Improving the Patient Experience: Gramercy’s Patient-First Culture & New York’s ASC Momentum

Ep. 124: Improving the Patient Experience: Gramercy’s Patient-First Culture & New York’s ASC Momentum

Here’s what to expect on this week’s episode. 🎙️

Delivering a superior patient experience doesn’t happen by chance — it’s engineered and reinforced at every touchpoint. In this episode, Jeffrey Flynn, COO at Gramercy Surgery Center and president of NYSAASC, shares how his team keeps patient care personal, calm, and safe — even at scale.

• One advocate, every step: name-to-name handoffs so patients always know who’s caring for them.
• Family-first comms: surgeons deliver post-op updates; escorts get real-time status from pre-op to PACU.
• Safety over schedule: nurses can call a case; leaders personally follow up on any concerns.
• Meet people where they are: multilingual materials, diverse staff, spotless environment, and off-hours RN follow-ups.

Jeff also gives us an inside look at what’s changing in New York state: ASCs now have a seat at the Public Health and Health Planning Council, the state is advancing rules to expand appropriate cardiac procedures in ASCs, RHIO/HIE participation is tightening, and Medicaid reimbursement conversations are underway — all aimed at improving care access, quality, and affordability.

The takeaway: Design the patient experience with intention — don’t hope for it. Clear communication, empowered staff, and thoughtful policy turn surgical anxiety into trust.

Listen to the full discussion on your favorite podcast platform or watch on YouTube for even more practical tips and recommendations.

Episode Transcript

Alex Larralde: Hi everyone. Here’s what you can expect on today’s episode. I am joined by Jeffrey Flynn, Chief Operating Officer at Gramercy Surgery Center, and president of the New York State Association of Ambulatory Surgery Centers. As part of our series on improving patient experience here on the podcast, Jeff gives us an inside look at how Gramercy delivers superior patient care at scale. With strategies like training every team member to be a patient advocate and even empowering nurses to call a case if something feels off, Jeff shares some incredible insights into what it means to create a patient first culture.

We also get into what’s changing on the ASC scene in New York with the state conference coming up in October in Albany, from expanding access to care to more cardiac procedures moving outpatient, to securing a seat on the Public health council, our listeners will get the inside scoop on some of the biggest news coming out of the state before you hear it in New York.

Then in our industry news segment, we’re going to talk about why anesthesia providers are increasingly choosing ASCs over the hospital setting; what CMS’s proposed 2.6% payment update and expanded list of covered procedures mean for industry growth; ASCA’s latest EHR adoption stats from their July 60-Second survey and a nationwide New Zealand study using AI to speed up stroke imaging.

I hope you enjoy the episode and here’s what’s going on this week in surgery centers.

Alex Larralde: Hi Jeff. Welcome to This Week in Surgery Centers. Thanks so much for joining us. Can you introduce yourself to the audience and tell us a little bit about your role at Gramercy and with the New York State Association as well.

Jeffrey Flynn: Sure.

Thank you, Alex for having me. My name is Jeff Flynn. I’m Chief Operating Officer of the Gramercy Surgery Centers, which are located in Manhattan and Queens in New York. And I’m also president of the New York State Association of Ambulatory Surgery Centers.

Alex Larralde: Fantastic. I wanted to have you on because there’s a lot of exciting stuff happening in New York, which we’re going to get into, but we’re also talking patient experience right now on the podcast, and I know that you have some really incredible stuff that you’ve been doing at Gramercy. So, I wanted to ask you a few questions about that.

Let’s talk a little bit about growth at Gramercy. I understand that you’ve grown a ton over the last few years, so how have you made sure that the patient experience has remained personal, efficient and centered on comfort?

Jeffrey Flynn: That’s a good point because I think that’s where a lot of centers, if they experience a tremendous growth, that’s where things start to lag. I think one of the things is, and I’ve always made it a point to make sure that the patient experience really training our staff to begin with, that the patient experience is utmost, at the top of the list. And one of the things is, is if a patient doesn’t have a good experience, I will call the patient directly myself. No matter what it is.

I’m sorry it wasn’t the experience you wanted, please tell me about the experience because I think in all complaints, there’s some validity along the lines, but also teaching your staff that they’re coming in for surgery, there’s anxiety. And it’s very important to do that. It’s interesting because I just looked back on this because yesterday was my 23rd anniversary at Gramercy.

Alex Larralde: Awesome. Congratulations.

