Global 1 and the team from Sequoia Surgical Pavilion discuss their process for building and scaling an Outpatient Total Joint Replacement Surgery Program. In this segment, they discuss continuing to scale and growth opportunities in the future.
Global 1 and the team from Sequoia Surgical Pavilion discuss their process for building and scaling an Outpatient Total Joint Replacement Surgery Program. In this segment, they discuss roadblocks and challenges faced along the way.
Global 1 and the team from Sequoia Surgical Pavilion discuss their process for building and scaling an Outpatient Total Joint Replacement Surgery Program. In this segment, they discuss patient education, consistent care team throughout their surgical experience, and the importance of post-op at-home care.
Global 1 and the team from Sequoia Surgical Pavilion discuss their process for building and scaling an Outpatient Total Joint Replacement Surgery Program. In this segment, they discuss working as a team to determine best practices for standardizing trays and consistent protocols for procedures.
Global 1 and the team from Sequoia Surgical Pavilion discuss their process for building and scaling an Outpatient Total Joint Replacement Surgery Program. In this segment, they discuss how their process has evolved in selecting candidates for outpatient TJR surgeries.
Global 1 and the team from Sequoia Surgical Pavilion discuss their process for building and scaling an Outpatient Total Joint Replacement Surgery Program. In this segment, they discuss how they came together and look at outpatient surgery as a team effort.
We are pleased to drop the first video in a 7-part series featuring Scott Leggett as he discusses Bundled Payments & Transparency. Global 1 and the team from Sequoia Surgical Pavilion discuss their process of intentionally scaling an Outpatient Total Joint Replacement Surgery Program.
In this segment, they discuss how bundled payments have helped their center and patients. In addition, they discuss transparency, data, research, and costs.
Keep an eye out for the release of the second video in this informative series.
Swipe Right on Healthcare?
Millennials Connect with Tech & Convenience
When talking to Millennials about health and healthcare, making sure it is communicated clearly via text, an app, or a user-friendly online platform is key. This is the generation of digital natives after all.
According to Pew Research Center and the U.S. Census Bureau, “Millennials have surpassed Baby Boomers as the nation’s largest living adult generation.” Millennials, or Gen Y, shop, eat, communicate, and take care of their health in ways unimagined by previous generations. The technological innovations that have become commonplace with Millennials mean that healthcare will need to continue to adapt to be able to reach younger generations.
Dr. Brian Su is a Board Certified Spine Surgeon, the Chief Development and Strategy Officer of California Orthopedics and Spine, and just shy of being a Millennial himself. He agrees that his Millennial patients prefer to communicate through a screen. “It’s still calling the office and waiting on hold for 20 minutes. I think Millennials don’t have the tolerance for that, and I think they don’t have the time or perhaps the attention span,” says Dr. Su.
This group of young people is growing up and making their own decisions. With that comes healthcare with convenience, speed, and personalization. As the first generation raised with instant internet access, Millennials have high expectations when it comes to selecting a doctor and that doctor’s ability to evaluate their needs.
With telemedicine and telehealth serving as the new norm due to COVID-19, Millennials have not felt the same discomfort as older generations. Prior to the pandemic, many Millennials preferred to see a doctor virtually, stressing the inconvenience of finding time during the day to make appointments. According to Dr. Su, to support communication efforts for the Millennial audience “online platforms and algorithms for scheduling, video visits and being able to easily contact your doctor electronically need to be efficient and user friendly.”
When it comes to Millennial debt and making healthcare decisions, price and transparency also matter. According to Becker’s Hospital Review, “50 percent of Millennials avoid seeing the doctor to save money.”
Echoing this note, Dr. Su believes, “for younger patients, if they practice good preventative care, they typically don’t get sick. So if they don’t get sick, what’s the point of paying for a high-cost plan? Maybe they choose one that has a high deductible, and they just want to be able to get their routine checkups. So I think when you’re young, you’re not really thinking about that kind of stuff. You’re thinking more about your income and being able to save.” It is clear that Millennials prefer to save by choosing a high-deductible insurance plan that carries a lower premium. Knowing they need insurance, they will often choose the plan that will cost the least.
In matters of health, another influence on Millennials’ decisions is confusion, and likely ignorance, regarding how intimidatingly complex modern healthcare works. Transparency is vital.
