The Hospital Finance Podcast®

Improving Lack of Price Transparency in Surgical Ccare [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Dr. Sanjay Prasad, Author, and Founder of SurgiQuality. Dr. Prasad examines the lack of transparency in surgical care and offers a solution to the problem.

Learn how to listen to The Hospital Finance Podcast® on your mobile device.


Highlights of this episode include:

  • Where health care in the US is headed
  • 2014 all-inclusive price model benefits
  • Flaws in the surgery referral process
  • Resetting Healthcare book

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance podcast. Surgical intervention is usually a dramatic and costly step in the care continuum for a patient. On today’s episode, I’m joined by Dr. Sanjay Prasad, a neurosurgeon, author, and founder of SurgiQuality. In his new book, Resetting Healthcare, Dr. Prasad examines the lack of transparency in surgical care and offers a solution to the problem. Dr. Prasad, welcome to the show.

Dr. Sanjay Prasad: No, thank you so much. I really appreciate being on. And I’m not a neurosurgeon, so I don’t want to mischaracterize my specialty. It’s otolaryngology with a subspecialty in neurotology, so I’m focused on microsurgery of the ear and skull base, just to be clear. But thank you for having me.

Mike: Got it. I understand. It’s certainly complex stuff. So I know you know what you’re talking about here and certainly appreciate having you on the show. And I think you’re going to have some unique perspectives because you’re working deeply both on the clinical as well as the financial side of things. So let’s start big picture. Where do you think health care in the US is headed?

Dr. Prasad: Well, even before the pandemic, the health care costs were exorbitantly high and premiums continued to soar. Patients were in high deductible health plans. And we really had a system that really wasn’t working on behalf of the patients. And as you know, with coronavirus and I’m sure your audience knows very well, nonurgent surgeries were put on pause in 2020. And so what this created was a backlog of surgeries that are about to be scheduled in ’21 and beyond. And this is a great time to reset health care as we know it today. And I can tell you that the COVID pandemic, probably one of the biggest things that it brought that were positive in terms of health care was this whole idea of telemedicine, telecommunications with the physician, virtual visits. It really forced all the surgeons, the providers, even the hospital staff to get up to speed, develop a back line so they can connect directly with the patient. It’s such a beautiful thing. And we can grow from there for sure.

Mike: Absolutely, it definitely changed how we look at getting care and following it through, so, yeah, agreed with that. Sometimes there is a silver lining. Let’s talk a little bit about costs and pricing. In 2014, your surgery center started to bundle surgical prices for an all-inclusive price model. What was the driver behind that? And how has that been beneficial or challenging for you?

Dr. Prasad: Well, it was definitely beneficial. We were lowering costs for– and we were providing this for uninsured patients, patients who had very high deductible health plans, 10,000, 20,000 dollar deductibles. So the patients were essentially feeling the brunt of the entire cost of their care. And we were able to combine the surgeon fee, facility fee, anesthesia fee, the post op fee all in one low price. We started doing this in our surgery center in 2014. And since then, of course, the surgery center, we’ve moved on and sold it. But it gave us a lot of insight into what the market needs are. And that was pricing. But I think the thing how we’re going to move forward in terms of value based health care is all about quality. No question.

Mike: Yeah. So let’s talk about the surgery referral process, because that absolutely is a quality issue, because you’ve got patients that maybe need to head down a surgical track or maybe there’s other interventions that can take place before you get there. Right? So in your view, there are some flaws with that process. How do you view it currently and what do you think we could be doing about it?

Dr. Prasad: Well, the process is– and again, you’re talking to someone who has been operating for 30 years, have seen tens of thousands of patients. And so that’s my background qualification. But patients are referred to their surgeon from their primary care doc when their condition warrants, obviously. But that referral is not necessarily being made on the basis of cost of care. That is, is my surgeon in network? Is that anesthesiologist going to be in network? What are my deductibles? How much am I going to pay for it? And then more importantly, they’re not being referred on the basis of the outcomes, the surgeon outcomes. That is, what’s their success rate, what’s their complication rate? And so what’s happening in today’s world is patients are pigeonholed to maybe one surgeon, maybe the primary care provides them two, but they have a whole provider book of orthopedic surgeons, per se, in their network. But they have no way to choose their surgeon using quality scoring and surgeon outcomes. So with this, there’s definitely a flaw. It’s not working for the patient and we’ve got to do something serious.