Jeffrey Flynn: I started the company with the founder of the company, Katie Chang. And from day one, we wanted it to be about patient experience. We wanted to be access of care for doctors who needed to get into the ORs. There was a shortage of ORs in New York. So that’s where we started out, and just along the way, each time we’ve always kept in mind, even as we’ve grown, have a second site in Queens, it was really concerning to make sure that when the patient left the place, we want that patient to say, I had a wonderful experience. What we see is, and it’s the chaos of hospitals and larger places we really see a lot of problems in the sense of there’s 10 or 15 people talking to a patient from start to finish. If you go to an outpatient surgery at a hospital, you’ve talked to so many different people. When a patient comes back and names the nurse that helped.

I had one nurse who admitted me. There was another nurse in the OR who handed me off to another nurse. When you mention those three names, because they’ve introduced themselves, they’re there for them, they’re the patient advocate. You know, you’ve done a successful job because you really did make an impact on the patient, and it’s really teaching your staff that that impact is crucial.

One of the bigger issues I’ve noticed, and I know that, HST does this other companies do it too specifically, is patient communication. One of the best parts about the anxiety and the experience is if the loved one waiting for the patient knows exactly where the patient is throughout time, they’re in pre-op, they’re in the procedure, they’re in post-op, and that’s one of the big issues that go forward.

I also insist that the doctor speak to the patient’s family. That’s a strict rule that we have, that it’s, you’re not going to just send a nurse out to say that. You’re going to go out and say, you’re going to spend two minutes to just tell the, that everything’s okay, the procedure went well, and that makes them feel heard.

Because the doctor finds out when he goes to the office, the patient comes into the office and says, oh, you went out and spoke to my wife, my husband, whoever it is, and it just is a better experience for the postoperative period, too.

Alex Larralde: You’ve also mentioned before that Gramercy serves a pretty diverse patient population in New York. How do you adapt your care model to meet potentially different cultural, linguistic, socioeconomic needs?

Jeffrey Flynn: You know, the bottom line is, I think especially if somebody’s going into a surgery, you’re about to be in a very vulnerable position, you’re going to be under anesthesia. First and foremost, I think you have to have a diverse staff. If you walk in and see somebody that looks like you, there just is a level of anxiety it’s softened immediately as you walk in. If there’s eye contact with the patient and everything right off the bat.

We have several multi-languages, obviously. Specifically in Queens, but also in Manhattan. We do have a number of staff that speak several different languages as well as the fact we do have the backups for the rare ones we don’t have.

I really do think it’s important to have patient information also translated into their languages. Key factors too. We’re in not downtown Flushing, but the north side of Flushing, but if you walk into Flushing and you just have English and Spanish, you’ve just missed half the population here. You need to have it in Mandarin; you need to have it in Korean. And it’s just having that other information for them, they feel like it’s been thought of. And that’s a better experience for the patient also.

Alex Larralde: We’ve talked a little bit about this, but surgery is stressful. What other steps do you take at Gramercy to try to reduce anxiety for patients?

Jeffrey Flynn: One of the most simple things, which is really one of the things is making sure the facility is absolutely spotless, making sure your facility’s clean.

Because I have to tell you, if you walk in and you walk into a dirty bathroom you say — I hope the OR is clean — it’s just one of those things that you know that that’s going to run through their mind. Having a culture in place that, you know, if there’s a piece of paper on the floor, if I’m walking through Gramercy, I immediately pick it up and I want everybody else to feel that they need to pick it up or that they will intervene in a situation and not just wait for something. I often do like spot checks and kind of walk through. If you walk into the doctor’s lounge and the garbage is filled at 10 in the morning. You know what? That’s only going to get worse. Make sure they take it out.

We have our maintenance staff on walkie talkies, but it’s also crucial that they understand, they’re responsible for delivering a very big part of the patient experience. Because a clean facility is going to ease the patient’s mind.

I have an excellent front desk staff in my Manhattan center, and I do a lot of development too, so I’m not always there. And I do remember, it was a hospital administrator who reached out to me that said that he had a very good friend that was having surgery the next day. I said, oh, I’ll go and say hello to him. And that particular hospital administrator was being the patient’s escort when they left. So, I walked over to meet the patient, and we had a new person behind the front desk, which was great. I was waiting for the patient to just finish with the front desk before I said hello.

And without a step, the new employee smiled at me and asked for me for my insurance card and my ID and that they would be happy to take care of me. And it was just, it was perfect. I remember they were horrified. I was like, absolutely not. That was, that’s exactly what I want. You’re not waiting for somebody to address you, you are walking, and somebody says hello to you right away with a smile. That’s a real crucial aspect of it. One doctor sent me something on Saturday about Friday. He said the person at the front desk was absolutely wonderful to my staff member.

