Stephen Punzak, MD, founder and CEO of One Medical Passport, spoke to Becker's ASC Review about the shift of more complex surgeries to the outpatient setting and how ASCs can use technology to enhance patient preparation and recovery.
Note: Responses were lightly edited for style and clarity.
Question: How will the outpatient migration of more complex procedures reshape healthcare?
Dr. Stephen Punzak: It's taken the government and insurers a while to figure it out, but truly excellent care can be delivered in an ASC, even for complex cases. Now that that trend has started, it's never going to go back to the way it was. [This shift] is causing a shakeup in the industry, but 100 percent — it's going to be in the patient's best interest. It's going to help to control costs and quality is going to improve, without a doubt. When you have competition, prices come down and quality goes up. Particularly in this day and age, when any patient can hop on social media and leave reviews in addition to standardized surveys, you have to be on your toes. Providers are being measured and should make sure every patient has a truly exceptional experience at their facility.
Q: What are the biggest challenges ASC administrators are facing in relation to that shift?
SP: Patient selection is really, really important. Technology for screening patients [and] having a patient's accurate history available well in advance of a procedure so you can either fine tune that patient, get additional testing if you need it, or say, 'This patient isn't a great candidate.' Most [surgeons] are good at patient selection but some might push the envelope a little too far, and I think that's where the process can backfire.
The second [challenge] is patient education. If patients know what to expect, they're going to be better prepared physically and mentally for the procedure and they're going to understand why the various things they're being asked to do are important — for instance, a hibiclens scrub of the knee.
Q: How can ASCs leverage technology to improve patient education?
SP: If you send a patient home with a stack of written instructions, they often get lost somewhere in the shuffle with insurance papers. The patient is busy, and there's a very good chance that they're not going to even read or understand [postoperative instructions]. So, sending targeted messages that are specifically tailored to that patient, their particular procedure with a particular surgeon — because there's surgeon preferences in terms of how patients are prepped preoperatively. You can't have a one-size-fits-all [approach], which usually ends up being one size fits none. You have to be customized, and the next evolution of that is video.
In the U.S., we watch; we don't read. So, if you want the attention of a busy person, you need to give them short video clips of doing the hibiclens scrub or why [they] should be learning to do the crutch walk before going home. If a picture's worth a thousand words, a video clip is worth a million words. Don't dump everything on them at once — space it out in a logical sequence that the center, surgeon and clinical team deems appropriate. Deliver these messages to the patients preoperatively to prepare them for surgery, use the same technology on the day of to keep the family in the loop, and then use the same technology postoperatively to make sure that the patient is doing everything that he or she should do to recover successfully. Technology can play a huge role in keeping the patient informed.
Q: How would you address barriers to implementation in ASCs, which tend to be leaner, physician-run operations where it's hard to introduce new technologies?
SP: The barriers to implementation usually come from risk. Nobody wants to be on the hook for being the one who raises his or her hand and says, 'We should do this,' but then it fails. So, I think when you're implementing technology, it pays to go with a company that is a proven leader in the space and has done it hundreds and hundreds of times.
Second, it's very important that you reduce — as much as possible — the financial barriers. For instance, [by] keeping implementation fees low , making sure that people really understand the technology before they sign off on it, and having a very smooth implementation process that isn't going to negatively impact the center. Because [ASC staff] are busy during the day, they don't have any extra time to be learning difficult new technology.
Q: What else have you seen in terms of procedures shifting to the outpatient setting?
SP: The patient engagement solution, Passport Engage, that One Medical Passport built came out of my direct experience [as a practicing anesthesiologist] in seeing that the more complex cases were going outpatient and that you needed some type of technology to fill the gap between having a patient admitted for a few days postoperatively vs having their ride take them off into the sunset. There has to be a happy medium. Anything you can do to make that outpatient experience more predictable, more consistent, easier for the patient's follow up, you're going to get better results.