Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Maura Cash – The ASC Industry's Role in Reducing the Disparity of Care
111 Plays1 year ago
Maura Cash is the VP of Clinical Strategies here at HST Pathways, and she is here today to talk to us about the ASC industry’s role in reducing the disparity of care. Now if you’re a frequent listener of our show, you know exactly who Maura is and her impact on the industry, so it should be no surprise that she is bringing us this incredibly important information. Together we cover what disparity of care means, what the most common social determinants of health are, how surgery centers come into play, and most importantly, how surgery centers can close the chasm of care.
In our news recap, we’ll cover the FTC’s proposed ban on non-compete laws, the surgeon suing the state of North Carolina over certificate-of-need laws, a tiny patch aiming to reduce the need for bloodwork, and of course, end the news segment with a positive story about a new blood test that can help identify pregnant women who are at a high risk of developing pre-eclampsia.
Articles Mentioned:
Doctors no longer bound by noncompetes under FTC’s proposed ban
Meet the surgeon suing North Carolina over certificate-of-need policy
A Tiny Patch May Someday Do Your Patients' Lab Work
FDA approves blood test able to predict pre-eclampsia in pregnant women
Brought to you by HST Pathways.
Recommended
Transcript
Podcast Introduction
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guests. And then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have. So let's get started and see what the industry's been up to.
Role of ASC in Reducing Care Disparity
00:00:27
Speaker
Hi, everyone. Here's what you can expect on today's episode.
00:00:31
Speaker
Maura Cash is the VP of clinical strategies here at HSC Pathways, and she's here today to talk to us about the ASC industry's role in reducing the disparity of care.
00:00:43
Speaker
Now, if you're a frequent listener of the show, you know exactly who Maura is and the impact she has had on the ASC industry. So it should be no surprise that she's bringing us this incredibly important information. Together, we cover what disparity of care means, what the most common social determinants of health are, how surgery centers come into play, and most importantly, how surgery centers can get started in closing the chasm of care.
00:01:10
Speaker
In our news recap, we'll cover the FTC's proposed ban on non-compete laws, the surgeon suing the state of North Carolina over certificate of need laws, a tiny patch aiming to reduce the need for blood work, and of course, end the new segment with a positive story about a new blood test that can help identify pregnant women who are at high risk of developing preeclampsia. Hope everyone enjoys the episode and here's what's going on this week in Surgery Centers.
Maura Cash's Nursing Journey
00:01:44
Speaker
Hi, Maura. Thanks for joining us today. Thanks for having me. You have been on the podcast before, but just in case our listeners miss that episode, can you share a little bit about yourself and your experience in the surgery center world? Sure.
Understanding Disparity of Care
00:02:01
Speaker
I've been a nurse for 45 years. The last 18 years of that was in the ambulatory surgery world.
00:02:12
Speaker
had every role that you can think of in an ASC, starting with staff first and moving all the way up to resource manager for all the people, parts and equipment that are in the search race center.
00:02:26
Speaker
Very cool. So obviously with all of that experience, you are a very sought after speaker in the industry right now. And this topic we're going to talk about today is one that you actually gave at ASCA this year. And then a few state AAC associations have reached out as well. So due to its popularity and importance, we wanted to get you on the show.
00:02:49
Speaker
to talk about the ASC industry's role in reducing the disparity of care. And I think after every time you do this talk, you and I connect. And one thing I think that we're both always surprised about is how little people are thinking about this topic and how much it is needed. So at a high level, can you share what the term disparity of care means?
Impact of Social Determinants on Healthcare
00:03:13
Speaker
Right. So disparity of care is when people cannot receive
00:03:19
Speaker
the care that they need, and they cannot get the care that they need when they're at a surgery center or any other medical facility. And they also can't have an outcome, a desired outcome from that procedure. So the disparity can be at the access level, it can be at the care level, and it can be at the outcomes level postoperatively.