She said she came in; it was early in the morning, it was 6:30, disheveled, you know, just getting up for surgery, not having eaten, everything else. And he walked her right to her seat, let her handle just the paperwork from the chair, taking the tablet over. They really enjoyed that. And it’s important that you point that out to your staff, that you are hearing that back so that they’re getting positive feedback and not just, hey, there was a complaint here.

You really have to encourage your staff to be like that.

Alex Larralde: How do you describe the culture at Gramercy when you’re onboarding somebody new? Is that part of like your culture, your values as you talk about it with staff? Tell me a little bit about that.

Jeffrey Flynn: Very much so, and you know, I view Gramercy kind of like as a family. I somewhat have expanded that to New York State’s ambulatory community too, is that, you know, we know each other and we’re here to support each other.

And one of the things is, you know, if there’s an issue, let’s talk about it. Let’s get it out there. I’ll support you in whatever the case may be, because you are there supporting my center. You are there, actually, right there. You’re the one who’s going to make sure the patient experience is good, but you’re also going to tell me if something’s a little awry.

At Gramercy, when an anesthesiologist calls to cancel a case and or a surgeon calls to cancel a case, I’ve done something different I think it’s protecting the center and protecting the patient.

The nurse is there to be the patient’s advocate. A circulating nurse can call a case at Gramercy. Now if something’s just wrong, if it’s like, you know, I think this patient really did eat, and I, I’m telling you right now, they’re saying they didn’t, but I, whatever the case may be, that’s the case.

It was funny, it was somebody walked in, and they had a water bottle, and they were drinking from the water bottle. And it was like, yeah, you’re not going to have surgery. I wasn’t drinking from the water bottle. And I was like, it’s on our camera, I’m sorry. But I went and handled that with the patient. I didn’t put it them in that situation, but they have to realize, and the staff really has to feel that they’re going to be supported and that everybody on that team is so crucial to get everything done.

So, we don’t put people in particular categories at Gramercy. It’s all one big group because everybody’s part is crucial to deliver the product. Superior patient care.

Alex Larralde: Absolutely. How does Gramercy ensure continuity of care once your patients leave?

Jeffrey Flynn: It’s making sure that we’ve set up everything and they do have the doctor’s information, they have everything set up, and also, we do a follow up call. And one of the things we’ve done with that is, with our pre-op and post-op calls, we actually have New York state licensed nurses, but they’re not on site. Because they’re able to call the patient off hours. The patient’s at work the day before they missed the call, they’re calling back up.

So, these nurses are able to call like at six o’clock or seven o’clock. How was your experience yesterday at Gramercy? And we do follow up very carefully. If there’s any complaints on anything, the patient will be hearing directly from me, I will drop everything and make sure the patient hears because I want to know what exactly occurred that, made it happen.

I had a wonderful experience. One of my maintenance people saw a woman was having cataract surgery, walking in with a cane. He saw that she was a bit unsteady, introduced himself as one of the employees of Gramercy and proceeded to assist her in the room.

And she, she just was absolutely stunned. She said, oh, he saw me outside and he immediately helped me right in here. And it was just a nice experience to hear that he realized that that was part of our whole experience. And even though patient care isn’t his issue, making sure the patient was safe and brought in was, I like the fact that they all felt that way to jump in, in that need.

And his comment to me is, well, I have a mother, and I would want to know she was treated well. That was his, he just dismissed it as he walked away. But it was, it was wonderful to hear that, that was actually happening. And as I say afterwards, we also contact the doctor if there is some issue that the patient was dissatisfied with.

Or if the issue is, is that they’re unsure of something. I mean, you give them their discharge instructions, you give the escort, the instructions because patient coming out of anesthesia, you know, very often, well, nobody told me what the instructions are, but you’re holding them in your hands.

That’s just a common thing. But I mean, just to get as many points out as to what their immediate postop care will be, and to know that we know that a follow up postop appointment has been made. So, we keep to that too.

Alex Larralde: Well, that’s incredible. Jeff, thank you so much for sharing what you’re doing at Gramercy. But you have another role and that is as head of the New York State Association of Ambulatory Surgery Centers.

And I understand that there’s a ton of exciting stuff going on in New York right now that is going to be talked about at your upcoming conference in October. As we ramp up to that event, I wanted to kind of get a preview of what people are going to learn.

So, tell me a little bit about your role there and the kind of advocacy work that you’ve been doing lately.

Jeffrey Flynn: Well, you know, it’s interesting. It went back several years ago, back in 2017, the downstate surgery centers just didn’t feel like we were participating. And the state association at the time, I want to say it was 30 surgery centers in it, and they would hold the meetings upstate consistently.

