MD
#Good morning, <UNK>.
Well, we think that there will always be opportunity to do both.
We definitely want to move more towards the definitive read world.
But we think there are always going to be opportunities for both our percentage of definitive is increasing, and we expect that we will continue down that path.
Well, birth ---+ admissions to the NICU are always going to be a percentage of birth.
So as births go up, you can expect this maybe 10%, 11%, 12% admission to the NICU.
So as births go up, NICU admissions are going to go up.
Neonatal abstinence syndrome is a big contributor to that.
I also think that if you ---+ if you know anything, if you follow what's going on in obstetrics, hospitals have gone to in-rooming their babies with their mothers.
And so the old concept of a nursery with 20 kids in it, that the nurse was feeding and taking care of, that ---+ that's probably gone in most, if not all, places across the country.
And what that means is there are more ---+ there are always babies now staying with their mother.
And that makes the pediatricians nervous because if anything happens to a baby while they're in the room with the mother, the mother is not likely to pick up on it.
If the baby whatever turns a little blue or ---+ And so I think there is less tolerance from the pediatricians to leave these babies rooming in with their mothers.
And at the first sign of any change in the baby, they're likely to want to admit the baby.
So the only place we can admit them is the level 2 neonatal NICU.
Perhaps if that baby was in the nursery with all the fat eight bound babies around and the baby turns a little blue the nurse knew enough to not worry about it or to at least tell the pediatricians, reassure the pediatricians that the baby was okay, et cetera.
If that happens in a room with a baby and the mother, chances are that baby's going to end up in the neonatal ICU.
Yes.
No.
We continue to grow that program very nicely.
And it's all ---+ it's not acquisitions.
We may at this point be the largest group of pediatric or of OB hospitals in the country and all of that growth is organic.
There hasn't been any acquisitions.
I think we ---+ <UNK>, what did we get, ten of those.
Ten of those programs across the country so, yes, it continues it grow.
That's a nice ---+ a nice area of growth for us as well.
Yes.
No, I'm not saying artificial.
I'm saying that in the old days, there was a nursery with some newborn nursery nurses who had experience caring for these babies and who could identify ---+ there are babies that do well for the first 12 hours and then something happens, and they end up when their (inaudible) closes, they end up in the NICU.
And so there are a number of admits to the neonatal intensive care unit that come not from the delivery room but from the NICU when the baby develops infection or sepsis or something and it takes time for those symptoms to express themselves.
That ---+ when the baby is in a regular nursery with nurses who know had they're doing who have been taking care of these well babies for a long time, the nurses are able to pick it up immediately and to determine, make the call and get the baby taken care of.
When that happens in a regular room with a mother who is not used to seeing sick babies and transitional babies, et cetera, it's likely to be a while before it gets picked up.
And what I'm saying is that some of these admissions are cautious pediatricians who recognize that if there is any ---+ if there are any of these symptoms that happen while the baby is rooming, they're not going to take any chances and say, well, let's wait three hours and see how the baby proceeds.
They're going it say let's get the baby into the step down the level 2 nursery, not the level 3 NICU but let's get the babies to the step down nursery and make sure he gets monitored and we've got somebody looking at the child who knows what ---+ what they're doing.
I think some of the admissions are allowed.
The question was why the increase in admissions, and they said was it all related to do neonatal abstinence and I said no I think births are going up, and admissions are a percentage of that, and neonatal abstinence is a percentage of that, and I think that this also may play a role.
No.
We're definitely changing our marketing patterns, and we have definitely had a number of conversations with not just one, with our hospital partners.
And so, yes, we are looking to be a solution for our hospital partners for whatever problems they might have.
And you probably heard me say in the past that we have three pediatric surgery practices and one pediatric GI practice, et cetera, and those are just a reflection of some of these conversations that we're having with our hospital partners.
Yeah.
Good morning <UNK>.
So commercial pricing has been pretty challenging over the last, I don't know, couple years already.
So that continues to be the case.
But this ---+ this quarter was specifically related to lack of having that favorability because we had a big favorability in the last quarter.
So that was pretty much it, as well as, obviously, the parity decline.
So for the third quarter historically there is a slight increase in payor mix, not really that ---+ that large.
So there could be.
But given that we had such an increase in the second quarter, we're not expecting that to be so ---+ so drastic.
But, again I keep cautioning about payor mix because it has been something that has been volatile over the last years.
So we have ---+ we have in your guidance, as I think somebody ---+ somebody else had asked <UNK> the drivers of the same unit, a big chunk of it is volume and less on pricing similar to what you saw on Q2.
Thank you.
Yes.
I mean I don't know that I would say for all of the ASEs, but certainly for most of them depending upon the hospital contracts.
If the hospital owns a couple of ASEs, we are very likely to have those ---+ the coverage of those ASEs.
Now if there's a hospital ---+ if there's a hospital system that has six hospitals within a community and we're providing coverage in four of those hospitals and somebody else is in two, then ---+ then we wouldn't.
Yes.
This is <UNK>.
So in talking to a few ---+ talk a little bit about as <UNK> said the volumes going to outpatient, we are seeing outpatient volumes growing but they're growing both for hospital outpatient to part of the hospital so he we would get those as well at outpatient surgery centers and it is a mix.
It depends if we have a system-wide contract or specific hospital within a system we won't necessarily get that new surgery center.
Clearly, if the system is opening a new surgery center, we are pushing to be part of that.
And we are seeing growth in addition outside of the ORs in the hospitals so we're seeing things in the cath lab and GI and EP.
We're seeing a significant movement of using anesthesiologist in those areas of the hospitals and we're seeing volume growth from that.
And that's been moving across a lot of hospital systems so we expect to continue to see that.
As far as the peri-operative process, yes, there is a big movement to try to get anesthesiologists more involved this that, whether it's pre-op, a lot of our practices are already involved preoperatively to the patients, but there is a push to do more of that.
There has been an initiative by the ASA on the peri-operative surgical home on getting anesthesiologists much more involved.
We actually have five practices involved in that collaborative, and actually we're currently working on hospitals and all of those require the hospital to be involved in that process as well.
And we are working with hospitals on how do we move that forward, more systematically in the future.
So we're involved in how the patients get prepared for surgery and actually some post-surgical work as well to make sure that we can help the hospital with the pre-admissions, and design the process around that.
We also have other programs around recovery after surgery that we're rolling out in multiple practices.
And we've seen some significant impacts on length of stay.
Okay, if there are no further questions, then I will just thank everyone for participating today, and we will look forward to speaking next quarter.
Thank you.
