Latest / Becker’s Healthcare Podcast / Haroon Ansari, Chief Executive Officer of Pinnacle Hospital

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Haroon Ansari, Chief Executive Officer of Pinnacle Hospital · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
• 0:04
  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
• 0:45
  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
• 0:52
  - This is Laura Dierdahl with the Becker's Healthcare
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  - podcast. I'm thrilled today to be joined by
• 0:56
  - Haroon Ansari, chief executive officer at Pinnacle Hospital.
• 1:00
  - Haroun, it's a pleasure to have you on
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  - the podcast today.
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  - Hi. Thank you for having me on this
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  - podcast. Thank you very much.
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  - Absolutely. Now I'm excited for our conversation. I
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  - know I'm a lot of it going on
• 1:12
  - in the health care industry today, so it's
• 1:14
  - gonna be,
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  - so important for us to kinda talk through
• 1:18
  - some of the things that are going well
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  - as well as how you're thinking about the
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  - future. But before we dive in, can you
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  - tell us a little bit more about yourself
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  - and your background? Yeah. Sure. That's no problem.
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  - So I've been a health care executive for,
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  - almost twenty nine years. For the last,
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  - eighteen years, I've been CEO at Pinnacle Hospital,
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  - and I am also simultaneously
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  - CEO of an ambulatory surgery center,
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  - in Indiana. And I've been CEO there for
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  - twenty one years.
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  - So I bring a pretty unique perspective from,
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  - physician
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  - governance, if you will, and managed,
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  - both ambulatory care as well as, inpatient,
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  - hospital as well. So
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  - that's kinda what I've been doing, for some
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  - time. And,
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  - my education is in health care administration,
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  - PhD,
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  - master's,
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  - and bachelor's. All of that, it was in
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  - health care administration and public policy. So that's
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  - kinda what my background is.
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  - Well, it's amazing to hear. You know, what
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  - a a great experience and exposure to both
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  - the ambulatory surgery center side as well as
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  - the hospital side, which I know
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  - is so important now.
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  - So much of the care is shifting into,
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  - the outpatient setting and then obviously still a
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  - lot needed, from inpatient too. So that's great
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  - to hear.
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  - Could you give us just a quick state
• 2:32
  - of the union for Pinnacle Hospital? What's gone
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  - well this year, and what are you focused
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  - on for the rest of 2026?
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  - No. I think that's a very good question,
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  - Laura. I appreciate you having me on your
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  - podcast, and I'm looking forward to speaking at
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  - Vectrus as well. I think, you know,
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  - as far as the good points, and we'll
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  - talk about the challenges here in a minute
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  - too,
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  - there's a lot going on. I think that,
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  - in,
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  - 2625
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  - and post COVID, if you will, we've seen
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  - this artificial inflation of labor has gone down
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  - significantly. I've seen that supply of nurse practitioners
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  - has improved
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  - because, supply and demand for specialties and primary
• 3:06
  - care is still a very challenging situation, which
• 3:09
  - we'll talk about later.
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  - I'm also seeing that there are more specialized
• 3:12
  - NPs out there, especially for cancer care, heart,
• 3:15
  - spine, and orthopedics.
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  - So I think we're able to meet some
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  - of those demands.
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  - I'm also seeing,
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  - as far as positive,
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  - that covered lives in self funded markets, for
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  - commercial plants where you have a lot of
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  - manufacturing plants, is getting to be more predictable.
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  - From 2018
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  - to 2024,
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  - we've seen massive fluctuation in commercial lives. And
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  - it was hard for health systems and smaller
• 3:41
  - facilities like ambulatory surgery centers and physician owned
• 3:44
  - hospitals to,
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  - predict budgets and allocate expenses and to figure
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  - out how to manage anesthesia
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  - and all those high cost services that you
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  - have. So that's also very positive.
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  - I also think that there are more
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  - options out there for,
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  - consumers.