They held it in Cooperstown. And I, for people around the country who don’t realize Cooperstown is 80 miles off the nearest highway. In that part of New York, it’s just really remote to get to.

And then we saw that there was a board of five, but that there was one seat for Westchester South. We made up 84% of the surgery centers, and so we, we challenged it by holding a downstate ambulatory surgery center meeting, we did invite the president at the time to come and he did come. The one factor though that happened was, I approached him about, you’re announcing it’s in Cooperstown again. He said, well, that’s kind of the direct center of the state. And I said, not by any means is it the direct center of the state.

So, I asked him to take a chance and let the people who ran the downstate conference, let us chair the conference. And he agreed to, and I said, but we also need to reform the organization. And we started talking with different people around the state.

One of them, he’s now on the ASCA board and he’s my predecessor, Jon Van Valkenburg from Upstate Orthopedic Ambulatory Surgery Center in Syracuse. And he was feeling the same thing, that there really wasn’t a connection. It really was like they’d show up at a conference, but nothing really got done.

We ran the conference where it was only surgery center members that were there as attendees, there were exhibitors there to go through. And at that one we changed to a board of 15, and I was elected to, that board, went in, and I remember the first thing I knew that needed to happen is that John would take over as president because it was very important that it was upstate. This wasn’t an upstate downstate thing. It was group of people who wanted to work together.

And then we got a new lobbyist who really had a strong, relationship from the Department of Health, had a strong relationship with the governor’s office, and she took a chance on us too at the time. She had just started her company, Lisa Alteri, who is now our executive director, in addition to being our lobbyist. And what happened is she kept telling us: what are your priorities? And everybody would say, you know, nothing. It was like that. Then we got very organized. We ran a conference upstate, downstate. We were really working well together.

And it was then we said, we should look at some priorities. What do we want to do as an organization so we’re not just a conference and there’s a lot in New York state that even the Department of Health didn’t really know to utilize us in certain things. And then when COVID happened, we decided to do a daily phone call, separating fact from fiction, because that’s what was happening in March of 2020. People were just saying anything.

Alex Larralde: Absolutely.

Jeffrey Flynn: And then the Department of Health suddenly realized that, well, they might be a resource for us. And they actually started joining the call.

So, it was like we suddenly got recognition that we were there — initially we weren’t even thought of. Because we applied to be able to be open as an essential service. And I remember the response we got back from the application was, you are deemed an essential service. Like it was almost don’t bother us again. And they really didn’t put surgery centers down in that list. So, we had some work to do to educate people.

And then one of the things we did was get our legislators into centers. Get people into centers and we really started and strive to do that.

And Governor Hochul, when she was Lieutenant Governor, she actually came and visited Gramercy Surgery Center in Queens here and she found out what a surgery center was. She was understanding that.

Our founder passed away in 2020. Katie Chang, this was actually the first woman-owned surgery center in the state of New York.

Alex Larralde: Wow.

Jeffrey Flynn: And she was actually friendly with the lieutenant governor at the time, and so she was able to talk a little bit more about it as the transition happened and then she became the governor, there was more opportunity to work with everybody and what did we want to do?

The Public Health Council. There’s a feeling that they have a negative view of surgery centers. You know, we cherry pick cases, we don’t take Medicaid cases. It angers me when I hear that because like for instance, in New York City alone, back in 2022, they asked us, oh, well you’re not doing colonoscopies. We did 22,000 colonoscopies on Medicaid patients.

We have a center in the Bronx that is 80% Medicaid, where there would be no way for those 7,000 patients to be treated anywhere annually. Mid Bronx Surgery Center, actually it’s in the district of the Senate Health Committee Chair. And he actually came to it. He is very pro-ASC; I think we’ve gotten him through about eight surgery centers in the state and he’s also one that has encouraged his other members to see it.

So, we’ve had a number here in Queens and in Manhattan, the same thing. speaker Hastings has actually come to Gramercy Manhattan and also East Side Endoscopy, which is one of the SCA centers we’re located in the same building. So yeah, it’s one of those things we can show the multi-specialty and the GI specialty all in one building.

But in addition to that, we wanted a seat on the Public Health Council. It actually passed both houses unanimously and the governor signed it into place, finally giving us as independent surgery centers a seat on that board so we could actually dispel some of the issues that we hear about consistently.

And one of the big things is we can be a tool to assist in providing access of care. So, we’re not looking at it just from a standpoint, we’re private, joint venture, or with hospitals, but we can actually be part of that experience to get access of care to people. And we started to get people to listen to that.

There’s 22 cardiac codes that are actually approved in 2020 to be done in ambulatory surgery centers. That CMS approves — immediately, New York State said, no, you couldn’t do that, and several states have the same situation.

