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Benita Tapia – Simplifying Board Meetings with a Financial Committee
71 Plays8 months ago
For the month of April, we will focus our guest discussions on quarterly board meetings. Benita Tapia is the Administrator and Director of Nursing at 90210 Surgery Medical Center in Beverly Hills, CA, and she joins us for our first episode of the series to talk about how you can simplify your quarterly board meetings by meeting with your financial committee a week in advance. Benita oversees four surgery centers, so this helps them to be as efficient as possible with their time.
In our news recap, we’ll cover 4 ways generative AI is transforming healthcare, two plastic syringe manufacturers the FDA recommends you stop using, where noncompetes could be banned next and, of course, end the news segment with a positive story about a WWII nurse who just celebrated her 105th birthday.
We are just one week away from #ASCA2024 in Orlando! HST has so many fun things planned for the show, so we hope to see you all there. When you swing by our booth (next to ASCA’s at Booth #709), you can take a quiz to win a prize and give all our products a test drive.
Articles Mentioned:
4 ways generative AI is transforming healthcare
FDA Recommends U.S. Healthcare Facilities Stop Using Plastic Syringes from two Chinese Manufacturers
Where noncompetes could be banned next
Brought to you by HST Pathways.
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Transcript
Introduction to Podcast & ASC Industry
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.
Guest Focus: Benita Tapia & Board Meetings
00:00:28
Speaker
Hi, everyone. Here's what you can expect on today's episode. For the month of April, we will focus our guest discussions on quarterly board meetings. So to kick us off, Benita Tapia is the administrator and director of nursing at 90210 Surgery Medical Center in Beverly Hills.
00:00:46
Speaker
And she joins us for our first episode of the series to talk about how you can simplify your quarterly board meetings by meeting with your financial committee a week in advance. Benita oversees four surgery centers, so this helps them to be as efficient as possible with their time.
News Recap: AI, FDA Warnings, Non-compete Bans, WWII Nurse
00:01:03
Speaker
In our news recap, we'll cover four ways generative AI is transforming healthcare, two plastic syringe manufacturers the FDA recommends you stop using immediately, where non-competes could be banned next, and of course, end the new segment with a positive story about a World War II nurse who just celebrated her 105th birthday. Hope everyone enjoys the episode and here's what's going on this week in Surgery Centers.
Benita Tapia's Role in ASC
00:01:35
Speaker
Benita, welcome to the show. Thank you very much. Pleased to be here. Benita, so the topic today is board meetings within an ASC setting and specifically the role that a financial committee can play within the board process. Before we jump in, can you talk a little bit about your background in the industry? Yeah, so I've actually had 40 years in the industry and I started off as a pre-op PACU nurse, OR nurse,
00:02:05
Speaker
then director of nursing, and then fell into the administrative role. I am certified by ASCA, so certified administrator of surgery centers. And that's about it. There's not too much in the surgery center arena I haven't done, so. Fantastic.
Governing Board Roles Explained by Benita
00:02:25
Speaker
And tell us a little bit about your role today at 90210.
00:02:28
Speaker
OK, so today I'm actually the administrator and the director of nursing, so have quite a broad oversight. I have other members of our team that obviously support that, so it's not just a one month show. I could assure you you are nothing without the team that's around you. Sounds like you wear a couple hats. Tell us in terms of different hats, tell us about what role that you play in the board meeting process at 90210.
00:02:59
Speaker
Okay. So a government board, if you don't know, Ashley has the oversight of everything in the surgery center. They're the ultimate responsibility. So that's a huge task in itself. And there are several members of the board, including me, and we all have different roles. So you're overseeing everything that goes on, whether they're transfers, whether there's quality.
00:03:28
Speaker
and obviously the financial health of the facility, but also responsible for policies and procedures, emergency plans, environment of care plans, infection control plans. So that is huge, right? There are several members of the team. I am part of several parts of the meeting, which includes the financial committee.
00:03:56
Speaker
which includes like the medical executive committee. And then finally, everything funnels up into that governing board that has the ultimate control. Got it.