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  - Like you said, there's a,
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  - a big push towards ambulatory care.
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  - So I think, we're moving towards that too,
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  - In our hospital
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  - side of things, we'll be seeing a lot
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  - of migration from traditional DRGs to CPTs. And
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  - as a result of that, one thing positive
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  - that has occurred
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  - is that many, many vendors
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  - have also adjusted their costs
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  - for different supplies. And as a result of
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  - that, I think,
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  - some of the the cost is becoming a
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  - little bit more affordable as well. So that's
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  - kind of the nutshell of the positives, if
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  - you will, in terms of,
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  - where we are in 2026
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  - for the hospital.
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  - I love it. I think that's really helpful
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  - to understand it. And definitely
• 4:48
  - looking at, you know, some of the things
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  - you mentioned in terms of,
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  - migration for DRDs and CPTs and some of
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  - the vendor,
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  - you know, challenges and issues there. I think
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  - so many organizations are seeing,
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  - you know, things similar to them. And so,
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  - you know, when you look ahead, what are
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  - some of the other big headwinds that you're
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  - keeping your eye on? What are you preparing
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  - for? How are you thinking about, trying to
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  - make sure you're sustaining success even given some
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  - of these challenges?
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  - No. I think that's a very good question.
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  - I think that, number one, from underwriting perspective,
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  - health plans,
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  - especially the ones that are working with Medicare
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  - Advantage or value based care and things of
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  - that nature, they would need to really understand
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  - Medicare, double a p c c's, you know,
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  - predictability and where that's going and also how
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  - Medicare changing is outlier reimbursement. No one has
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  - a good handle on that for both ambulatory
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  - care as well as for inpatient facilities. That's
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  - a big area that I think people need
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  - to get focused on because that will change
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  - reimbursement. It's not just DRGs to CPTs.
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  - This this will change the whole
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  - functionality of how the reimbursement is done. So
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  - that's a big area of financial aspect of
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  - things we need to look at. And as
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  - you know, when Medicare makes those, changes,
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  - a lot of those changes going to the
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  - commercial market with Blue Cross, United, and so
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  - on. So I think that's an important aspect
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  - of area of focus, if you will, that
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  - our hospital and I think
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  - facilities like ours, big and small, need to
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  - really get more focused on that. I think
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  - that from access standpoint,
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  - we need to have more formal programs out
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  - there for training, nurse practitioners and the mid
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  - level providers,
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  - to help out because supply and demand, nationally
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  - for both certain specialties and physicians, it's just
• 6:28
  - getting tough. There's a lot of retirements going
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  - on.
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  - You know, you look at average age of
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  - physician in certain markets, especially rural, rural markets,
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  - smaller markets where you get critical access hospitals.
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  - Those physicians on their sixties and seventies now
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  - are still working,
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  - which is good, but I think that we
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  - need to have, robust recruitment and have different
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  - ways of doing things. And I think more
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  - formality into training nurse practitioner,
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  - in different specialties, I think, is needed, and
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  - and I think that's important as we go
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  - forward.
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  - I also think that IT enhancements are needed.
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  - I think that more mobility tools we bring
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  - for patients and providers for integration of both,
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  - preventive as well as interventional care.
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  - Using those tools is gonna be very important,
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  - and I know that AI is gonna play
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  - a big role, as you said. I think
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  - that,
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  - robots are are going to happen, not just
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  - robotic surgery, but robotic,
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  - managed health care.
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  - I think that you'll see a a lot
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  - of that, coming up.
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  - I think those are important challenges as we
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  - go forward.
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  - But, again, I I think overall,
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  - our focus is also going
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  - to be looking at how do we align
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  - our,
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  - health care systems in this changing market, which
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  - we'll talk a little bit more as you
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  - ask me more questions about opportunities
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  - and, what the focus should be as as
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  - we go forward.
