Latest / Becker’s Healthcare Podcast / Nathan A. Merriman, MD, MSCE, Interim Senior Medical Director Surgical Specialties and Digestive Health Clinical Program at Intermountain Medical Center

Transcript

Nathan A. Merriman, MD, MSCE, Interim Senior Medical Director Surgical Specialties and Digestive Health Clinical Program at Intermountain Medical Center · Becker’s Healthcare Podcast

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  Hello. This is Franchesca Matthews with the Becker's
• 0:03
  ASC review podcast.
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  I'm thrilled to be joined today by doctor
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  Nathan Merriman, the interim senior medical director of
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  the Surgical Specialties Digestive Health Clinical Program at
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  Intermountain Medical Center.
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  Doctor Merriman, thank you so much for being
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  here today.
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  Thank you for having me, Franchesca.
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  Absolutely. To start us off, could you please
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  introduce yourself and tell us a little bit
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  about your background?
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  Oh, sure.
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  So I won't go all the way back
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  to the beginning, but I would I will
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  say I grew up in
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  health care and medicine,
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  on the East Coast in academics.
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  Went to UNC Chapel Hill for medical school
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  and up to
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  Philadelphia at University of Pennsylvania for residency and
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  fellowship,
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  and then got a master's in clinical epidemiology
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  and with a focus on, clinical trial design
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  and had intended to stay in academics.
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  And then my wife and I decided to
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  go into private practice. She's maternal fetal medicine
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  and then,
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  for me in GI in Delaware and loved
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  our experience there for twelve years,
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  learned a ton,
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  about the business side of medicine.
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  Also, we had our own endoscopy center,
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  worked with
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  an AmSurge partner to help optimize
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  the clinical,
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  operational, and financial
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  health of the endoscopyAC and worked with the
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  health system ChristianaCare
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  as well
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  to understand
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  teamwork across,
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  health systems
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  and private practice partners.
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  And then,
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  also worked with start up companies on learning
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  about innovation and
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  how we can
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  actually work together across different,
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  partnerships in health care,
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  to be better because we can't all be
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  good at everything.
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  And then,
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  decided in 2020,
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  my wife and I decided that we would
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  leave our private practices and, join the Intermountain
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  Health team.
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  So we moved our four kids up to
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  Utah and have loved every minute of being
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  a part of Intermountain.
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  And
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  I'll just say candidly,
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  I see a lot of
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  collective strength
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  with an Intermountain system because we can
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  take some parts of academics,
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  some parts of,
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  private practice models of care,
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  and then,
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  center
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  on our mission focus,
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  on helping patients live their healthiest lives and
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  working together to prevent avoidable suffering across our
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  communities. So I can't say enough about how
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  happy I am to be with Intermountain.
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  Awesome. Yeah. That's that's great to hear. And
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  I love speaking with folks who have experience
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  in private practice. I write a lot on
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  the physician leadership side of our publication, and,
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  yeah, there's definitely I'm I'm kind of seeing
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  growing movement towards sort of hybrid models of
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  doing things just to kind of respond to
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  the very dynamic health care environment today,
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  which kind of transitions into our next question,
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  which I'm I'm curious. What are the top
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  three trends that you're following in health care
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  today?
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  Yes. I would start with,
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  understanding the the patient experience
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  and working toward patient centered design and improving
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  access to care.
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  What we're we're really trying to work on
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  and I'm following companies
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  both in startups as well as health systems
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  and private practices is how can we make
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  it easier
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  for our patients,
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  to get the right care they need at
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  the right time in the right venue.
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  And so by far, that's number one.
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  Human centered care design, I think, is something,
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  we need to all continue to work on
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  because
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  I've said this before. I've never done a
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  colonoscopy without a patient's help, and I know
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  that sounds basic, but
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  it is fundamentally true is if if we
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  leave our patients out of the design of
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  care,
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  we're gonna lose them.