Mike: So, Dr. Prasad, tell us about your book Resetting Healthcare. Why did you write it and how did your family’s experience have an influence on it?

Dr. Prasad: Yeah, so I wrote it during the pandemic. Nonurgent surgeries are on hold and I had a lot of free time thinking about this subject. And the bottom line is patient– understand what’s happening to them, because they get told they need surgery. They are pigeonholed from their primary care doc to a surgeon without any cost or quality concerns or issues, and they’re not weighing everything. The book was really a way to educate patients on the current state of what’s happening to them when they develop a condition and how the health care system and the health care maze works, but also to offer a solution, a very pragmatic, very realistic, very reassuring solution to get them to the best surgeon. So it was a way to educate the public, if you will.

Mike: What is one thing that you most want people to take away from your book?

Dr. Prasad: Well, there are many things. The title of the book is Resetting Healthcare Post COVID-19 Pandemic. And you can find information on the book on resettinghealthcare.com. But the one thing that I want patients to do is, when they are seeing a surgeon and they’ve been told they need surgery, they need to pause. They need to stop and not go right from the exam room to the scheduler and get the surgery scheduled. They need to pause and rethink and ask some tough questions. Doctor, do I really need the surgery? What’s going to happen to me if I don’t have the surgery? Are there alternatives to surgery? And Doctor, how many of these have you done the previous year or the past five years if it’s something rare, and what are your success rates? What does success look like? What are the potential complications from this type of surgery? And has anybody ever died? And I think those are very important questions to ask. And oftentimes patients don’t even know what to ask. They don’t know how to interpret the answers that they get from surgeons. So that’s where SurgiQuality comes in. That’s where we help them.

Mike: Yeah, I think that’s absolutely true. If you’re referred to a surgeon, you’re pretty much on the track where you just kind of go with the flow, right? You’re not really stopping to talk through all of those issues. Right?

Dr. Prasad: Yeah. And I think what happens is patients also– sometimes patients know when they are going to need surgery, it’s going to be recommended, but oftentimes patients don’t know and they’re shocked when they hear the word surgery. What’s racing through their mind is, oh, my gosh, what’s going to happen with my job, what’s going to happen with the people I take care of, my loved ones? Do I have enough disability insurance? Do I have life insurance? All these things are racing through their mind when the surgeon’s trying to explain the procedure, the complication, success rates, etc., and they’re just not getting it. They’re not understanding at all. They’re not absorbing all that information. That’s where we come in and help.

Mike: Excellent. Dr. Prasad, if someone wanted to get a copy of your book or learn more about SurgiQuality, where can they go?

Dr. Prasad: Well, you can go on resettinghealthcare.com and learn more about the book. You can order it through Amazon or Barnes & Noble. We’re here to help you. And SurgiQuality is really a company that was started with a group of surgeons who really wanted to fix health care on behalf of the patients. And the solution is rather simple. The execution is a bit more complicated, but the solution involves a personalized concierge service that handholds the patient from the moment they’ve been told they need surgery until they’re back to work. And what that concierge does is we’ll have the patient sign a release, a HIPAA release for their medical records and imaging. And then all this magic happens behind the scenes. And the magic I’m talking about is the concierge gathering their medical records, gathering their imaging, sending it through the cloud to multiple surgeons through the surgery connect app and system and to surgery centers and hospitals. And then we ask surgeons whether it’s necessary for them to have the surgery. And then we also ask surgeons about their volume, success rates, complication rates, and we quality score the surgeons according to each quality measure, very specific to their condition. So patients now are empowered, they’re empowered to be able to compare surgeons within their network based on the quality measures that are reported and make intelligent, well-informed decisions. And how beautiful could that be?

Mike: It sounds like a great service and a great path forward. Dr. Sanjay Prasad, thank you so much for joining us today on The Hospital Finance Podcast.

Dr. Prasad: Great. Thank you so much for having me.

