 This is Think Tech Hawaiians, Community Matters here. Aloha and welcome to Business in Hawaii with Reg Baker. This is a show that broadcasts every Thursday from 2 to 2.30 in the very high tech studios in downtown Halaululu of Think Tech Hawaii. We have some of the best technicians working with us down here and we also have some of the best guests joining us. We're a show that highlights on success. We look at the successful companies in Hawaii and we talk a little bit about what they did to make it successful. We've all heard the negativity, the sad stories about how tough it is. All of that may be true, but we've got some very successful individuals that have made it work here in Hawaii and we wanna hear their story and this show is all about that. So today I've got two individuals that I have been working with for a while. They are frequent visitors to Hawaii. They're working with some businesses here in Hawaii in the challenging world or environment of health care. Now we've all heard about the rising costs and how complicated it is with the Affordable Care Act and some of the issues in the health care industry right now, particularly on the mainland, but they're trying to simplify things that actually have an impact on reducing some of those costs and we're gonna talk about some of the surgical centers that are available that they've been doing across the country and they're trying to bring and help us here in Hawaii on that. So I wanna introduce Woody Moore and also Jeff Blankenship. Now you both have companies that work in this industry and I think what we might need to know is a little bit more about what is an ambulatory surgical center. Woody, can you answer that? Sure. An ambulatory surgery center, we often refer to it as ASC, is a surgical facility where outpatient procedures are commonly done that do not require an overnight stay. That's kind of a simple way of looking at an ambulatory surgery center. And most every specialty can be done in an ASC setting. So there's been tremendous growth over the years in that sector. Matter of fact, I think a lot of the surgeries that I've been having in the last 20 years have all been same day type of surgeries that I would go and check in and then they do the procedure and then I would be released that afternoon after the doctors blessed my departure. And so this is the type of facility that would take it out of the hospital environment and put it into a different type of center, which what, maybe a little bit smaller scale or have specialists there? By the nature of being ambulatory, oftentimes their ground floor could be in a community, much like family physicians have been more community based. Ambulatory surgery centers are in about a number of communities across the country. Yeah, and if I can add to that as well, ambulatory surgery centers, there's probably about 7,000 in the US right now. And most ASCs are multi-specialty performing multiple different procedures from orthopedics to GI to general surgery to plastics to anything from A to Z. And essentially the beautiful thing about an ASC is is that you're able to get in quick and get out quick at the same day and the outcomes are fantastic. But more importantly, the cost of the procedure is typically 50% less than it would be in a hospital setting. So that's a big savings. It is and a lot of the people in America are very unaware of it. So now with the situation of high deductibles and high co-pays, obviously that makes a big difference. And I guess the convenience can also be a factor that maybe not only is it more convenient because it potentially could be located in your neighborhood, but also the wait time maybe a little bit less. That's one of the reasons why the surgery center numbers grew so fast because it's good for the patient. It's good for the physician. The scheduling for both the patient and the physician becomes a tremendous asset. Right, some of these we may already have here in Hawaii. I think there's 21 of them. And a lot of people don't maybe connect the dots on this, but sometimes the laser surgery and some of the different surgeries for the eyes are done in an ASC. There's a number of great stories in Hawaii. Oftentimes surgeons, because of the convenience, they will create a partnership and help set those up in communities. And it just makes it so much more convenient for the patients and for the physicians. They have control over the equipment, the staff, and that, as Jeff said, yields positive outcomes. The infections in ambulatory surgery centers, there's basically no infections coming from ambulatory surgery centers as opposed to other sites of service. Well, that's an interesting point because I think some of the other sites of service are areas that would have generally a lot of sick people. Absolutely, and again, hospitals are great. We all need hospitals, but when you have an outpatient procedure that needs to be performed, it's best to go to an ASC because you don't know when you go into that OR at a hospital, it could have been an infectious biopsy. It could have just taken place. And then all of a sudden, the infection rate is tremendously much higher as well as the readmissions. And there's obviously a lot of issues with sepsis and other staff infections and things. So hospitals are fantastic when needed, but the ASC is actually what's needed in America for outpatient and to bring down the cost of healthcare. Again, literally based upon Medicare rates, it is 50% less than what a hospital will charge. And that's a significant savings. What do you think there's about, how many, 22, 23? There's 21 in Hawaii. And as Jeff said, across the country where there's been another resurgence in the growth, we talked about the patients and we talked about the physicians and then of course there's the payers of these services. And since they've been recognizing