December 11, 2019 • 33 mins
On this podcast we talk about how Mr Becker decided to get into law, healthcare law and his journey to Harvard law school. We talk about how important family support is and how his was there for him. Additionally, we discuss physicians and allied healthcare providers roles as we continue dealing with the challenge of access to healthcare in a fiscally responsible manner. Lastly, we talk about ASCs, HOPDs and where Mr Becker sees healthcare headed in the future. This is an amazing man with great insight into the future of our industry and you do NOT want to miss this one!
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Speaker 1 (00:00):
[inaudible].
Speaker 2 (00:01):
Welcome to anesthesia deconstructed science politics
realities.
Listen and miss medicalprofessionals join industry
expert Mike McKinnon to discussthe latest science and medical
advancements, the effects of ourpolitical climate and the
realities of today's changinghealthcare environment.
Let's get started with yourhost, Mike McKinnon.
Speaker 1 (00:28):
Today in the podcast, we're excited to have Mr.
Scott Becker, J D CPA.
He's a 1989 Harvard law schoolgraduate, author of four books
and a leader in the healthcareprofession as a partner in a
national law firm of McGuirewoods.
Scott Becker provides legal andstrategic services exclusively
in the area of healthcare.
In addition to all that, he runsBecker's healthcare, which is
(00:48):
the go to source for healthcaredecision makers and one of the
fastest growing media platformsin the industry with over 3.4
million subscribers.
Welcome to the podcast, Mr.
Becker.
It is our honor to have youhere.
Speaker 3 (01:03):
Well thank you so much Mike.
We appreciate you having me.
Thank you sir.
Speaker 1 (01:06):
So tell us a little about your journey into lie and
your back.
Speaker 3 (01:10):
Sure.
So great question and I see someof the questions you pose.
I feel so non-direct and so nonlinear.
So I ended up in law school.
Goodness.
I grew up in a community wherethe concept was you have three
choices, you can be a doctor, alawyer or an accountant.
Those were the three choices.
I ended up wanting to be inbusiness and slash an accountant
(01:31):
and then went to university ofIllinois as an undergraduate,
which is in the middle of thecountry.
Champaign-Urbana ended upapplying to law school and doing
sort of double business major incollege and accounting, applied
to law school, applied tobusiness school inadvertently
got accepted to Harvard lawschool, ended up in law school,
but it was sort of a verysecondary choice.
(01:52):
But one of those kinds of thingswere once you got into Harvard
law school was hard to turndown.
So when our law school, itwasn't some great planner
design.
This sort of inadvertently endedup there.
Speaker 1 (02:01):
It's crazy.
And I mean Harvard law school ishuge.
That's a, it's where people wantto go.
So once you get the acceptance,it's not like you can turn it
down.
Speaker 3 (02:09):
And that's really how it worked.
Like I came from a family.
My parents are wonderful peopleand they struggled and that the
company my father worked forwent broke when we were in high
school.
So he ended up having to find anew profession, new job, new
business and sort of they to thegreat credit and a chance to go
to another law school on a totalscholarship.
And my parents to their greatcredit were like, no, no, no,
(02:31):
no.
We'll find a way to make thiswork.
And XOs.
I ended up at Harvard law schooland sort of as you said, I had
no visions of going on to lawschool and end up being a
wonderful, wonderful experience.
I had the chance to be ateaching assistant with Barack
Obama, one of my classes, peoplelike that much brighter than
myself.
It was a fascinating experience.
And again, what cards?
My parents who basically steppedup when they really didn't have
(02:51):
the finances to do so and said,we'll help you do this.
You got into Harvard, we'll go.
So it was a great experience.
Speaker 1 (02:57):
That's amazing.
I mean, it's amazing whenparents take that much, you
know, put that much work intotheir children to give them the
best opportunity.
And that's basically whathappened in your case,
Speaker 3 (03:06):
it's really true.
Speaker 1 (03:07):
And how'd you end up getting interested in healthcare
and healthcare law?
Speaker 3 (03:10):
You know, it's so funny because each of these
questions end up being somewhatinadvertent.
I practiced my first two yearsafter law school in a large farm
and like many people did thefirst few years of law school
practicing in a large firm, itwas just, you know, 2040 500
hours a year of billable time.
It was sort of very, verychallenging but brutal.
(03:31):
I was kind of burnt out and sortof the one lesson I came away
with and I started to do somehealthcare corporate work, was
that if I was going to practicefor the long run, I had to sort
of figure out what I wanted todo.
And so I ended up joining a farmthat had quote unquote health
department and healthdepartments were different than
the typical departments.
Most departments in law firmsare built around a specialty
(03:53):
like litigation, corporate workor securities work or
malpractice work or whateverthey are.
Healthcare was built differently.
It's built as an industry group.
So the great thing about is youhad the chance to explore do I
want to do transactional work,regulatory work, you could
choose amongst those groups.
So I sort of inadvertently endedup in healthcare department
(04:15):
because it gave me the option tosort of figure out what I wanted
to do.
And I ended up focusing apractice in sort of the business
side of healthcare.
And that's where we, where weevolved through this.
And that was sort of how I endedup in healthcare.
It wasn't because of, I couldsay that I was like Jonas Salk
and wanted to solve, you know,create penicillin and solve
(04:37):
healthcare problems or, or, ortreat polio or fix cancer,
whatever it is.
It wasn't that, it was nothingthat was altruistic.
It was really me trying to findmyself at the age of 28 and I
tell my kids whenever they'retrying to figure out careers and
they're so worried about it.
And I say, Oh my God, yourfather did fine.
And I couldn't figure out thatwas 2030, you know, and I think
that's not atypical.
Speaker 1 (04:57):
I think that's really common.
And so basically healthcare gaveyou the opportunity to explore a
whole bunch of differentoptions.
It was a huge umbrella for youand opened it up.
Speaker 3 (05:05):
That's exactly right.
And when people are so scared tomake choices, I was able to make
the choice.
I was like, okay, 20% of theeconomy and not knowing myself
so much.
But ultimately in life you haveto narrow yourself to do well.
So it is what it is.
And then it'd be a greatspecialty grade area.
Speaker 1 (05:20):
Oh, that makes total sense.
It's interesting.
I think a lot of our listenerswill not know that about law and
how that works under an umbrellawith so many different options
within healthcare.
So that'll be interesting forpeople listening that may have
an interest in the future.
Speaker 3 (05:33):
100%.
Speaker 1 (05:34):
And then, you know, you develop this amazing
resource, which I've beenreading for years.
Um, Becker's healthcare, whichis an umbrella organization to
which you have Becker's AyersASC, Becker's hospitals, CFOs,
um, the whole thing.
It's a, it's a large consortiumof stuff with a lot of
employees.
You guys are seeing there like1.8 million views a month, over
(05:55):
3 million subscribers.
I mean it's huge.
Tons of people to yourconferences.
I know you just finished one.
Uh, how did you end up goingfrom that to creating this huge
resource, which I mean it'sliterally millions of people are
relying upon.
Speaker 3 (06:08):
Sure.
So it really happened in twosort of core steps.
The first step was early on,we're in our 27th year of one of
our conferences.
It's in the surgery center areaand I was trying to build a name
in healthcare law as, as alawyer who was a leading lawyer
in, in the area.
So we started doing a verysimple newsletter around the
surgery centers and simpleconferences around surgery
(06:30):
centers really to be at theintersection of the world of
health care surgery centers andwalk nicely, sort of
unexpectedly, almost likedeciding to be a lawyer side of
me.
And healthcare unexpectedlystarted to go well, people
started to be attracted to it.
We started to be able to trackaudiences and it was really a
pleasure and a lot of fun.
(06:52):
At some point.
This thing I've been able to do,I've made some nonlinear
decisions is once I've madethose decisions, I've been able
to sort of recognize patternsand double down on what seems to
be working.
At some point in the greatcredit goes to Jessica call our
CEO and why did the editorialleadership and our team at some
point I started hiring peopledirectly into that company to
(07:12):
expand that company beingBecker's healthcare and so about
12 years after really startingyet, I was outsourcing
everything.
To that point about till about15 years ago, 12 years ago, I
started it.
We started to hire folk come inplace and we started to expand.
We were just in surgery centersto begin with.
We grew into two different areasat that point.