But over time, a number of states have actually changed that. And there are 26 states now that are currently doing Cardiac. Well, we got that in front of the governor because we’ve met with her several times. There were studies out, not a lot of information, but studies out that it also didn’t hurt the hospitals in the states that it was being done in because their cath labs were clogged already.

So, what happened is the diagnostic ones and lower acuity ones were able to shift into certain centers, but those were replaced by higher acuity. So, you’re actually getting access of care to the patients. In Brooklyn, we’re estimating 14% to 15% of the people who actually have cardiac issues to begin with are not getting treatment at all.

It’s because there isn’t access of care. It’s an emergency room, it’s a clinic, there just isn’t people going after that care. In addition to the fact, the cost efficiency, we could save the Medicaid system a significant amount of money if we’re doing more of those procedures and higher acuity procedures in the ASC setting.

So there needed to be discussion about that. And finally, the governor is in favor of this, and the health department actually has proposed this to go forward and has given a date that they would like to see regulations by December to be implemented at some point next year. So that’s a really big thing that’s going to happen to open up access of care in New York.

So, we’re very excited about that. But we’re also excited in looking around the state so that each place has a pinpoint to, ‘we can start a cardiac program here, we can start one here.’ And in many cases, we’re working with hospital systems to do that.

But in addition, what we’d like to see was there to be more of a discussion about Medicaid to begin with.

Alex Larralde: Right.

Jeffrey Flynn: The hospitals get paid a higher rate than we do, but in addition to the fact they’re allowed to bill the codes where they get paid for the implants and they get paid for the supplies, we’re not allowed to do that in the ASC setting.

If we could just do that in the ASC setting — and this is a discussion we’re having now with the state leaders, and this fall is the budget season where the governor will present a budget in January — they’re actually allowing us to participate in that conversation of what could change. Because a lot of times the implant is more than what the reimbursement is, so you’re underwater to begin with. You can’t afford to do that case. But if the implant was paid for, there’s so many more cases we could do, and they’re paying for it in a hospital setting already, and that’s where most of those cases are getting done.

Another issue of access is the length of time it takes somebody to get when they’re waiting on a hospital list versus an ASC list. And so that’s where we really do feel we can transform healthcare and it’s working with the government leaders. Very exciting that when we’re filming today, it’s actually happening on Monday, is Governor Hochul is going to visit probably our most technologically advanced new center that opened. It has integrated some AI into their sterilization processes, it’s implemented programs into the patient trackings, which is also there.

It is a beautiful center too, and she is from Buffalo incidentally, so, we’re showing her in our own hometown that we don’t have to just show her New York City surgery centers. We want to show her across the state. And she’s been very helpful to us.

She made the comment at a reception we had, that the ASCs of New York are part of her solution to deliver healthcare to the 20 million people in New York. That’s a crucial point. And she said it’s the patient experience; it’s the cost of care. And obviously she’s very concerned about what will happen in the Medicaid budget in the upcoming years to come.

We only have 182 surgery centers in the state of New York, and we’re 46 per capita in the nation because of that. If we’re going to start saying, oh, you’re my competitor, that’s not where it goes. There’s so much business, there’s so much access care issues that need to be done. We should be colleagues, we should be supporting each other in certain instances, we should be policing each other.

The state treasurer actually is CEO of East Side Endoscopy, and that’s in the concourse of the building where Gramercy Surgery Center is on the 10th floor. We constantly borrow stuff from each other or pop in to visit each other, or it’s just different things. But also, if anybody calls up and says, ‘ I’m out of this and I need this.’ Of course, if we have it, we’re going to share it with you. I mean and share it back. It’s building that type of community with each other.

And I do think that it started with our calls during COVID because we were kind of concerned about it, what was going to happen. And then all of a sudden, we realized we’re all in the same boat, we’re only doing essential procedures.

But it was exciting when we finally got through and realized now it’s time that we can really learn from each other but also support each other. We’ve had six surgery centers that have been hacked, and it’s wonderful that if you’re one of those centers that you can talk to somebody else who’s in the same position you are.

Alex Larralde: Mm-hmm.

Jeffrey Flynn: You’re going to have to send out a notice. But just having that support with each other and be able to have those conversations with each other that’s out there, that that’s happening.

And it’s also learning the fact the health department’s not your enemy. And trying to teach each of our centers around the state. The health department, you should be able to call them and get a guided resource from them of, ‘ can I do this, can I do this’? I’m not sure what the situation is.