This younger generation is generally more health-conscious and more proactive. They are willing to spend more money on gym memberships or fitness classes, healthy food, and self-care products. When asked about the difference between health and healthcare, Dr. Su says, “Health is preventative. Most people think of healthcare as reactive, whereas someone’s health really should be proactive. There’s very much been a push towards preventative care and being proactive. Whether it be eating healthier, more vegetarian, eating less red meat, drinking less alcohol, and so on.” Dr. Su finds that Millennials are more in tune with this movement since healthcare costs can be unpredictable.
As a Global 1 surgeon, Dr. Su understands the benefits of cost transparency for his patients. He has seen first-hand patients delay their procedure based on the cost estimate. With cost sensitivity at such high levels, it is essential to make sure patients of all generations understand their medical bill. With a bundled payment program for healthcare procedures, there is a well-established strategy for managing costs and removing economic uncertainty. For the patient, there is one price, one payment, and no surprises.
With the growing number of Millennials in the workforce becoming doctors, physician assistants, nurse practitioners, and so on, it might be an adjustment for Baby Boomers to be treated by someone who could be the same age as their own child.
According to Dr. Su’s Clinical Assistant and Research Coordinator, Christian O’Connor, a Millennial himself, “A lot of patients we see, especially in the older demographic, are hesitant and/or unwilling to see a physician assistant or nurse practitioner as they believe they are unqualified. If there is any drawback between seeing a doctor and a lower-level practitioner, the gap is very small. I’ve found the Baby Boomer generation is pretty unwilling to pursue that route but the younger generation is willing and thankful to be able to be seen sooner and get the same level of care through lower-level practitioners.”
Despite age prejudices, aging Baby Boomers currently do or will eventually lean on their Millennial children to be a healthcare advocate for them. “It’s actually extremely helpful and improves the quality of care for the patient if a family member is present,” says Dr. Su. “Whether or not it’s a son, daughter, spouse, it just has to be somebody that’s a healthcare advocate. As a patient gets older, it’s important because at the end of the day it’s more information to help the physician.” Ultimately the Millennial generation is going to transform the way healthcare is delivered.
It’s no surprise Millennials and even Gen X are turning to fast-acting membership-based medical practices like Forward and One Medical. O’Connor says, “About 10% of our patients are referrals from One Medical with patients generally being in their 40s, or Gen X.” The medical industry is taking the appropriate steps to evolve and meet quick service expectations by making healthcare on these platforms affordable, accessible, and enjoyable.
The healthcare industry must take notice as Millennials present new and distinct challenges. So, will this younger generation swipe left or right?
By Scott Leggett
January 26, 2021
At the forefront of embracing the growing advancements in surgery is Dr. Alexandre Rasouli, a nationally recognized, board-certified spine surgeon. With his focus on the innovations and advancements of technology in surgery, he is paving the way to incorporate these elements into his practice and encouraging other surgeons to follow suit.
“Minimally invasive deformity correction, computer-assisted surgery, and image-guided surgery have revolutionized our ability to successfully treat spinal conditions,” emphasizes Dr. Rasouli.
With stress on efficiency, Dr. Rasouli highlights the importance of making sure everything he does is productive, purposeful, and effective. If something does not add value, he will find a new way to perform procedures more efficiently, and that starts with working at a well-fitted Outpatient Surgery Center.
Dr. Rasouli has found, after working at 90210 Surgery Medical Center (affiliated with Cedars-Sinai) for the past six years, that he has been able to complete multiple complex surgery cases with zero complications. Moreover, understanding the importance of teamwork, he surrounds himself with like-minded, experienced surgeons, nurses, and anesthesiologists to ensure each surgical procedure results in minimal blood loss, short operative time, and minimally invasive techniques to yield strong outcomes.
“Surgeons with a particular skill set can leverage their skills to do surgeries in a setting where patients can go home the same day, regardless of the caliber or magnitude of the surgery. So at that point, we decided that the setting of the surgery suddenly becomes the innovation,” notes Dr. Rasouli.
