Imagine this. You're at the Hyatt Regency Chicago surrounded by the top minds in the ambulatory surgery center industry. Welcome to the Becker's 30th annual meeting, the business and operations of ASCs from October 30th to November 2nd 2024. Picture the excitement as you collect business cards from over a 1000 executive level attendees forging priceless connections. Feel the buzz of conversations as you participate in more than 60 sessions led by over 225 elite ASC speakers. Envision yourself gaining actionable insights on topics like private equity strategies, ASC business growth, and innovations in spine, orthopedics, GI, ophthalmology, and cardiology. Now imagine yourself listening to inspiring keynotes from Hall of Fame boxing world champion, Lila Ali, and professional basketball player, Caitlin Clark. Their stories will motivate you to take your business to new heights. You'll leave with a wealth of knowledge and a network of connections to help lead your ASC into the next year. Don't miss out. Get registered today. Visit beckershospitalreviewdot com and click on the events page to find the conference website. That's the beckershospitalreview.com events page. See you in Chicago. This is Laura Dierda with the Becker's Healthcare podcast. I'm thrilled today to be joined by doctor Brian Krenzel, chief quality and development officer at OrthoCarolina as well as board chair for Viewmont Surgery Center, a multispecialty ASC in Hickory, North Carolina. Doctor Krenzel, it's a pleasure to have you on the podcast today. Thank you, Laura. I'm excited to be here, excited to talk about Viewmont and our recent growth as well as all things, orthopedic value in nature. Fantastic. Well, I know we've got a lot to talk about and certainly excited to learn more about, what you're doing at the surgery center. But before we dive in, can you tell us a little bit more about yourself and your background? Sure. I am a fellowship trained adult reconstruction specialist. I have, certainly focused the bulk of my, professional practice career in the hip and knee replacement realm. I have, evolved that into some leadership roles within OrthoCarolina as well as outside of OrthoCarolina and our surgery center venture here in Hickory. Really evolved, I would say, over the past dozen years or so into the value space, really trying to figure out a better way to deliver hip and knee replacement, through improvements in quality as well as, the all important, cost drivers and trying to identify those levers we can pull to to change, the incredibly high cost of health care throughout our country and in our region. So, ultimately, really spend a lot of time living in that, value realm. That's great to hear. Now first and foremost, what are some of the biggest issues that you're following in health care today? What's top of mind for you? In my space, working in value and in my leadership role, really, what we're focusing on and seeing as a main driver is is where can we find the cost containment. I think a lot of a lot of the aspects of of health care focusing on cost have really ignored the value piece, however. And what I mean by that is we see a lot of movement towards various side of service shifting, potentially even out of the country with some of our local employers here in Hickory. But the patients aren't necessarily getting the highest quality care out of that. And when you ignore one piece for the other, you're not necessarily driving value. And, that value equation quality divided by cost seems to be one of the larger hot button issues that is on the talking points for the orthopedic realm, especially with spine and joint replacement surgeries being as historically costly as they've been in the hospital based settings. We're seeing this conversation not just being driven at the highest level from CMS, but also all the way down to the more granular level of local health care delivery with small business and and how they're able to manage their health care spends through through, population health tools, and all the way to bundling, the singular episodes of care. A lot of lot of spectrum there to discuss, but, ultimately, one of the key pieces to that and one of the biggest things that we're seeing is is a shift to some of these higher cost surgeries like hip and knee replacement into the ambulatory surgery space, and that's been something gaining a lot of traction over the past decade, but certainly over the past 5 years, and and COVID was a big driver in that. That makes a lot of sense. And, you know, I I can really appreciate having those procedures going to the outpatient setting. From your perspective, have you seen, you know, patients as well as clinicians get on board with being able to perform more of these higher acuity cases in the surgery center, or has it been a little bit of a a journey to really make that transition? Yeah. I think there's a small subset of patients that are a little bit reluctant. They feel safer in the traditional brick and mortar hospital as opposed to the ambulatory space. But if you take the time to talk to the patients to educate them on why an ASC may be right for them, they tend to really favor that even with those higher acuity cases. I think most people would expect to go to an ambulatory surgery center for rotator cuff or an ACL. Some people look at you kind of wide eyed when you talk about joint replacement or spine surgery in that environment. In fact, interestingly enough, you're seeing side of service shifting from carpal tunnel and trigger finger type cases out of the ASC even into minor procedure rooms that are built in our orthopedic clinics. So we're we're seeing benefit there, where patients may once it paid a facility fee at an ASC rate now coming to the office to have a carpal tunnel and paying an office co pay, which is considerable savings for them, and and that's been proven to be safe, and reproducible from a quality perspective. That side of service shift is very powerful. Once you explain that to patients and they understand it, you get great deal of buy in. That's really great advice and certainly glad that it's worked out well for you. Now I'm wondering, you know, what when you look ahead, what are the things that make you most excited and what are you nervous about? Well, looking ahead, particularly, with what we've been able to create here in Hickory, the thing that makes me most excited is is to gain even more, control and impact on the patient relationship that I have. I I don't I don't have the barriers that often come with traditional inpatient care. We have a lot of freedom in how we choose to deliver care in the ambulatory environment, giving us a lot of opportunity to innovate and to be creative to continue to improve outcome and lower cost. That gets me very excited both from the, ability to control that episode of care, and then expand, the opportunities we can deliver patients. In that same vein, it's exciting to build new service lines. At our ASC in particular, we've expanded our spine service line. Recently, we're offering numerous, ENT cases that have, that have grown such as the Inspire sleep stimulator. We're bringing head and neck cancer cases into our ASC that have typically