The Hospital Finance Podcast

The Hospital Finance Podcast

In this episode, we are joined by Dr. Sanjay Prasad, Author, and Founder of SurgiQuality as he examines the lack of transparency in surgical care and offers a solution to the problem.

Learn how to listen to The Hospital Finance Podcast® on your mobile device.


Highlights of this episode include:

  • Where health care in the US is headed
  • 2014 all-inclusive price model benefits
  • Flaws in the surgery referral process
  • Resetting Healthcare book

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance podcast. Surgical intervention is usually a dramatic and costly step in the care continuum for a patient. On today’s episode, I’m joined by Dr. Sanjay Prasad, a neurosurgeon, author, and founder of SurgiQuality. In his new book, Resetting Healthcare, Dr. Prasad examines the lack of transparency in surgical care and offers a solution to the problem. Dr. Prasad, welcome to the show.

Dr. Sanjay Prasad: No, thank you so much. I really appreciate being on. And I’m not a neurosurgeon, so I don’t want to mischaracterize my specialty. It’s otolaryngology with a subspecialty in neurotology, so I’m focused on microsurgery of the ear and skull base, just to be clear. But thank you for having me.

Mike: Got it. I understand. It’s certainly complex stuff. So I know you know what you’re talking about here and certainly appreciate having you on the show. And I think you’re going to have some unique perspectives because you’re working deeply both on the clinical as well as the financial side of things. So let’s start big picture. Where do you think health care in the US is headed?

Dr. Prasad: Well, even before the pandemic, the health care costs were exorbitantly high and premiums continued to soar. Patients were in high deductible health plans. And we really had a system that really wasn’t working on behalf of the patients. And as you know, with coronavirus and I’m sure your audience knows very well, nonurgent surgeries were put on pause in 2020. And so what this created was a backlog of surgeries that are about to be scheduled in ’21 and beyond. And this is a great time to reset health care as we know it today. And I can tell you that the COVID pandemic, probably one of the biggest things that it brought that were positive in terms of health care was this whole idea of telemedicine, telecommunications with the physician, virtual visits. It really forced all the surgeons, the providers, even the hospital staff to get up to speed, develop a back line so they can connect directly with the patient. It’s such a beautiful thing. And we can grow from there for sure.

Mike: Absolutely, it definitely changed how we look at getting care and following it through, so, yeah, agreed with that. Sometimes there is a silver lining. Let’s talk a little bit about costs and pricing. In 2014, your surgery center started to bundle surgical prices for an all-inclusive price model. What was the driver behind that? And how has that been beneficial or challenging for you?

Dr. Prasad: Well, it was definitely beneficial. We were lowering costs for– and we were providing this for uninsured patients, patients who had very high deductible health plans, 10,000, 20,000 dollar deductibles. So the patients were essentially feeling the brunt of the entire cost of their care. And we were able to combine the surgeon fee, facility fee, anesthesia fee, the post op fee all in one low price. We started doing this in our surgery center in 2014. And since then, of course, the surgery center, we’ve moved on and sold it. But it gave us a lot of insight into what the market needs are. And that was pricing. But I think the thing how we’re going to move forward in terms of value based health care is all about quality. No question.

Mike: Yeah. So let’s talk about the surgery referral process, because that absolutely is a quality issue, because you’ve got patients that maybe need to head down a surgical track or maybe there’s other interventions that can take place before you get there. Right? So in your view, there are some flaws with that process. How do you view it currently and what do you think we could be doing about it?

Dr. Prasad: Well, the process is– and again, you’re talking to someone who has been operating for 30 years, have seen tens of thousands of patients. And so that’s my background qualification. But patients are referred to their surgeon from their primary care doc when their condition warrants, obviously. But that referral is not necessarily being made on the basis of cost of care. That is, is my surgeon in network? Is that anesthesiologist going to be in network? What are my deductibles? How much am I going to pay for it? And then more importantly, they’re not being referred on the basis of the outcomes, the surgeon outcomes. That is, what’s their success rate, what’s their complication rate? And so what’s happening in today’s world is patients are pigeonholed to maybe one surgeon, maybe the primary care provides them two, but they have a whole provider book of orthopedic surgeons, per se, in their network. But they have no way to choose their surgeon using quality scoring and surgeon outcomes. So with this, there’s definitely a flaw. It’s not working for the patient and we’ve got to do something serious.