To gain more traction for this outpatient surgery movement, insurance companies, government entities, and the like will also need to be on board. “We’re going to need vocal surgeons,” says Dr. Rasouli. “The surgeons that are vocal right now are part of the ‘old guard.’ They generally take much longer in surgery, which can lead to additional blood loss and more extended hospital stays for their patients. Those are the surgeons right now that are being looked upon for guidance on policy. In contrast, a surgeon trained in an outpatient surgery center can take approximately half the time to do the same surgery. So it’s going to take some younger, more vocal surgeons to be able to get those entities to start to shift gears a little bit.”
According to Dr. Rasouli, ten years ago, surgeries were driven by scientific studies conducted on the spine. More recently, he has seen a paradigm shift as patients are now more informed. Patients are more likely to conduct their own online research and bring the findings to their surgeon for the procedure they want.
“If a patient wants an artificial disc, it’s because they’ve done the research and they believe an artificial disc is better suited for them,” explains Dr. Rasouli, who is the first surgeon in the nation to use the new modular ProDisc lumbar artificial disk replacement system.
“A surgery is only as complex as the surgeon makes it,” says Dr. Rasouli. To further clarify, complex surgery is “considered complex merely by the fact that they involve a fusion in the back where you have to go in from multiple approaches. There are some surgeries where we have to approach the low back from multiple angles, say from the front and the back. That’s considered a complex surgery. There are surgeries in the neck, for example, where you’re replacing not one disc but several discs simultaneously, say three or four. That’s considered a complex surgery. Any procedure on the mid-spine, what we call the thoracic spine, which carries with it the spinal cord and all those things would be considered a complex surgery,” explains Dr. Rasouli. In addition to completing these complex surgeries in an outpatient setting, they can be done safely and cost-effectively.
There is a well-established strategy for managing costs and removing the economic uncertainty of surgical procedures. That strategy is bundled payments for healthcare procedures. For the patient, there is one price, one payment, and no surprises.
Highlighting the importance of this, Dr. Rasouli says, “some insurance companies have caught on to the value-add proposition. If you can get the same product for a fraction of the price because you’re doing it at an outpatient setting, which is more efficient and doesn’t involve an overnight stay, then it’s less of a financial burden to the system.
In this case, the insurance companies would have to pass those savings onto the system. So I think Global 1 is innovative in that it’s been able to link with a particular payer to offer that and make that a reality. Since migrating more cases to an outpatient setting due to COVID, we’ve seen a 20 percent increase in Global 1 bundled cases with Blue Shield. I’m hopeful other insurance companies will come around.”
When looking to the future, Dr. Rasouli is adamant that if something does not prove efficient, he will not incorporate it. “If I go to wear a pair of goggles that show me exactly where I have to go with my screws, and I wouldn’t need to bring in an x-ray into the room or a microscope, that’s suddenly a big value-add,” notes Dr. Rasouli who is currently working with a company to bring augmented reality headsets into his surgery center.
“In my opinion, the most promising technology in the outpatient setting is an augmented reality headset because remember, you don’t want to add time to the case,” says Dr. Rasouli, who stresses that every millimeter counts when guiding a spinal surgeon through operations.
It is clear that groundbreaking advancements are being made to revolutionize surgery, and “augmented reality, which shows you things that you wouldn’t be able to see no matter how good you are, hold the promise of the future of surgery,” affirms Dr. Rasouli.
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Scott Leggett is co-principal, Global 1. With more than two decades working in orthopedics, Leggett’s experience includes founding a network of independent, physician-owned outpatient surgery centers. In addition, he served as the president and board member of the California Ambulatory Surgery Association (CASA). Find Scott on LinkedIn.
Global 1– As the leader and largest administrator of outpatient surgery center-based perspective and commercial bundled payments in the nation, Global 1 provides an innovative, value-based surgical delivery and payment program. By aligning the facility, surgeon, and anesthesiologist, the Global 1 Bundled Payment Program supports high-quality outcomes in a lower-cost setting, providing a single transparent price for an episode of care. More than 70 bundled procedures are available within specialties including orthopaedics, spine, general surgery, ear/nose/throat, and women’s health.
By Scott Leggett
December 9, 2020
Nine months into the COVID-19 pandemic and cases are soaring. As we head into the colder months, the forecast is grim, with an estimated surge of COVID-19 hospitalizations nationwide. The pandemic has made people pause and re-evaluate their careers, lifestyle choices, social circles, and even their healthcare. At a time when our health is most important, people must prioritize the care they need and identify the safest site for receiving their care. When it comes to surgery, the safest location is an outpatient surgery center or OSC – commonly referred to by the industry and Medicare as ambulatory surgery centers or ASCs.