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  - Absolutely. That makes a lot of sense. And,
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  - you know, I I think all of these
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  - things are very much interconnected. I I I'm
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  - curious. You know, you talk about,
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  - having the workforce especially,
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  - shifting and changing a bit, you know, whether
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  - it's,
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  - physicians and and nurses retiring or needing to
• 8:13
  - recruit
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  - more of us pipeline there. And so,
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  - what's it like for you to bring new
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  - specialists and and clinical,
• 8:21
  - clinical,
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  - folks into the team? I I know it's
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  - something many hospitals and organizations are trying to
• 8:27
  - figure out. So is there anything that's worked
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  - well for you as you're trying to,
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  - build up the the base of the next
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  - generation nurses and doctors, or, is that something
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  - you're still troubleshooting at?
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  - Yeah. I I I think,
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  - like I said, supply is getting a little
• 8:43
  - bit better in nursing and nurse practitioners.
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  - I would say maybe about 10% or 15%
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  - in our market. But like you said, there
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  - are still challenges to recruit,
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  - certain specialists and to retain them as well.
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  - And and, so there are many models out
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  - there, as you know, to do that. You
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  - can have individuals join private equity groups. You
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  - You can have individuals join large group practices
• 9:02
  - or join a health care system or just
• 9:03
  - simply get employed.
• 9:05
  - Very kind of a hybrid, model in our
• 9:07
  - physician owned facility and physician governed. We have,
• 9:10
  - both independent doctors
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  - who are, if you will, stockholders
• 9:13
  - of the, for profit health care, which is
• 9:16
  - our,
• 9:17
  - a physician owned hospital. And then you also
• 9:19
  - have employed physicians on board, which, like you
• 9:22
  - said, it's very important to have certain employed
• 9:24
  - physicians on board, both primary care and specialists,
• 9:27
  - because we have to meet the needs of
• 9:28
  - the community.
• 9:30
  - And then the third model is unfortunate, but
• 9:32
  - you have to kinda work towards that. Sometimes
• 9:34
  - you have no choice but to work with
• 9:36
  - locums because of supply and demand.
• 9:38
  - We don't have to do that as much
• 9:39
  - because we're not like a big box hospital.
• 9:42
  - We are doing doing pretty much 100% of
• 9:44
  - elective surgeries. We're able to better, better manage,
• 9:47
  - that aspect of it.
• 9:49
  - But like you said,
• 9:50
  - you know, collaboration and innovative partnerships as we
• 9:54
  - go forward
• 9:55
  - will be
• 9:56
  - key both in consolidation
• 9:58
  - as well as in defining new roles of,
• 10:01
  - how different stakeholders will come together to define
• 10:03
  - health care. I do see that next five
• 10:05
  - years is going to really reset,
• 10:08
  - various markets,
• 10:10
  - in terms of how health systems are going
• 10:12
  - to approach both financially and programmatically.
• 10:17
  - Absolutely. That makes a lot of sense. And,
• 10:19
  - you know, it is, really helpful to understand
• 10:21
  - those different models and how their work intertwined
• 10:24
  - and interconnected in order to,
• 10:26
  - ensure you've got the right, resources in place
• 10:29
  - to provide care for the community. Now let's
• 10:31
  - talk about growth. What are your some of
• 10:33
  - the best opportunities that you're seeing in the
• 10:34
  - next two to three years or so?
• 10:36
  - Yeah. No. I think that's a very, very
• 10:38
  - good question. I'm going to,
• 10:40
  - try to answer it, in a simple manner,
• 10:43
  - but it's a little bit complicated. So, you
• 10:45
  - know, in our world, I'm seeing,
• 10:47
  - more and more,
• 10:49
  - involvement of private equity.
