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Jim Stilley - How Medical Assistants Can Help with Staffing Issues & Reduce Spend
154 Plays2 years ago
Almost every surgery center is struggling with two issues right now – staffing shortages and rising costs. By hiring Medical Assistants, you might be able to tackle both problems at once. Jim Stilley, the CEO at Great Lakes Orthopaedic Center, currently the largest practice north of Grand Rapids, joins us today to share his perspective on hiring Medical Assistants where appropriate might just be the answer you're looking for.
In our news recap, we'll cover how Smartwatches can impact Pacemakers, the relationship between ChatGPT and the healthcare industry, four ways tablets are transforming patient care, and the Nurse of the Year in Uganda.
Articles Mentioned:
Could Your Smartwatch Interfere With Your Pacemaker?
Why ChatGPT In Healthcare Could Be a Huge Liability, Per One AI Expert
Revolutionizing healthcare: 4 ways tablets are transforming patient care
Ugandan Nurse Agnes Nambozo Makes Treacherous Climb to Patients
Brought to you by HST Pathways.
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Transcript
Introduction and Episode Preview
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.
00:00:28
Speaker
Hi everyone, here's what you can expect on today's episode. So I know everyone is always promising solutions for the current staffing crisis, but today we actually have some real advice to share that will not only help with staffing, but also help you save some money.
Interview with Jim Stilley: Staffing Solutions
00:00:44
Speaker
Jim Stilley is the CEO at Great Lakes Orthopedic Center, and he's here to share his perspective on how hiring medical assistants in lieu of RNs where it's appropriate
00:00:56
Speaker
will help with staffing issues while also reducing spend. In our news recap, we'll cover how smartwatches can impact pacemakers, the relationship between chat GPT and the healthcare industry, four-ways tablets are transforming patient care, and of course, end the new segment with a positive story about the nurse of the year in Uganda. Hope everyone enjoys the episode and here's what's going on this week in Surgery Centers.
00:01:29
Speaker
Jim, welcome to the show. Thanks for joining us today. Thanks. Glad to be here. Jim, you're the CEO of Great Lakes Orthopedic Center in Traverse City, Michigan. Can you give our listeners a feel for your facility in terms of specialty and general size range? You bet. We have 14 orthopedic surgeons, 11 APPs, and 10
00:01:57
Speaker
physical therapy providers. And we're the largest practice north of Grand Rapids in Michigan. Great. How many ORs do you guys work out of? Well, we have three in our ASC. And we're looking at potentially building more at another location. We're pretty geographically remote.
00:02:25
Speaker
communities up here. So we have physicians that travel quite a bit. Fantastic. And so that's where you're at now. Give us a sense of a little bit of your overall history within the industry.
00:02:39
Speaker
I've been in the ASE industry for about 20 years. I was the president of the Michigan Association twice, and I have run very large ASE with 10 ORs and 130, 140 staff. And I've also been vice president of operations for some management companies and
00:03:07
Speaker
have helped build three ASEs. Fantastic. So you've seen different scenarios in use cases and different evolutions in the industry. And so right now, everybody's talking about staffing and spending and expenses as two kind of challenges that facilities are grappling with. And I know you have some thoughts around each of them. I wanted to start there. You kind of described your
00:03:35
Speaker
you know, physician and staffing mix of your facility. If we kind of think of a typical ASC facility, kind of mid-size, multi-specialty ASC facility, what do you see in terms of the typical staff makeup in terms of types of individuals that work there, you know, the mix between physicians and RNs and that type of staffing mix? You bet. And it's all over the place, depending on the subspecialties.
00:04:04
Speaker
and the specialties that are being utilized. But for the most part, there's usually a pre-op and post-op team.
Cost Efficiency in ASCs
00:04:14
Speaker
And they can, in some of the smaller ASCs, be the same folks. In larger ASCs, they're completely different divisions. And then we have OR staff.
00:04:27
Speaker
We also have front desk administrative staff. But one of the things with ASC, we can spend anywhere from 20 to 33% of our budget on personnel. And so we're always looking for ways to kind of reduce some of that expense. We always think more cases will work our way out of not making enough. And when you do a case,
00:04:53
Speaker
that money goes to a lot of things. It goes to supplies, it goes to other things. But when you actually save a dollar, 100% of that money goes right back to the bottom line. And so the best way we can do to save money or make money is be as efficient as possible. Sure. And so when you think about those different kinds of teams or groups within the ASC, how many of those
00:05:21
Speaker
FTE or personnel are typically registered nurses. I see that split working. Yeah. In some centers, I've seen that where all their clinical staff is registered nurses. They had a philosophy that a registered nurse can work in pre-post and in times of shortage, they can even work in the OR and some specialties.
