As a joint venture with the local hospital system, Spartanburg Regional Healthcare System, Ambulatory Surgery Center of Spartanburg has found success and support since its inception. “They went into this venture about five years ago, when it was fairly unpopular for hospitals to be getting into joint ventures,” says administrator Mike Pankey, RN, MBA. “Most executive officers were feeling like we were the enemy.” Challenging this notion was significant in establishing the center, and the arrangement has proved beneficial for all parties. Although the hospital system has input and board representation, it allows the center to retain a good deal of independence.

The 28,000-square-foot facility was originally a hospital outpatient department. Now a freestanding ASC, it has seven operating rooms and two endoscopy procedure rooms and performs ophthalmology, orthopaedics, pain management, and podiatry cases, among others. Since the conversion, case volume has gone from around 500 to 800-plus per month. Part of this increase has come from non-owner physicians in the area. “We cater to our non-owner clientele and try to make them feel as important as our owners as they have no other reason to be here other than the service that we can provide them,” says Pankey.

A multi-specialty facility, Ambulatory Surgery Center of Spartanburg is exclusive in its area. “There are a couple of surgery centers in Greenville, which is about 10 to 20 miles down the road, but we’re currently the only multi-specialty center in Spartanburg,” Pankey explains. “The uniqueness and convenience of not having to go to a hospital system I think has been the driving factor for patient and physician satisfaction. What we try to provide that other healthcare providers in town don’t provide is high-quality healthcare with a level of service to the patient and the physician that exceeds any of our competitors.”

For Pankey, a large part of this effort is paying close attention to patients’ needs. “I think hospital systems lose sight of the customer service aspect of it,” he says. “We drive it home.”

Beacon was completed in April 2003 to serve the orthopaedic needs of Cincinnati as well as the surrounding tri-state area. In fact, the 65,000-square-foot facility is the only ASC in the region to focus exclusively on orthopaedic-related surgeries. It received three-year AAAHC accreditation in May 2004.

“What makes our center unique is that we have an integrated musculoskeletal campus,” says administrator Steve Scheffel. “Inside this building is the clinic, where we can have four physicians in at one time. We also have a chiropractor, an orthotics lab, an MRI, a rehabilitation center, a baseball training facility, and an ASC.” These features also make Beacon a renowned center for amateur and professional athletes.

“What we do is set up the schedules so that if you see a physician at 10 a.m. and you need an MRI, you can just walk across the hall and get an MRI that same visit, and then come back,” Scheffel explains. If surgery is indicated, patients can then tour the ASC and meet with pre-admission testing nurses and financial counselors. All of these steps can be completed in one visit. “There’s no other center like that in this region,” says Scheffel. This level of convenience is popular with patients, as indicated by overwhelmingly positive surveys and feedback.

This convenience extends to Beacon’s group of 12 physicians as well. “Another key for us having the surgery center in the same building as the clinic is surgeons’ efficiencies,” says Scheffel. “For example, we have one surgeon in particular who might do two or three cases in the morning and then walk 30 feet to the clinic and see patients for the balance of the day.”

Another popular aspect of Beacon is the ability for patients’ families to watch and interact with surgeons during procedures via two viewing rooms off the surgery suite. “There’s two-way audio and video, so you can talk to the surgeon wile he’s doing the case and the surgeon can educate the mom or the trainer or the agent as to what’s going on,” Scheffel explains. This can help family members to better understand the case and feel more comfortable with, and confident in, the surgeons’ skills and abilities.

What began in 2000 as a 16,000-squarefoot ASC with four ORs and two endoscopy suites is now Ohio’s first registered, physician- owned, multi-specialty, surgical hospital and the first such facility approved by JCAHO in the state, says Mary Ann Gellenbeck, chief operating officer at the hospital. In August, the Butler County Medical Center became an eight-bed hospital, with eight ORs, two anesthesia induction rooms, three endoscopy suites and two procedure rooms.

The center, located in the growing area just north of Cincinnati, offers total joint replacements, larger shoulder procedures, hysterectomies, oopherectomies, mastectomies, hernias, controlled bowel resections, and more. In 2003, 7,765 procedures were performed.

Sixteen physician owners joined together to start the center in 2000. Today, the number of physician investors in the Butler County Medical Center stands at 31.