• 10:51
  - And I think that,
• 10:53
  - hospitals like ours will have to consider and
• 10:56
  - look at vertical integration with private equity,
• 10:59
  - with some sort of,
• 11:01
  - situation where we can work with
• 11:03
  - Steeraj, as it relates to both insurance managed
• 11:06
  - care and Medicare Advantage programs, whether it's value
• 11:08
  - based care, ACOs,
• 11:10
  - or,
• 11:11
  - through acquisitions, through, you know, fully vertical
• 11:14
  - vertically integrated health care system. So private equity
• 11:17
  - is playing a major role in that, and
• 11:19
  - that's a huge opportunity for our system
• 11:22
  - to get involved in. I think sustainability
• 11:25
  - for independent,
• 11:26
  - stand alone, physician owned hospitals nationally,
• 11:31
  - and as well as some of the ambulatory
• 11:32
  - surgery centers, I think it has to be
• 11:34
  - looked at. Because I think, when you look
• 11:36
  - at purchasing,
• 11:37
  - GPOs are going to play a big role,
• 11:39
  - and you have to join one, and you
• 11:41
  - have to coexist. I think you mentioned,
• 11:44
  - provider shortage.
• 11:46
  - Coexistence is the way to go because health
• 11:48
  - care, bigger no matter how big they are,
• 11:50
  - they're still struggling with that aspect of it.
• 11:52
  - And we're seeing that large independent groups
• 11:55
  - are not necessarily throwing in the towel,
• 11:58
  - but they're,
• 11:59
  - seeking more security by joining private equity. So
• 12:02
  - you can't really overlook when you have a
• 12:04
  - 200 group position,
• 12:06
  - you know, center or or the 300, and
• 12:08
  - and they're in your community for fifty years
• 12:10
  - or a hundred years. Well, at that point
• 12:12
  - in time, you have to change your ways,
• 12:14
  - and you have to challenge how you're doing
• 12:16
  - things currently. And you have to look at
• 12:18
  - it from the standpoint of compliance, legality,
• 12:22
  - and like you mentioned,
• 12:24
  - the financial aspect of your DRGs to CPTs,
• 12:27
  - professional services reimbursement, different kind of contracting methodologies.
• 12:31
  - I think that's an opportunity for us. So,
• 12:33
  - we are going to probably, at some point
• 12:36
  - in time, look at a partner and align.
• 12:39
  - And alignment is not just, you know, one
• 12:41
  - avenue, meaning a health care system. It may
• 12:44
  - be two or three things that we align
• 12:45
  - with to create,
• 12:47
  - storage, maintain the storage to offer communities, especially
• 12:50
  - in our market.
• 12:51
  - It's a manufacturing
• 12:53
  - area, so it's a self funded group pretty
• 12:55
  - much out there for commercial. And we're also
• 12:57
  - seeing a big growth in our Medicare population
• 12:59
  - in the last four years. We have seen
• 13:01
  - an increase almost by 20 to 25%.
• 13:03
  - So when you look at that, like you
• 13:04
  - mentioned,
• 13:05
  - you'll see more and more ambulatory
• 13:08
  - surgery centers out there for for for to
• 13:10
  - to meet the population needs. We're a non
• 13:13
  - c o n state, so we can create
• 13:14
  - a surgery center like seven elevens. We can
• 13:17
  - erect them quickly.
• 13:18
  - But at same time, you need providers, and
• 13:20
  - you need to collaborate on that part of
• 13:22
  - it. Secondly, I'll say that,
• 13:24
  - you know, as far as headwinds and opportunities,
• 13:27
  - I'm seeing lots of what they call REIT,
• 13:30
  - a health care REIT, which is real estate
• 13:31
  - investment trust, which are, real estate companies
• 13:34
  - that are getting involved with both,
• 13:37
  - big box health care systems and independent doctors
• 13:40
  - kinda alleviating their financial struggles as it relates
• 13:43
  - to managing real estate so they can grow,
• 13:44
  - so they can recruit, so they can
• 13:46
  - invest in technology and EHR and new systems
• 13:49
  - that they have to to continue to provide
• 13:51
  - care and the outcomes that they wanna maintain.