(07:33):
Hospitals and health systems inorthopedics and spine, and then
finally you fast forward aboutfive to seven years ago we got
into the health key area, soit's really four core
specialties, hospitals, healthsystems, health it, surgery
centers and spine, and thenwithin those there's different
different publications in thosefour.
But this way ended up being sortof starting to fully the
(07:56):
marketing purposes and grew intoreal business.
Speaker 1 (07:58):
It's pretty amazing.
I mean you started thisessentially at a time when the
internet was in its infancy, soit took some vision to move it
from this newsletter you createdinto what is now this huge
online content creator with alot of information that's
accessible for everybody.
Speaker 3 (08:15):
Well, no thank you and I don't think of it as great
vision.
I think if it, I liked thecompliment, but I think of it
differently.
We got into this and we're justdoing some small things and as
we grew into the hospitalsector, there's a magnificent
publication in the hospitalsector called bottom health care
(08:35):
, which was the great printpublication in healthcare.
There's also a great printpublication in surgery centers
at that time called outpatientsurgery.
And there was another one calledthe surgery center.
And what essentially happenedwas we didn't have the resources
to win in print.
You know, starting a printpublication is a very expensive
(08:55):
endeavor.
You have to print it, you haveto publish it, you have to mail
it, you need all the writersitself.
So we made a decision early on,and this was the smart part of
it, but it wasn't a vision.
It was, Oh my God, we can't winin those areas.
We can't be the best plant.
It's too expensive.
I needed the resources, I wasfunding it myself.
And so we ended up deciding wewould try and be calm in online
(09:18):
publications and in events, andthat was really the direction of
the company.
So we're able to focus veryclearly, almost on necessity,
not out of brilliance and not ata vision without a necessity.
We can't win there.
Let's pick things we could winat.
Speaker 1 (09:32):
Right.
That makes sense.
And also hard work.
I mean, that's the other side ofit, right?
It's not just a, it's not justthat you fell into it, it's more
that you put the effort in inthe work and cause it certainly
was bootstrapped by you guys.
Speaker 3 (09:43):
A lot of work, you know, game takers was, you know,
in the first couple of years Istarted hiring full time people
must have hired 10 or 15 in sortof sorted them out to be left
with several magnificent people.
And those people have reallybeen, you know, there's only,
you know, what I've learned inlife is nothing gets done
without teams.
(10:04):
So whatever you do, nothinggreat gets done without teams.
Anybody who says differently iseither extra ordinary or a liar.
And for me the difference makerin my law practice and in this
business was hiring anddeveloping great teams that go
with having a plan anddeveloping a direction.
Once we sort of clarified thedirection.
Speaker 1 (10:21):
All right, find the right people, put them in the
right positions and give themthe ability to take ownership.
Speaker 3 (10:26):
Yeah, it's really true.
Speaker 1 (10:27):
And now you guys are just coming off of, you
mentioned at your 26th annualmeeting for the ASC side, which
is your oldest one, how manypeople did you have there?
And I just want people to get asense of how huge these meetings
, I mean people should attend iswhat I'm trying to tell them.
Speaker 3 (10:41):
Sure.
So we have our core businessmodel.
I mean the core way we reach ouraudiences on the meeting side is
we have two big houses, twomeetings a year, two big health
I team meetings a year and twobig surgery center meetings,
meetings a year.
A big surgery center meetingmight be 1500 people.
So it's not, it's not thousands.
Our big hospital meeting is5,000 people.
(11:01):
But even in our surgery centermeeting, which is in 26 year
1500 people, but highly focusedon the business of surgery
centers.
And then we try and have thisconcept, lots of sessions to
learn and then a handful of funkeynote sessions at the meeting.
So at this meeting we had peoplelike Kevin O'Leary from shark
tank.
(11:22):
When you saw Dr.
Berg and sort of a famous radiopersonality and the sister of
Mark Zuckerberg, terrific womanleader and speaker sugar Ray
Leonard, the boxer who was justfun to have in person.
Just a pleasure of a person.
And then we have Tucker Carlson,the Fox TV show host, uh, and we
(11:42):
try and be completelynonpartisan.
So talk to her.
Carlson spoke at this meeting,our last meeting team meeting,
Hillary Clinton spoke at, youknow, former secretary of state
Clinton.
We try and be totallynonpartisan, but we do try and
make this mantra in all of ourmeetings.
It's a lots of learning, lots ofeducation, lots of networking
plus entertained.
(12:02):
So we try to have fun keynote.
So it's really become a labor oflove and a great team supports
all of it.
Speaker 1 (12:08):
Yeah.
Meetings like that are reallywhere you get an opportunity to
interact with those who are justas interested as you are in that
sector.
And that's where the experts aregoing to be.
To put all this together.
It's just been a hugeundertaking for you and your
team.
And, uh, you know, I, I want tosay it now.
So the people here, I talked topeople all over the country and
(12:31):
people are very thankful thatyou have created this resource.
I mean they don't know theprocess behind it and I've only
recently learned all of theinformation between how long it
was and all the differentfunctions.
But it is pretty amazing to haveput this together.
People are pretty excited tohave the availability just to
read some of these articles.
I mean, you can't get thatinformation easily anywhere else
(12:53):
and it's all in one place.
So Becker's has been huge.
Speaker 3 (12:57):
It, kudos to editorial team, editorial team,
great leadership, the twoeditors and chief Malik gamble
or not to give him a quick shoutout and a lot of greater sort of
leadership and then the coremission of being short and
concise to the point, you know,giving people what they need to
know, a quick sense of what'sgoing on in the old days.
I think of myself as very brightHarvard lawyer, all this kind of
(13:18):
stuff.
I write long articles that Ithought was interesting, but no
one would read them.
And so we moved towards was theshort concise method of writing
and it took a long time to getan editorial team that was
willing to get on board withthat concept.
And we've got great leadershipthere because what we really
moved towards was away from thewriting that I used to think I
(13:41):
wanted to do in terms of writingtheir audience actually relates
to and wants to read.
It was a fascinating sort ofeducation for me of writing very
deep softball articles andnobody read that, you know?
And then we moved towards short,concise, giving you what they
need.
Here's what's going on in yoursector, here's what's happening.
And that's what people want toknow and want to know what's
going on here.
(14:01):
What's going on there?
Do I have to worry?
Do I have to think differently?
They're not interested inScott's long thoughts.
They're just not.
Speaker 1 (14:07):
Absolutely, it is an art form to shorten something
down.
It's way harder than writing alot.
I'm the same way.
I want to write a long thing, asoliloquy about my thoughts and
no one cares, but they just wantthe bullet points.
Right?
And those, and we're in a, we'rein a world of sound bites and
that's what people are lookingfor.
Speaker 3 (14:22):
It's true.
And what happens is we hadenough data and analytics, I
mean, we talked about, which isget very clear.
You get great clarity of thisway to read that article, this
move.
We're at that article.
I better write more like this,
Speaker 1 (14:35):
for example.
Yeah.
Yeah.
It tells you, they tell you whatthey want essentially.
Speaker 3 (14:40):
Exactly.
Speaker 1 (14:42):
Well, awesome.
It's an amazing story, certainlyfor sure.
And then one of the, you know,one of the questions that I had,
I had mentioned to you is aboutthis executive order that came
out from president talking aboutremoving regulatory barriers and
States and federally, and itkind of relates, um, in part to
APRN CRNs like myself, nursepractitioners, physician
assistants.
How do you see in the futurethat rolling in to impact the
(15:05):
industry?
Speaker 3 (15:06):
Sure.
So it's a great, great question.
And I personally try andcompletely stay out of this
fight that goes on betweenserenade and the medical
doctors, the MD anesthesiologistin the turf way that's there.
The thing that I will comment onis there was no way around it
with the growing population thatlives a lot longer, soon, 25
(15:29):
million people and livinglonger, more people coming into
Medicare every single day.
There is no other way to addressthe shortage of physicians then
to allow people to practice thetop of their license.
It doesn't mean that I'm on oneside or the other, but there's
gotta be this movement to allowwhere you can people rising to
(15:50):
the top of their license becauseyou just, you just, there's just
not enough doctors in thecountry.
There's just not.
It's a problem that we need toaddress for our nation needs to
address.
The doctors are critically,critically important to the
delivery of healthcare.
If you ever need a specialist,you're in a small town, a large
town.
It's just very hard to findthem.
(16:11):
Medical school should beshorter.