00:03:47
Speaker
So the disparity itself is just a term that means the equity of care is not being delivered. And there's a huge difference between equality of care and equity of care. So equity means we all have the same potential
00:04:07
Speaker
to reach our full health capacity. Perfect. That's very helpful. We can't obviously talk about disparity of care without talking about social determinants of health, which is another phrase that I think we know pretty well at this point, but it's interesting how much education still needs to be done in this realm. So tell us more about what social determinants of health are and how they fit into this disparity of care idea.
00:04:33
Speaker
So according to the Centers for Disease Control, the social determinants of health are conditions in places where people live, learn, work, and play that affect a wide range of health and quality of life risks and outcomes. So basically, they contribute to the disparity of care because of social environments, things like discrimination,
00:05:02
Speaker
income, education level, marital status, and in physical environments, such as residence, overcrowding, transportation, isolation.
ASC's Role in Addressing Social Determinants
00:05:15
Speaker
So COVID in the last couple of years have really brought this to the attention of everyone. And it's primarily those physical environments, the isolation, the high rents and mortgages, the overcrowding, the immigration issues.
00:05:32
Speaker
the living in tents, shelters, that kind of thing. It's brought it to a huge head in our country that people can't get care. And when they can get care, they can't always achieve the outcomes that we want for them because their social determinants have them living in conditions that
00:05:55
Speaker
badly affect their outcomes. Sure. Yeah. And I think how you said it originally looking at every step of the way, like you have the access issues, then you have the care issues, then you have the post-op issues as well. There's really so many moving parts to this and things that need to be addressed so that everybody could have access to basic human rights like healthcare.
00:06:19
Speaker
Okay. So how do these, I think you gave some examples here, but how do these social determinants of health impact in individuals' healthcare? Can you give us some specific examples of when they might come into play? Sure. Economic stability is the big one, right? So it's employment that it provides a living wage. It's things that support employment like worker protections, paid sick leave, childcare, access to reliable transportation.
00:06:48
Speaker
and affordable housing. Those economic stability things can cause people to not even be able to seek the care that they need, to not be able to afford the care that they need. And even if they can't afford it and they can't seek it, they may not be able to get there. We have to keep in mind that economic stability is a huge player. And then we have the social and community context. So
00:07:15
Speaker
their own communities? Do they have discrimination there? Are there conditions in the workplace that put them much higher on the injury scale? Are they in areas where they cannot even get out to exercise? Their environment exposes them to very healthy risk behaviors. Those kinds of things that affect how they can access the care are really huge. And then the kind of care that's available for them.
00:07:46
Speaker
Sure. Definitely. Okay. Let's talk about the surgery center's role. So how can surgery centers and our listeners help to start to identify how some of these social determinants of health might be impacting their patients and then what can they do to lessen the disparity of care? Believe it or not, the most important social determinant of health is not socioeconomic. It's education.
00:08:16
Speaker
And ASCs can play a huge role in educating our patients once we've identified what their educational needs are. In that aspect, ASCs can certainly provide education in a format that best suits their patient population. If you have illiterate patients, written discharge instructions are really not going to help those people. If they speak a foreign language but they can't read that language,
00:08:47
Speaker
You might have some trouble educating them beforehand about what their procedure is going to entail and after the fact, what they need to do to best recover and have the best outcome from those procedures. So education is a huge piece of this, but I think the primary thing that ASCs can do, and we do many things well, but one of the primary things that we could do is identify
00:09:17
Speaker
those people that need a little help start to get those best outcomes. We can do that by asking the right assessment questions. A lot of doctors' offices now do social determinants of health questionings for all of their patients. When they send in a request for surgery, attach that social determinant of health questionnaire so that you can see what kind of needs this patient might have before you actually schedule their procedure.
