the Chief Growth Officer of Surgimate. Hi.

And I’m Justin Rockman, the VP

of Business Development at Surgimate.

Always a pleasure to be with you here, Justin.

So, SurgiSnacks, we are two mates that love

to geek out about anything related to surgical

specialties and the business of surgery.

And during these sessions, we want to try to

deliver you bite-sized content, 5-10 minutes long with

some interesting topics that we hope you’ll enjoy.

And during that, for each session, we want to bring

along some snack that’s sort of representative of the topic

for today. I got to choose last time.

So, Justin, what are we going with today?

Oh, thank you, Al. Yes. My turn.

So it’s Tim Tams, my favorite Australian biscuit.

And it definitely is linked to today’s topic because

the Tim Tam has a chocolate coating on the

top, a chocolate coating at the bottom, and

in the center is

a beautiful chocolate cream. Tasty treat. Absolutely.

And the topic for today is, in fact, centralization.

So we think if you look at the evolution of

private practice, where we’ve gone from small, sort of small

practices all around the country, becoming larger, merging up, we’ve

gone from decentralized group care groups right where you might

have a doctor who has a medical secretary who does

everything for that doctor to more of a specialized

model where maybe you have sub-teams within a practice

that are dedicated to one area.

Maybe they do pre-cert or they

do eligibility or patient financial responsibility.

And as groups have gone from big to kind

of mega in size, where you have private equity

money coming in or you have just private practice

groups consolidating, they’re now centralizing functions.

So not only do I have maybe if

I have three divisions, I’m going from three

different billing teams to one central billing team.

So we see that in a lot of different functional areas.

Right.

And the question is whether or not

surgical care coordination is going to be

the next frontier, especially with a lot

of surgical schedulers working remotely post-COVID.

Is this an area that is primed to be able

to work in a centralized manner and possibly even as

a service, not even having your own internal teams there?

It’s not that there’s a right or wrong model on this.

Being centralized or decentralized isn’t

inherently good or bad.

There’s benefits both ways.

Decentralization is great if you want to

create more innovation and you want to

bring your services closer to the customer.

So if that’s important to you as

a practice, that makes total sense.

Centralization, on the other hand, allows you to

standardize processes, often allows you to control quality

and in many cases, control costs.

So it’s not that it’s right or wrong, but if

you have an interest in doing something like moving to

centralization what are the things you got to be thinking

about? There’s outside of any industry, even outside of healthcare.

When you think about a framework to

consider moving to centralization, there might be

three core elements to consider.

The first is there a regulatory

requirement to move into centralization.

The second, what’s the value, the

organizational value in financial terms that you’re

going to achieve through centralization?

Can you achieve something like a five to

ten percent additional value through moving to this model?

And the third are, what are the risks?

What are the risks that you’re going to encounter?

And if you had all three,

then it’s obviously a no-brainer.

But if you have, maybe only one or

two, it should be something which you consider.

But you have to look at the framework

and you have to look at what needs to happen. So I love that.

So if we look at that for surgical care, coordination

and scheduling, how do we sit on those criteria?

So first, there’s no regulatory need.

There’s nothing legally that’s saying, well, at least not

yet, you never know what’s going to happen.

That’s true, knock on wood.

But there’s nothing necessarily today that’s

saying we have to do this.

So it’s number two or number three.

Number two is, is there a significant financial benefit?

From our perspective, it’s a no-brainer when we

look at these different groups, when we have a

chance to analyze workflows and look at the benefits

of this from reduced cancellations, from better reschedule rates,

from better surgery time utilization, and also from being

able to kind of tamp down the costs, because

this is a very expensive function for many practices.

There’s often five or ten percent of value in that.

So I think we hit number two pretty regularly

if you’re a practice and you look at this.

So it kind of comes down to number three.

Can you manage the risk of trying something like this?

And what would the risks be?

We think about it.

I think there are two core risks that groups have

talked to us about moving to centralization have brought up.

The first is from the perspective of the physicians

as to whether or not they feel that they’re

going to continue to receive the same degree of

care with their own workflows, with their own protocols.

Will a centralized team be able to understand?

How is it that they like to schedule and coordinate?

Do they know their special flavor of

what they want for each other? Unique cases?

What are my equipment reps that I work with?