00:05:46
Speaker
Other places, you know, it's a lot broader depending on the number of patients that you're seeing each day. And so that's really the determinant of whether we get outside of an all RN-staffed model or we start to get into a model that has nurse-directed teams with medical assistants or nurse assistants helping that
00:06:11
Speaker
that nursing team. Sometimes I see anesthesia assistance helping and some of the biggest changes that I've ever had to do in my career is changing that mindset that an all RN team is the best way to go for a certain ASE and it's really taken a lot of
00:06:32
Speaker
communication to get those teams to realize the addition of some paraprofessional staff can really be helpful to help that RN work at the higher end of their license.
State Regulations and Task Delegation
00:06:44
Speaker
Sure. And that seems to be kind of more and more timely and more and more being contemplated now that staffing is challenging. It is. And RNs are hard to come by. And RNs are hard to come by. And so you mentioned medical assistance.
00:07:00
Speaker
you know, what is a medical assistant and how did they kind of fit into this equation? Well, you know, every state has a different guideline on what it, what it allows, or it will authorize, um, in the Midwest where I've typically worked and I've also worked in, um, Nevada and California. Um, it is that state that kind of determines
00:07:25
Speaker
what that is, and it can be a certified nursing assistant, it can be a medical assistant, and there's lots of different types of credentials for medical assistants. But in the Midwest, in two or three states, you're not required to have a credentialed or a certified medical assistant. In many cases that RN can delegate authority to trained individuals,
00:07:49
Speaker
And so we will bring on team members in many of our ASCs and train them to help with stretcher cleaning and litter patient transport, helping to bring nourishment to patients. It doesn't have to be a certified medical system. It can be pretty much anybody that you train.
00:08:14
Speaker
And I just feel like there's a lot of opportunity in that area. And if you really look at your state regulations to what you can have in an ASC, I think a lot of people would be surprised. And it's just making sure that you have a well-trained team. Got it. So it seems like you're kind of really, in some cases, breaking down the tasks.
00:08:36
Speaker
that the clinical staff is doing and saying, hey, is there an opportunity for specialization here? Do we need experience-trained RNs for everything?
00:08:46
Speaker
or they're kind of more repeatable, trainable tasks that you can actually use other folks for. Right. And some of the most numerous ASCs are ophthalmology and gastroenterology. And they're not very wide on the spectrum of the number of procedures that they perform. So they get really technical in what they do and they're not super invasive and high risk.
00:09:10
Speaker
and you're starting to see it is really how many patients can we move through this platform each day. And so there are a lot of tasks that having an RN move a patient and get them ambulating and things along those lines, it's not really an RN requirement. It is a requirement for an RN to take a look at a patient to make sure that they're recovering from anesthesia, effects of anesthesia appropriately, but there's lots of ways that you can skin that cat.
00:09:39
Speaker
Sure. Yeah, that's interesting. And for the medical assistant in particular, what's kind of the typical skill set difference or level of training experience difference between a medical assistant and an RN?
00:09:53
Speaker
It's night and day. The RN has a lot of things that only an RN can do, and that's what we're really looking for in that ASC. When things go south, you need that RN to work at the highest end of their license when it comes to drug reconciliation and their years of experience and training.
00:10:19
Speaker
But for most of the functions in an ASE on an average day when things aren't going wrong or incredibly busy, you can have people that assist that.
Staffing Model Challenges and Patient Safety
00:10:31
Speaker
And there's a wide range of skills. There are MA programs that get medical terminology that assist in blood pressures that assist in different phlebotomy skills. Starting IVs can be delegated.
00:10:47
Speaker
to MAs, as long as you have a training protocol and you have proficiencies that have to be demonstrated and supervised, each state will outline what can be delegated to a paraprofessional, a non-licensed individual. Yeah. And you mentioned, hey, there's a big difference in terms of credentialing and experience.