00:09:48
Speaker
Sure. So somebody's listening and they're ready to do an internal check, see if they're doing the necessary things to cover the spaces. Do you think that the assessment is the core of being able to determine patients who might need an extra leg up? Like the pre-assessment questionnaire? I think the assessment is important, but I think a lot of people might be reluctant to admit that
00:10:16
Speaker
Maybe they used their food money to buy their post-op meds, or maybe they don't have the best diet because they can't afford some quality food. So maybe they have food insecurities and they're not willing to admit it. Maybe they came into your center in the dead of winter and they only have a sweater on and you can observe certain things, right? Cleanliness, appropriate clothing without
00:10:45
Speaker
necessarily embarrassing them or judging them on these things. But still you could say, it's really cold out there today. We have a lot of coats in our lost and found. Maybe you might want to take the coat home because keeping your body warm is super important for the healing process. So you can tie those things together, but sometimes assessments are not accurately answered and you'll have to use your visual cues and ask the patient
00:11:15
Speaker
in a roundabout way to get the answers that you need. Yeah. And so it sounds like the assessment observation, and then also just building that trust with them and making them feel not judged. And like, it's a safe space for them to share whatever is actually going on when the doctor or post-op nurse shares any instructions with them, making them
00:11:40
Speaker
feel like they can honestly respond and say, I don't have access to three meals a day or whatever it might be. Yeah. Nurses, particularly your pre-op call nurses and your discharge nurses are in such a unique position to build that trust and show no judgment, but just empathy and support and give them some tools that they can use to better have
00:12:09
Speaker
access to what they need to heal after surgery. Yeah. And I heard you give this example, maybe it was at ASCA, I think it was primarily around transportation and how if a patient calls and needs to reschedule or cancels last minute, obviously it's frustrating. But getting to the root cause of why, I can't
00:12:32
Speaker
fill a morning appointment and it's like, okay, maybe the bus schedule doesn't work like that or maybe their significant other, they share a car and the significant other will be taking that car to work. And just trying to understand with empathy, why are you unable to follow these instructions and things like that? Exactly. I mean, cancellation is very costly for the ASC, but also delayed treatment is costly for patients, right? So if we ask that second question,
00:13:02
Speaker
if they just say, Oh, I can't get their transportation. Like you said, maybe they only have childcare for this window. Maybe they only have a buddy to take them there and bring them home and you've changed their times two or three times. And now that neighbor or that friendly face at church is not able to assist them. So we have to be considerate of their time and
00:13:29
Speaker
helping them to understand why it was important to change the time of their surgery, but also dig a little deeper, like you said, and ask those follow-up questions to see if maybe we can assist them in part of that transportation. Yeah. And another thing too is I feel like we always talk about how important it is for surgery centers to be members of their community and to
00:13:55
Speaker
not necessarily partner with other businesses, but be aware, build relationships and community education. And it also seems like it would be a great idea if they're not doing it already for surgery centers to keep a list of resources on hand. So here are transportation options, here are food delivery services, whatever it might be. Exactly. And there's so many services in our communities that we often don't think about taking advantage of because
00:14:22
Speaker
ASCs in particular have always lived in this sort of separate little bubble where our patients are elective surgeries and they usually have insurance or pay in advance or if they made arrangements for the payment for that surgery. And they're usually in and out in a day. So we don't typically think of their social determinants of health affecting
00:14:50
Speaker
their care and that we could do much to help their situation. But the truth is there's so many agencies locally and there's an awful lot of philanthropic associations like the Lions Club and sororities and fraternities and those kinds of things that offer services that we never tapped into because our patients have always been
00:15:14
Speaker
outside of the usual fray of hospital care. But more and more procedures have been brought to the ASC. More and more of those patients are of sick or chronic health, maybe, or additional conditions. And there are bigger surgeries that sometimes require longer length of stay. We are getting some patient populations that we never tapped into before. And we need to think about these social determinants of health
00:15:43
Speaker
if we want to provide the best care that we can. Yep. I agree. So if somebody is listening that would like to again, get started in this world, we talked about the assessments. We talked about observation. What else can they do to start going down this path? Google is your friend here. If you Google assessments for social determinants of health, you're going to get hundreds of hits.
00:16:11
Speaker
You're going to be able to read some of those and say, oh, this is exactly what we would want to ask our GI patients or our cataract patients or our orthopedic patients because orthopedic is a great example, right? If they can't do the follow-up exercises because they live in overcrowding conditions or they live alone, they don't have anyone to help them get down and up off the floor. These are important things to know rather than just give discharge instructions.
00:16:39
Speaker
asking the right questions up front will help meet their needs truly.