• 13:54
  - So
• 13:55
  - REITs are coming on board. I think they're
• 13:56
  - gonna play a big role. If you look
• 13:58
  - at most of the big health care systems,
• 14:00
  - they're actually a big real estate company. They
• 14:02
  - have billions and billions of dollars worth of
• 14:04
  - real estate, but on the balance sheet, it's
• 14:05
  - a depreciating asset. So now health care system
• 14:08
  - are looking at it in terms of what
• 14:09
  - what can we do to offload
• 14:13
  - some of that? And if you do that,
• 14:14
  - we'll also gain access to a whole bunch
• 14:15
  - of new doctors in new community. And the
• 14:17
  - whole aspect of, hub and spoke model
• 14:20
  - and providing care on a at a regional
• 14:23
  - level
• 14:24
  - is kinda coming back,
• 14:27
  - through skinny networks, which I think will reduce
• 14:30
  - duplication and improve access.
• 14:32
  - And that's kind of being looked at. So
• 14:35
  - in Indiana, for instance,
• 14:37
  - I'm seeing tremendous amount of consolidation. Matter of
• 14:40
  - fact, some of the Indiana based health care
• 14:43
  - systems are moving into lower Michigan markets
• 14:46
  - and are acquiring,
• 14:47
  - systems,
• 14:48
  - in there. And when you talk about growth,
• 14:51
  - I think that some of the groups that,
• 14:54
  - are really going to be working with private
• 14:57
  - equity and health systems in our hospitals like
• 14:59
  - ours will have no choice but to work
• 15:00
  - with them will be orthopedics,
• 15:03
  - spine,
• 15:04
  - some of the primary care physicians
• 15:06
  - that are independent. And I I also think
• 15:08
  - that some of the cardiology,
• 15:10
  - groups and oncology, I think, will be a
• 15:12
  - big part of that. These are four or
• 15:14
  - five specialties that I think will play the
• 15:16
  - biggest role with private equity and vertically integrated
• 15:19
  - health care system. To us, this is a
• 15:21
  - huge opportunity.
• 15:22
  - Lastly, and coming back to this, as I
• 15:24
  - mentioned before,
• 15:26
  - I think movement towards and understanding DRGs and
• 15:29
  - CPTs
• 15:30
  - and innovation with technology and how we can
• 15:33
  - manage that and how we can work with
• 15:36
  - payers, including Medicare, to have the right kind
• 15:39
  - of incentive in place,
• 15:42
  - outcome based incentive to be able to provide
• 15:44
  - those kind of services
• 15:46
  - in this changing reimbursement environment. It's it's a
• 15:49
  - lot of work, but I think we have
• 15:50
  - to do that. There's some legislative initiatives that
• 15:52
  - have to have to be looked at
• 15:54
  - to accomplish that. But then, also, I think
• 15:56
  - there's a lot of work involved with, national,
• 15:59
  - payers, and I'm hoping that Aetna and Blue
• 16:02
  - Cross and UnitedHealthcare's of the world,
• 16:04
  - Optum,
• 16:05
  - that they get involved and start looking into
• 16:07
  - some of these changes and partner,
• 16:10
  - and play a big role with consolidation. Because
• 16:12
  - I think consolidation is going it's here. I
• 16:13
  - think it's gonna it's gonna be staying around.
• 16:15
  - So
• 16:19
  - Absolutely. That's fascinating to hear. And I think
• 16:21
  - especially
• 16:22
  - looking at, you know, how,
• 16:24
  - health care is consolidating and the ways that,
• 16:27
  - organizations are coming together, different types of partnerships
• 16:30
  - and and acquisitions and more.
