“Being a patient at the Institute for Outpatient Surgery, LLC, confirmed what I have said for the past three and a half years — the IOS is the best,” says Christy Cox, RN, administrator of the facility. “From the registration process through discharge, everyone put me at such ease — much different from past surgeries performed in hospital settings.”

The Institute for Outpatient Surgery (IOS) became an ambulatory surgery center (ASC) on July 1, 2002, and is a joint venture with 27 physician owners, University of Missouri Healthcare, and Nueterra Healthcare. The 7,300 cases a year include elective outpatient procedures in ophthalmology, ENT, orthopedics, plastics, urology, general, GYN and pain management.

In May 2005, the IOS achieved three-year Joint Commission on Accreditation for Healthcare Organization (JCAHO) accreditation, which will assist the ASC in maintaining its high standards, says Cox.

Staff is the greatest internal asset at the facility; physicians hand-picked staff members before opening, and new staff members must demonstrate a positive, caring attitude as well as skill. Not only is staff turnover low, but a few staff members who left have even returned. “There is a mutual respect between the medical staff and IOS staff that greatly enhances the perioperative team that delivers excellent care to patients,” says Mark Adams, MD, IOS’ board chairman.

Staff members are rewarded monthly with small gifts based on patient satisfaction surveys and patients’ notes and letters. Catered meals, quarterly bonuses, and employee-of-the-quarter are incentives to demonstrate appreciation for staff. “I believe the processes we have in place delivered by our friendly, caring staff are why so many of our patients return a second and even a third time for their elective surgical needs,” states Cox.

IOS benchmarks with the national Surgical Outcomes Information Exchange to align itself with national ASC standards. Nueterra Healthcare, IOS’s management group, provides benchmarking with its 22 other ASCs it manages.

Performance improvement is a top priority of the IOS. Ongoing projects include facility utilization, turnover times, cancellations, narcotics review, patient satisfaction, quarterly medical records review, variance reporting, infection rates, length of stay, transfers and contracted services. “The IOS can be termed a success so far due to the hard work of the staff and management team to create a very supportive, nice environment for the patient undergoing surgery,” says Adams. “The patient and his/her family are the prime focus of each staff member’s day.” — K.D.

Kurtis D. Gramley, CPA, is the CEO of Edgewood Surgical Hospital in Sharon, Pa. “Surgery centers in general are cost-efficient facilities, and I think that it starts at the design level,” he says. “We opened in March 2004, and our atmosphere is that of a five-star hotel. If you’re going to be the best, you have to look like you’re the best.”

Gramley, the ASC’s real estate developer, had been approached by a large surgical practice, and spent nine months evaluating the markets before agreeing to develop a new surgery center. The result is a successful facility that serves a county of 120,000. “We’ve done no advertising; we provide exceptionally good care and word gets out, and we take care of our physicians. They are our customer as well. We think what’s good for the physician translates to good healthcare for the patient.”

Staff is the third cornerstone, he adds. “You have to be selective, and pay for the best. We could not do what we do without the best staff. They’re part of a team, not a number in a hospital, where physicians treat them badly and administration treats them badly. We provide them lunch every day, and we provide it in a cafeteria where the physicians eat with them as well. To me that’s the key — treating people like they’re part of the team. I think it’s inconsistent in hospitals that they want to provide a caring service to patients, and then don’t treat staff in a caring manner.” — K.D.

The benefits of El Paso Day Surgery in El Paso, Texas, are obvious from the first look at the design. “We have two ORs with nothing but windows for walls,” says Mark F. Gan, DO, medical director and co-developer of the IT department at the surgery center. “It’s a panoramic view — there’s no obstruction to your vision. Because we’re on the second story, high on a hill, you can see 100 miles into New Mexico.”

The stunning view is only part of the center’s appeal; El Paso Day Surgery was the first ASC in the United States to be both paperless and wireless at the same time. The system was grown in-house with the help of consultants from Microsoft. At the end of the day, everything is digitized; the center has no medical records storage area, and thus saves a great deal by not paying rent on space wasted on charts. “An IT budget for a normal surgicenter built by Nueterra, our partner, is about $200,000. Ours is about $600,000. The longterm benefits of that will be tremendous in terms of archiving.”

A community outreach program is especially notable — one Saturday in November, the center screened impoverished members of the community for free surgical procedures, performed the following Saturday. All time and resources were donated by the surgery center, including staff time and supplies. “Our philosophy is, if we take excellent care of our patients and provide them the very best service possible and we do it with an attitude of caring and fun, we’re going to have good results, happy patients, they’re going to give us great post-op reports, and we’re going to make a good living. All you have to do to make a good living is be willing to work hard and do a good job, no matter what field you’re in.” — K.D.

Ohio Orthopedic Surgical Institute is an allorthopedic ASC located on the campus of Ohio Orthopedic Center of Excellence, which includes the physician’s offices, physical therapy and imaging.

“Our physicians and staff are experts in the care of orthopedic and pain management patients. The environment is calming and incorporates the patient’s family in their care from the start. Patient satisfaction is very high (95 percent) and they continue recommending us to their family and friends without hesitation,” says Lynn Saul, administrator.

“Efficiency is vital to our success. An experienced staff, state-of-the-art equipment and OR suites, and the use of Stryker’s Trio beds contribute to our low turnovers and high patient safety. The care of the pain management patient is segregated from the surgery area, allowing us to better individualize their care and meet their needs.