Streamlining Financial Data for Board Meetings
00:04:08
Speaker
And how often does the governing board meet at your center? Okay. It meets four times a year, quarterly. At one point I had one center and now I have four centers that we're responsible for.
00:04:23
Speaker
So it's really important that if you think that you're going to want to have one center, there was one government board meeting a year, but as time goes on, there are so many facets to this board that it would be practically impossible to throw everything into an annual government board meeting. Sure. Okay. So four, four facilities you mentioned now at one quarterly board meeting, do you discuss all facilities at the same time? Yes, we do. We do.
00:04:53
Speaker
is try and get it as efficient as possible. It's hard enough getting people to board meetings, let alone if you had four board meetings four times a year, right? That makes sense. Okay. And wanting to talk specifically, Benita, about the financial committee that you set up and pick your brain on that one. When you set up the financial committee, what was the problem you were looking to solve? What was the reason that you guys decided to set up that committee?
00:05:23
Speaker
OK, so the financial health of the surgery centers is extremely important, but it's very much in depth. There's a lot of data that goes into each part. So if you think of, first of all, budget in itself could take the budget for the year and the budget, whether you're meeting it, whether it's staffing cases, equipment, capital, cost of cases, that in itself could take a whole meeting.
00:05:54
Speaker
And the reason that we decided to come up with a separate finance committee is that in the essence of being efficient and also put the people that really have the knowledge of financial in that committee. So a lot of times you have clinical people or doctors that may be not quite as financially savvy. So to have the right people look at that data ahead of time,
00:06:22
Speaker
and make recommendations. Otherwise, frankly, the finance is honestly the longest thing that takes in the government board, especially when you come to financial money. And at the end of the day, if you have members, their distribution and how you got to that distribution. So that could, I tell you, I've been in the government body masons till past midnight.
00:06:48
Speaker
I don't want to do that. I'd rather be in bed because I lose track after a while. So that's how we came about it. It was agreed by the government board that we could have a financial committee ahead of time. And in that committee, we will put people that would actually have financial knowledge of some of the things that we needed to address and make decisions on, or at least make the recommendations to the government board.
00:07:14
Speaker
Got it. So just to paraphrase you there, it sounds like one of the things that was taking time, maybe creating some roadblocks in the overall governing board meeting were these decisions like budgets or other financial decisions like capital equipment that were creating a lot of discussion and back and forth in the actual board meetings. Is that right?
00:07:34
Speaker
Yeah, so look at capital equipment. That's just one little part, right? One, that you want to make sure that you need that capital equipment. Two, you have a performer that you're looking at, is this a good thing to bring into the surgery center? Is it going to bring more cases, more surgeons? Is it actually reimbursed by the insurance companies or the carriers?
00:08:00
Speaker
So that in itself, and the cost of it, and how long is it going to live? And then there's other capital equipment that we look at the life of, right? So we need to know, is this coming to a point where we need to replace it? So that is only one portion of the financial committee. Making sure that you're on budget, right?
00:08:21
Speaker
Making sure that, one, you're going to look at the year ahead and you're going to decide, did you make budget last year? Is there things that you need to change? Is it staffing? Is the cost of supplies? Is the case cost? There's multiple facets to that. Your AR, your reimbursement from your carriers.
00:08:42
Speaker
Are you meeting those goals? Right. And then you look, another thing is you look at the year ahead. Like you need to make the goals for the next year. So those are just a couple of things. The other things we have like expansion going on. Right. So we need to look how we're going to fund that expansion. Maybe there's different types of loans to do that. Where are you going to bring the cases from?
00:09:07
Speaker
Is it worth doing the expansion in the first place? Is it really viable that you've got new cases coming in and what kind of cases that you've got coming in? And so there's a lot of data that goes into that too, to figure out like, is it worthwhile doing. Got it. I like that. And those are some meaty topics that you mentioned for the financial committee in terms of budget and historical performance and future performance and growth.
