Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in providing safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.
Bill Prentice: 0:27
Hello, and welcome to the Advancing Surgical Care Podcast. I’m ASCA’s CEO, Bill Prentice, and the host of this episode. My guest today is Nader Samii, the chief executive officer of nimble, a leading revenue cycle management company and an ASCA affiliate. Nader began his career as a corporate finance attorney and investment banker, and prior to founding National Medical Billing Services, nimble’s predecessor company, he was the cofounder and president of Ajuba International, a leading healthcare revenue cycle outsourcing company. Nader is joining me for this conversation at ASCA’s 2023 annual meeting in Louisville, Kentucky. In addition to being the lead sponsor of our annual meeting, Nader chose this week to launch the rebranding of his company, and we’ll talk more about that in a moment. In addition to serving as CEO of nimble, Nader is also well-known for his thoughtful insights about the ASC community and the reason I asked him to spend a few minutes talking with me today. With that introduction, Nader, welcome to Louisville, and welcome to the podcast.
Nader Samii: 1:28
Thanks, Bill, really excited to be here. I appreciate it.
Bill Prentice: 1:31
Nader, as I mentioned in my introduction, you’ve recently completely rebranded your company. I’m sure there are lessons that any enterprise could glean from the process you’ve gone through and it’s no doubt a costly exercise, but you obviously must believe that there’s a long-term value in your rebranding and repositioning. Can you share with us some of the thinking that led to the decision as well as some of the highs and lows of essentially adopting a new identity?
Nader Samii: 1:55
Yes, absolutely. It’s a great question, and it’s been a fun process really, almost a year in the making, I think, from kind of the decision to do this to completion. And really, there were a few things, you know the company has really evolved over the years—our company was named National Medical Billing Services, founded by our president Lisa rock, and we’re so grateful for everything that she’s done in regard to that. And she was the one who’s probably most excited about going through kind of an elevation of the brand and such, so we made the decision for a couple of reasons. One, we’ve evolved, and we wanted to reflect the broader work that we do that is above and beyond strictly billing services and also reflect kind of who we are and how we behave in the market. And secondly, we really wanted to embrace that we had done four acquisitions in 2022, and we wanted to bring all of the companies into the fold under a fresh new name, where we were all kind of one together. And so that was really the thought process and the driver, to both capture who we are and what we do and also create kind of a new home for all the families. And so that was the thought process on why we did it.
Bill Prentice: 3:07
Well, you’ve certainly been busy. For the listeners, we’re recording this at ASCA 2023 in Louisville. So, you’ve hopefully been hearing from some of the meeting attendees about the change and we obviously have enough branding of nimble around the hall. What have you been hearing from folks?
Nader Samii: 3:22
Well, thanks. It’s been extremely well-received. And just to answer a little bit of your first question to the parts that I didn’t answer—the process itself was relatively intensive. We spent a lot of time with an agency interviewing our executive team, and then deeper within the team, interviewing clients, interviewing others in the industry in general, to get a good feel for all of it so that we were reflecting everything accurately and also, like I said, to kind of get to that brand. But our team’s been very excited about it, and we’ve had very positive views and reviews from everyone here and anyone who’s seen it. So, we’re excited about it and excited to take it forward.
Bill Prentice: 4:04
Well, seeing the logo all around ASCA 2023 because of your platinum sponsorship—which, first of all, thank you for that—it’s a really cool logo and very eye-catching, so good work on that front.
Nader Samii: 4:18
Bill Prentice: 4:19
So, Nader, I’m also always eager to hear about what you’re seeing and hearing from your clients in terms of market conditions and any emerging trends that you think might be of interest to our listeners. So, let’s talk about some of the basic metrics like year-over-year growth as many ASCs continue to work their way back from pre-pandemic levels. So, what are your thoughts about some emerging technology trends also? And we can come back to that after you tell me about what you’re seeing in the market.
Nader Samii: 4:47
Yes, so as it relates to the market, from where we sit and just observe and the discussions we have is that this is a really exciting time to be in the surgery center market. Growth is really projected to be at an all-time high. If you kind of look at projections, they’re projected annually to be about 7 percent growth in the market each year, year-over-year for the next five to six years. So, taking a $40 billion market to a $60 billion market in the next five years, which is in really any industry really rapid growth from that kind of macro level. And it’s being driven through a combination of multiple things, but in general, the obvious reasons that I think our world all knows, the benefits to the payer, benefits to the provider, benefits to the patient from a cost and convenience and flexibility standpoint are all there, which we’ll get to this part of the question next. But a lot of the technologies, advancement in technologies, are driving this growth, but also these areas of combined technology and an aging population. Orthopedic, spine, cardiology are big ticket items, high-acuity, high-reimbursing, and those are moving in quite rapid volume to the surgery centers. And those are probably the single biggest driver of the overall industry growth, although all specialties really are continuing to move. There is one stat I saw was that 80 to 90 percent of orthopedic surgeries will be done outpatient, not all ASC but outpatient, within the next five years.