There shouldn't be so manyweed-out types of things for
doctors.
There's a lot of brilliantpeople that could be doctors
that are weeded out stupid way.
Uh, we need more doctors orcountries, doctors to the back,
one of the systems to go withtheir nurses to go with the
allied health practitioners.
So I don't have a side of theissue.
I do believe that people need topractice sources of top of their
(16:32):
license and that we're gonnaface horrible shortages in our
country.
Speaker 1 (16:35):
Right.
Effectively we need everyone todo everything they can that
they're trained to do, to try tomitigate the risks that's coming
with so much shortage foreverybody.
Speaker 3 (16:45):
That's about right.
There just is not enoughphysicians, et cetera in the
country, in the log run accessis problem.
Now I'm in the middle of thehealthcare business and to
actually get the back or I needto get for a certain thing for a
family member and you'd useevery connection I hae out and I
can't even imagine we'rebuilding out in the middle.
The healthcare business.
Speaker 1 (17:04):
Right, exactly.
I mean I live in a small ruraltown here.
There's only so many people.
If I wanted a specialist, I'vegot to travel to somewhere where
I don't know these people, Idon't have, my connections don't
exist there in the way that theymight here.
And so it definitely becomescomplicated.
Access is a huge deal.
Speaker 3 (17:20):
No, 100%.
Speaker 1 (17:22):
And when you're looking down the road of all,
all this time you've spentlooking in healthcare, the
healthcare industry dealing withBeckers, what are you see as
head in in the next five yearsto 10 years with surgical
services in general in thehealthcare system?
Do you think this is going toend up in a bundled care
Medicare for all somethingtotally, totally different,
Speaker 3 (17:43):
right?
So that's a great question.
There's three different sort ofcore options people talk about.
They talk about Medicare forall, they talk about a public
option and they talk about thefree market as, let me start
with the free market is not athing.
And what I mean by that is thepercentage of care provided by
(18:03):
Medicare, Medicaid is no matterhow you look at it, getting you
to be a bigger and biggerpercentage regardless of
Medicare for all or a publicoption, 40 50% of all carriers
provided the Medicare andMedicaid now and it's just
simply going to grow given theaging population.
So do I believe in how savingsaccount, consumerism,
(18:24):
transparency.
Absolutely.
What do I believe that theentire healthcare is going to be
a free market.
It's not now in campy.
It's a highly regulated industrythat the government pays for
half of it already.
So then you end up so saying,okay, you could have a
bifurcated pre-market.
We'll never going back to a truefree market.
It's just not happening.
We're not going to have Medicareand Medicaid at this point.
(18:47):
At least my perception is thenyou look at public option and
some of the other issues likefor example, whether you, Hey
president Obama love presidentObama, everybody agrees they
want to be able to get careregardless of preexisting
conditions.
There's certain things,Republicans, Democrats, porn,
rich, whatever ethnicity you arepeople want.
(19:07):
That's one of them.
The other thing that I thinkpeople uniformly or ultimately
want is some sort of publicoption and maybe the public
option is a, you know itcertainly is something that's
wanted by the wealthy and thepoor.
The rich and the not rich peoplewant an option.
(19:29):
They don't want to be heldhostage by an insurance company
works just an insurance company.
There are only choices and so atsome point I assume those two
platforms and maybe I'll havemore consumerism, more
transparency, more healthsavings accounts when adoptables
as well, which already have alot of that, but at some point I
think you'll have this, theserules on insurance that allow to
(19:50):
get coverage regardless ofpreexisting condition and you'll
probably go public option.
Some States are starting to havea public option.
It just seems just like you havethe post office as opposed to
FedEx and ups.
It seems like at the end of theday you're going to end up with
some kind of public option atsome point.
Speaker 1 (20:03):
Yeah, I absolutely agree.
I mean, we're at that pointwhere people have insurance but
they've got a$10,000 deductibleand they make$30,000 a year.
Well that's not reallyinsurance.
That's, that's disaster careinsurance.
Effectively.
Speaker 3 (20:16):
That's exactly what it is.
And that's okay.
That's what insurance wasultimately supposed to be in
the, in the, in the, in the, inthe first case.
But it is, it depends on income.
You know, the insurancecompanies will say to you, we
haven't raised your premiumsthat much.
Yes.
My premiums are still 10 12,000a year for a family of four, et
cetera.
But what they've done is mydeductibles come from 1000 to
(20:36):
6,000 so the reality is my truehealth care costs have gone up
to 16 70,000
Speaker 1 (20:42):
exactly.
Exactly.
And it's unattainable for somepeople frankly, to pay it.
Speaker 3 (20:47):
Oh, hot episode.
Speaker 1 (20:48):
It's just brutal.
Yeah, I agree.
It is.
It's been different for me.
I'm Canadian.
So originally I came fromCanada, moved to the U S to see
that that different type ofsystem has been, it's a stark
contrast.
Very different from what I'mused to.
Speaker 3 (20:59):
Yes.
And then you get questions ofaccess, quality and cost.
And so, you know, you get intoissues, I mean, it's different
for a country of 350 millionversus 50 million.
You get all these differentissues that are out there.
Like you get into veryinteresting cost access and
quality issues.
You know, quality here is verysolid.
There's lots of great things inour system.
There's lots of fantasticthings.
(21:20):
But when you end up with arelative with a, you know, a
life threatening disease, youfind that there's great care in
other countries too, thatthere's places where they're
better than us.
I mean, there's all kinds ofthings that are good about our
country's healthcare system.
There's places where we needimprovement.
Speaker 1 (21:35):
When you're looking down the road at anesthesia, uh,
my profession, what do you seehappening within AFCs and
hospitals down the road in thefuture?
How do you see that whole thingchanging?
Speaker 3 (21:47):
Yeah, no, it's a, it's a, it's a great, great
question.
It's a fascinating question.
I mean certainly you see thisgreat movement towards
outpatient surgery that's begunand continues to begin and
continues to push forward andit's just more and more
consistent outpatient.
Now all of those cases that moveoutpatient, some of them moved
to physician offices, some ofthem moved to surgery centers,
some of them moved to hospitaldepartments.
(22:08):
So it's not as though it wasgreat one with the outpatient
and they're all flooding surgerycenters, surgery centers this
past year actually in terms oftotal numbers of surgery
centers, still numbers ofprocedures, but it's not, it's
not 12%.
It's a couple percent.
And so you continue to see thismovement.
It's bifurcated betweenhospitals, surgery centers, and
really, I shouldn't saybifurcated, it's more than that.
(22:29):
And practice offices.
Speaker 1 (22:31):
Absolutely.
There's some, there's some bigshifts changing and uh, you
know, you're certainly seeingmore surgery centers open and I
think there seems to be a trendtoward HOPD.
These are hospital outpatientdepartments shifting toward the
ASC side, transitioning to ASC,eh, have you been seeing a lot
of that?
I've read a few things onBecker's about a HOPD shifting
(22:51):
to ASC.
Is that something that you've,you've been seeing?
Speaker 3 (22:54):
We don't see that much of it.
We see some of that, I meanstill get paid twice as much as
surgery students get paid forabout the same procedure.
All kinds of historical reasonsfor that.
The med tech CMS goal is to paysurgery centers enough.
They cases migrate out ofhospitals to surgery centers,
but not so much as there'sexcess profit leftover.
(23:16):
And so I don't know where thosenumbers will end up.
Um, you know, and, and hospitalsare trying to, there's some
building of surgeries and somany hospitals, but they're also
trying to keep the reimbursementthey get in the hospital
outpatient department.
Speaker 1 (23:31):
Right.
And that's a lot of money.
A Medicare pays, like you said,about twice as much for the same
procedure or an HOPD versus anASC.
And at some point you wouldexpect the government will be
looking to change that.
If they can do a cheaper thanASC overall savings, more
efficiency assumably then willthere be a push to decrease HOPD
(23:52):
reimbursement?
Speaker 3 (23:53):
Well in the end.
This is the great question.
And of course the hospitalsystems are very, very
important.
Our country's infrastructure isthe biggest employer in lots of
places.
There's a lot of huge positivesabout what the big hospital
health systems do.
And so it's a very cautiouspolitical game between how you
(24:14):
work through politics of pushingcases out of hospitals.
Well, sustaining our hospital dostill do we want to work to take
care of their 325 millionpeople.