00:09:35
Speaker
Who sits on the financial committee? Those are some important kind of recommendations that are being made there. Is it a subset of the board or other folks?
00:09:44
Speaker
There are both. So there is a subset of the board that represents like medical, the medical doctors. And then the ones that we had picks for that are the ones that really take a strong interest in the financial and understand it more. And then the JV partner, which is a hospital. And so we pick their financial, a couple of their financial people from the hospital that kind of represents them.
00:10:11
Speaker
And then we have a representative, a vice president from the hospitals as our chief executive. And there's me that really is more on the clinical side. This is the equipment that we need. This is why we need to purchase those things, right? Benita, you mentioned that the financial committee makes recommendations at the governing board meeting.
00:10:34
Speaker
And so is that how the process works? So the committee meets before the board meeting, the committee reviews the information, discusses, comes up with a recommendation, but that's not a final decision, right? That still needs to be taken in front of the full board. Is that how it works?
00:10:49
Speaker
Yes. So remember, as I said before, the governing board is the ultimate stop. It oversees the whole. So those are recommendations, right? Ultimately, your whole governing board makes that final decision. And so the job of the financial committee
00:11:08
Speaker
is want to get all the data together, recommend, but also then we will send out a few days before some of the recommendations, some of the data, not all of the data, because if a government board member actually wants to get more in depth, because he's very interested in that,
00:11:27
Speaker
We're very transparent, but sometimes it means them coming on site to see that. At least seven days is actually a long time because, believe it or not, I've gone through government board meetings and you send out seven days and they don't remember, right?
00:11:43
Speaker
It's not a memory thing. Usually it's about 72 hours before and we're like, you have any questions? Please find all your questions first. And so we try to get those questions ahead of time. Again, it saves that issue when we're on time efficiency when we get to the government board. Yeah, that sounds like a great process. To prepare for that financial committee.
00:12:09
Speaker
Who's in charge of preparing the numbers and the analysis and putting that information together? It takes different people to do that. It could be a financial controller. It could be an actual billing company that's sending the information regarding AR and accounts of where we are. It could be our own financial controller.
00:12:30
Speaker
that is like telling us our cash status and where we're at that. It could be the chief executive who really controls our budget and looks that we're meeting it or that we need to have answers of why we didn't meet certain things. And then there's a formula for the big one, which is the members distribution that usually has the most questions, right?
00:12:55
Speaker
And then, okay, your distribution is this. We have this expansion going on, and I think we need to hold money back until we get these loans. And those, when it comes to distribution, particularly for the members, those are probably where the biggest questions come. So.
00:13:12
Speaker
It's, as I said, again, it's a group of people that gets all the data together, depending on what part. For me, it might be like, I need this clinical equipment. I know the life of this is going to end within the next six months. Oh, you know what? Let's look at this. We spent so much money on a contract, service contract. We could have bought this twice over. So those are the things that come together, right? But it's a group effort. Who's in charge of kind of pulling
00:13:40
Speaker
summarizing it all together and putting it in the right format.
00:13:43
Speaker
We have a wonderful chief executive that pulls it all together. As I said, we have multiple facets. So his portion, the chief executive, which I love him for doing that, he pulls that part together. I have to pull what's called the medical executive committee together, which is more the quality, the clinical transfers and everything that occurs in that portion of it. And between the two of us,
00:14:11
Speaker
and he's on that board too. We pull all of this data ahead, get it to the governor board members ahead of time, and then we funnel the questions so that we have an efficient governor board meeting. Sounds like great prep. Your board members must love it. Yeah, it's all about the prep. If anything that I can say is don't wait till the last minute,
00:14:35
Speaker
and gather your documentation and your data ahead of time, pretty much prep to know what you're going to do and get it to those governing board members ahead of time. And most of all, they want recommendations. If they want to question that recommendation, then we're going to funnel it to the right person. On that evening, we're not there till past midnight. It's basically yes, no, yes, no. You agree, you don't agree. Everything has been taken care of ahead of time.