The “family atmosphere” is one of the reasons for its success, says COO Mary Ann Gellenbeck, RN, CASC. “Nursing as a profession is valued, not discounted, here. Patients are treated as individuals, with dignity and respect.” In fact, children are welcomed with artwork and treats designed to put them at ease.

The center is 100 percent physician-owned. “When physicians take personal financial risk, this ensures that the centers are truly patient-friendly and optimized for operational efficiency,” says CEO Ajay Mangal, MD, MBA.

In addition, the center features an open model, in which any credentialed physician who can provide services can participate in control of the care they deliver. Non-investor physicians also can apply for surgical staff privileges. The hospital is one of three surgical facilities that are part of Premiere Healthcare Partners, which requires geographic separation of at least 12.5 miles in dense geographic areas.

“Our philosophy is to grow in-house management expertise that is shared among our facilities, therefore decreasing the cost of management for every center, with no markup on costs. Our size also enables us to get better pricing from vendors and to streamline business functions,” Mangal explains. “It is the alignment of goals, risks and rewards that differentiates us from the traditional healthcare provider. We are all about building community healthcare assets.”

With a single specialty in orthopedics, the Creve Coeur Surgery Center, owned by 19 physicians and managed by Woodrum/ASD, has been in operation since December 2000.

Start-up was smooth, but busy, says Carol Hollowood, RN, BSN, CNOR, CASC.

“The big challenges were finding and hiring the correct staff. I believe that personality is just as important or more important than skill level when you have a small facility like this,” she says. “I was very selective on the staffing. Of course they were reluctant, because it was a new place; they were secure in other jobs. But they also knew the doctors who were coming here who were owners, so that made a big difference.”

The center boasts high efficiency, very little post-op nausea and vomiting, an infection rate far below the national average, and fast turnovers. “Happy doctors and happy staff make happy patients,” says Hollowood.

A cohesive staff that cares about each other, plus owners and orthopedic surgeons who care about the staff makes for a great team. “It’s a completely different concept than working in a much larger facility,” says Hollowood. “Our staff cares about each other. It’s very much an extension of our families.”

Personalized patient care puts Creve Coeur Surgery Center ahead of the competition. “The luxury we have of providing more personalized service to our patients sets us apart,” says Hollowood. “Our staffing ratio is such that we can afford to know the patient a little more, and give them better pre- and post-op care, which makes all the difference in the world.”

“What sets us apart? Our staff is very competitive and very interested in delivering the best quality of care possible to their community,” says Brenda Cyrulik, RN, CNOR, nurse administrator at Eastland Medical Plaza Surgicenter, LLC. “We keep our noses to the grindstone and keep plugging away at working to our full potential.”

Saint Joseph Medical Center in Bloomington, Ill., is on the cutting edge in the healthcare industry and in 1989 opened a 16,219-square-foot facility known as Eastland Medical Plaza Surgi-center. Three years ago the hospital sold 49 percent of the business to 24 physician owners; it was then that the transition from hospital-based surgi-center to a free-standing center occurred. It was very similar to opening a new business, says Cyrulik. “We became an independently operated facility with new human resource processes, benefit packages, employee recruitment, accreditation standards and materials management. Essentially every function within the system underwent some sort of change and at times it was a struggle. In addition, some of our staff opted to stay with the hospital during the new venture, creating a need for a strong commitment to recruiting quality new employees and training them properly.”

Today the center, managed by Woodrum/ASD, averages 750 procedures per month. It has four suites dedicated to multi-specialty surgical procedures and four suites dedicated to endoscopy and pain management.

Cyrulik raves about the center’s highly qualified staff and a cohesive team. “It’s an innovative team that begins with the governing board members, and enthusiasm trickles throughout the organizational structure. Everyone is an agent for change. We operate in an organized fashion and tasks are well-communicated with appropriate timelines assigned. Everyone is on the same page working toward the same goal, which is patient, employee and physician satisfaction, all equally important to the organization. We have achieved excellence in service and we never sit back to say ‘We are done’ or have gotten to where we want to be. We are driven to continue to set the high standard our community deserves.”

“When I go into a center I try to make it the best place to work, and I have been very successful at that,” says Bob Scheller, CPA, CASC, executive director of the Lake Park Surgicare Center, who adds, “Our goal is to be the No. 1 healthcare facility around. The employees are key.”

