Brian Gantwerker, MD, is a spine neurosurgeon at The Craniospinal Center of Los Angeles.
Dr. Gantwerker will serve on the panels “The Easy Way ASCs Can Become Patient-centric in the Digital Age” and “Best Ideas to Balance Patient, Surgeon and Employee Needs Without Breaking the Budget” at Becker’s ASC Annual Meeting. As part of an ongoing series, Becker’s is talking to healthcare leaders who plan to speak at the conference on Oct. 27-29 in Chicago.
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Question: What is the smartest thing you've done in the last year to set your organization up for success?
Brian Gantwerker: I think the smartest thing has been really focusing on the customer/patient experience in the office. We haven’t changed our personnel in quite some time; I've basically had the same crew working with me for the last eight to almost 13 years in one case. We’re really focusing on how patients pass through the office and their experience from the first touch when they call the office. They’re very clear on what insurances we accept and what we don’t accept; we set expectations right away. We’re going to be asking them to bring in their records and so forth, so that there’s no surprises. Then when they’re actually in the office, I make sure that we allot enough time for each appointment to really make sure that the patients are super comfortable when they leave the office, so there’s no pending questions. If they’re going to go to surgery, then they looked at their films with me and I've explained the philosophy and the reason behind what I’m proposing or why I won’t offer surgery.
That’s been a real focus that we’ve drilled down on, and I think that’s one of the smartest things we did is just lengthen the appointment slightly and allowed for a lot more time to interact with the patients. Unfortunately, it’s made a bit of a backlog for people to come and see me, but that’s been the trade off.
Q: What are you most excited about right now and what makes you nervous?
BG: Probably the thing that makes me the most nervous is the obvious play insurance companies are making to essentially squeeze as much profit as possible out of medicine. There is an unwillingness within Congress to confront the largest driver of healthcare costs, which is the insurance company insurance premiums and Big Pharma, so they continue to go after physicians and physician reimbursement. The No Surprises Act, while it was a very good piece of legislation, has been asymmetrically applied to favor the insurance companies. I think what’s really fearsome is that the bureaucracy within the centers for Medicare just seems to be either tone-deaf or willfully ignorant of what’s really driving the cost of care. That’s really scary because over 110,000 physicians left the practice in 2021 — that should give pause to everybody, and I don’t think you can grow physicians fast enough to really take up that gap.
Letting a health insurance company run the entire system is not the way to get equity in healthcare, and it’s another way to create an even further divorced, two-tiered system. That’s not fair to people. I think it’s fixable, but we have to realize that the people that are telling you that healthcare costs too much are the same people who are posting $5 billion a quarter in profit. That’s got to stop. If we don’t stop it, we’re going to continue to slide down the slope into that bed of thorns at the bottom of the hill.
What makes me excited, though, is the fact that the topic of spine surgery is now becoming mainstream; there is a lot of great stuff coming down the pipeline with robotics, but I think the main thing is that among physicians there is a new, renewed sense of efficacy. Physicians are taking notice of what’s going on around them, taking stock and becoming effective leaders. They’re getting to stand up and push back.
Q: How are you thinking about growth over the next 12 months?
BG: I think growth is a good thing, but I think stability is better. People are obsessed with quarterly statements and growth, growth, growth. My practice has been stability and slow growth. I’ve had to make some changes; one of my offices I had to close because it was costing money to actually see patients there. So we did some consolidating, but we’ll have more of a pool now throughout the local area. We offer a great alternative to the big-box medicine with very fast appointments. Overall, referring doctors and patients around me, being slow and steady and being essentially as consistent as possible is very important. Sometimes I have to make changes like closing an office, but you have to maintain that same stability and quality while you’re trying to shift and move things over to be more favorable to your bottom line.
If you grow too much and you’re seeing that your waiting times are too long, that doesn’t make too much sense. If you open up three or four or five locations that may look good — I know some of my colleagues love the fact that they’re opening out of state clinics — but I think you end up diluting the quality of what you’re doing. Consistency is key, and reproducibility is also key.
Q: What will healthcare executives and leaders need to be effective leaders for the next five years?
BG: They need to realize that there is a cost to having good people working at new organizations. I think the consistent evaluation of the ability of a nurse, doctor or other healthcare worker to provide good care in lieu of paying them less is really what got hospitals in the current predicament they’re in right now. The pandemic made it worse. A lot of nurses just pulled up stakes and said, “I’m out of here because they’re not paying me enough to make it worth my while — I can make 10 times what I’m making and don’t have to take call,” and so forth. I think when hospitals say they’re bleeding red, I really have little sympathy for them. Because for a long time, they didn’t pay their nurses and their staff what they were worth. People are not USB keys you just yank out and plug back in whenever you feel like it. When you devalue your staff, this is what you get: increasing costs and worsening outcomes. I think healthcare executives really have to suck it up and they have to understand that they have to pay their people what they’re worth.
Q: What is your strategy for recruiting and retaining great teams?
BG: I really look for experience. I don’t look for the cheapest person. I’m very fortunate, I’ve had one of my staff that has been with me since the literal beginning, and another one has been with me for almost eight years now. I focused obviously on their experience, their personality types, their ability to think independently and to be creative in solutions. And I think also on your end, you have to be willing to listen when things aren’t working well. You have to give people what they’re asking for. I encourage people to speak up when you hire them, have an open door policy. Always be respectful and even if they’re ideas are not workable, explain why it isn’t — but sometimes you’ll find yourself realizing the efficiencies you thought you had are really not efficient at all.
I think it’s important that you have seasoned staff who are independent thinkers, who can problem solve but also are able to work on a team. That’s very hard to find, but it’s worthwhile to find that good hire.