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  And so I think really focusing on patient
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  centered care is number one.
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  Number two is a
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  a massive concern about the cost of health
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  care, which is
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  is unsustainable
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  and more and more,
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  awareness around this. And I know this has
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  come in waves before, but I think this
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  is one of the biggest waves that we're
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  seeing in
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  true unsustainability
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  if we keep doing what we're doing,
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  currently in terms of the cost of care.
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  And then the third
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  big trend is thinking about innovations
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  in team based care model
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  and technology. I I am of the opinion
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  that often
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  people use the word innovation
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  referring to technology, but there's so much more
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  to innovation.
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  As we're trying out new ways of working
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  together,
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  we're trying out,
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  at Intermountain, we're really focusing on proactive care,
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  which I believe is is
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  the right thing to do. How do we
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  get upstream,
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  working with patients on identifying,
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  health concerns,
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  conditions earlier
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  before they progress,
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  and get more costly and and more harmful
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  to patients. So
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  proactive care, I I believe, is a a
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  form of care innovation.
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  And so
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  using
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  team based care models to innovate with our
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  patients,
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  would be number three.
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  Mhmm. Absolutely. And what are you most excited
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  about right now?
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  I I think
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  I'm excited about competition.
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  And I don't I don't know if that's
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  a
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  popular response or what others say, but,
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  I think if we're competing on the right
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  things, we will all help our each other
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  to to get better faster.
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  And just in the the frame in GI,
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  I I think the way we're looking at
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  it is how do we compete against colon
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  cancer?
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  And then using that frame, then we start
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  to see each other across,
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  academic centers,
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  community health systems, and and,
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  larger groups as well as private practices and
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  start up companies is we're all teammates fighting
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  against colon cancer. And so I think I'm
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  very excited
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  about competition,
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  in and
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  how do we collaborate,
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  to compete on the right things,
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  High safety, high quality care,
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  lower cost of care for our patients,
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  and then human centered care, with a team
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  based approach with every patient as our teammate.
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  I I think
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  that's what I'm most excited about is,
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  competing on the right things to help make
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  care
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  better and more more affordable for our patients.
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  I really that's really interesting framing. I think
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  that sometimes, you know,
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  like, the you said is I don't know
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  if that's a popular response. And I think,
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  you know, most people kind of think about
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  competition in a different way. But what you
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  said of, you know, we're competing against colon
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  cancer, this is a collaborative
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  thing, and we're we're competing on the same
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  team. I think that's that's a really, you
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  know, poignant
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  note there.
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  How are you and your your center thinking
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  about growth over the next twelve months?
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  Oh, great great question. So and one thing
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  I should step back and share.
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  When I came to Intermountain in 2020, we
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  had no,
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  ambulatory endoscopy centers,
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  and
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  that was very surprising to me because I
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  was a physician investor and co owner and
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  co manager in one previously, and I I
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  knew about the value proposition
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  of,
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  ambulatory endoscopy centers. And so over the last
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  five years, we've worked together at Intermountain to
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  then,
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  initiate,
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  having ambulatory endoscopy centers, in Utah.
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  And
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  we've merged with SEL Health,
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  and so they also now we're we're one
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  big Intermountain team of teams.
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  They have three ambulatory endoscopy centers in the
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  Denver area,
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  that are joint ventures with
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  a very strong aligned private practice partner Gastroenterology
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  of the Rockies.
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  So now
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  I think as we started up the Altaview,
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  ASC, which is multi specialty with ENT, ophthalmology,
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  and GI,
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  and next week, actually, we have the ribbon
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  cutting,
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  for our first ever fully ambulatory endoscopy center
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  in Utah with Intermountain Health,
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  at Makady.
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  That's very exciting.
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  And,
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  as we then start up and and convert,
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  our HOPD
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  facility
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  at Riverton Hospital, and this is, to me,
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  fascinating, Franchesca, is
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  we are disrupting ourselves by saying we have
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  a hospital based facility,
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  and we're gonna convert that into,
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  an ASC in endoscopy at Riverton.