Mike: So, Dr. Prasad, tell us about your book Resetting Healthcare. Why did you write it and how did your family’s experience have an influence on it?

Dr. Prasad: Yeah, so I wrote it during the pandemic. Nonurgent surgeries are on hold and I had a lot of free time thinking about this subject. And the bottom line is patient– understand what’s happening to them, because they get told they need surgery. They are pigeonholed from their primary care doc to a surgeon without any cost or quality concerns or issues, and they’re not weighing everything. The book was really a way to educate patients on the current state of what’s happening to them when they develop a condition and how the health care system and the health care maze works, but also to offer a solution, a very pragmatic, very realistic, very reassuring solution to get them to the best surgeon. So it was a way to educate the public, if you will.

Mike: What is one thing that you most want people to take away from your book?

Dr. Prasad: Well, there are many things. The title of the book is Resetting Healthcare Post COVID-19 Pandemic. And you can find information on the book on resettinghealthcare.com. But the one thing that I want patients to do is, when they are seeing a surgeon and they’ve been told they need surgery, they need to pause. They need to stop and not go right from the exam room to the scheduler and get the surgery scheduled. They need to pause and rethink and ask some tough questions. Doctor, do I really need the surgery? What’s going to happen to me if I don’t have the surgery? Are there alternatives to surgery? And Doctor, how many of these have you done the previous year or the past five years if it’s something rare, and what are your success rates? What does success look like? What are the potential complications from this type of surgery? And has anybody ever died? And I think those are very important questions to ask. And oftentimes patients don’t even know what to ask. They don’t know how to interpret the answers that they get from surgeons. So that’s where SurgiQuality comes in. That’s where we help them.

Mike: Yeah, I think that’s absolutely true. If you’re referred to a surgeon, you’re pretty much on the track where you just kind of go with the flow, right? You’re not really stopping to talk through all of those issues. Right?

Dr. Prasad: Yeah. And I think what happens is patients also– sometimes patients know when they are going to need surgery, it’s going to be recommended, but oftentimes patients don’t know and they’re shocked when they hear the word surgery. What’s racing through their mind is, oh, my gosh, what’s going to happen with my job, what’s going to happen with the people I take care of, my loved ones? Do I have enough disability insurance? Do I have life insurance? All these things are racing through their mind when the surgeon’s trying to explain the procedure, the complication, success rates, etc., and they’re just not getting it. They’re not understanding at all. They’re not absorbing all that information. That’s where we come in and help.

Mike: Excellent. Dr. Prasad, if someone wanted to get a copy of your book or learn more about SurgiQuality, where can they go?

Dr. Prasad: Well, you can go on resettinghealthcare.com and learn more about the book. You can order it through Amazon or Barnes & Noble. We’re here to help you. And SurgiQuality is really a company that was started with a group of surgeons who really wanted to fix health care on behalf of the patients. And the solution is rather simple. The execution is a bit more complicated, but the solution involves a personalized concierge service that handholds the patient from the moment they’ve been told they need surgery until they’re back to work. And what that concierge does is we’ll have the patient sign a release, a HIPAA release for their medical records and imaging. And then all this magic happens behind the scenes. And the magic I’m talking about is the concierge gathering their medical records, gathering their imaging, sending it through the cloud to multiple surgeons through the surgery connect app and system and to surgery centers and hospitals. And then we ask surgeons whether it’s necessary for them to have the surgery. And then we also ask surgeons about their volume, success rates, complication rates, and we quality score the surgeons according to each quality measure, very specific to their condition. So patients now are empowered, they’re empowered to be able to compare surgeons within their network based on the quality measures that are reported and make intelligent, well-informed decisions. And how beautiful could that be?

Mike: It sounds like a great service and a great path forward. Dr. Sanjay Prasad, thank you so much for joining us today on The Hospital Finance Podcast.

Dr. Prasad: Great. Thank you so much for having me.

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