00:15:04
Speaker
Fantastic. It sounds like this has been effective. You mentioned at the top, hey, we're looking to solve the problem of board meetings taking a long time and a lot of back and forth on financial decisions. Has pulling out the financial committee helped solve that original problem? 100%. I can tell you that I used to sit there with a PowerPoint, do the PowerPoint, and each one of those slides would probably have questions, especially when it came to financial.
00:15:34
Speaker
which frankly is one of the biggest the financial health is unfortunately one of the most important thing that they are looking for. And so those funneled the most questions and kept us there the longest. So doing that and I'm the person doing that and I have done in the past just by myself.
00:15:53
Speaker
I'm not really an accountant or a financial controller. I'm more like administration on the operations of the day, right? So all those things that are taken care of ahead of time, it's 100% better. This is great advice. I think there's a lot of other centers and administrators and chief executives that they're going to benefit from this because we've heard this time and time again, which is board meetings can go over.
00:16:23
Speaker
and they can get contentious or there can be a lot of back and forth if there's not the adequate prep and information presented in advance. And frankly, five hours into a board meeting, you can't think straight anyhow, so it's just better to get this done ahead of time. Right, right. Fantastic.
Enhancing Surgery Centers through Communication & Surveys
00:16:42
Speaker
Okay, Benita, one final question for you, and we do this every week with our guests. What's one thing our listeners can do this week to improve their surgery centers?
00:16:50
Speaker
I think communication is always a big thing. There's no doubt that communicating the financial information to the government board. But I'm a big advocate, a patient advocate, and we are there for our patients. And if I would give you one piece of advice, read those patient satisfaction surveys. Your patients will tell you where the problems are.
00:17:15
Speaker
and often like your own staff will be able to tell you or the patients how to fix it. Again, I will say it is always a team. We are, we're not successful without the team behind us. Empower your team. I guess that's one, one answer to that, right? I love it. I said one, one final question, but I want to ask you just one follow up to that.
00:17:39
Speaker
Because the patient satisfaction survey is a great info. How do you disseminate those results across your team? Okay. Wonderful. Great question. We have a huddle, which is on every Monday morning. So at 7 30 every morning, all of the staff, any staff can call in. They don't have to be onsite. They can call into that huddle.
00:18:03
Speaker
Every Monday morning, we view those patient satisfaction surveys, okay? It also goes out to the staff, so if they couldn't be there, they will see on their huddle those patient satisfaction surveys. And as I told you, I have four centers, right? I meet with each center once a week, and each week this comes up. We will say, how do you think that we can fix that? And that will be a team.
00:18:32
Speaker
They're the ones that usually give the answer how they can do this. There was times where, you know, this is just one example, but the patients were like, the nurses were all at the nurses stations, right? The patients were all just waiting to go into surgery.
00:18:48
Speaker
Those patients have nothing to do but listen to everything that is going on, right? They have nothing else to do. They're waiting, they're anxious and everything. So now we have, one, the documentation. If they're charted, they'll chart by the bedside. So they're actually with the patient. But we also have it that they round. The staff round in the waiting room. They round the patients. And it's actually on a big board behind the nurses station.
00:19:16
Speaker
that they actually sign off that they have rounded. So they've checked on every patient and made sure that they're okay. Got it. I love it. But yeah, thanks so much for joining us this week.
Transformative Role of Generative AI in Healthcare
00:19:28
Speaker
You're welcome. Thank you.
00:19:34
Speaker
As always, it has been a busy week in healthcare, so let's jump right in. Healthcare Dive did a nice roundup of four ways that generative AI is transforming healthcare. Before we dive in, I did just want to give a quick refresher on what generative AI is, just because I know a lot of this is new for a lot of us. There are two common types of AI.
00:19:57
Speaker
generative and predictive. When it comes to generative, it's exactly how it sounds. It's all about creating new content, whether that's images, text, copy, video, or even software code.