There’s so many people that are willing to help. And that’s one of the things I’d like to see happen. And I’ve been going to the establishment meetings of our public health council. Because I want to meet the owner of who’s applied and who just got approved for a surgery center because I tell them, that’s when you should join our organization. Not after you’ve built, you’re going to have thousands of years of experience of different people you can reach out to so you don’t make the same mistakes.

Opening up a surgery center in the state of New York. We’ve all done it by the seat of our pants. I mean, I jokingly tell people I do drink the ASC Kool-Aid 100%, but it’s not just for my own centers. I want to see the access of care grow. We are at a certain window of opportunity of a number of things happening in New York with our PHHPC seat, with cardiac, and with this bigger Medicaid discussion, that we have really made known that they do know who our organization is. We were the ones who consistently lobbied the governor, the health department to make this happen. And it’s not to take credit for it, to be honest with you. It’s really to give better patient care and better patient access out there. I do want to share one story with you about the access of care, which is important across the state to hear.

There’s a cardiac group in New York and it’s called the Sorin Medical Group. I actually do believe that Dr. Puma, who runs it, has actually been on this podcast. He had two patients that came in, called in.

One was a patient who didn’t speak English, who called into the helpline. They told him show up at eight o’clock tomorrow morning. One was a VIP patient that got through, show up at eight o’clock in the morning. They had doctors positioned in all cath labs every single day of the week, two doctors in each one, wherever they are. Both patients had clots. So, both patients were going to have to be stented.

Both patients go to Presbyterian Westchester. The VIP patient goes there. The patient goes there, who was a Medicaid patient. Both of them got done that day and left, but they left corrected. They didn’t just put them on a blood thinner and figure out what was happening. They looked at it. They saw the clot, they went in. They fixed the problem. And both patients were home by 5:00 PM that night.

Had that Medicaid patient gone into an emergency room and not sought out the Sorin Group to begin with, he wouldn’t have gotten care like that. He would’ve been put on a blood thinner, sent home. And I’ll tell you, the punchline in this story, is I was the VIP patient. I saw the care the other patient got. The patient got the same care I got.

Those are the people that I’m proudest to work with, that they took those two patients and they put them both in that care. They didn’t even admit them through the emergency room because they had access to the thing. They admitted them directly into the cath lab. I remember telling the governor this story is that that’s the type of care she wants New Yorkers to get.

And it’s nothing against any of the emergency rooms in New York, but they’re dealing with trauma, they’re dealing with a number of things, limited resources. They’re diagnosing then, well, we’re going to refer to this doctor, that doctor…

Alex Larralde: Right.

Jeffrey Flynn: And that’s where we could be part of the solution. And I think in New York State, we have to work together to be part of that solution. That’s why I’ve been trying to get a number of the owners very actively involved. And we’ll have more owners at this conference than have ever been before, because now they are very interested in knowing that that conversation’s going to happen.

But engaging expectations, we have to be smart about those conversations. We need to show where we can save the state money, but can afford to do these cases.

And it’s so important for this conference coming up, 90% of the people at this conference, it’s going to be the only conference they go to all year. So we are a tight-knit community, but people live in their own silos because, you know, you’re not looking for something new unless it breaks or somebody, a doctor asking for something new or a service. Your day is filled.

This conference is an opportunity for exhibitors to really start relationships, but also understand what products that are out there. This is what you should be using. This is something that might be an alternative to you. One of the biggest concerns I have, and New York did not make this easy, is we initially were exempt if your software systems did not, go with the RHIOs, the Healthcare Exchange Program, but we saw that was going to be a problem. Back in 2021, and we got roasted by a deputy commissioner who just was saying, I can’t believe — because 40% of our centers are still on paper. We knew that something was going to come to this.

Alex Larralde: Mm-hmm.

Jeffrey Flynn: Last May, the Public Health Council took the exemption away. And the way New York State made it difficult, they divided the state into five regions and they picked a different company for each region. So for any of our software vendors that we use, you suddenly had to work with five different companies with the RHIOs to go through. And some weren’t very cooperative, some were.

Now they’ve just changed as of September 30th. We all have to sign new agreements, but we can pick any company of the five we want. And I’m encouraging people to pick the ones that have worked with HST, has worked with SIS, has worked with ProVation. There’s going to be a penalty at some point next year where we’re going to lose part of our Medicaid money if we are not participating in the healthcare exchange. But one of the things is, is getting that information out to people to say that this is true, this is coming.

We also have a threat with the Grieving Families Act up again in New York. We’re very thankful that she has vetoed it twice and we’re hoping she vetoes it a third time. Because she actually understands that it’s really affecting the cost of doing business.

And the other factor is in New York State, we train almost 20% of all the surgeons in the nation here, yet 90% of them leave New York.