Advocating for Equitable Healthcare Access
00:16:44
Speaker
And Google will also give you, if you type in food assistance, you'll get all kinds of hits for it. There's a sorority in North Carolina, I believe, that provides nutritious carryout bags for patients leaving high protein, high carb, good nutritional value to help them in those first couple of days, get off to a really good start.
00:17:09
Speaker
And just say, Hey, we have these great food bags for anybody who would like to have them on discharge. That's a huge thing. If you have a grade school who's collecting coats and hats and mittens, you can have a little collection there and hand them out. We give out the winter in Minnesota, we give out free scarves, hats and mittens to our clients. Those things are important to have available. And it's such a simple thing that you could do and get your
00:17:38
Speaker
neighborhoods and communities involved in that kind of activity. Perfect. Thank you, Maura. I think the more people we can get talking about this, the better. And I love that you're spearheading this in the industry, making sure that everybody knows the importance of this and also easy ways to get started with it as well. These are already doing so much, Erica.
00:18:01
Speaker
that we just need to continue to fight the fight. We offer excellent care at lower prices and we need to market ourselves out there to let people know there is an affordable option for you. And we also need to use our collective force in Washington and make sure that the same deductible cap that's applied to hospitals for Medicare patients is applied to ASCs and that they have full access to ASCs
00:18:31
Speaker
at the federal level because that will make a huge difference. We already do so many things for our patients and our potential patients, but we don't advertise it enough. We don't get that message out. It's a great opportunity for us to even that playing field and make sure that people who have some issues with the social determinants of care know that they do have access to ASCs.
00:19:00
Speaker
Beautiful. Perfectly said. All right. So we do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers? So sticking with this topic, there's one thing that we ask every single patient that we see. And that is when was the last time you had anything to eat or drink? If we rephrase just that one question and maybe added a writer and what was that meal?
00:19:30
Speaker
But when was your last substantial meal and what was that meal? We have great food insecurity in this country and it's hidden. It's a hidden little gem because the beautifully coiffed woman who comes in for her cataract surgery may not have bought any substantial food so that she could pay for her post-doc care or her eye drops.
00:19:56
Speaker
So we want to make sure that we're asking the right questions. And that is such a simple question to expand on and maybe get a hint that there may or may not be food insecurity in this person. Perfect. That is great advice. Thank you, Maura. Appreciate you as always. My pleasure. Bye.
FTC's Non-Compete Ban Proposal
00:20:22
Speaker
As always, it has been a busy week in healthcare, so let's jump right in.
00:20:27
Speaker
The Federal Trade Commission has proposed a ban on non-compete clauses and employment contracts, aiming to eliminate non-competes entirely for physicians. This would be a huge change for the industry, so of course it's getting a ton of attention. And as you can imagine, lots of attorneys are raising concerns and chiming in about the potential disruption it could cause to existing physician-employer relationships
00:20:52
Speaker
And also raising this question, does the FTC have the authority to implement such a rule?
00:20:59
Speaker
So if passed, this would really upset the status quo and they recognize that, the FTC, and they're arguing that non-competes currently depress worker wages, limit competition, and result in higher healthcare costs. And they're suggesting that by eliminating non-competes, it actually opens up a potential annual healthcare cost savings of up to $148 billion. Now,
00:21:24
Speaker
I'm not exactly sure where they got that specific number from. So I'm going to take that with a grain of salt, but that is what they are sharing. The last piece of this is actually around non-solicitation agreements as well. So the proposed rule targets non-competes, but it does allow for meaningful restrictions through non-solicitation agreements, which would prevent physicians from soliciting former patients or colleagues from joining them if they do leave their place of current employment.
00:21:53
Speaker
So as expected, lots of people chiming in, lots of pros and cons on each side. And while the elimination of non-competes could bring about increased competition, higher earnings, potential cost savings, the disruption to established physician-employer relationships, and again, the uncertainties around the FTC's legal authority kind of remain those two key concerns.
Dr. Singleton's Legal Battle Against Healthcare Monopolies
00:22:15
Speaker
So we will definitely be keeping a close eye on this story as it develops.