So it's a great politicalbalance,
Speaker 1 (24:28):
right?
And you're not seeing thoseprivately owned ASC has taken
all the no pay patients orthey're doing all the indigent
care that the hospital's goingto do.
Speaker 3 (24:36):
It just is the reality of the different
businesses.
And some are for profitbusiness, some are not for
profit businesses and thehassles need some margin to keep
on doing what they do.
And what they do is critical.
You could bash them all youwant, but when you have a
relative that needs hospitalcare, we want them to be around.
Speaker 1 (24:56):
Exactly.
You want that place to be there
Speaker 3 (24:59):
and we want it to be good.
We want it to be good at what itdoes.
Speaker 1 (25:01):
Exactly.
Not just there.
Yeah, that's a good point.
So now as we're moving forward,you know, ASC is obviously
privately owned or are forsurgeons.
Physicians as a group areattractive because you know they
can get a piece of the facilityfee.
It's good business, you know,they, they are incentivize then
to do more cases there.
So overall the model workspretty well and we have a couple
(25:22):
of surgery center contracts andwe see that, you know, surgeons
are, are running, they're tryingto make it happen.
Is there a way that hospitalscan structure and HOPD in a
manner that will have that samething?
Because you know, if you're aphysician and you can get a
piece of this facility fee andyou're doing a lot of cases in
an ASC, but then you want to getinvolved in this HOPD right now
(25:43):
you can't.
So how do you attract thosepeople and keep them at the
hospital?
Speaker 3 (25:48):
Yeah, there's, there's, yeah, there's, there's
two or three questions on that,that are there.
So it's very hard for hospitalsto legitimately give physicians
part of the money that comesfrom the HOPD.
It's just very hard to do itlegitimately.
People try all kinds ofdifferent things and there's
variation, but at the end of theday it's hard to duplicate what
you have in a surgery centereconomically.
The other big problem is notjust economic, it's clinical as
(26:11):
well and it's convenient aswell.
You hear, you know, a surgeon isdoing seven cases a day, eight
cases a day in the Catterickposition, it might be 12 cases a
day if he or she has to fightthe hospital operating room to
do that.
He or she now is spending twodays doing what they could do in
four hours.
And so there are hugeconvenience issue and in a world
(26:31):
where we have shortages ofphysician shortages of allied
health practitioners and greatburnout and great burden, the
surgery center provides a hugeoffset to some of those
problems.
I mean, imagine you would do itin a CNA.
Sometimes instead of getting 10cases done in five hours, you've
(26:53):
got something that's gone wrong.
You have to be there for 10hours, you know, and it, and
it's extremely exhausting.
Everything else.
So surgeons, they get used topracticing in an environment
that they get relatively goodcontrol over and move the
schedule along.
Don't want to go back tohospital, you know, unless they
have to.
Speaker 1 (27:12):
Absolutely.
Absolutely.
I think, I think that'sabsolutely correct and that's
what you hear from themeffectively.
Now in the bigger picture, doyou see healthcare starting to
contract a little?
One of the things that wasdifferent from Canada where I
came from is that things arecentralized and that saves
money.
Right.
Do you think that's coming forus?
I noticed I'm just reading bothon Becker's and other resources
that a lot of smaller hospitalshave closed across the country
(27:34):
over the last few years and sorural facilities kind of like
the one I'm at.
Do you think that's there?
We're heading down that roadmore as a trend.
Decreasing access again?
Speaker 3 (27:43):
Yeah, I mean it's a great, great question.
The smaller facilities in ruralareas, community hospitals and
cities, all of the ultimatelyafter the side, what are they
going to be great at and whatare they not going to do?
So it's, you know, if you're ina rural community, there are two
(28:03):
kinds of rural communityhospitals.
There's those that understandthis is what we're doing and
we're going to do a great, andthere's those that are trying to
do too many things.
And so the great example of therural hospitals trying to do too
many things, you could literallysit in a board meeting where
none of the board members willtake their family members to
(28:24):
that hospital for care.
You follow me?
And the ed is typically a ruralhospital that unfortunately due
today's world is trying to domany things.
They just can't stamp it.
There's not enough physicians,there's not enough staff,
there's not enough anything tokeep those things going in the
right direction.
So you will see more and more ofthis where people travel for
(28:45):
more advanced care, for tertiarycare, for certain types of
things.
The world has become over thelast 50 years, more urban than
it was.
And it's an unfortunate thing,but it is what it is.
I mean, it's almost like in theold days, all these positions
would graduate.
They'd come out in the army andthey'd go anyplace in the
(29:06):
country to be in greatcommunity.
Now for a million reasons,family reasons, spouse reasons,
all kinds of reasons.
They all congregate.
So the more urban area, and it'snot too different with staff.
So you've got a situation whereit's very hard for the community
hospitals to do what they usedto do for a lot of reasons.
(29:28):
And so do I see more of acontraction?
Probably.
Yeah, 100% and then it's notthat the country has to pay to
do all things in every singleplace, but he has to make sure
those people in our communitieshave access to great care in
total.
And it's harder.
But that's why, you know whatyou talked about early pressing
the top of your license, remotecare, virtual care, and
(29:51):
ultimately finding ways tocreate pathways where there's a
great local facility that doesX, Y, and Z.
Well people have the ability toget to a more regional community
hospital or center for morechallenging or critical care.
Speaker 1 (30:06):
Oh absolutely.
I mean there's downward economicpressure on healthcare.
We're all, we all know that.
And ultimately to get, you know,new surgeons, new services that
are rural area that you got topay a premium.
I mean if you could live inScottsdale, Arizona versus small
town Arizona where the biggeststore is Walmart and make more
money down there, why would youcome here?
It's it, it's a difficult thingto, to manage for these small
(30:28):
facilities cause they've onlygot so much resource.
Speaker 3 (30:31):
Yeah.
I mean people are all over theplace where they want to live.
It's just that if there's asmall swath population, health
care system doesn't have theresources to put all the,
recreate all the doctors andeverything else in that
community.
Speaker 1 (30:48):
What's your next big thing?
What's the next big thing forBecker's?
Speaker 3 (30:51):
Yeah, no, for Becker's healthcare, our core
mission is to strengthen theears.
We're in the hospital healthsystem community, the surgery
center community, the health itarea, and then the spine
community.
And we're a big believer in youput 89% of your efforts into
what you're doing currently,what's going well, doubling down
(31:12):
on that.
And then we spend 10 15% of ourtime exploring other areas and
trying to look at those.
And those are more sort of likewhat you call creative dabbling
into either new product lineswithin those four vertical areas
that we're in or a new verticalarea.
But really 89% of our mission isreally focusing on making sure
(31:35):
we've got six meetings a year.
We've been in this for 27 years.
Our businesses never have ameeting, a week meeting.
It's really 20 sector a year.
We don't really want any morethan that.
We want to make sure the thingsthat we do, we actually do
great.
And so it really starts with the[inaudible] efforts in doubling
down on what we're doing.
Speaker 1 (31:52):
Awesome.
I think that's going to servemore people ultimately.
And so what last words of wisdomwould you want to leave?
For our listeners out there, theanesthesia listeners and the
others that are gonna listen tothis podcast, what can you, what
would you tell them about ourindustry?
Healthcare in general.
Speaker 3 (32:07):
Yeah.
No, there's so much.
It's such a broad question.
What we, what we tell people thegreat game in life is to have a
plan and stay in Gates.
And so find your plan, stayengaged.
And then again, we always talkabout nothing happened without,
without great people and greatteams.
I mean I look at what you dousually that gives a job as a
(32:29):
CNA and then you make it a jobtrying to stay in touch with
your community and stay engagedin what's going on and know
what's happening.
And that's half the battle,right?
There is no your core stayengaged and obviously do things
with pretty people.
And so it's just a pleasurebeing on your podcast and
visiting with you.
Thank you.
Speaker 1 (32:47):
Oh, I appreciate it, Scott.
You've been great.
It was fun to talk to you.
I mean, we've had somecommunication in the past and
I've read a lot of your stuff,but, uh, just the opportunity to
have a discussion back and forthhas been amazing.
I'm sure people are gonna reallyappreciate it and thank you for
taking time out.
I know you're really busy to dothis with us and uh, excellent.
Thank you so much.
Thank you very much.
Speaker 2 (33:09):
That's all for this episode of anesthesia
deconstructed.