Bill Prentice: 6:21
Obviously, we’ve had kind of a rocky road with the national economy the last couple of years. Has that kind of put any kind of damper on your outlook, or do you think that’s just a bump in the road that we’re going to get past relatively soon?
Nader Samii: 6:34
So, we are lucky in the sense that I view healthcare and certainly the surgery center market as recession proof. Healthcare in general—people are sick, they need surgery—but in an ASC, it’s even another step further in that it is a generally lower-cost solution, and so it’s even more of a reason to drive surgeries there. So, it’s, like I said, extremely recession proof. I would say from that standpoint, demand for surgeries in surgery centers I don’t think will slow down in this economy. The area where it does start to show up a little bit is in the shortage of staffing, shortage of available capable people. There are shortages with anesthesia, there are shortages with nursing, and those are areas where we are seeing centers struggle sometimes to be able to staff properly to be able to handle the volume that they actually are seeing.
Bill Prentice: 7:28
Indeed. Yes, we hear about that a lot at ASCA as well. So, let’s go back to the issue of emerging technologies that I referenced earlier. We’re hearing and seeing more every day about surgery centers acquiring and adopting new technologies, especially like robotics and obviously in SAS. A lot of the equipment and training we’re talking about often have required big capital expenditures for an ASC, yet they apparently believe that the investment will pay returns in the longer term. What are you seeing and hearing about the level of participation and investment in new technologies in your clients?
Nader Samii: 8:03
A great, great question. And that really is, I do think, that the advancement in technologies is going to be the largest driver now that everyone sort of understands the macro themes that are driving business to ASCs. The advancement in technologies, that kind of really is going to be what unleashes and creates that bigger opportunity for almost, I wouldn’t say everything, but a very high percentage of surgeries to move in that direction. And I think that the forward-looking groups, the ones that are a bit more visionary and understand where it can go in terms of creating that better patient experience, will be the ones that are on the cutting edge of investing in those advanced technologies because patients are going to see that and they’re going to look for it and they’re going to want it—we have a much smarter consumer as a patient today. And so, I think that those who do are the ones who are going to thrive. And I will also say that most of those organizations, device companies and others that are selling those technologies, have quite interesting financing type structures and packages that allow centers to invest in it without being entirely out of pocket upfront.
Bill Prentice: 9:15
Yes, and that’s critically important, particularly with obviously the lower reimbursement levels that ASCs generally receive and the efficiency of the model. So, I think that’s one of the things that I think on the device side is they have to recognize that hospital pricing doesn’t exist in our space. So, Nader, can you give me some examples of those emerging technologies? And I imagine they run the whole range of the patient experience in the facility.
Nader Samii: 9:42
Yes, absolutely. And it’s, like I said, this is probably one of the most fascinating areas creating the biggest opportunities for that movement into the ASC space. And so, for example, there are virtual reality technologies now that allow a patient to actually envision what the entire kind of preop process is going to be for the surgery and postop recovery. So, they actually kind of manage the expectations and can provide them with the information and such they want, and that is such a big part of the patient satisfaction journey. There are other technologies, kind of this augmented reality and virtual reality as well a type of technologies also tying in artificial intelligence, where the surgeons can now be, you can have the premier surgeons in the country and in the world performing a procedure or surgical technique together, coaching each other, talking through it, and you can have surgeons from everywhere else around the world, like somewhere in South Dakota watching a procedure happening in Manhattan with the best and the brightest, and really bringing that to the forefront. And then we’re seeing other things, for example, on the pain management side, devices now starting to arrive to eliminate opioids from the process where you could get a nerve block in an opioid-free fashion and have that even connected to a neurostimulation approach and module where now you can manage the entire pain through the entire episode of surgical care without ever needing to touch on or utilize any opioids, which is really quite important. And there’s the No Pain Act, which is coming, and so it kind of fits very nicely and that’s going to help with reimbursement. So, just really interesting things like that that are helping all the way and really across the board that will really, again, accelerate that movement to the ASC environment.
Bill Prentice: 11:31
That’s fascinating, Nader. And boy, it’s going to be a very interesting future for us all. And I want to thank you and Lisa and your entire team for all the support you provided to ASCA over the years and certainly at this conference. And I’m really looking forward to working with you and nimble in the coming years as we try and serve your clients, my members, and help them to provide great care to patients.
Nader Samii: 11:53
Great, thanks again, Bill. Really appreciate being here.