Making Surgery Simpler - Better Way Medical Group

This video provides an in-depth exploration of healthcare delivery innovation, focusing on the shift of common surgical procedures from traditional facility settings (Hospitals/ASCs) to physician offices. CJ Brock, CEO of Better Way Medical Group, details a model that leverages advances in local anesthesia to dramatically reduce the cost of care, improve patient outcomes, and enhance the physician experience. The core premise is that by eliminating the need for general anesthesia and the associated facility overhead, procedures like carpal tunnel and trigger finger release can be performed safely, effectively, and at a fraction of the traditional cost.

The "Better Way" methodology centers on creating a "pop-up procedure room" within an existing exam room, requiring minimal physical modification and staff changes. This allows physicians to control the pace of their surgical schedule and avoid the delays typical of surgery centers. Crucially, the use of local anesthesia allows the patient to be awake and communicative, enabling the surgeon to perform intraoperative testing (such as checking full range of motion during a trigger finger release). This direct feedback mechanism significantly reduces the natural revision rate (typically 2-5%) associated with procedures performed under general anesthesia, where the surgeon must rely on estimation.

From a systemic perspective, the model directly challenges the high cost of care driven by facility fees, which often constitute 80% or more of the total episodic spend. Better Way Medical Group reports that the average cost for a procedure in their office setting is about $2,500, compared to $5,000 in an ASC and $8,000 to $10,000 in a hospital outpatient department (HOPD). With an estimated one million annual procedures for the five most common hand and wrist CPT codes, the potential national savings from this site-of-service shift is calculated at a conservative $2.5 billion annually. To scale this model against resistance from large national payers (BUCAs), the company focuses on creating a physician consortium to collectively bargain with self-funded employers, benefit consultants, and TPAs, ensuring physicians are appropriately incentivized to adopt the lower-cost, high-quality model.

Key Takeaways:

• Site of Service Cost Differential: The average cost for soft tissue hand/wrist procedures in the office setting is approximately $2,500. This compares favorably to $5,000 in an ASC and $8,000–$10,000 in an HOPD, demonstrating massive potential savings by eliminating the facility fee, which is the largest cost component.
• Patient Experience and Recovery: Utilizing local anesthesia (lidocaine and epinephrine) allows patients to avoid pre-op testing, drive themselves to and from the procedure, and be home in less than three hours, often returning to work the same day, eliminating the "hangover" and risk associated with general anesthesia.
• Quality Improvement via Intraoperative Communication: Performing procedures under local anesthesia allows the patient to communicate with the surgeon and move the joint during the operation. This capability ensures the procedure is fully resolved the first time, drastically reducing the 2-5% revision rate typical of procedures done under general anesthesia.
• Incentivizing Physician Adoption: The key to scaling the model is ensuring physicians are appropriately compensated through higher professional fees. This offsets the external costs (staff, supplies) they incur performing the procedure in-office, making the shift economically advantageous compared to relying on facility fee ownership at an ASC.
• Market Scale and Savings: Focusing on just the five most frequently performed soft tissue hand and wrist CPT codes reveals a market of about one million procedures annually, highlighting a potential national cost savings of $2.5 billion if the in-office model were widely adopted.
• Strategic Payer Engagement: Given resistance from large national payers (BUCAs) due to existing profitable structures, the strategy involves creating a physician consortium to negotiate standardized, fair rates with self-funded employers, TPAs, and benefit consultants.
• Minimal Infrastructure Requirements: The model utilizes existing exam rooms as "pop-up procedure rooms," requiring only about 20 minutes for setup. This low barrier to entry makes the model highly repeatable and scalable across various physician practices.
• Expansion Opportunities Beyond Hand/Wrist: The methodology is transferable to other specialties that can utilize local anesthesia and minimally invasive techniques, with immediate expansion targets including Podiatry (Foot and Ankle), ENT, Dermatology, and Pain Management (e.g., percutaneous needle treatment for tennis elbow).
• Driving Utilization through Incentives: Self-funded employers should implement strong economic incentives for employees, such as zero out-of-pocket costs and cash bonuses, to encourage voluntary use of the preferred in-office providers, even if it requires domestic travel (domestic medical tourism).
• Embracing Geographic Flexibility: Consultants and employers should not let limited initial geographic coverage stop them from adopting the solution. The proven success of domestic medical tourism means patients are willing to travel 2-3 hours or even fly for cost-effective, high-quality, same-day procedures.
• Risk Reduction Case Study: A patient who underwent a procedure in the surgery center experienced a $100,000 complication requiring a three-day ICU stay due to general anesthesia issues, while a patient receiving the same procedure in the office under local anesthesia went home without incident.

Key Concepts:

• Sight of Service Change: The strategic shift of where a medical procedure is performed (e.g., moving from a hospital/ASC to a physician's office) to reduce facility costs and improve efficiency.
• Facility Fee: The charge levied by a hospital or ASC for the use of the physical space, equipment, and non-physician staff, often comprising the largest portion of the total cost of care.
• Domestic Medical Tourism: Encouraging patients to travel within the country to access high-quality, cost-effective care when strong economic incentives are provided.

Examples/Case Studies:

• Anesthesia Complication: One patient treated at a surgery center required a $100,000 ICU stay due to complications from general anesthesia, while a comparable patient treated in the office under local anesthesia was discharged the same day without issue.
• Heart Box Technology: A brief mention of the $80,000 single-use device used to keep donor hearts alive during transport, which has increased the donor pool for DCd transplants by almost 50%.
• Percutaneous Treatment: The use of minimally invasive needle treatments for conditions like tennis elbow and golfer's elbow, which can be cured in the office under local anesthesia.