• 16:33
  - And I think it's especially interesting, like you
• 16:35
  - mentioned, market by market, there can be a
• 16:36
  - lot of variety and variations in how things
• 16:39
  - are going. But from your vantage point,
• 16:42
  - you know, and and to your last point,
• 16:43
  - looking at the different payers, national, local, and
• 16:46
  - regional,
• 16:48
  - you know, what types of shifts have you
• 16:50
  - been seeing with them? Is anything getting easier,
• 16:54
  - moving toward, you know,
• 16:56
  - different types of arrangements? What have you been
• 16:58
  - seeing, especially from the payer landscape,
• 17:01
  - you know, that that's been changing or shifting
• 17:03
  - the last year or so?
• 17:04
  - Yeah. Sure. And that's a very good question.
• 17:06
  - I think,
• 17:07
  - payers have tried everything as you know. I
• 17:09
  - mean,
• 17:10
  - I've I've been involved in peer markets. And
• 17:12
  - one of my major strength areas, managed care
• 17:15
  - and contracting and contracting methodologies. I can tell
• 17:17
  - you that,
• 17:18
  - payers have tried literally, you know, work towards
• 17:21
  - a straight contract with carve out codes. They've
• 17:23
  - worked at, back in the day, as you
• 17:25
  - know, that capitation based programs and reverse capitation
• 17:28
  - came into place in late nineties. Then the
• 17:30
  - carve out systems came in with the PHOs.
• 17:33
  - Then CINs came in. But now I think
• 17:35
  - what the peers are looking for is what
• 17:37
  - they call case rate methodologies,
• 17:39
  - where on an outpatient, what they're trying to
• 17:41
  - do is to just do a case rate,
• 17:42
  - which is a bundle that includes everything.
• 17:46
  - In some cases, they're going as far as
• 17:47
  - including professional services and and anesthesia services. But
• 17:50
  - one of the challenge I'm seeing with the
• 17:52
  - payers is that they're not able to implement
• 17:55
  - implement that administratively, and they're not also able
• 17:59
  - to monitor and put audit systems in place
• 18:01
  - to make sure that that is working correctly.
• 18:04
  - Second aspect of that is that, I think
• 18:05
  - that many, many health care system are just
• 18:07
  - not prepared for it. They're just working on
• 18:09
  - the old fee for service kind of a
• 18:11
  - system.
• 18:11
  - And if you're dealing with that, you need
• 18:13
  - an overhaul of repricing methodologies, how third party
• 18:16
  - administrators work, how the intermediaries
• 18:18
  - work when you have pre authorization process going
• 18:21
  - on in place and codes change and codes
• 18:24
  - get reclassified
• 18:25
  - based on,
• 18:26
  - op reports or retrospectively or prospectively. I mean,
• 18:29
  - there's a lot of effort from infrastructure standpoint
• 18:32
  - that I think payers need to implement before
• 18:34
  - they implement new
• 18:36
  - cap rate methodologies
• 18:38
  - or,
• 18:39
  - just carve out rate methodologies
• 18:41
  - inclusive of everything. Now what I'm I am
• 18:43
  - seeing what, many payers are doing is that
• 18:46
  - they're moving towards
• 18:48
  - a,
• 18:49
  - a process where they're looking at,
• 18:52
  - outcomes
• 18:53
  - and incentivizing outcomes by reducing length of stay,
• 18:57
  - looking at the infection rate,
• 19:00
  - looking at readmissions, for instance, like Medicare does.
• 19:03
  - They are working on those kinds of initiatives
• 19:05
  - where it's kinda like a value based care
• 19:07
  - system,
• 19:08
  - to incentivize providers to do better. And if
• 19:11
  - they do better, they'll get, 10% or 15%
• 19:14
  - better pay or they'll withhold x amount of
• 19:16
  - pay, and then they'll go ahead and reimburse
• 19:19
  - them towards the end of the year after
• 19:20
  - they reconcile.
• 19:21
  - Now those kind of methodologies are coming back.