00:11:15
Speaker
And so is there also a significant difference in the cost or salary of, you know, a medical assistant versus a full line? You bet. Um, like I said, you can do anything from somebody that is well intentioned coming off the street that you train yourself for certain functions. You know, like if you just, if you're big enough ASC and you have 40 striker stretchers and somebody needs to clean those and disinfect it, well,
00:11:43
Speaker
Sometimes it makes sense that that's just RNs in between cases when you don't have a high volume place. Sometimes you're so busy that it may make sense to bring that non-trained individual and train them to do that. And so that's the real trick is finding what are the things that a non-trained MA can do and you can train.
00:12:12
Speaker
What do you want? And that pay scale is pretty low. And then if you go to a CMA or CCNA, they've done six months of school. They get a little more medical terminology. They can do a little bit more. And that pay scale is a little bit higher. But even at the highest end of a pay scale for the CNA or the MAs, there's still about a third of the cost
00:12:40
Speaker
of your lowest priced RN. This is interesting because this opens up the labor pool in terms of the clinical staff members, people that can operate on a clinical side, if you're willing to open the types of roles and credentials that you're looking for.
00:13:03
Speaker
So it opens up the labor pool, but it also potentially seems like it puts more of a burden on the center of the facility on training. Is that right? It does. And what we're not talking about is just having fewer nurses do more work. What we're talking about is having nurse-directed teams to have that RN supervising what's happening in pre and post-op.
00:13:30
Speaker
interjecting herself or his self into the situation when a licensed nurse is needed, documenting where appropriately, and supervising the rest of the team to help them accomplish that. It does take a little bit more thought.
00:13:48
Speaker
But I guess I would put it out there. If you're an all-RN team and you're doing a lot of volume and you don't have any paraprofessionals working with you, then you should be asking yourself, well, what could we do if we had some of these team members? We could spend more time with patients on the things that nurses need more time to do.
00:14:11
Speaker
because the nurses are still running around giving nourishment. They're still running around doing gait training that could be delegated to a medical assistant to do certain things at different surgery centers for that specialty. Right. Absolutely. And you mentioned earlier that
00:14:29
Speaker
There's hesitation in some cases, there's change management required to think about the model differently, to think about staffing staffing differently than our end clinical team. Yes. Why do you think that is?
00:14:44
Speaker
Well, I've had some nurses tell me that I'm giving away their favorite part of their job at times. Giving a warm blanket from the blanket warmer to a patient and see that smile on their face when they're freezing and you give them that warm blanket can be what many nurses actually came into the profession for.
00:15:01
Speaker
to have that interaction with the patient. But if you're in a busy surgery center and you start to separate tasks based on licensure and the ability to find team members, I can see where parts of those you will never see, parts the lower end of that license ever being done by those nurses. Again, many times they regret that.
00:15:28
Speaker
And so, ASC is a different animal anyway. There's clinic nurses, there's hospital nurses, there's ASC nurses. Even nurses from pre and post-op working in the OR are a different type of nurses.
00:15:47
Speaker
And we've just got to be sensitive to what makes that nurse love his or her job and not take that from them, but realize that there are team members that can help them do the things that they can't do it all themselves. I mean, we're taking patients to the parking lot.
00:16:06
Speaker
why should an RN and all RN team do that? If they didn't have to take that patient to the wheelchair, to the parking lot to get in and out of their car, that's 15 minutes in some cases to help an elderly patient get in and out of their car. That nurse is gone for that period of time. And so I just urge people to start thinking about that. It doesn't mean that we'll have
00:16:30
Speaker
less RNs, but what it may mean is you may not have to look for more RNs when volume goes up because you have a team that allows that one RN to do more. Yeah, yeah. And the role specialization model makes a lot of sense to me in carving up those tasks and saying, what skill sets do we need for the different tasks? Could someone that wanted to poke holes in this model or take a contrarian approach say,
00:16:59
Speaker
Hey, but what about patient safety? Doesn't this leave us more exposed for patient safety issues? And what have you seen in practice in terms of folks that have rolled out a more specialized model? How have they taken those maybe precautionary steps around patient safety? Well, it was always the thing that was the main opponent when I would bring this into a new center was that it's the risk. You know, we like to have an ORN team,
00:17:27
Speaker
We're not good at some of these things that you want us to do, like setting up protocols, setting up proficiencies, supervision of paraprofessionals. We like the one-on-one nursing aspect of what we do.
00:17:44
Speaker
I would say yes, if it wasn't executed correctly, you could open yourself up to some risk and to some safety issues. But we're not asking these paraprofessionals to give medications. That's not what we're doing.