the high quality, low cost that the ambulatory surgery centers can provide, they've been adding new specialties, new codes, if you will, new reimbursement vehicles such as total joints and most recently, spine that are being done in an outpatient setting very safely. Fairly sophisticated, complicated type of procedures. I mean, doing a hip replacement is something that, I didn't realize it, but I guess that could be a same day type of procedure as well. That's the big move. Medicare as an example, they've added about 10 new codes. So those of us that will be needing those can have those done in an ASC setting. And just to add to that also for the general public, if they would like to get more information on ambulatory surgery centers, I'd recommend to go to the Ambulatory Surgical Center Association, ASCA. That's the National Association and their website is fantastic. They have a lot of helpful information that explains about ambulatory surgery centers, about the procedures being done, about cost and the processes and a little bit about them. I mean, the resources there, everybody should go to it at least to figure out what an ASC is and to be familiarized with it because you do have options. And at the end of the day, you want the best option and for Americans now, we all have to be better stewards of our healthcare choices. So... Well, we all have to be accountable. Absolutely. And it's our body, it's our health. So we need to be engaged. But one of the big challenges in Hawaii, as I'm sure you know, is that we've got these neighbor islands and most of our facilities, because most of our population is central on Oahu, but you got Maui, you got Kauai, you got both sides of the Big Island. These are, relatively speaking, low-cost type of facilities that can be put into the neighborhoods to bring that healthcare solution to these underserved areas relatively cheap. So of the 21 surgery centers, three islands have ASCs on them. And we were, we just held, and thank you for being a guest as well and Jeff as well, the first Hawaii Ambulatory Surgery Center Association conference. That's a mouthful. It is. And the outcome of that was, we anticipate there will be new ambulatory surgery centers growing in other places in Hawaii. The surgeons are needed, the payers recognize the value, the patients love the ambulatory surgery center setting. Well, I'm pretty sure we've got the patients. The question is, do we have the individuals, the surgeons that could actually provide the services? Are we short of those? Do we need some or do we have them? Is it a matter of getting credentials so that they can do it either in a hospital or in one of these centers? How does that work? Exactly. So every physician surgeon has to be credentialed before they can have privileges at a surgery center. And every surgeon also has privileges at a hospital as well. So oftentimes you have a choice whether you wanna go to a hospital or to an ASC. It's just, again, take it upon yourself to research, ask questions, and to find out economically as well as outcomes, which is the best solution for your particular procedure that you're in need of. And a lot of times the facilities will actually publish your outcomes. Yes. And for the viewers that don't quite understand what an outcome is, I mean, all facilities need to watch and see what their outcomes are of the patients that visit them and for hospitals, there's readmission rates that don't reflect well on them if there's some reasons that they should not be coming in and getting re-emitted. So healthcare outcomes is a real benchmark that a lot of facilities wanna watch very closely. And I guess the ASCs have a fairly good result of their healthcare outcomes. They do, and they also, the ASCs have probably about a 98% patient satisfaction rate, which is phenomenal in healthcare. That's very high. It really is, it really is. And the whole experience of an ASC, it's kinda, you know, it's so powerful if you've never had a surgery done. And if it's an outpatient procedure, I would recommend to go to an ASC before I would ever go to a hospital. And is that something, I guess if the physician, if I'm going to a physician that's handling a hernia or an eye or some sort of procedure that needs to be done, I can ask them if they can do this through an ASC and if they can, then I can ask them to give me that procedure in this ASC. Absolutely, it's 100% the patient's choice where he elects to have that procedure performed. We've got a, on the screen, we've got the ASCA website that one of our very on the ball technicians have called up for us. And so this gives us an example of some of the information that's on the website for that national association. So. My dad, you know, on that same website is the very simple question you ask about, what is an ASC? There's a great video on there about what is an ambulatory surgery center. That's very good. And this is something that we probably should get some of our elected officials to take a look at and become a little bit more familiar with. I know Senator Josh Green was at this conference as well and he heads up one of the health committees at the Senate level. He's totally familiar with this, but he should make this required viewing for all of his committee members so they get a comfort with what this is and how much it could really influence Hawaii. We're gonna have to go on a short break. We're gonna be gone for about 60 seconds. This is business in Hawaii with Reg Baker. I'm here talking about ASCs and ambulatory surgical centers. We've got two of the top people in the country here talking to us today and explaining what that is. We're gonna find out a little bit more about what they do with their companies that help serve that industry in the second half of the show. So we'll be back in about 60 seconds. This is Think Tech Hawaii, raising