And it’s how do we attract people to stay in New York? And that’s another big question the governor’s addressing, so that there are people to treat patients here in New York. Anesthesia is another big one, is that we have such a threat with the shortage of anesthesia now and how it’s gone up.

Do we change anesthesia in New York to allow nurse anesthetists to work independently? Will that improve access of care? But anesthesia really across the board, I think in the country is the number one threat to, ASCs right now is the coverage of it.

Three years ago we were not paying for anesthesia, you know, and now with the fact of the shortage of them. The salary hikes that have occurred there, both with nurse anesthetists and with anesthesiologists, that’s really been a, a situation we need to talk about, and that’s another community thing.

And as I said this time, we’re really excited that this is really going to turn out to be probably our best attended conference, but also with a number of owners attending, administrators, DONs attending. This Week in Surgery Centers is going to be there too. So we’re very excited about that. And our state health commissioner, Dr. McDonald is going to be the keynote speaker, and it’s interesting this year he’s going to be talking about how the ASCs can team up with the health department and him to provide more access of care. We need another 75 surgery centers in the state of New York to properly give care to everybody. So how do we make that happen? How do, and the way we make it happen is if we’re cultivating and supporting each other.

I consistently talk with different people who talk about wanting to open a surgery center, and I’m always open to that conversation. It’s not a secret sauce by any means. It’s just your determination. Do you want to do it? And do, you have the wherewithal to do it, but it’s also you don’t want to see somebody fail.

You want to see everything go well. A black mark is a black mark on all of us, just because we’re not known as much in the industry. And that’s where we need to really promote ourselves because in the past years, we’ve been bad advocates, and it’s, you know, exciting, not only is the governor visiting on Monday, Northtowns, state Senator Jackson is visiting a center in the Bronx on Monday. And the more we can get out there to educate people about that, our legislators about it, and the more they see us as they’re battling this budget and what will happen with Medicaid, we really can be that solution.

Alex Larralde: Fantastic.

I mean, there is a ton of stuff going on, so I would encourage anybody who’s in New York or in the region who maybe doesn’t have their own state conference or association to definitely join us. Remind me, dates, location.

Jeffrey Flynn: Albany. The capital, which is easy access. Airport, Trains, go straight there. It’s at the Desmond, October 6th to 8th. And actually, it’s interesting you say that Vermont only has two surgery centers and we’ve told them to join us until they have more to make their own association. So we’ve welcomed them and some of the ones in Western Massachusetts join us also.

So I’m personally very excited to attend and I encourage anybody who’s listening who’s interested in hearing these updates, learning more about how build a strong relationship between your association, your centers, and your legislative team that is there to help you. It’s a partnership. So you’re doing a phenomenal job. I’m excited to hear more.

Alex Larralde: I have one final question for you, and it’s something that we do with our guests every week, but if you were to give our listeners one piece of advice that they could use to go out and improve their surgery centers this week, what would it be?

Jeffrey Flynn: I will tell you, go through your own center as a patient. And if you do it, and maybe just doing it virtually, but go through, look at the whole care in your center itself. And if you can walk out of there saying, I’m really proud of what I just saw, then you’re doing a great job.

But more importantly, if you find a lapse in it, don’t get angry at that lapse. It’s a point of education. It’s a chance for learning. It’s something that we haven’t encouraged a particular person to know that. That would be the one thing I would tell you to do in that situation to improve your center.

But the other aspect is because we are a big community, and I have to say this from the state association standpoint, join your state associations because the networking, and it’s not just the officers, it’s the networking of the people you meet at these different conferences. You want to be able to call somebody who lives your life, and get advice from that person. Get a different perspective. And I’ve been so fortunate to have that opportunity because of the state association. But I, I really hope that people feel the need to jump out and do that. It’s often, I have conversations with people and it was like, I never thought of it that way.

I remember sitting down with a board member, and the board member said to me, we’re not the charm job we once were, we’re doing higher acuity procedures, this isn’t that we’re just doing simple seven to three. We walk out the door, don’t think of it till the next day. Those are the surgery centers of the nineties.

So in understanding that your nurses, your nursing directors and stuff have to go through much more, the job’s more stressful than it was 25 years ago. And it’s important that we, as the operators of surgery centers understand that and really understand what are your staff facing? But more importantly, what is your patient facing? I remember when that person said that to me, I was just so stunned. It’s not the easy job that it once was. You’re doing joint replacements, we’re doing laparoscopic sleeves, laparoscopic general surgeries and we need to recognize that, and that was really eye-opening when that person said that to me. She was absolutely right.