00:17:58
Speaker
What we're really talking about is helping figure out what functions absolutely have to be done by a nurse, what functions do not have to be done by a nurse. And then there's that gray area. And that's where the more experienced MA you get can be trained to do a urinalysis pregnancy and record the results. And it's perfectly legal and it's perfectly safe as long as you've done the training and you do the protocols.
00:18:28
Speaker
that's not something that an RN has to do. And so I just, when I get those, the pushback on the safety, I say, show me, show me the documentation. Where in any of our state regulations or where in the CMS, where within AORN or ASPAN does it say that this has to be done by an RN? Yep, exactly.
00:18:58
Speaker
I like this, Jim. I think ASCs are challenged with rising expenses. I think it's on top of everybody's mind in terms of rising expenses and the impact on profitability and at the same time, everybody's challenged with staffing and staffing up and retaining team members and hiring new ones.
Appreciating Staff and Reinvesting Savings
00:19:20
Speaker
I think you're giving our listeners a model to think about that addresses both of those. For some people, it's probably not a good fit for, but it's certainly something for everybody to think about the applicability to their centers. It's hard on the administrators, it's hard on the clinical coordinators to make sure that they have the right balance of a team because now you're not just thinking, okay,
00:19:44
Speaker
this nurse can do this in the morning and can do this in the afternoon and I'm well set. But in a larger center, you do have to think about different types of skill sets. And I think one of the carrots, if you will, is if I'm saving, like I said, two thirds of the price of salary, that
00:20:08
Speaker
two-thirds saving doesn't all have to go back to the bottom line or to distributions. It can go to increase salaries for nurses. So I kind of let them know if we have 20 nurses and we're going to grow by 10%, do I really need to pick up another two or three nurses or do I need to pick up four MAs that can help these nurses and still bank?
00:20:37
Speaker
a significant amount of that savings to put back into salaries for growth in RN salaries, which are historically lagging in ASCs. Yeah. To reinvest some of those dollars in retention around kind of your clinical team leaders that can help operate a model like this, right? Because a model like this probably does depend on having strong clinical team leaders to manage it. Correct. Great.
00:21:06
Speaker
Jim, final question for you, and we ask this of all our guests every week, what's one thing our listeners can do this week to improve their surgery center? Wow. I think maybe just take a time out and realize that, I mean, the staff in my office and the practice are just overwhelmed because nobody's getting paid more anymore. I mean, we're all getting paid less and we're required to do more.
00:21:35
Speaker
And I think just, I know we do a good job of it in the surgery center industry, but I think just taking a time out and making sure all the employees know that you rely on them, that they're incredibly important in value and that they feel that stress just like we all do of this metronome of productivity, just increasing and increasing. When will it end? And it may not, but what they also have to understand is we're
00:22:00
Speaker
relentless. I know my peers in the industry are relentless at looking at ways to make their jobs easier, not harder, to find help, to help them in these processes, and to let them know that we care about them, we understand that they're stressed, and we're working every day to make sure that they're less stressed and that we just value our team. Great. This is a great conversation, Jim. Thanks so much for joining us today. Thank you. I appreciate it.
00:22:30
Speaker
As always, it has been a busy week in healthcare, so let's jump right in.
Tech in Healthcare: Smartwatches and ChatGPT
00:22:35
Speaker
Today's first burning question is, could a smartwatch it possibly interfere with a pacemaker? According to a new study reported by US News, the answer is yes. Smartwatches, rings, or scales that emit electrical currents
00:22:50
Speaker
can interfere with implantable heart devices, even causing them to malfunction. The wearable devices that cause confusion and problems are ones that use bioimpedance, which is the response of a living organism to an externally applied electric current. The study found that even the slight
00:23:12
Speaker
electrical currents from these gadgets can potentially cause problems and even cause a pacemaker to send an unnecessary shock to the heart if it mistakenly thinks the heart needs to be restored to a regular rhythm. Now I will say
00:23:26
Speaker
Given the fact that all these technologies involved are relatively new, there is a lot of unknown here, and it's hard to say with certainty what the risk is and the probability of something going wrong. Additional studies are obviously needed, but for now, if you or someone you know does have a pacemaker, it's probably a good idea to avoid smartwatches and other gadgets of that sort, or at the very least, have a discussion with your doctor.
00:23:54
Speaker
Our second story comes from MedCity News, and one AI expert is sharing their concerns about the relationship between chat GPT and the healthcare industry. Chat GPT has been dominating the headlines lately, but if you're not familiar with it, it's basically an automated intelligence tool that analyzes language to answer questions and produce written content that humans can understand.