The 17,500 square-foot multi-specialty center, managed by Aspen Healthcare, has four ORs and two procedure rooms, and will treat close to 5,000 patients in 2004. Scheller credits his team for the facility’s success. Personal patient escorts from lobby to pre-op, state-ofthe- art surgical suites and a family conference room available for the doctors to talk with family members post-surgery are just some of the elements that add up to high patient satisfaction. “The patients just absolutely love coming here,” says Scheller.

Scheller thinks that creating a strong presence in the community is every ASC’s responsibility. “Being a part of the medical community also means being a part of the financial community, the political community and the local community,” he says. “We’re part of the Better Business Bureau, the high schools all have our name on stuff, we support the little league teams. We hold a public open house when we have our anniversaries. The other surgery centers around here don’t do that sort of thing — we’re the only one.”

Scheller also believes in integrating into the area healthcare system. “I’m a joint venture realist — I promote it,” he says. “The hospitals hate it. It will take them five years to figure out that I’m really their partner. In the meantime, you just keep them from taking too big a bite out of you. They’re saying we are stealing their cases. It’s very tough for them to realize that those are not their cases; they’re the doctors’ cases. I see ambulatory surgery as an arm within the local healthcare system, and I see it doing well.”

“We are 98 percent plastics,” says Joan Culberson, director of the MD Aesthetic Center. “I think that in this day and age, the plastic makeover thing is a big craze, but my doctors are well-seasoned professional doctors. Some have a history of plastics over 40 years, so it’s not fly-by-night.”

The center uses Woodrum/ASD as a management company. The ASC draws patients from all over the world; it has a surgical team composed of three men and three women, so it appeals to patients who tend to prefer a surgeon of their own gender, Culberson observes.

Popularity is assisted by the personable staff and the center’s location — MD Aesthetic is located in the museum district of Houston, just outside the Houston Medical Center, one of the largest healthcare facilities in the country. The museum of fine arts is located across the street, and the building is surrounded by a park.

Culberson has little to no turnover; she points out that Houston always has a shortage of nurses, but that her facility never does. And the community is friendly to the facility, which is adjacent to the hospital that leases their space.

“Here in Houston, one of the reasons why plastics are doing well in the outpatient arena is that the hospital settings did not want plastics. I can stay in one room for 12 hours. The hospital could make 10 times that for those 12 hours if they do 12 shoulders, or some orthopedic knee procedure. They are very friendly to us, because they want us to do what we do and not have plastics over there,” she says, laughing.

“Business is great for plastics, thanks to all of the great makeovers and all of them showing that it is not just millionaires and movie stars who can have plastic things done. You can make a change. Television has helped us a great deal. And I didn’t pay for any of that; I get to ride on their coattails,” she adds.

A tranquil ‘sensory garden’ is the jewel in the crown of the Mentor Surgery Center managed by Health Inventures. Conceived by a blind benefactor who wanted to create an environment for those with sensory-deprivation challenges, the courtyard garden features three waterfalls and year-round beauty, all visible from the center’s lobby.

The 16,000 square-foot full-service center’s two operating rooms and endoscopy procedure room have been providing quality care for more than eight years.

“We are in a position to take very good care of the patient,” says the center’s director of nursing, Carol Imes, RN, MPA, CNOR. “We are very thorough with their pre-op and post-op education. We aren’t so busy that they are a number — we can still treat them as a person. We have always kept very good staffing levels, so the patient often sees the same nurse pre- and post-op. We walk most of the patients to the operating room, so they keep their independence.”

Imes notes that as an older center, they’ve experienced the full cycle of ASC existence. “We’ve gone from the growing pains of just starting out — where we’d take any case because we wanted to work. All of a sudden we grew so fast, and we could do nothing wrong. We built it, they came. We had incredible volume growth, but we knew that we couldn’t keep that up forever. It leveled off and started to shrink, and we’re now on the shrinking side of volume. We’re busy looking for new services.

“Ambulatory surgery is definitely here to stay, and I am a strong advocate of it,” continues Imes. “It’s best for the patient, the family, the doctor. It’s efficient — the doctors like it because the turnover is fantastic compared to a hospital. That’s probably what the doctors compliment us about the most. Even the simplest cases at a hospital can take 40 minutes to turn over. Our average turnover is 10 minutes.”