00:20:08
Speaker
It's creating new stuff based on user prompts. And then the other common type of AI is called predictive AI. And that actually uses large historical sets of data to recognize patterns across time, draw conclusions, and maybe suggest outcomes in future trends. So in this instance, we'll be talking about generative AI. And so here are the four ways that our AI is helping to transform healthcare and how they can benefit physicians and patients too.
00:20:39
Speaker
The first one is that AI can document patient encounters and integrate information right into an EHR in a perfect world. The American Medical Association estimates that for every hour a physician spends with a patient, they could spend up to two hours completing administrative work.
00:20:56
Speaker
There are tools out there that can automatically transcribe conversations between a clinician and a patient and add that complete story right into the EMR for the physician. So obviously this not only reduces that admin work, but also allows the clinician to have candid conversations with the patients face to face without needing to worry about typing and taking notes the whole time.
00:21:20
Speaker
The second use case is that AI can offer insights into diagnostics and imaging and can improve the accuracy and efficiency of analyzing medical images. So imagine radiology, pathology, cardiology, this technology can digest and learn from reams and reams of data. And research has already shown that it can catch things in the imagery that sometimes can be overlooked by natural human error.
00:21:49
Speaker
And I feel like this is the part of the story where I always like to remind people that this is not by any means replacing the human element, but just supporting and helping. Imagine 10,000 mammograms and 200 show something that might be concerning, but four snuck through that human error naturally missed that AI could then pick up on. That's four human lives that could be saved and impacted.
00:22:15
Speaker
So anyway, the third use case toes the line a little bit of predictive AI, but it can certainly help enhance clinical decision-making. So if all the records and an EHR are examined, it could help a clinician in making treatment recommendations. According to the American Hospital Association, analysis by AI outperformed the modified early warning score, which is a traditional tool used by hospitals to calculate a patient's risk for declining health.
00:22:45
Speaker
And lastly, AI will likely help accelerate drug discovery and development. This is a crazy number, but on average, it can take 10 to 15 years to develop a new medicine at a cost of around $2.6 billion. But because AI can be used to automate some processes and help predict outcomes, there's a lot of potential here. Now, this one definitely gives me the biggest pause, but again, just here to make these processes more efficient.
00:23:15
Speaker
And I will leave you with this because I thought this was helpful context. The American Medical Association recently did a survey and found that 65% of physicians believe AI
00:23:27
Speaker
does offer advantages, particularly when it comes to reducing administrative burdens. So that's 65% of physicians who believe it offers advantages, but in practice, only 38% of physicians surveyed said they're currently using AI in any capacity. Now, I have to say that 38% is actually way higher than I would have guessed. I would have estimated maybe closer to 5% to 10%, but very cool to see the interest and the comfort level rising.
00:23:56
Speaker
This next story is a quick one, but I felt it was important to share.
FDA Syringe Warnings & Non-compete Ban Updates
00:24:00
Speaker
The FDA has advised all healthcare facilities to stop using plastic syringes from two specific manufacturers. So the FDA has had an open and ongoing investigation into potential failures with plastic syringes. It's important to know that glass syringes, pre-filled syringes, and syringes used for oral or topical purposes were not part of this investigation, just plastic.
00:24:26
Speaker
And Jeff Sheren, who is the director of the FDA Center for Devices and Radiological Health, said, and I quote, continue to use them as needed only until you are able to transition to alternatives and closely monitor for leaks, breakage, and other issues and report any problems to the FDA.
00:24:48
Speaker
The concern is that the plastic syringes could leak, break, or deliver the wrong dosage of medication when used alone or with medical devices such as infusion pumps. The FDA sent multiple warning letters to Jiangsu Shenli Medical Production Company based in China, as well as Medline Industries and Soul Millennial Medical, which market and distribute them in the United States.
00:25:14
Speaker
So if you have plastic syringes from that parent company, the Jiangsu Shenli Medical Production Company, unless the syringes absolutely must be used, the FDA is recommending that you stop using them immediately. So if you do use plastic syringes, this might be something that you need to look into.