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  And so we're,
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  actually going to,
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  be making less money.
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  The cost of care for our patients is
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  gonna go down, as we make that disruption,
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  and and it's the right thing to do.
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  So going
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  from
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  the McKay Dee Ambulatory Endoscopy Center,
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  opening next week to Riverton,
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  Hospital,
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  HOPD conversion,
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  to an ambulatory endoscopy center
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  in in, I believe,
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  2026.
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  That is the big growth currently. And then
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  thinking ahead in,
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  early twenty twenty seven, we have a St.
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  George
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  ambulatory endoscopy center we're we're opening as well.
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  I I think
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  I'll I'll share, if it's okay,
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  the
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  excited about that growth and understand the challenge
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  in moving a lot of patients out of
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  the hospital based facilities in endoscopy we have
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  in Intermountain
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  into these lower cost of care settings,
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  is is going to be a challenge. And
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  I'm I'm really excited about that because we're
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  gonna be able
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  to work with our physician partners at each
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  center and then connect the centers to each
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  other to optimize
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  safety, quality,
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  efficiency,
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  in the patient experience at every center,
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  and that that's been a nice benefit of
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  working with surgery partners,
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  across our sites in Utah for the the
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  surgery ASCs as well as the endoscopy ASCs,
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  and they're connecting us,
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  on a shared platform of
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  who's doing things the best,
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  how can we learn from each other.
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  It's really the Intermountain way of
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  working together, to improve safety, quality,
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  operational
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  efficiency,
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  and the human experience for our patients.
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  Absolutely. And that is so interesting, the way
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  you kind of phrase, you know, the the
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  disrupting yourselves and moving out of the HOPD.
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  You know, I think that I I wonder
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  if that's something that we'll see
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  across more systems and, you know, ASC
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  organizations as,
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  you know, just kind of the the the
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  migration to outpatient kind of continues. And I
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  think that that,
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  the lower cost setting will just kind of
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  continue to prevail is sort of what I'm
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  hearing from sources. But that's definitely super interesting.
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  Anything else to add here that I haven't
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  asked about so far?
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  The one other thing
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  I'll share is traditionally
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  and and it's it had been said in
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  a meeting
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  several months ago too is, oh, Intermountain
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  doesn't really do,
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  ambulatory endoscopy centers, and and so we're changing
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  that. And that was the historic perspective.
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  It's really helped,
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  connect and align with our GI physician partners,
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  because they're also,
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  investing in the centers and and,
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  you know, part owners in the centers, and
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  and that's the the private practice model I
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  had experienced before. And,
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  to be open, that's helped with recruiting. It's
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  helped with,
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  also physicians being very
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  engaged and aligned on,
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  you know, operational efficiency, working together with our
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  anesthesia,
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  our nursing partners, our surgery partners team,
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  to bring out the best in each center.
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  And and I think
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  that's gonna be exciting to continue to do,
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  and and to be honest, it's a unique
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  value proposition I think we have as a
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  health system,
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  to have physicians being able to invest and
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  and buy into these,
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  both on the surgery ASC side as well
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  as the endoscopy ASC side.
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  Mhmm. Absolutely. And we'll have to continue to
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  follow-up with y'all to hear more about that,
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  because certainly it's very resonant over here as,
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  like I mentioned earlier, just as health care
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  kind of evolves, I feel like I'm hearing
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  more and more about just kind of new
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  and, you know, for lack of better term,
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  creative,
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  innovative ways that people are thinking about investment
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  and ownership. So,
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  yeah, that's that's all I have for you
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  today, though, doctor Merriman. Thank you so much
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  for joining us.
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  Thank you, Franchesca.
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  Absolutely. It's been a pleasure speaking with you,
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  and I look forward to connecting with you
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  again in the future.