Midwest Center for Day Surgery is a 13,000-square-foot multi-specialty surgery center that has been serving patients since 1986. The center’s 160 surgeons and physicians practice a broad range of specialties in its five operating suites, including interventional pain management, orthopedics, general surgery, gynecology, plastic surgery, otolaryngology, ophthalmology, podiatry and urology. The facility is a joint venture between physician shareholders and Oak Brook, Ill.-based Advocate Health Care.

Midwest Center for Day Surgery is managed by Midwest Surgical Management Group (MSMG), a company with 15-plus years of surgery center management experience. The president of MSMG, Ronald Ladniak, also serves as the facility’s administrator. In this role, Ladniak and the rest of the management team seek to fulfill the center’s mission of providing high quality patient care, sustained surgeon satisfaction, efficient operating practices and profitable financial performance.

“Our management team recognizes the importance of fostering and sustaining good physician relationships and believes strong alliances with physicians are the first step in creating an atmosphere at the surgery centers that is efficient, cost-effective and pleasant for all to work in,” says Ladniak.

Ladniak explains that outsourced management offers many benefits to the facilities MSMG works with, including the ability to share resources among them. “As a result of the centers’ close geographic proximity to each other, some equipment and instrumentation can be shared, which allows us to maximize our buying power, negotiate better pricing and utilize costly equipment to the fullest,” he says.

Patient satisfaction, a key indicator of the center’s success, is excellent — according to surveys, 99 percent of patients indicate they would return to Midwest Center for Day Surgery if they needed surgery in the future. Special attention is given to the facility’s younger patients, as children receive a ride to the operating room in a red wagon. Additionally, parents are able to be with their children in the recovery area after surgery has been completed.

The River Oaks Endoscopy Center is a 7,500-square-foot single-specialty facility on the second floor of a medical office building within an integrated medical plaza. Averaging 350 gastroenterology cases per month, the center’s closest competition is actually an outpatient surgery center right down the hall. A no-compete, symbiotic relationship exists between the two centers, which can rely on each other in a pinch.

The center is a model of efficiency — all clinical employees wear two-way headsets, so that they can communicate with each other instantaneously, says administrator Robert McDavitt, RN. “We know if a physician is running behind; we know if a patient has an issue, we know when it’s time to bring someone back.”

The center is also focused on patient comfort, providing heated gowns and full-size hospital blankets in an aesthetic atmosphere of care. “There are other GI centers nearby, but they’re not as beautiful, and they’re not as efficiently run. They’re not at the level we are,” says McDavitt. “It’s like the difference between going to a Hyundai dealership and a Mercedes-Benz dealership. You know when you’re in a Mercedes dealership.”

McDavitt credits the center’s success with pre-build research and planning. “The design of the center is where it starts,” he says. “The physicians did a lot of homework. They toured a lot of centers and talked to a lot of other physicians. They did two years of research before opening this center. Now other doctors have seen it, and they think that you can just build a building and it all comes together. There’s much more to it than that.

“We met with very early success,” continues McDavitt. “We were profitable within six weeks; within three months we were able to pay off our working capital loan and were self-funding. Dealing with success and challenging your employees and leadership to take it to the next level is a continuous process, that rigorous pursuit of excellence.”

The Surgery Center at the Pavilion is an ambulatory surgical center owned by the Scott & White healthcare system, which includes Scott & White Memorial Hospital, one of the top 15 teaching hospitals in the nation.

“We currently utilize six OR suites and average 600 cases per month. Plans are in place to complete an additional two suites early in 2005,” says nurse manager Annilyn Donnell. “Original goals for the surgery center included diverting outpatient procedures from Scott and White’s main operating room, changing the organizational culture through improving processes and reflecting a positive margin.”

When creating the pavilion, the principals combined market research with multiple site visits and staff input; the intent was to combine the efficiencies of a freestanding center with the benefits of a hospital-based center. ORs were designed larger to accommodate future advances in equipment; hallways were widened by an additional four feet to allow for stretchers, carts, etc.

As with many outstanding facilities, patients are the top priority; their families are given additional consideration and allowed to wait in the patient’s room during the surgery.

