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Jeff McLaren (00:06):
Here we have Aaron Stewart with Symmetry. Aaron, you gave a great presentation a minute ago. Thank you. So thank you for that. I wanted to maybe ask you a few questions and maybe you could cover some of the same information in abbreviated form that you provided in the presentation. So you discussed a financial model that you use. Is that financial model used for internal assessment on how you would approach a prospective facility or is it used in real time as you're working through coverage modalities with the facility to try to dial in what's affordable from their perspective? Or maybe it's both?
Aaron Stewart (00:50):
Yeah. I think the answer really is both because what we've learned is that there's not a one size fits all coverage model to any facility. And we've also known that kind of subsidies can't be avoided when it comes to anesthesia. And so that model's really something that's used to, as we're kind of thinking through and working through with the facilities of, hey, what's the right fit? What's the impact of some of the decisions that are being made? And so a couple of the inputs are around the structure of the care team. And so the largest differences may be all physician versus all CRNA. If you just kind of show the business.
Jeff McLaren (01:31):
Either medical direction. Or just supervision. How far are they going?
Aaron Stewart (01:36):
You've got it exactly right. And so it's really a tool that's used kind of initially and then during the conversations just to help one, provide clarity around what's driving the cost and kind of where those inputs are. And then two, just cost isn't necessarily the first and it shouldn't be the very first consideration, but when you're structuring your anesthesia coverage.
Jeff McLaren (01:59):
I would imagine that a tool like that, and it's great, would be really helpful as an education tool for your counterpart. At the CFO, at the hospital that may not really fully understand all the levers that can be pulled to drive cost or to change cost dynamics.
Aaron Stewart (02:21):
Yeah, that's exactly right. So I created it just to educate myself because I used to be similar to one of those guys...
Jeff McLaren (02:27):
To one of those guys.
Aaron Stewart (02:29):
One of those guys, right? So first I had to educate myself and so that's part of it is just using it as a tool to educate counterparts and then also just to collaborate and figure out, okay, well, what can we do to address what the true needs are?
Jeff McLaren (02:44):
I would imagine too, just coming as a CFO, speaking to a CFO, that that's comforting for them to have that kind of mechanism where you can have a real conversation around the dynamics of coverage that are driving cost. Yeah. So in terms of that kind of approach of looking at coverage models, do you see or do you receive, when you begin those conversations, do you have enough data where you can do modeling ahead to a large extent? Or is this part of a discovery process where you're getting certain dynamics and a conversation and you're inputting into that model that then advances the discussion?
Aaron Stewart (03:33):
Yeah.
Jeff McLaren (03:33):
Maybe that's both too. I don't know. Yeah.
Aaron Stewart (03:35):
It's a little bit of both, but it's kind of a starting point, but we definitely do need inputs when we think about kind of volume, kind of historical and projected and utilization and around points of service and then what the desired care team is. And what we try to do is we don't frame the conversation entirely around cost. Cost is the elephant in the room, but it's framing around kind of what's the true need here. And a lot of times it's not to reduce costs, it's to control costs, but what we hear, it's more around, okay, points of service or we're all physicians, we need to move to a care team model or we don't have enough physicians. We need to-
Jeff McLaren (04:15):
Do you see a lot of that still? The all physician shops?
Aaron Stewart (04:19):
We see some of them. So there's one that came up recently as a 150 bed hospital that was all physician and they received notice from their coverage provider with like 60 days of that the contract's coming to an end, go find some coverage. Interesting. So that's the other thing that comes into play when you think about the provider market when it comes to anesthesia is there's scarce resources, both the physicians and the CRNAs, but a more moving towards a more kind of physician plus CRNA care team leverage model kind of helps mitigate some of that risk.
Jeff McLaren (05:04):
Do you guys see particular opportunity in hospitals of that size, which might be more rural, or do you see opportunity for symmetry in more larger metro areas? And maybe this hospital was in a metro area, but just maybe a smaller hospital in that area.
Aaron Stewart (05:24):
Yeah. So I think that the bigger opportunities for symmetry would be a larger metro area just because for any staffing firm, kind of having the economies of scale and being able to share resources within a team, I think that's important.
Jeff McLaren (05:43):
I agree.
Aaron Stewart (05:44):
We saw one of the presentations talked about the scheduling model, right? And I always think about the right care at the right time and not all days are created equal and not all shifts are created equal. And so to really be able to provide the best scale, it's kind of being in a market that's small enough that you have concentration there, that if you need to staff providers down, move them from one facility to the other or staff up kind of conversely.
Jeff McLaren (06:10):
Yeah. I think that's a challenge that many of the health systems that are insourcing anesthesia, they're treating each facility as an isolate in terms of a labor pool, and they're not looking at multiple facilities in their system as a potential broader pool for shared resources between individual facilities. And that's frankly how large practices achieve scale for the last 20 years, right? I agree. Was looking at a pool of facilities, not just a single facility. So that makes a lot of sense. And I guess that's one way you inject opportunity to markets where you're in where you have multiple facilities.
Aaron Stewart (06:58):
That's right.
Jeff McLaren (07:01):
Aaron, thank you for the time today. I really appreciate your thoughts.
Aaron Stewart (07:05):
Thanks for having me.
Jeff McLaren (07:05):
All right. Absolutely.
Jeff McLaren founded Medaxion in 2008 to maximize information technology opportunities in the anesthesia market. Previously, he served as co-founder and CEO of Safer Sleep, LLC, a provider of anesthesia safety and record automation services in New Zealand and the UK. Jeff began his healthcare technology career as co-founder, President, and Chief Product Officer of HealthStream, Inc.