For more information based ontoday's discussion, be sure to
visitus@anesthesia-deconstructed.com
you'll also gain access to ourblogs, editorials, and more
resources to keep you updated onthe science, politics, and
realities of today's medicalindustry.
That'sanesthesia-deconstructed.com.
[inaudible].
Speaker 2 (00:01):
Welcome to anesthesia deconstructed science politics
realities.
Listen and miss medicalprofessionals join industry
expert Mike McKinnon to discussthe latest science and medical
advancements, the effects of ourpolitical climate and the
realities of today's changinghealthcare environment.
Let's get started with yourhost, Mike McKinnon.
Speaker 1 (00:28):
Today in the podcast, we're excited to have Mr.
Scott Becker, J D CPA.
He's a 1989 Harvard law schoolgraduate, author of four books
and a leader in the healthcareprofession as a partner in a
national law firm of McGuirewoods.
Scott Becker provides legal andstrategic services exclusively
in the area of healthcare.
In addition to all that, he runsBecker's healthcare, which is
(00:48):
the go to source for healthcaredecision makers and one of the
fastest growing media platformsin the industry with over 3.4
million subscribers.
Welcome to the podcast, Mr.
Becker.
It is our honor to have youhere.
Speaker 3 (01:03):
Well thank you so much Mike.
We appreciate you having me.
Thank you sir.
Speaker 1 (01:06):
So tell us a little about your journey into lie and
your back.
Speaker 3 (01:10):
Sure.
So great question and I see someof the questions you pose.
I feel so non-direct and so nonlinear.
So I ended up in law school.
Goodness.
I grew up in a community wherethe concept was you have three
choices, you can be a doctor, alawyer or an accountant.
Those were the three choices.
I ended up wanting to be inbusiness and slash an accountant
(01:31):
and then went to university ofIllinois as an undergraduate,
which is in the middle of thecountry.
Champaign-Urbana ended upapplying to law school and doing
sort of double business major incollege and accounting, applied
to law school, applied tobusiness school inadvertently
got accepted to Harvard lawschool, ended up in law school,
but it was sort of a verysecondary choice.
(01:52):
But one of those kinds of thingswere once you got into Harvard
law school was hard to turndown.
So when our law school, itwasn't some great planner
design.
This sort of inadvertently endedup there.
Speaker 1 (02:01):
It's crazy.
And I mean Harvard law school ishuge.
That's a, it's where people wantto go.
So once you get the acceptance,it's not like you can turn it
down.
Speaker 3 (02:09):
And that's really how it worked.
Like I came from a family.
My parents are wonderful peopleand they struggled and that the
company my father worked forwent broke when we were in high
school.
So he ended up having to find anew profession, new job, new
business and sort of they to thegreat credit and a chance to go
to another law school on a totalscholarship.
And my parents to their greatcredit were like, no, no, no,
(02:31):
no.
We'll find a way to make thiswork.
And XOs.
I ended up at Harvard law schooland sort of as you said, I had
no visions of going on to lawschool and end up being a
wonderful, wonderful experience.
I had the chance to be ateaching assistant with Barack
Obama, one of my classes, peoplelike that much brighter than
myself.
It was a fascinating experience.
And again, what cards?
My parents who basically steppedup when they really didn't have
(02:51):
the finances to do so and said,we'll help you do this.
You got into Harvard, we'll go.
So it was a great experience.
Speaker 1 (02:57):
That's amazing.
I mean, it's amazing whenparents take that much, you
know, put that much work intotheir children to give them the
best opportunity.
And that's basically whathappened in your case,
Speaker 3 (03:06):
it's really true.
Speaker 1 (03:07):
And how'd you end up getting interested in healthcare
and healthcare law?
Speaker 3 (03:10):
You know, it's so funny because each of these
questions end up being somewhatinadvertent.
I practiced my first two yearsafter law school in a large farm
and like many people did thefirst few years of law school
practicing in a large firm, itwas just, you know, 2040 500
hours a year of billable time.
It was sort of very, verychallenging but brutal.
(03:31):
I was kind of burnt out and sortof the one lesson I came away
with and I started to do somehealthcare corporate work, was
that if I was going to practicefor the long run, I had to sort
of figure out what I wanted todo.
And so I ended up joining a farmthat had quote unquote health
department and healthdepartments were different than
the typical departments.
Most departments in law firmsare built around a specialty
(03:53):
like litigation, corporate workor securities work or
malpractice work or whateverthey are.
Healthcare was built differently.
It's built as an industry group.
So the great thing about is youhad the chance to explore do I
want to do transactional work,regulatory work, you could
choose amongst those groups.
So I sort of inadvertently endedup in healthcare department
(04:15):
because it gave me the option tosort of figure out what I wanted
to do.
And I ended up focusing apractice in sort of the business
side of healthcare.
And that's where we, where weevolved through this.
And that was sort of how I endedup in healthcare.
It wasn't because of, I couldsay that I was like Jonas Salk
and wanted to solve, you know,create penicillin and solve
(04:37):
healthcare problems or, or, ortreat polio or fix cancer,
whatever it is.
It wasn't that, it was nothingthat was altruistic.
It was really me trying to findmyself at the age of 28 and I
tell my kids whenever they'retrying to figure out careers and
they're so worried about it.
And I say, Oh my God, yourfather did fine.
And I couldn't figure out thatwas 2030, you know, and I think
that's not atypical.
Speaker 1 (04:57):
I think that's really common.
And so basically healthcare gaveyou the opportunity to explore a
whole bunch of differentoptions.
It was a huge umbrella for youand opened it up.
Speaker 3 (05:05):
That's exactly right.
And when people are so scared tomake choices, I was able to make
the choice.
I was like, okay, 20% of theeconomy and not knowing myself
so much.
But ultimately in life you haveto narrow yourself to do well.
So it is what it is.
And then it'd be a greatspecialty grade area.
Speaker 1 (05:20):
Oh, that makes total sense.
It's interesting.
I think a lot of our listenerswill not know that about law and
how that works under an umbrellawith so many different options
within healthcare.
So that'll be interesting forpeople listening that may have
an interest in the future.
Speaker 3 (05:33):
100%.
Speaker 1 (05:34):
And then, you know, you develop this amazing
resource, which I've beenreading for years.
Um, Becker's healthcare, whichis an umbrella organization to
which you have Becker's AyersASC, Becker's hospitals, CFOs,
um, the whole thing.
It's a, it's a large consortiumof stuff with a lot of
employees.
You guys are seeing there like1.8 million views a month, over
(05:55):
3 million subscribers.
I mean it's huge.
Tons of people to yourconferences.
I know you just finished one.
Uh, how did you end up goingfrom that to creating this huge
resource, which I mean it'sliterally millions of people are
relying upon.
Speaker 3 (06:08):
Sure.
So it really happened in twosort of core steps.
The first step was early on,we're in our 27th year of one of
our conferences.
It's in the surgery center areaand I was trying to build a name
in healthcare law as, as alawyer who was a leading lawyer
in, in the area.
So we started doing a verysimple newsletter around the
surgery centers and simpleconferences around surgery
(06:30):
centers really to be at theintersection of the world of
health care surgery centers andwalk nicely, sort of
unexpectedly, almost likedeciding to be a lawyer side of
me.
And healthcare unexpectedlystarted to go well, people
started to be attracted to it.
We started to be able to trackaudiences and it was really a
pleasure and a lot of fun.
(06:52):
At some point.
This thing I've been able to do,I've made some nonlinear
decisions is once I've madethose decisions, I've been able
to sort of recognize patternsand double down on what seems to
be working.
At some point in the greatcredit goes to Jessica call our
CEO and why did the editorialleadership and our team at some
point I started hiring peopledirectly into that company to
(07:12):
expand that company beingBecker's healthcare and so about
12 years after really startingyet, I was outsourcing
everything.
To that point about till about15 years ago, 12 years ago, I
started it.
We started to hire folk come inplace and we started to expand.
We were just in surgery centersto begin with.
We grew into two different areasat that point.
(07:33):
Hospitals and health systems inorthopedics and spine, and then
finally you fast forward aboutfive to seven years ago we got
into the health key area, soit's really four core
specialties, hospitals, healthsystems, health it, surgery
centers and spine, and thenwithin those there's different
different publications in thosefour.
But this way ended up being sortof starting to fully the
(07:56):
marketing purposes and grew intoreal business.