00:22:21
Speaker
In our second story from Becker's ASC, we are circling back to North Carolina's certificate of need law. A few weeks ago, we've reported a story recapping the states that are actively trying to change the certificate of need laws, and North Carolina is kind of at the forefront right now.
00:22:38
Speaker
We now know more about the man behind the most well-known lawsuit, and it is Dr. J. Singleton who owns an ophthalmology practice. Now, he is suing because of the state's laws stating that he simply can't perform procedures at his ASC.
00:22:54
Speaker
Under the current law, Dr. Singleton can only perform an incidental number of surgeries at the center, and he must instead perform procedures at nearby hospital Carolina East, which charges substantially more per procedure for patients.
00:23:09
Speaker
He also can't begin the certificate of need application process because state regulations have determined already that the community doesn't need another center. So he's kind of stuck here. Dr. Singleton sued North Carolina in April of 2020, but the North Carolina Court of Appeals unanimously dismissed the case. So now the case is pending before the North Carolina Supreme Court, Jamie Kavanaugh.
00:23:33
Speaker
But in the meantime, the state treasurer, Dale Falwell, has filed a brief in support of reforming certificate of need laws in the state, which does give Dr. Singleton some hope for his case. I thought this was interesting. Dale Falwell shared a statement basically saying that certificate of need laws contribute to consolidated health care monopolies in North Carolina by distorting market power in favor of large institutional hospitals, which is pretty powerful.
Innovations in Medical Testing
00:24:01
Speaker
So same as always, we'll be watching how this story develops and I hope for Dr. Singleton and his community that he comes out on top. In our third story from Medscape, a tiny patch may someday do your patient's lab work.
00:24:16
Speaker
We're used to things like smartwatches being able to tell us a lot about a patient's health, but there's still a need to rely on blood work for the bigger things. The hope is that a wearable patch could replace the need for blood work and doctors would be able to track markers in interstitial fluid under the skin.
00:24:36
Speaker
So thinking about different use cases for this, it really reminds me of my grandma who in her last few years was constantly going to the doctor's office for blood work in order to maintain some of her prescriptions. And it was so much work getting her safely out of the house, into the car, into the office, back in the car, and so on. It was really exhausting and overwhelming for her. So a wearable patch like this maybe could have reduced the need for all of those visits.
00:25:04
Speaker
And I'm sure there are a ton of other use cases like that as well. But anyway, how does it work? Interstitial fluid leaks from tiny blood vessels and it carries nutrients to and removes waste from your skin. So to capture this fluid, each monitor has either a tiny wire or an array of less than a millimeter long microneedles that penetrate the skin for days, weeks, or however long you wear it.
00:25:30
Speaker
The microneedles or wires are made from a polymer that sucks up the fluid, which flows to a biochemical sensor targeting the marker you want to measure. Now that certainly sounds like a lot, but doctors are saying you wouldn't even feel it and you wouldn't even know all of that was going on. Ideally, this technology would help manage chronic disease, monitor prescription drugs, measure stress and hormone levels, measure athletic performance, and more.
00:25:58
Speaker
However, while early studies have been promising, the doctors cited in the article do believe we are still a few years out from this being approved and available, maybe even looking at another decade. Hopefully it'll come sooner than that, but it is still very exciting progress there.
00:26:15
Speaker
To end our new segment on a positive note, a blood test has been approved by the FDA that can help identify pregnant women who are at high risk of developing preeclampsia, which is a serious complication that can be life threatening. Dr. Doug Wolkers, a professor of maternal fetal medicine, told the New York Times, it's revolutionary. It's the first step forward in preeclampsia diagnostics since 1900, when the condition was first defined.
00:26:45
Speaker
The new test measures the ratio of two proteins produced by the placenta and can determine with up to 96% accuracy whether a woman with symptoms will develop preeclampsia within the next two weeks. Having that information would be able to keep mom and baby much safer rather than waiting to find out the hard way. So very cool development there.
Conclusion and Call to Action
00:27:09
Speaker
That news story officially wraps up this week's podcast. Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we will see you again next week.