With the overwhelming need for hospital beds for COVID-19 patients, operating in an OSC setting is the clear choice for elective surgeries. In response, Hospitals across the country are beginning to suspend elective surgeries as these beds are a necessity for COVID-19 patients. Underscoring the importance of safe patient care and health protocols amid a pandemic, the need for these very safe OSC facilities is essential.
Dr. Michael Hannon, a double board-certified Orthopedic Surgeon, was forced to re-evaluate his practice once the COVID-19 shut down occurred, tapping the breaks on any hip and knee surgeries until mid-June. Fortunately, Dr. Hannon was able to use the time to help develop a Robotics Total Joint Program and the comprehensive outpatient protocols to support it at Cedars-Sinai Precision Ambulatory Surgery Center, where he is migrating medically appropriate partial and total knee replacement cases. Located in the heart of Beverly Hills, the center was recently ranked among the Top Ten Best ASC in the US by Newsweek and is part of a network for four ASCs treating patients across all specialties.
“Patient care is important,” notes Dr. Hannon. “People are missing routine screening tests, and, unfortunately, they are not getting all the care that they need. If you’re an end-stage osteoarthritic patient, we can perform a safe procedure at our OSC despite the fact that we are in the middle of a pandemic. We’ve developed the appropriate protocols to make these elective surgeries streamlined and as safe as possible.”
To simplify the billing process that comes with elective surgeries, Dr. Hannon teamed up with Global 1 to help provide one, up-front price for the patient in an outpatient setting via the Global 1 bundled payment program. “In my opinion,” says Dr. Hannon, “for patients that don’t have comorbidities, outpatient centers can provide patients a superior experience. Studies have confirmed this to be the case. The Global 1 program provides price transparency and reduces financial anxiety from the procedure.”
According to Dr. Hannon, “there has been a huge impact on doctors in terms of the flow of patients. Our patient volumes are still down 15-20 percent. Elective healthcare has been significantly affected.” Needless to say, the ability to continue to see and care for his patients in a safe outpatient setting has been vital. Patients and doctors have always put a great deal of trust in outpatient surgery centers to provide high-quality service with a high standard of care.
When the shutdown was enforced in mid-March, Dr. Hannon knew he could not just sit around. “I didn’t stop working because our patients still needed care,” says Dr. Hannon. “It gave me the final push to help an outpatient program, and I am pleased that it has come to life.”
Dr. Hannon has also incorporated robotic surgery to assist with his outpatient knee replacement cases. This technology helps improve outcomes as it provides the surgeon with increased accuracy and consistency.
Another benefit to outpatient surgery is the patient returns home the same day as the surgery. Allowing the patient to recover in the comfort of their own home in a clean and safe environment is key to solving patients’ needs for medical care and potentially slowing the spread of COVID-19. Outpatient centers do not treat sickly people, such as patients with COVID-19 or other infectious diseases.
Finding the silver lining, Dr. Hannon says, “Though COVID-19 has been terrible for so many people, there is some good that comes out of negative situations. Because of the pandemic, we were able to take the time to launch this extensive program. It has given me the time to research, develop, and give my full attention to what was needed. I wouldn’t be surprised if COVID-19 cases continue to increase and elective surgeries at hospitals are halted again. Thankfully, we can continue to provide some needed care in an outpatient setting.”
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Scott Leggett is co-principal, Global 1. With more than two decades working in orthopedics, Leggett’s experience includes founding a network of independent, physician-owned outpatient surgery centers. In addition, he served as the president and board member of the California Ambulatory Surgery Association (CASA). Find Scott on LinkedIn.
Global 1– As the leader and largest administrator of outpatient surgery center-based perspective and commercial bundled payments in the nation, Global 1 provides an innovative, value-based surgical delivery and payment program. By aligning the facility, surgeon, and anesthesiologist, the Global 1 Bundled Payment Program supports high-quality outcomes in a lower-cost setting, providing a single transparent price for an episode of care. More than 70 bundled procedures are available within specialties including orthopaedics, spine, general surgery, ear/nose/throat, and women’s health.