“Providing a safe, pleasant place to work is also a priority,” Donnell says. “Staff and physicians are encouraged to communicate process improvements. Most improvements originate from employee suggestions. Through multi-tasking by all team members, turnover times average 13 minutes or less.” Additionally, she says, “We have recently enacted a gain-sharing program for our employees. The quarterly payouts are based on meeting specific criteria that include patient satisfaction and cost containment.”

Donnell adds, “Outpatient surgery in the central Texas area continues to grow. The reimbursement dollar continues to shrink while costs continue to rise. Cutting costs while maintaining quality and safety is key to survival in the outpatient surgery market. All surgery team members must contribute to reducing the cost of providing care and maintaining quality.”

The Surgery Center on Soncy has less than a 2 percent staff turnover in five years, says Dave Clark, administrator of the surgery center. “We’re investor-owned, so we have 12 investors who are part of this. We’re part of Universal Health, our corporate partner. It’s been a great relationship,” he observes.

“My motto is not to act like a hospital. Physicians are tired of that. They get a lot of excuses, but that is not how we respond. Staff want to be able to treat patients without a lot of restrictions,” says Clark. “Those are basic things, but physicians say ‘I didn’t know it could be this way. We have quick turnaround. Our staff is cross-trained, so we don’t have a special housekeeping team that cleans ORs; we do it all. We look nice, with an atmosphere like a den. Everything’s very warm, with overstuffed chairs, couches, and plantation shutters. People walk in and say, ‘This is cool.’”

The casual, comfortable atmosphere means complaints are rare. “We might get one a month,” Clark confirms. “It’s stunning, because I worked in a big hospital as a vice president. I dealt with complaints every day — the food’s terrible, the beds are uncomfortable, the nurses don’t answer their bells, we’re understaffed, they never clean my room — but here, it just doesn’t happen.”

The surgery center has such a good reputation that only 28 percent of its business comes from investors. “The remaining 72 percent is from other physicians in the community. We’re right at 5,800 cases a year. We do cardiac fibrillator implants, orthopedics, ACL, total joints, total knees. That’s given us a good base of business,” says Clark.

The facility stands out because it never denies patients based on their ability to pay. “We tell our doctors, ‘If you do the case free, we do the case free.’ We feel that the more we give away, the more it’s going to bless our center.

That sounds kind of spiritual, but it’s a basic premise. We know the criticism toward surgery centers is we don’t take anybody who can’t pay their bill. We’ve never taken that approach.”

The Waterfront Surgery Center is located in an area inundated by many large, corporate- owned hospitals with attached surgery centers. Open since June 2003, the center has far exceeded its expectations for the first year.

“Within a year, we were doing average caseloads of 18 to 19 patients; there have been days where we’ve had 30 patients,” says Charlene Wehmer, RN, BSN, a PACU nurse, quality assurance nurse and risk manager at Waterfront.

Waterfront provides GI, podiatry, orthopedics, eye surgery, and some cosmetic procedures, as well as general surgery. “The iLIANT management group had the foresight to hire a diverse staff,” she points out, allowing a range of offerings. The staff came from a pediatric hospital, an adult hospital, and some had emergency room experience. That background will now allow the ASC to add pediatric dental surgery and other pediatric-related cases.

The surgery center is positioned in the midst of a shopping complex, surrounded by brick streets, quaint shops, restaurants, a cinema and a microbrewery. When asked if patients are actually up for a shopping expedition after surgery, Wehmer replies, “Some people are, depending on what we do. Our nurse anesthetists and anesthesiologists all have it down to such a system that some patients are walking out of the recovery room within 20 minutes of getting there. They go out to breakfast or lunch. We tell them not to go shopping, because the drugs might make them buy something ugly. We use all drugs with a very low rate of nausea, so our patients all feel very good, so they can get something to eat before they go home.”

Management company iLIANT was integral to the center’s success; the executive director and business operations manager are actually employees of iLIANT, and will continue to ensure that the ASC is running well before leaving. Those two employees had been instrumental in developing surgery centers within the Children’s Hospital environment, which had three surgery centers. “They had the expertise to know how to make a freestanding surgery center run. Everybody’s very happy here, and we have a good time while we’re doing our job, and I think that is because of the way they were able to bring everybody together,” Wehmer adds.

“Our patients are so thrilled that this is here and they don’t have to go to the big hospitals and sit all day and wait all day. That’s what makes the difference.”

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