00:25:35
Speaker
All right, so we have talked about non-competes a few times over the last six months, but there's even more news coming out now. So as a reminder, there are four states that have banned non-competes. That's California, Minnesota, North Dakota, and Oklahoma. There are six states that have pending legislation that could ban non-competes, and Becker's ASC did a really nice roundup of where each state currently is in their process. Let's go through them.
00:26:04
Speaker
The first is Illinois and legislation is in the Illinois House and it would make non-competes unenforceable. The bill applies to non-solicitation agreements, sale of business non-competes, and agreements prohibiting trade secret disclosures among others. It would ban non-competes no matter where and when the agreement was entered. The bill was introduced and referred to the Rules Committee on February 9th.
00:26:32
Speaker
The second state is Maine. So legislation in Maine would ban all non-competes except for when a business is sold, when a shareholder sells his shares, or when a partnership is dissolved. The bill has passed the House and Senate. It was sent to the governor's desk on March 19th. She is expected to sign the bill into law. So I would say out of the six we're going to go through, Maine definitely seems like it will be the fifth one to ban non-competes entirely.
00:26:59
Speaker
The third state is Massachusetts. So although Massachusetts already strictly curtails non-competes, it is looking to further restrict them in a Senate bill that would make non-compete agreements void and unenforceable. The bill was referred to the Committee on Senate Rules on March 4th.
00:27:17
Speaker
The fourth state is Michigan. A bill in the Michigan house would ban any agreement that prohibits an employee from any employment after termination. There has been no activity on this bill since it was referred to the committee on labor in May of 2023. So that one looks like it may have hit a dead end as we're coming up on a year of no movement.
00:27:39
Speaker
The fifth state is Rhode Island. A bill in the Rhode Island House would make non-competes unenforceable except in the sale of business context. It was introduced and referred to the House Labor Committee on March 13th. And then last but not least, the sixth state is Wisconsin. A Wisconsin Assembly bill would make employee non-competes void, but would apply to non-disclosure agreement, I'm sorry, would not apply to non-disclosure agreements or non-competes that are limited
00:28:08
Speaker
to intellectual property owned or licensed by the employer. The bill was referred to the Committee on Labor and Integrated Employment on October 12th, so about six months ago.
00:28:20
Speaker
So all that to say, it is hard to say exactly what will happen with these six states that are in flux. Definitely looks like Maine is a shoo-in and the closest, but we'll keep a close eye on all of this and non-competes are very limiting for physicians and have been shown to also impact and limit patient care.
00:28:39
Speaker
and many other reasons, so I hope to see more and more states banning them.
Celebrating Alice Darrow's 105th Birthday & Her Life Story
00:28:43
Speaker
And to end our new segment, on a positive note, Alex Darrow, a former Navy nurse, was honored for her patriotic commitment to our country as one of the last living links to Pearl Harbor when she celebrated her 105th birthday surrounded by family, friends, and community members.
00:29:03
Speaker
So, Alice was born in 1919 and enrolled in nursing school after finishing high school. She then served as a Navy nurse and worked at Pearl to Hospital in Oakland when Pearl Harbor was attacked on December 7, 1941. She is considered among the last of the greatest generations in American history.
00:29:23
Speaker
Alice shared a fascinating story about how she was present when a naval officer was blown off his boat. The Japanese gunman kept firing, but Alice climbed aboard his rescue boat to help anyway. The officer was shot in the back, but managed to survive thankfully. And it wasn't until four months later, when the officer was being treated for appendicitis, that he reconnected with Alice as she was assigned to him as his nurse.
00:29:50
Speaker
the naval officer asked Alice if she would marry him if he survived his appendectomy. She said she laughed and said yes because she didn't think he would make it through the surgery. Flash forward, the couple had gotten married and stayed married for 50 years and had four kids together. So unfortunately he has passed but
00:30:13
Speaker
Alice credits her longevity to her secret to life, which is always have something to look forward to. It gets your body and mind ready for what's next. And of course, family, friends, and laughter. She has already planned an Around the World cruise later this year with her daughter.
00:30:32
Speaker
And 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.