00:24:19
Speaker
So, for example, I can go to chat GPT and type in something fun like write me a poem about my cat and the dishwasher and within 20 seconds the poem is written. Or I can type in something more serious like why is my surgical site red and swollen and it will also produce an answer.
00:24:41
Speaker
Conversations around where and how AI and automation fit into the healthcare world can definitely get heated. Some welcome it, looking for ways to save money, save time, solve for staffing issues and other benefits, but others don't welcome it simply out of concern for patient safety and the quality of patient care.
00:25:00
Speaker
The AI expert interviewed in this article is Matt Hollingsworth, and he is the CEO of Carta Healthcare, which develops AI software to reduce the amount of time clinicians spend on mundane tasks. So it's interesting that even as someone selling healthcare AI tools, he is quoted saying this about chat GPT.
00:25:22
Speaker
I think it is an awesome advancement. There's a bunch of really cool things that it can do, but it's a tool. A hammer can be used to build a house or bludgeon somebody to death. It's all about how you use the tool that matters, which I think is a good perspective for everybody. But to summarize his primary concerns,
00:25:41
Speaker
ChatGPT is accessible to all and it's built to produce convincing sounding content, even if it's 100% wrong. People already turn to sources like Reddit and TikTok when they have a medical concern or are looking for medical advice. So adding chatGPT into the mix could
00:26:02
Speaker
start to cause problems. The reality though is that tools like this are obviously not going anywhere and the more you know the better. So if you haven't already definitely give it a try so you can become familiar with it and start to make your own decisions about the role something like this might play in your world both personally and professionally.
Tablets in Patient Care
00:26:25
Speaker
And switching gears to our third story, Healthcare Dive shared an article about four ways tablets are transforming patient care and four ways they can be used at the point of care. If you're not using tablets in your surgery center right now, you are really missing out on a lot of benefits like increased efficiency, productivity, and just overall collaboration between the patients and the entire care team. So let's review the four use cases that they shared.
00:26:55
Speaker
The first is EHR access. So by using tablets, a few benefits include significant time savings for both nurses and doctors, improved documentation, reduced errors, better patient care, lighter workloads, and the list goes on. Because by charting in real time, the benefits are really endless when you compare it to the paper process.
00:27:18
Speaker
The second is virtual patient observation. This allows patient care teams to check in and monitor their patients remotely. And in this scenario, a tablet can be mounted on a patient observation cart and trained staff members can observe their patient's health conditions and behaviors from a distance.
00:27:39
Speaker
The third use case is telemedicine. Imagine you're in pre-op or post-op and you need to loop in a specialist or another member of the care team who is off-site. Using a tablet, you can call them, turn the cameras on, and they're immediately with you in that room.
00:27:56
Speaker
I know we're all familiar with virtual doctor's visits from, you know, with your PCP, from the COVID days. And some of that has continued. I believe I just had a dermatologist appointment virtually. But now that we have these options available to us, providers are continuing to think out of the box and how they can be used.
00:28:21
Speaker
And then last but not least, the fourth use case is called video remote interpreting, which is kind of just a fancy way of saying a translator. But I can imagine many scenarios where this is helpful. If you have a patient that is hearing impaired or English is their second language, finding local translators can be challenging and super expensive and most likely will cause care delays if you're not prepared.
00:28:48
Speaker
So, something like VRI can bring an expert translator right into the room with you. So, those are just four examples of how tablets can impact how you care for your patient in an influential way and in a way that is impactful and can produce real change and results.
Inspirational Story and Episode Conclusion
00:29:08
Speaker
And to end our new segment on a positive note, a nurse in Uganda was recognized as nurse of the year by the country's health minister after she was seen climbing up an incredibly dangerous ladder in order to bring and administer vaccines to children in a remote area. Agnes Nambozo is her name and you have to go to the episode notes so you can see the article and check out this video for yourself. Whatever you're picturing in your head,
00:29:35
Speaker
The climb this nurse is making is 10 times more dangerous than what you're picturing. It's kind of hard to tell for sure, but she has a backpack-like box strapped to her back, presumably filled with the supplies. And the latter looks to be hand-built with tree branches and looks to be at least a few stories high, at least from where the angle of the camera is. So the commitment that
00:30:01
Speaker
Miss Nambozo has taken care of her community is so inspiring and her Nurse of the Year title is well deserved. 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.