What are my case lengths? Especially

as you have surgical specialties that

are quite complicated, then it can be

something that surgeons get concerned about.

And the second is, from the perspective of

the patients, practices are often concerned that

the patient will not receive the same degree of

service, the same level of high sort of

experience that they’re going to expect to get.

They’re completely understandable concerns, right?

You can’t get those things wrong. It would cost

a lot as a practice to mess with your

surgery workflows in a way that impacts

actual billing and whatnot, but it has successfully been

done in other areas of the practice.

And I think we both agree 10 or 15 years

ago you might have heard the same thing from doctors.

I can’t centralize my call center, my billing team.

They’ll screw everything up so I can’t centralize it.

But practices have found a way to do it.

So like anything with change management, there’s

a couple of key criteria, right?

You need the right leadership. You need to

impose the right culture and communication plan and

make sure that you distribute out a vision

for what you’re trying to do.

And lastly, I think a really core

tenet of all of these centralization tendencies

has been technology and process.

So if you look at centralizing billing teams, one

of the key enablers for many practices is they

get on one central practice management system.

It’s really hard to bill on a central

team if you’re in three or four

different systems with different processes and different workflows.

So getting them on one technology, same thing for

call center, same thing with HR and managing payroll.

You see that technology is one of the

core enablers here and I think it can

be the same thing with care coordination.

There are systems today that allow you as a

practice to say I want to define exactly the

process I want and I can customize it.

I know Doctor A has very specific requirements and I

can get those built into the system and Doctor B

has different ones, or facility A and facility B and

make sure that all those steps are observed and monitored.

And in fact, because you have it in one

place, you can actually streamline your process and improve

it instead of having to document it on paper

are the ways that most practices would do that.

Everybody’s trying to move to a greater

standardization across all their processes.

There’s also outside influences to ensure

that you are creating standardized processes

that also can be tracked.

Having the right key performance indicators, the right KPIs

for each and every one of those teams.

And if everything is done in a very

dispersed manner, it’s very hard to define those

KPIs and also track them moving forward.

And when it comes down to it, almost getting

close to the end of our time, what are

some of the tips and tricks which we’ve seen

groups use to make this a successful initiative?

I think one of the big sort of mental barriers

for most groups taking a big change like this is

that in many cases it’s an on or off switch.

Like I used the example of billing. If you

install a new system, it goes from Friday it

was one thing, and Monday it’s something new and

everybody has to be ready to go.

And there’s a lot of prep and a lot of

angst around that and things that can go wrong.

So, understandably, you got to

really think through that change.

But in the case of care coordination,

surgical case scheduling coordination,

it’s possible to experiment in this world.

And I think that’s a reasonable approach here.

So, as an example, you might have two or three

divisions in a region, and you might say, well, my

instinct is, well, I have to get them all on

one platform and start to schedule all at once.

I don’t think that’s the right way to go.

You could, for example, say, well, let me

take one subspecialty within my area, right?

My retinal specialist or maybe my

foot and ankle specialist or something,

depending on your surgical specialty.

And because they have a lot of standardization of

process and the types of cases they’ll see

you can say, well, let me carve out just this

group here and let me try to centralize across

those three divisions onto a couple of schedulers today.

Significant cost savings for our practice, right?

And so one is regarding specialty areas.

I think another way to think about this

is also defining what the workflow and the

tasks are across the different teams and identifying

one area, such as, for example, pre-certification.

Can pre-certification be extracted out?

So instead of having a surgical scheduler,

do the pre-cert and get the authorization.

Can that be done by a centralized team?

I’ve been to practices where I’ve seen three

surgical schedulers waiting on the phone, on hold

to speak to the same insurance company.

That’s a really prime area, why couldn’t it, if you’re

thinking about it, something of interest, maybe by subspecialty,

maybe carving out one part of the process itself

and trying to get that centralized.

But a lot of value to be had

here, and I think it’s worth the exploration.

And an interesting topic, something we haven’t

seen really in the industry happening yet,

but very well could become a trend.

And hopefully, you found today’s session interesting.

We are up against our time. That’s right.

It’s now time to enjoy the Tim Tams. So here we go.

Let’s do it.

So if you like today’s session, like, subscribe,

give us comments and we’d love your feedback about how

we can continue to make this better.

Until next time, take it easy. Snack up. Cheers.