• 19:24
  - In some cases, they're,
• 19:26
  - being administered,
• 19:28
  - but they're being administered in a managed kind
• 19:30
  - of situation where organizations like Previa, for instance,
• 19:35
  - that is a very large national group working
• 19:37
  - with primary care that, administers value based care,
• 19:39
  - which is their main product, is able to
• 19:41
  - administer that. So they're able to take the
• 19:43
  - premium or percentage of premium and go ahead
• 19:46
  - and allocate those resources and administer it, and
• 19:48
  - then they have a,
• 19:50
  - you know, incentive program in place with the
• 19:52
  - payer and the organization. And then,
• 19:55
  - providers are involved in that and their equity
• 19:57
  - partners,
• 19:58
  - which is completely legal and compliant. And that's
• 20:00
  - one way to address it. It works good,
• 20:03
  - but you need to have at least a
• 20:05
  - mass of at least 20 to 25 physicians
• 20:07
  - in that kind of a setting with a
• 20:09
  - possible participation of, like you said, ASCs and
• 20:12
  - IDTFs and things of that nature. There's also
• 20:15
  - a lot of shift going on right now
• 20:17
  - from payer's standpoint
• 20:18
  - to do what they call, classification
• 20:21
  - or site of service differentials. So if you
• 20:23
  - have a health care system that has, you
• 20:25
  - know, 20 sites,
• 20:26
  - they're requiring all the health care systems to
• 20:28
  - have, you know, 20 different contracts because they're
• 20:31
  - saying, hey. Look. Your site of service here
• 20:33
  - is different than the site of service you
• 20:34
  - have elsewhere. So we can't give you just
• 20:36
  - one master agreement for health care system with
• 20:38
  - one reimbursement. We're gonna do it by ZIP
• 20:40
  - code or by geographics.
• 20:42
  - So we're seeing a lot of that changes,
• 20:45
  - coming in third. I'm seeing that they're incentive
• 20:49
  - based payments and professional services
• 20:52
  - where,
• 20:53
  - a surgeon is encouraged to use,
• 20:55
  - or physician, I should say, not just surgeon,
• 20:57
  - physicians are encouraged to use outpatient setting for
• 20:59
  - their ancillary care, radiology care, and where possible
• 21:03
  - and clinically appropriate, their interventional care, meaning surgeries
• 21:06
  - and whatnot in an outpatient setting. In an
• 21:09
  - in a like, what I call a completely
• 21:11
  - freestanding outpatient center
• 21:13
  - as opposed to an inpatient or HOPD
• 21:16
  - facility. And if they are not making that
• 21:18
  - choice and patient is qualified to be in
• 21:22
  - an outpatient setting,
• 21:23
  - they're actually disincentivizing
• 21:25
  - reimbursement by 10 to 15% in professional services.
• 21:28
  - So you'll see
• 21:30
  - behavior changes will occur. If it's a health
• 21:31
  - care system, they're gonna look at it from
• 21:34
  - system perspective and say, hey. Look.
• 21:36
  - Professional services are down by in in reimbursement
• 21:39
  - by 20%. What happened? So as a result
• 21:41
  - of that, I'm seeing a lot of health
• 21:43
  - systems now creating partnerships with
• 21:46
  - ambulatory surgery centers, whether it's a
• 21:49
  - joint venture or full acquisition.
• 21:51
  - But they're they're doing that to make sure
• 21:53
  - that they do not lose this 1520%
• 21:55
  - on professional services reimbursement. So lots of challenges.
• 21:58
  - There are some legal challenges. There are some
• 22:00
  - legislative issues too around that, but that's kind
• 22:03
  - of where things are being, you know, headed
• 22:05
  - at as as we speak. So
• 22:10
  - Got it. Okay. That's,
• 22:11
  - perfect and helpful to know. I mean, what
• 22:13
  - a dynamic and,
• 22:15
  - really interesting field to be in, and thank
• 22:17
  - you so much for kind of explaining that
• 22:19
  - at a at a very granular level. I
• 22:21
  - think that's really helpful to understand and then
• 22:23
  - thinking through what is gonna make the biggest
• 22:25
  - difference,
• 22:26
  - for organizations in the future. Now before we
• 22:28
  - wrap up our conversation, I wanted to ask
• 22:30
  - Yeah. Who do you admire as a leader
• 22:31
  - in from really in the industry and why?