public awareness. Second half, we'll just go on. Play, so any chance you play at all. Everyone, I'm DeSoto Brown, the co-host of Human Humane Architecture, which is seen on Think Tech Hawaii every other Tuesday at 4 p.m. And with the show's host, Martin Despeng, we discuss architecture here in the Hawaiian Islands and how it not only affects the way we live, but other aspects of our life, not only here in Hawaii, but internationally as well. So join us for Human Humane Architecture every other Tuesday at 4 p.m. on Think Tech Hawaii. But grandmother, what big eyes you have? She said, research says reading from birth accelerates our baby's brain development. Push! Read aloud 15 minutes. Every child, every parent, every day. Welcome back, this is Reg Baker, business in Hawaii. I'm here with two outstanding professionals talking about the ASC marketplace. They both have businesses that serve this area. This could be a big positive impact in our healthcare here in Hawaii. Jeff, you've got a business. Can you tell us a little bit about the business that you're in and how it supports ASCs? Absolutely. My main business is called Surgical Notes. And Surgical Notes is an internet medical record, service and software company, specifically for ambulatory surgery centers. And we assist in everything from the pre-admissions to the transcription, coding, billing, collections, as well as we have a full tablet-based EMR, as well as we have other proprietary business software solutions, which helps assist in the ASC. And EMR is an electronic medical record that all patients should have to kind of follow them around and helps the providers keep track of what's going on. Correct, yes, sir. Yeah, so that's Surgical Notes. And currently we have about 10% of the entire market. We have 700 ASCs, a little over 700 ASCs and 17,000 surgeons that we work with. So that's the main company. But obviously with our foundation and being in this business for 20 years, and obviously with the advent of the current healthcare situation with the Obamacare and the Healthcare Act, the cost, the new problem that's taking place now is consumers are having a hard time affording their insurance, whether they're deductible so high, their co-payments, their premiums and so forth. So what's been happening lately is there's a lot of people who are having the need for a surgery, but they can't afford their out-of-pocket cost. So my other company, Surgical Funds, which we have been working on for about a year and a half now, we are creating a funding platform for patients that will assist them and allow them to get their surgeries. And we've got different programs, but we're also gonna be rolling out a Surgical Funds MasterCard, which will be the first of its kind, which will be a restricted access credit card, primarily for only healthcare expenditures. So you can't use it for travel. You can't use it for groceries. You can't use it to check into a hotel. You can't buy clothes with it. It has to be strictly under the service industry codes of healthcare. So, and why this is, is because obviously, if you have a $5,000 deductible, well, we want you to be able to have at least a $20,000 line of credit because if that major medical event does take place and you happen to be in the hospital or need to have a major medical operation or some testing or something that needs to take place, we want you to be able to afford it. Number one, number two, get the treatment as soon as possible. And number three, hopefully not go broke or go into debt by the cost of healthcare because it's continuing. The cost just keeps increasing. Well, I was just gonna mention that is because sometimes the timeline to get the procedure done, the longer you wait, the worse it gets. That's right. That's right. So getting it done sooner is generally always better than getting it done later. Exactly right. And again, the longer you wait, it's only gonna exacerbate that situation. Whether it's spine, regardless of the procedure, everyone needs to get it done quickly. And obviously, again, ASCs are a perfect avenue for it. If your surgeon recommends that you need to go to a hospital because of your health condition or of some other, then obviously you would go to the hospital. But the majority of outpatient procedures should be done in an outpatient ambulatory surgery center. And do you see a potential opportunity here in Hawaii for both of these companies? Absolutely. And we already have a couple of customers here now currently here on the island. And I also was speaking at this conference with Woody yesterday. And part of my topic was medical tourism. And Hawaii is in a great situation for medical tourism to come from Asia, especially China as well as the other countries. So I can see Hawaii increasing ambulatory surgery centers rather rapidly. What you need to do is do a joint venture or partner with some of the hotels and the resources. That's right. Put some ASCs out on their properties and allow a recovery wing to take place that people can come in and have the procedure done, recover there. The families can enjoy the beach and the beautiful weather. Hey, after having a good surgery and coming home with a good tan, it can't beat that. That's good stuff. That's great. That's Hawaii style. Now, Woody, you've got a business as well, right? And can you tell us a little bit about that? Sure. My company is called the Physicians Advocate. 