Speaker 1 (07:58):
It's pretty amazing.
I mean you started thisessentially at a time when the
internet was in its infancy, soit took some vision to move it
from this newsletter you createdinto what is now this huge
online content creator with alot of information that's
accessible for everybody.
Speaker 3 (08:15):
Well, no thank you and I don't think of it as great
vision.
I think if it, I liked thecompliment, but I think of it
differently.
We got into this and we're justdoing some small things and as
we grew into the hospitalsector, there's a magnificent
publication in the hospitalsector called bottom health care
(08:35):
, which was the great printpublication in healthcare.
There's also a great printpublication in surgery centers
at that time called outpatientsurgery.
And there was another one calledthe surgery center.
And what essentially happenedwas we didn't have the resources
to win in print.
You know, starting a printpublication is a very expensive
(08:55):
endeavor.
You have to print it, you haveto publish it, you have to mail
it, you need all the writersitself.
So we made a decision early on,and this was the smart part of
it, but it wasn't a vision.
It was, Oh my God, we can't winin those areas.
We can't be the best plant.
It's too expensive.
I needed the resources, I wasfunding it myself.
And so we ended up deciding wewould try and be calm in online
(09:18):
publications and in events, andthat was really the direction of
the company.
So we're able to focus veryclearly, almost on necessity,
not out of brilliance and not ata vision without a necessity.
We can't win there.
Let's pick things we could winat.
Speaker 1 (09:32):
Right.
That makes sense.
And also hard work.
I mean, that's the other side ofit, right?
It's not just a, it's not justthat you fell into it, it's more
that you put the effort in inthe work and cause it certainly
was bootstrapped by you guys.
Speaker 3 (09:43):
A lot of work, you know, game takers was, you know,
in the first couple of years Istarted hiring full time people
must have hired 10 or 15 in sortof sorted them out to be left
with several magnificent people.
And those people have reallybeen, you know, there's only,
you know, what I've learned inlife is nothing gets done
without teams.
(10:04):
So whatever you do, nothinggreat gets done without teams.
Anybody who says differently iseither extra ordinary or a liar.
And for me the difference makerin my law practice and in this
business was hiring anddeveloping great teams that go
with having a plan anddeveloping a direction.
Once we sort of clarified thedirection.
Speaker 1 (10:21):
All right, find the right people, put them in the
right positions and give themthe ability to take ownership.
Speaker 3 (10:26):
Yeah, it's really true.
Speaker 1 (10:27):
And now you guys are just coming off of, you
mentioned at your 26th annualmeeting for the ASC side, which
is your oldest one, how manypeople did you have there?
And I just want people to get asense of how huge these meetings
, I mean people should attend iswhat I'm trying to tell them.
Speaker 3 (10:41):
Sure.
So we have our core businessmodel.
I mean the core way we reach ouraudiences on the meeting side is
we have two big houses, twomeetings a year, two big health
I team meetings a year and twobig surgery center meetings,
meetings a year.
A big surgery center meetingmight be 1500 people.
So it's not, it's not thousands.
Our big hospital meeting is5,000 people.
(11:01):
But even in our surgery centermeeting, which is in 26 year
1500 people, but highly focusedon the business of surgery
centers.
And then we try and have thisconcept, lots of sessions to
learn and then a handful of funkeynote sessions at the meeting.
So at this meeting we had peoplelike Kevin O'Leary from shark
tank.
(11:22):
When you saw Dr.
Berg and sort of a famous radiopersonality and the sister of
Mark Zuckerberg, terrific womanleader and speaker sugar Ray
Leonard, the boxer who was justfun to have in person.
Just a pleasure of a person.
And then we have Tucker Carlson,the Fox TV show host, uh, and we
(11:42):
try and be completelynonpartisan.
So talk to her.
Carlson spoke at this meeting,our last meeting team meeting,
Hillary Clinton spoke at, youknow, former secretary of state
Clinton.
We try and be totallynonpartisan, but we do try and
make this mantra in all of ourmeetings.
It's a lots of learning, lots ofeducation, lots of networking
plus entertained.
(12:02):
So we try to have fun keynote.
So it's really become a labor oflove and a great team supports
all of it.
Speaker 1 (12:08):
Yeah.
Meetings like that are reallywhere you get an opportunity to
interact with those who are justas interested as you are in that
sector.
And that's where the experts aregoing to be.
To put all this together.
It's just been a hugeundertaking for you and your
team.
And, uh, you know, I, I want tosay it now.
So the people here, I talked topeople all over the country and
(12:31):
people are very thankful thatyou have created this resource.
I mean they don't know theprocess behind it and I've only
recently learned all of theinformation between how long it
was and all the differentfunctions.
But it is pretty amazing to haveput this together.
People are pretty excited tohave the availability just to
read some of these articles.
I mean, you can't get thatinformation easily anywhere else
(12:53):
and it's all in one place.
So Becker's has been huge.
Speaker 3 (12:57):
It, kudos to editorial team, editorial team,
great leadership, the twoeditors and chief Malik gamble
or not to give him a quick shoutout and a lot of greater sort of
leadership and then the coremission of being short and
concise to the point, you know,giving people what they need to
know, a quick sense of what'sgoing on in the old days.
I think of myself as very brightHarvard lawyer, all this kind of
(13:18):
stuff.
I write long articles that Ithought was interesting, but no
one would read them.
And so we moved towards was theshort concise method of writing
and it took a long time to getan editorial team that was
willing to get on board withthat concept.
And we've got great leadershipthere because what we really
moved towards was away from thewriting that I used to think I
(13:41):
wanted to do in terms of writingtheir audience actually relates
to and wants to read.
It was a fascinating sort ofeducation for me of writing very
deep softball articles andnobody read that, you know?
And then we moved towards short,concise, giving you what they
need.
Here's what's going on in yoursector, here's what's happening.
And that's what people want toknow and want to know what's
going on here.
(14:01):
What's going on there?
Do I have to worry?
Do I have to think differently?
They're not interested inScott's long thoughts.
They're just not.
Speaker 1 (14:07):
Absolutely, it is an art form to shorten something
down.
It's way harder than writing alot.
I'm the same way.
I want to write a long thing, asoliloquy about my thoughts and
no one cares, but they just wantthe bullet points.
Right?
And those, and we're in a, we'rein a world of sound bites and
that's what people are lookingfor.
Speaker 3 (14:22):
It's true.
And what happens is we hadenough data and analytics, I
mean, we talked about, which isget very clear.
You get great clarity of thisway to read that article, this
move.
We're at that article.
I better write more like this,
Speaker 1 (14:35):
for example.
Yeah.
Yeah.
It tells you, they tell you whatthey want essentially.
Speaker 3 (14:40):
Exactly.
Speaker 1 (14:42):
Well, awesome.
It's an amazing story, certainlyfor sure.
And then one of the, you know,one of the questions that I had,
I had mentioned to you is aboutthis executive order that came
out from president talking aboutremoving regulatory barriers and
States and federally, and itkind of relates, um, in part to
APRN CRNs like myself, nursepractitioners, physician
assistants.
How do you see in the futurethat rolling in to impact the
(15:05):
industry?
Speaker 3 (15:06):
Sure.
So it's a great, great question.
And I personally try andcompletely stay out of this
fight that goes on betweenserenade and the medical
doctors, the MD anesthesiologistin the turf way that's there.
The thing that I will comment onis there was no way around it
with the growing population thatlives a lot longer, soon, 25
(15:29):
million people and livinglonger, more people coming into
Medicare every single day.
There is no other way to addressthe shortage of physicians then
to allow people to practice thetop of their license.
It doesn't mean that I'm on oneside or the other, but there's
gotta be this movement to allowwhere you can people rising to
(15:50):
the top of their license becauseyou just, you just, there's just
not enough doctors in thecountry.
There's just not.
It's a problem that we need toaddress for our nation needs to
address.
The doctors are critically,critically important to the
delivery of healthcare.
If you ever need a specialist,you're in a small town, a large
town.
It's just very hard to findthem.
(16:11):
Medical school should beshorter.
There shouldn't be so manyweed-out types of things for
doctors.
There's a lot of brilliantpeople that could be doctors
that are weeded out stupid way.
Uh, we need more doctors orcountries, doctors to the back,
one of the systems to go withtheir nurses to go with the
allied health practitioners.