Alex Larralde: Amazing. Thanks for spending time with us, lots of exciting stuff going on.

So thanks again, Jeff. I appreciate it.

Jeffrey Flynn: Thank you, Alex, and we look forward to seeing you in October.

Alex Larralde: As always, it’s been a busy week in healthcare. So let’s jump into some of the latest news and headlines.

A recent headline from Becker’s spotlights, a growing trend. Anesthesia providers are increasingly drawn to ambulatory surgery centers, and it’s not just about money. Many say ASCs offer better work-life balance, less red tape, and a close knit culture compared to hospitals.

In fact, some hospitals have even tried to mimic ASC scheduling to keep their staff happy. But so far the ASC environment still comes out on top. Autonomy is another big perk. Anesthesiologists and CRNAs who are frustrated with hospital bureaucracy value the freedom that ASCs provide, including the option of flexible 1099 or W2 pay structures.

There’s also the chance to shape patient care more directly. ASCs give anesthesia providers an active role in designing efficient workflows, improving post-op pain management, and boosting overall outcomes. And leadership opportunities abound. Anesthesiologists often become medical directors influencing everything from EHR strategies to supply chain and revenue cycle processes. Simply put, ASCs offer anesthesia providers the chance to practice at the top of their license and have more control over both their schedules and their careers.

For the ASC industry, the message is clear. Attracting anesthesia talent isn’t just about pay. It’s about autonomy, culture, and leadership. ASCs already have the efficiency advantage, now they can double down on being the workplace of choice for anesthesia providers who are ready to lead and not just follow.

And while we’re talking industry trends, another recent Becker’s article unpacks some of the big policy moves that are fueling the ASC boom.

As you know, in fact, we discussed it right here on the podcast. Back on July 15th, CMS proposed a 2.6% payment bump for 2026, and rolled out a plan to shift hundreds of procedures off the inpatient-only list. We’re talking about 285 musculoskeletal services over three years, plus another 276 procedures that could be added to the ASC list as the criteria becomes advisory instead of mandatory. All told, that’s more than 500 new procedures potentially headed to ASCs.

State level deregulation is also fueling expansion. The rollback of certificate of need laws is removing barriers to entry and expansion for ASCs, making it easier to build and operate new centers.

For ASC Leaders, the growing scope of ASC-covered care and looser state regulations means it’s time to gear up. In short, ASCs are poised to become the go-to setting for more complex procedures as long as leaders seize the policy momentum to scale up fast.

In other news, ASCA recently released the results of their July ’60-Second’ survey showing that 76% of ambulatory surgery centers now use electronic health records, a record high, since ASCA began tracking in 2021. That’s up from 64% in 2023, and 55% in 2021, marking a 36% jump in just four years. The survey included 280 ASCs across 42 states offering a broad snapshot of adoption trends.

EHR use is strongest amongst physician owned centers, where adoption reaches 82% compared to 72% for joint ventures and 71% for hospital-affiliated ASCs. Among users, 76% would recommend their system to others citing better data gathering as the top benefit at 87%, followed closely by improved efficiency, at 85%.

Of the centers still using paper records, 68% say they’ll stay that way until forced to change with cost cited as the main barrier to switching. The message here is clear. Digital adoption is accelerating and EHRs are delivering on efficiency and data access.

As ASCs look to scale and streamline operations, EHR integration is moving from “nice to have” to “must have” for staying competitive in a data-driven healthcare environment.

Our final story is a real feel good one coming out of New Zealand where cutting edge technology is teaming up with healthcare to save lives. A new nationwide study is testing whether AI can help doctors diagnose and treat strokes faster, and the potential impact is huge. We’re talking hundreds more patients getting timely care each year and closing critical health gaps in rural and underserved communities.

A partnership between Nicolab, Health New Zealand, and the University of Otago is rolling out Stroke Viewer, an AI tool designed to speed up stroke imaging reads across as many as 36 hospitals. This national study will compare treatment times before and after AI implementation to measure its impact.

Early estimates suggest that faster AI-assisted scans could enable treatment for 850 more stroke patients annually, potentially saving NZ$5 million in healthcare costs and up to NZ$40 million in societal benefits each year. The study also focuses on equity, ensuring that rural and Maori populations who are often underserved in stroke care, see real improvements.

Researchers hope that this will become one of the largest evaluations of AI in acute stroke care and a model for integrating AI into emergency services worldwide.

And that officially wraps up this week’s podcast. Thank you as always for spending a few minutes of your week with us. If you enjoyed our episode today, please consider leaving us a rating or review on your favorite podcast platform. And be sure to join us next time on this week in Surgery Centers. We’ll see you soon.