• 22:34
  - Sure.
• 22:35
  - Yes. No. That's a very good question, and
• 22:37
  - I've answered that several times to several people.
• 22:39
  - I would say Steve Jobs.
• 22:41
  - And I'll give you examples real quickly here
• 22:43
  - in, next, fifteen seconds.
• 22:45
  - Yeah. He had clear vision.
• 22:47
  - He
• 22:48
  - just relentlessly
• 22:50
  - continued with his innovation.
• 22:52
  - He refused
• 22:53
  - to accept
• 22:54
  - how things were done in, you know, in
• 22:56
  - old ways. And he always looked at, you
• 22:58
  - know, leaving the old ways and coming up
• 23:00
  - with new ideas. And and he pushed his
• 23:02
  - teams
• 23:04
  - to break the old limitations, if you will.
• 23:07
  - And
• 23:08
  - he had a very good way
• 23:11
  - to create what I call organized market disruption.
• 23:15
  - I paid a lot of attention,
• 23:18
  - in terms of how he managed and what
• 23:20
  - he did and how he involved both consumers
• 23:22
  - and his team to lead that effort.
• 23:26
  - While doing that, as you know,
• 23:28
  - he was
• 23:30
  - a team oriented guy, a charismatic
• 23:32
  - leader,
• 23:34
  - and he was very emotional.
• 23:36
  - He he did not mind showing showing his
• 23:38
  - emotions to his team or his consumers as
• 23:40
  - to how passionate he was
• 23:42
  - on the items he was working on. And
• 23:44
  - I think that
• 23:46
  - is a very, very good trait of a
• 23:48
  - successful leader, in my opinion.
• 23:51
  - I was
• 23:52
  - very young in my very early career at
• 23:55
  - that point, but I was watching him doing
• 23:56
  - all that.
• 23:57
  - And I just
• 23:59
  - very much admired his way of managing things
• 24:02
  - and how he brought innovation to the table.
• 24:04
  - So and I'm trying to do that same
• 24:06
  - thing. I I I think that some of
• 24:08
  - my ideas
• 24:09
  - in health care are are different,
• 24:12
  - and,
• 24:14
  - and it's difficult to implement that. We have
• 24:16
  - just done a partnership with a large health
• 24:18
  - care system with our surgery center as well.
• 24:20
  - We were successful in doing that, and it's
• 24:23
  - a eight hospital system.
• 24:24
  - And I'm bringing some of the that thinking,
• 24:26
  - if you will, to the table and trying
• 24:28
  - to get people to understand how to break
• 24:30
  - this old way of managing things here because
• 24:33
  - there are new things on the horizon. All
• 24:34
  - the things that you mentioned from reimbursement
• 24:36
  - to alignment and supply and demand
• 24:39
  - versus how payers are looking at us and
• 24:41
  - how, things will be different five years from
• 24:44
  - now, and we have to adapt to it.
• 24:46
  - So
• 24:48
  - I love it. That's fantastic to hear. And,
• 24:51
  - you know, really the amazing leader in Steve
• 24:53
  - Jobs in in so many ways, was extremely
• 24:55
  - successful. But as you mentioned, being able to
• 24:57
  - be passionate about what you're doing and,
• 25:00
  - everything else is really, really amazing. So thank
• 25:03
  - you so much for joining us on the
• 25:04
  - podcast today, everyone. This has been a really
• 25:06
  - fun conversation. I I learned a lot and,
• 25:09
  - really, we'll look forward to connecting with you
• 25:11
  - again soon.
• 25:12
  - Thank you again for your time. Looking forward
• 25:14
  - to seeing you guys, later on for, speaking
• 25:16
  - engagement. Thank you.