So I don't have a side of theissue.
I do believe that people need topractice sources of top of their
(16:32):
license and that we're gonnaface horrible shortages in our
country.
Speaker 1 (16:35):
Right.
Effectively we need everyone todo everything they can that
they're trained to do, to try tomitigate the risks that's coming
with so much shortage foreverybody.
Speaker 3 (16:45):
That's about right.
There just is not enoughphysicians, et cetera in the
country, in the log run accessis problem.
Now I'm in the middle of thehealthcare business and to
actually get the back or I needto get for a certain thing for a
family member and you'd useevery connection I hae out and I
can't even imagine we'rebuilding out in the middle.
The healthcare business.
Speaker 1 (17:04):
Right, exactly.
I mean I live in a small ruraltown here.
There's only so many people.
If I wanted a specialist, I'vegot to travel to somewhere where
I don't know these people, Idon't have, my connections don't
exist there in the way that theymight here.
And so it definitely becomescomplicated.
Access is a huge deal.
Speaker 3 (17:20):
No, 100%.
Speaker 1 (17:22):
And when you're looking down the road of all,
all this time you've spentlooking in healthcare, the
healthcare industry dealing withBeckers, what are you see as
head in in the next five yearsto 10 years with surgical
services in general in thehealthcare system?
Do you think this is going toend up in a bundled care
Medicare for all somethingtotally, totally different,
Speaker 3 (17:43):
right?
So that's a great question.
There's three different sort ofcore options people talk about.
They talk about Medicare forall, they talk about a public
option and they talk about thefree market as, let me start
with the free market is not athing.
And what I mean by that is thepercentage of care provided by
(18:03):
Medicare, Medicaid is no matterhow you look at it, getting you
to be a bigger and biggerpercentage regardless of
Medicare for all or a publicoption, 40 50% of all carriers
provided the Medicare andMedicaid now and it's just
simply going to grow given theaging population.
So do I believe in how savingsaccount, consumerism,
(18:24):
transparency.
Absolutely.
What do I believe that theentire healthcare is going to be
a free market.
It's not now in campy.
It's a highly regulated industrythat the government pays for
half of it already.
So then you end up so saying,okay, you could have a
bifurcated pre-market.
We'll never going back to a truefree market.
It's just not happening.
We're not going to have Medicareand Medicaid at this point.
(18:47):
At least my perception is thenyou look at public option and
some of the other issues likefor example, whether you, Hey
president Obama love presidentObama, everybody agrees they
want to be able to get careregardless of preexisting
conditions.
There's certain things,Republicans, Democrats, porn,
rich, whatever ethnicity you arepeople want.
(19:07):
That's one of them.
The other thing that I thinkpeople uniformly or ultimately
want is some sort of publicoption and maybe the public
option is a, you know itcertainly is something that's
wanted by the wealthy and thepoor.
The rich and the not rich peoplewant an option.
(19:29):
They don't want to be heldhostage by an insurance company
works just an insurance company.
There are only choices and so atsome point I assume those two
platforms and maybe I'll havemore consumerism, more
transparency, more healthsavings accounts when adoptables
as well, which already have alot of that, but at some point I
think you'll have this, theserules on insurance that allow to
(19:50):
get coverage regardless ofpreexisting condition and you'll
probably go public option.
Some States are starting to havea public option.
It just seems just like you havethe post office as opposed to
FedEx and ups.
It seems like at the end of theday you're going to end up with
some kind of public option atsome point.
Speaker 1 (20:03):
Yeah, I absolutely agree.
I mean, we're at that pointwhere people have insurance but
they've got a$10,000 deductibleand they make$30,000 a year.
Well that's not reallyinsurance.
That's, that's disaster careinsurance.
Effectively.
Speaker 3 (20:16):
That's exactly what it is.
And that's okay.
That's what insurance wasultimately supposed to be in
the, in the, in the, in the, inthe first case.
But it is, it depends on income.
You know, the insurancecompanies will say to you, we
haven't raised your premiumsthat much.
Yes.
My premiums are still 10 12,000a year for a family of four, et
cetera.
But what they've done is mydeductibles come from 1000 to
(20:36):
6,000 so the reality is my truehealth care costs have gone up
to 16 70,000
Speaker 1 (20:42):
exactly.
Exactly.
And it's unattainable for somepeople frankly, to pay it.
Speaker 3 (20:47):
Oh, hot episode.
Speaker 1 (20:48):
It's just brutal.
Yeah, I agree.
It is.
It's been different for me.
I'm Canadian.
So originally I came fromCanada, moved to the U S to see
that that different type ofsystem has been, it's a stark
contrast.
Very different from what I'mused to.
Speaker 3 (20:59):
Yes.
And then you get questions ofaccess, quality and cost.
And so, you know, you get intoissues, I mean, it's different
for a country of 350 millionversus 50 million.
You get all these differentissues that are out there.
Like you get into veryinteresting cost access and
quality issues.
You know, quality here is verysolid.
There's lots of great things inour system.
There's lots of fantasticthings.
(21:20):
But when you end up with arelative with a, you know, a
life threatening disease, youfind that there's great care in
other countries too, thatthere's places where they're
better than us.
I mean, there's all kinds ofthings that are good about our
country's healthcare system.
There's places where we needimprovement.
Speaker 1 (21:35):
When you're looking down the road at anesthesia, uh,
my profession, what do you seehappening within AFCs and
hospitals down the road in thefuture?
How do you see that whole thingchanging?
Speaker 3 (21:47):
Yeah, no, it's a, it's a, it's a great, great
question.
It's a fascinating question.
I mean certainly you see thisgreat movement towards
outpatient surgery that's begunand continues to begin and
continues to push forward andit's just more and more
consistent outpatient.
Now all of those cases that moveoutpatient, some of them moved
to physician offices, some ofthem moved to surgery centers,
some of them moved to hospitaldepartments.
(22:08):
So it's not as though it wasgreat one with the outpatient
and they're all flooding surgerycenters, surgery centers this
past year actually in terms oftotal numbers of surgery
centers, still numbers ofprocedures, but it's not, it's
not 12%.
It's a couple percent.
And so you continue to see thismovement.
It's bifurcated betweenhospitals, surgery centers, and
really, I shouldn't saybifurcated, it's more than that.
(22:29):
And practice offices.
Speaker 1 (22:31):
Absolutely.
There's some, there's some bigshifts changing and uh, you
know, you're certainly seeingmore surgery centers open and I
think there seems to be a trendtoward HOPD.
These are hospital outpatientdepartments shifting toward the
ASC side, transitioning to ASC,eh, have you been seeing a lot
of that?
I've read a few things onBecker's about a HOPD shifting
(22:51):
to ASC.
Is that something that you've,you've been seeing?
Speaker 3 (22:54):
We don't see that much of it.
We see some of that, I meanstill get paid twice as much as
surgery students get paid forabout the same procedure.
All kinds of historical reasonsfor that.
The med tech CMS goal is to paysurgery centers enough.
They cases migrate out ofhospitals to surgery centers,
but not so much as there'sexcess profit leftover.
(23:16):
And so I don't know where thosenumbers will end up.
Um, you know, and, and hospitalsare trying to, there's some
building of surgeries and somany hospitals, but they're also
trying to keep the reimbursementthey get in the hospital
outpatient department.
Speaker 1 (23:31):
Right.
And that's a lot of money.
A Medicare pays, like you said,about twice as much for the same
procedure or an HOPD versus anASC.
And at some point you wouldexpect the government will be
looking to change that.
If they can do a cheaper thanASC overall savings, more
efficiency assumably then willthere be a push to decrease HOPD
(23:52):
reimbursement?
Speaker 3 (23:53):
Well in the end.
This is the great question.
And of course the hospitalsystems are very, very
important.
Our country's infrastructure isthe biggest employer in lots of
places.
There's a lot of huge positivesabout what the big hospital
health systems do.
And so it's a very cautiouspolitical game between how you
(24:14):
work through politics of pushingcases out of hospitals.
Well, sustaining our hospital dostill do we want to work to take
care of their 325 millionpeople.
So it's a great politicalbalance,
Speaker 1 (24:28):
right?
And you're not seeing thoseprivately owned ASC has taken
all the no pay patients orthey're doing all the indigent
care that the hospital's goingto do.
Speaker 3 (24:36):
It just is the reality of the different
businesses.
