Hey Joe, we sort of started this conversation 6 months ago when I first started with Buro. This piece highlights for me a couple of things I think we can talk about. First, reducing the overall cost of surgical care by outsourcing to ambulatory care centers. The VA is going to be looking for structures to increase veteran care while reducing overall costs. Since I sat on the energy and ops side for 7 years, I can without hesitation say that the O&M budget at the VA is a huge drain on overall medical care to vets. So how could we package this model to the VA? Second, for my personal interests, these focused surgical centers seem to be increasing in my perception. My interest will always be energy in this space. No Doctor or manager is looking at energy as a large cost center when they need literal bodies in and bodies out as their revenue model. If PE consolidation is growing in this space, how do we get the right players together so I can teach or demonstrate to these groups how to connect the energy O&M to a more cost effective and better overall ESG component? I was a great piece…. I really liked it.
PE really needs to prove that they are creating value for the market, and not inserting themselves as rent seekers trying to drain equity from the hospital network. While most folks don't like hospitals, folks will hating having to get taxi'ed around in ambulances to different surgical providers even more. This is because moving a patient who is in critical need between addresses is risky, expensive, and very slow in the context of a medical emergency. Finally, many rural areas do not have surgical capacity outside of the hospital, so attempting to change behaviors by confining outpatient care to emergency rooms as these people suggest will only result in massive price increases for the patient and not a rush of development in rural surgical capacity. We already see this happening with many rural hospitals cutting family birth services; even though such services bring in $3 million to $5 million dollars in revenue per year. Telling a pregnant woman "go to the emergency room or drive two hours away" is not going to go over well and will certainly invite regulation that harms the long term value of the strategy.