been done at the hospital. We're able to expand the complexity of the patient from a health perspective. We're able to take a little bit more sick, patients to the ASC, with our anesthesiology group we work with being top of the line and additionally, having overnight stay capabilities at our center as well. From a worry perspective, I think the one worry is that we that we get, too aggressive too fast. When you when you get some opportunity to think outside the box and get some of, for lack of a better term, freedom, I think you need to make sure you're paying attention, not getting too aggressive and getting too far out on the fringes. So taking this, with a scientific cautious stepwise approach as we expand indications and procedures is is the one place where we could slip up, so we need to be smart about that. That, you know, is really I can imagine a fascinating discussion that you're having, and cool to hear, you know, you've been able to expand the types of cases and types of patients you're able to, perform cases on at the surgery center. I'm wondering, you know, when you look at that focus on the value based care and focus on providing additional care for those types of patients, what do you really see as being essential as your guiding light going forward? Do you foresee more of the of, these types of cases going to the surgery center, or what comes next? Sure. I think it's certainly been proven to be safe to do hip and knee replacement in particular to at an ambulatory surgery center, in a same day discharge setting. I think in my practice, studying my individual practice and then looking out at the more large scale macro level, I think it's very reasonable to believe that 75 to 80% of joint replacement patients can safely be done in an ambulatory surgery center. I've recently expanded my indications and and virtually eliminated age as a restriction. Just a couple weeks ago, we did an 86 year old healthy, patient, sent them home the same day from an ASC. Patient's doing beautifully, had good family support. So the number of patients that can shift over there in the joint replacement realm, I think we have good science and a good understanding. I think that number is a little bit perhaps unknown. What percentage of patients could ultimately from a spine perspective be done there? I think we're gathering data and expanding those indications, but I'm very comfortable with the type of patient that we can take to the ASC, and that's a large number. And so it's gonna have a significant impact on on health care spend, across the entire country, quite frankly. That makes a lot of sense, and you're excited for that future to to come. Now before we wrap up our conversation here, what do you think most effective health care leaders will need in order to be successful in the next 2 to 3 years, especially as more of health care goes into the value based realm and outpatient procedures become more common? I think you have to have a a really structured approach to this. You have to have physician leaders that are willing to to step up to change the paradigm of care in your community to I I don't wanna say take risk, but certainly change their practice patterns. It has to be driven, I think, by physicians, particularly in the ambulatory surgery setting where physicians have opportunities for equity ownership. But equally important as in our community with Viewmont Surgery Center, you have to have hospital buy in and partners. What you don't wanna do is create a total war between you and your local hospital where you're pulling all of the volume out of the facilities and leaving them with the highest acuity cases, that are not necessarily the best and healthiest of patients that may be more costly. Our particular situation here in Hickory at Beaumont is really unique. We have 2 hospitals in our community. One is a, for profit private owned facility, and the other is a county facility. The hospitals are both of them joint ventured in our ambulatory surgery center. So for us to have the ability to have recently expanded our surgery center from 3 rooms to 6 rooms, to have the ability to have renovated our surgery center, we needed to have our hospital partners bought in. And in our community, we're very fortunate. Both of our facilities for our regional medical center, which is a Duke, Lifepointe facility and Catawba Valley Medical Center, our county hospital, have had forward thinking leadership that has partnered with us in a cooperative way and not in the manner in which, they've obstructed the growth of the center and the shift to the ASC. The physician leaders, having good strong relationships with your hospital partners are super important. And then from there, it just is a matter of developing the culture at your center, getting the right staff, having fantastic anesthesia partners like we do. Putting all of that together, I think it gives you a recipe for success. I think doctors can be perhaps a little shortsighted if they get too aggressive too quickly, about the growth of the center. And they're not considered particularly in smaller communities like ours, unlike bigger cities, of the implications that side of service shift would have for their local hospital facilities. So my suggestion is to, when possible, think think about partnerships, think about, integrating all aspects of your local health care market into it. Again, we're lucky we have a multispecialty center where we have ENT and pain partners that are able to, be involved in this. And I think when you do it that way, you get a huge win and a huge lift for for multiple people as opposed to one subset of physicians, or a hospital entity in and of themselves. That's really such a great point. And I know that, kind kind of dynamic that you talked about between physician surgery centers and hospitals is a very real and evolving, relationship. I can imagine a lot of, different regions and cities physicians are trying to navigate that. And your advice is certainly helpful to have that stealthy navigation through, and have a very, you know, strong working relationship with those folks because, as you mentioned, it's so important to have all aspects of the health care system represented in the most appropriate way, within the broader communities. I I'm really excited that this partnership that we've created will provide for the next 20 years minimum, opportunity for the patients of our community to find really high quality health care that's going to be affordable. And, and when needed, we have 2 hospital facilities to take them to that will provide similar, care, of that high quality nature, but, you know, obviously not going to be something that everybody needs. So this investment we've made in our facility and our community is one that I think will pay dividends for everybody, all of these stakeholders, and most importantly, our patients and employers locally. Absolutely. That's, you know, really great to hear. Well, thank you so much, doctor Krenzel, for joining us on the podcast today. This has been such a a great conversation, and I look forward to connecting with you again soon. Thank you, Laura. Appreciated, opportunity to speak to you and your time today.