And some are for profitbusiness, some are not for
profit businesses and thehassles need some margin to keep
on doing what they do.
And what they do is critical.
You could bash them all youwant, but when you have a
relative that needs hospitalcare, we want them to be around.
Speaker 1 (24:56):
Exactly.
You want that place to be there
Speaker 3 (24:59):
and we want it to be good.
We want it to be good at what itdoes.
Speaker 1 (25:01):
Exactly.
Not just there.
Yeah, that's a good point.
So now as we're moving forward,you know, ASC is obviously
privately owned or are forsurgeons.
Physicians as a group areattractive because you know they
can get a piece of the facilityfee.
It's good business, you know,they, they are incentivize then
to do more cases there.
So overall the model workspretty well and we have a couple
(25:22):
of surgery center contracts andwe see that, you know, surgeons
are, are running, they're tryingto make it happen.
Is there a way that hospitalscan structure and HOPD in a
manner that will have that samething?
Because you know, if you're aphysician and you can get a
piece of this facility fee andyou're doing a lot of cases in
an ASC, but then you want to getinvolved in this HOPD right now
(25:43):
you can't.
So how do you attract thosepeople and keep them at the
hospital?
Speaker 3 (25:48):
Yeah, there's, there's, yeah, there's, there's
two or three questions on that,that are there.
So it's very hard for hospitalsto legitimately give physicians
part of the money that comesfrom the HOPD.
It's just very hard to do itlegitimately.
People try all kinds ofdifferent things and there's
variation, but at the end of theday it's hard to duplicate what
you have in a surgery centereconomically.
The other big problem is notjust economic, it's clinical as
(26:11):
well and it's convenient aswell.
You hear, you know, a surgeon isdoing seven cases a day, eight
cases a day in the Catterickposition, it might be 12 cases a
day if he or she has to fightthe hospital operating room to
do that.
He or she now is spending twodays doing what they could do in
four hours.
And so there are hugeconvenience issue and in a world
(26:31):
where we have shortages ofphysician shortages of allied
health practitioners and greatburnout and great burden, the
surgery center provides a hugeoffset to some of those
problems.
I mean, imagine you would do itin a CNA.
Sometimes instead of getting 10cases done in five hours, you've
(26:53):
got something that's gone wrong.
You have to be there for 10hours, you know, and it, and
it's extremely exhausting.
Everything else.
So surgeons, they get used topracticing in an environment
that they get relatively goodcontrol over and move the
schedule along.
Don't want to go back tohospital, you know, unless they
have to.
Speaker 1 (27:12):
Absolutely.
Absolutely.
I think, I think that'sabsolutely correct and that's
what you hear from themeffectively.
Now in the bigger picture, doyou see healthcare starting to
contract a little?
One of the things that wasdifferent from Canada where I
came from is that things arecentralized and that saves
money.
Right.
Do you think that's coming forus?
I noticed I'm just reading bothon Becker's and other resources
that a lot of smaller hospitalshave closed across the country
(27:34):
over the last few years and sorural facilities kind of like
the one I'm at.
Do you think that's there?
We're heading down that roadmore as a trend.
Decreasing access again?
Speaker 3 (27:43):
Yeah, I mean it's a great, great question.
The smaller facilities in ruralareas, community hospitals and
cities, all of the ultimatelyafter the side, what are they
going to be great at and whatare they not going to do?
So it's, you know, if you're ina rural community, there are two
(28:03):
kinds of rural communityhospitals.
There's those that understandthis is what we're doing and
we're going to do a great, andthere's those that are trying to
do too many things.
And so the great example of therural hospitals trying to do too
many things, you could literallysit in a board meeting where
none of the board members willtake their family members to
(28:24):
that hospital for care.
You follow me?
And the ed is typically a ruralhospital that unfortunately due
today's world is trying to domany things.
They just can't stamp it.
There's not enough physicians,there's not enough staff,
there's not enough anything tokeep those things going in the
right direction.
So you will see more and more ofthis where people travel for
(28:45):
more advanced care, for tertiarycare, for certain types of
things.
The world has become over thelast 50 years, more urban than
it was.
And it's an unfortunate thing,but it is what it is.
I mean, it's almost like in theold days, all these positions
would graduate.
They'd come out in the army andthey'd go anyplace in the
(29:06):
country to be in greatcommunity.
Now for a million reasons,family reasons, spouse reasons,
all kinds of reasons.
They all congregate.
So the more urban area, and it'snot too different with staff.
So you've got a situation whereit's very hard for the community
hospitals to do what they usedto do for a lot of reasons.
(29:28):
And so do I see more of acontraction?
Probably.
Yeah, 100% and then it's notthat the country has to pay to
do all things in every singleplace, but he has to make sure
those people in our communitieshave access to great care in
total.
And it's harder.
But that's why, you know whatyou talked about early pressing
the top of your license, remotecare, virtual care, and
(29:51):
ultimately finding ways tocreate pathways where there's a
great local facility that doesX, Y, and Z.
Well people have the ability toget to a more regional community
hospital or center for morechallenging or critical care.
Speaker 1 (30:06):
Oh absolutely.
I mean there's downward economicpressure on healthcare.
We're all, we all know that.
And ultimately to get, you know,new surgeons, new services that
are rural area that you got topay a premium.
I mean if you could live inScottsdale, Arizona versus small
town Arizona where the biggeststore is Walmart and make more
money down there, why would youcome here?
It's it, it's a difficult thingto, to manage for these small
(30:28):
facilities cause they've onlygot so much resource.
Speaker 3 (30:31):
Yeah.
I mean people are all over theplace where they want to live.
It's just that if there's asmall swath population, health
care system doesn't have theresources to put all the,
recreate all the doctors andeverything else in that
community.
Speaker 1 (30:48):
What's your next big thing?
What's the next big thing forBecker's?
Speaker 3 (30:51):
Yeah, no, for Becker's healthcare, our core
mission is to strengthen theears.
We're in the hospital healthsystem community, the surgery
center community, the health itarea, and then the spine
community.
And we're a big believer in youput 89% of your efforts into
what you're doing currently,what's going well, doubling down
(31:12):
on that.
And then we spend 10 15% of ourtime exploring other areas and
trying to look at those.
And those are more sort of likewhat you call creative dabbling
into either new product lineswithin those four vertical areas
that we're in or a new verticalarea.
But really 89% of our mission isreally focusing on making sure
(31:35):
we've got six meetings a year.
We've been in this for 27 years.
Our businesses never have ameeting, a week meeting.
It's really 20 sector a year.
We don't really want any morethan that.
We want to make sure the thingsthat we do, we actually do
great.
And so it really starts with the[inaudible] efforts in doubling
down on what we're doing.
Speaker 1 (31:52):
Awesome.
I think that's going to servemore people ultimately.
And so what last words of wisdomwould you want to leave?
For our listeners out there, theanesthesia listeners and the
others that are gonna listen tothis podcast, what can you, what
would you tell them about ourindustry?
Healthcare in general.
Speaker 3 (32:07):
Yeah.
No, there's so much.
It's such a broad question.
What we, what we tell people thegreat game in life is to have a
plan and stay in Gates.
And so find your plan, stayengaged.
And then again, we always talkabout nothing happened without,
without great people and greatteams.
I mean I look at what you dousually that gives a job as a
(32:29):
CNA and then you make it a jobtrying to stay in touch with
your community and stay engagedin what's going on and know
what's happening.
And that's half the battle,right?
There is no your core stayengaged and obviously do things
with pretty people.
And so it's just a pleasurebeing on your podcast and
visiting with you.
Thank you.
Speaker 1 (32:47):
Oh, I appreciate it, Scott.
You've been great.
It was fun to talk to you.
I mean, we've had somecommunication in the past and
I've read a lot of your stuff,but, uh, just the opportunity to
have a discussion back and forthhas been amazing.
I'm sure people are gonna reallyappreciate it and thank you for
taking time out.
I know you're really busy to dothis with us and uh, excellent.
Thank you so much.
Thank you very much.
Speaker 2 (33:09):
That's all for this episode of anesthesia
deconstructed.
For more information based ontoday's discussion, be sure to
visitus@anesthesia-deconstructed.com
you'll also gain access to ourblogs, editorials, and more
resources to keep you updated onthe science, politics, and
realities of today's medicalindustry.
That'sanesthesia-deconstructed.com.
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