25 years ago, I had a surgeon say to me, there are a number of changes have been going on in health care for quite some time. And I think he realized that he couldn't do it all. He couldn't know it all. And so he said, So what do you think that a physician would say that? But go ahead. He said, we need an advocate. And I was just like, well, that's right up my alley. So I took the rest of my career. I started networking like crazy. People like Jeff and others. So I started the Physicians Advocate and started sports medicine clinics. That kind of was my first passion. Took care of patients. Then physicians started asking for help. So I would help them set up various things, which led me to the bulk of my business today is helping surgeons own and operate their own ambulatory surgery centers 100% until the day they decide they want to sell a portion of that. So you're the guy that people go to when they want to set one of these things up and get it launched and off the ground. There's a number of good companies across the country. Some are privately held and publicly traded. They're doing a lot of good work. My niche is that I set it up so they can own and operate. I don't want their management. I don't want their equity position. And so that's why I receive calls from some surgeons that have some active projects now. The other thing you can't be in this business for very long without realizing and Jeff touched on it is you have to be an advocate legislatively and things such as that. So I could not help myself. 16 years ago I started the Texas Ambulatory Surgery Center Society. Texas is number three in the country and the number of ambulatory surgery centers about 400. Just out of curiosity, who's number one? California. California, I'm sure. Yeah, California and Florida are ahead. But, and there's a number of reasons for that. But so we started the Texas Ambulatory Surgery Center Society and it's been very active. We patterned most recently, and I thank you as well, Ridge, for being part of helping us get started. The Hawaii Ambulatory Surgery Center Association, the 43rd State Association. And we now have a very active membership here and starting to dig in on some of the issues here in Hawaii. And that's what that conference was yesterday. That's correct. And I think, Woody might be going after Puerto Rico next. Well, I think we also heard that there's a need in Thailand. Yes. It's got a beautiful, it's a nice recovery area right down there. I spent some time there back in the day. I'm glad you mentioned the recovery again because that's the new move, is that while ambulatory surgery centers are the low-cost, high-quality provider, the payers have started recognizing the value of the ambulatory surgery centers. And now they're allowing some of these, what we call higher acuity, spine, total joints type cases. Well, those cases may require a little bit longer than a 23-hour stay, or in Hawaii, the regulations are 18 hours. So you'll be hearing about things such as recovery care suites. Could be the hotel that you're talking about or going home on home health from some of these bigger procedures. But the newest move is recovery care suites. Well, and the reason why I mentioned Thailand and Phuket is because Bangkok has got a very large medical tourism industry that has really developed quite nicely over the last five, 10 years. When I was with HMAA and involved as a COO and CFO over there, we took a look at that. And it's a very well-developed process in Bangkok. My thought at the time was Bangkok's probably not the best area for recovery. Phuket would be a better one. Not that dissimilar from Waikiki. And so there's an opportunity, I think, following that model for something here in Hawaii. Absolutely. So medical tourism, is that an area that you might be exploring here in the near future? It is, it is. The statistics show, I mean, just China alone has 1.4 billion people. And they're on the move, exactly. They're on the move because there are shortage of surgical facilities over there, as well as quality facilities. So I anticipate medical tourism to be coming to Hawaii rather quickly. And I think it's, couldn't be a better place for it than Oahu. Well, and it's another way of, as they say, a tide rises all ships. And so if we can provide more facilities, even if it's for the medical tourism, there's side effects, there's benefits of that. Peripheral opportunities for other people to get better healthcare, because now it's an industry that's growing. We're gonna have schools coming in. We're gonna have more physicians trained. I'd like to see us at some point be able to push down the need to have a physician touch every single patient. I think having some NPs and PAs involved in the process is a good direction to, again, lower those costs and bring more healthcare services to those that really need it. And to touch on that point, ASCs are very effective with their anesthesia by using CRNAs, which are anesthesia assistants. And that helps bring the cost down as well. So there's a lot of huge benefits other than just the quality of care from an ASC, but also the cost of the service provided. Because an ASC is only limited to build certain things where in a hospital they balance, build everything. And that's kind of where you might get that $300 aspirin. Yes, I've seen that before. But I really appreciate you guys being on the show today. I know you've been very busy with this conference and taking a look at all these opportunities out here. So thank you for cutting some time out of the day to come in and join me. Next time you're in Hawaii, whereas this business is, you know, start to take off, maybe in six months, we need to have a revisit so you can give us an update on all the things that you've been forward to that. That would be nice. This is Business in Hawaii with Reg Baker. We broadcast live every Thursday from two to two 30 from the downtown studios of Think Tech Hawaii. We look forward to seeing you next week. I'm going to have a guest host next week. This is someone that's done it before, Dai Lin Yanagida. She will be here talking with the University of Phoenix as I am in Washington, DC, attending a small business administration board of directors meeting. So I'll see you in two weeks. Until then, aloha.