“Thirty percent of our surgical patients receive regional blocks, preventing postoperative pain and avoiding the need for an overnight stay. Our patient transfers, emergency department (ED) visits and post-operative infections combined are .003 percent.”

The business office submits claims electronically, which results in gross receivables of less then 35 days on-hand with only 15 percent over 60 days and 4 percent over 120 days. Standardized supplies and consignment arrangements contribute to a $229 average supply cost per case (including implants and medications) and an inventory level of 28 days on-hand. Overall, the facility’s net income has averaged 20 percent of net revenue.” — K.D.

Founded in 1972 by Peter T. Pacik, MD, FACS, the Plastic Surgery Center of Manchester, N.H., provides state-of-the-art cosmetic procedures and facial rejuvenation to patients throughout the Northeast. During its more than 30 years, the facility has been in the forefront of many plastic surgery procedures, and is considered to be the surgery facility longest accredited (20 years) by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Pacik credits the AAAASF accreditation with helping the surgery facility maintain the highest standards of patient safety. In fact, Pacik recently was recognized within the augmentation mammaplasty specialty for a new technique that improves breast rounding and fullness and prevents breast fold lowering.

The center has an operating room devoted exclusively to cosmetic procedures, a recovery room and a skin care room. The staff includes Pacik, Daniel A. Sterling, MD, three RNs and a CRNA/ARNP. The facility is a long-time supporter of the cleft palate unit of Crippled Children’s Services and donates its services for this worthy cause.

Rush SurgiCenter, a limited partnership multi-specialty surgery center, is located in the heart of the Illinois Medical District in Chicago. Opened in March 1993, it is 14,000 square feet, with four operating rooms and 16 recovery rooms. In 2005, the surgery center anticipates a total of 5,000 cases.

The center tripled its net payments by doing T&M billing and negotiating improved contracts; it also remodeled portions of its facility to improve efficiency and appearance. A digital audio-visual system is used in all arthroscopic and endoscopic procedures.

“We give educational labs after-hours and televise live surgeries for international seminars,” notes Barbara L. Ramsey, RN, administrator. “We also support and provide clinical teachings for residents and fellows from the Rush University Medical Center, our general partner.

“Our surgicenter is outstanding because we work as a team,” she adds. “Our physicians, management team, and staff work as one. We are innovative in our procedures, as our physicians are involved in the research of many new procedures to improve the ability of our patients to return to an active, healthy life.” — K.D.

Specialty Surgery Center (SSC) in San Antonio, Texas, began performing cases in its new five-OR surgery center on Oct. 3 of this year. The center was the culmination of nine months of work by Steven Blom, RN, MAHSM, and his staff. The multi-specialty ASC originally began in May 1998 with two operating rooms, where the caseload had increased from 200 to 475 cases a month. Blom attributes this success to the caliber of the physicians and the staff. He also notes that many staff members who started the first ASC in 1998 are still with the facility, and they were heavily involved in the design and organization for the new building.

The resounding success of the original 6,600-square-foot facility — located in a medical office building — led National Surgical Care and the physician partners to expand. A freestanding 17,500-square-foot building was purchased to house the new 13,300-squarefoot surgery center. OR capacity has been doubled and the new building allows for future expansion. San Antonio, as in most of Texas, has a competitive ASC market, but Blom attributes most of the success to continued focus on the patient by providing a higher quality of care then they can receive in the local hospitals. — K.D.

The Suffolk Surgery Center, located on the eastern end of Long Island, N.Y., has been in operation since December 2000. After early life as the Long Island Eye Surgery Center of Suffolk, changes in ownership, administrative staff, and strategic direction necessitated a new identity, which led to a complete re-certification survey and full three-year accreditation status by the Accreditation Association for Ambulatory Health Care (AAAHC) in November 2004, says administrator Chuck Walters.

“Commitment, dedication, and talent combined with a true sense of pride and ownership are what sets the Suffolk Surgery Center apart from its competition,” says Walters. “The staff of the center has embraced a team approach toward providing high quality patient care and service to its physician staff. Everyone’s input is solicited, valued and incorporated into the quality assurance program. This is evidenced by the center’s patient satisfaction rate of over 99 percent.”

As a multi-specialty center, the challenges are many but so are the rewards. “At the end of a very hectic day, we all leave with a sense of accomplishment and pride,” he says. “The physicians are amazed at the turnover time and efficiency of the surgery center in comparison to the hospital setting, and the patients leave with a sense that they have received individualized, expert, and compassionate care. That is what surgery centers are all about.” — K.D.

Against incredible odds, the Surgery Center of Cincinnati has become a fiscally solvent business with satisfied patients and a strong team of physicians, nurses, and staff. The multi-specialty center opened in 1999 with a national ASC development partner and without a hospital partner. By late 2002, foreclosure was imminent. In early 2003, the 19 physician owners decided to work with Prexus Health Partners in Cincinnati, which is owned solely by physicians and manages ASCs, imaging centers, and surgical hospitals.

Today, the center is profitable and patient satisfaction ratings are superior. Staff are on track to beat last year’s total of nearly 7,800 procedures. The physician owners, now numbering 32, have just purchased several acres nearby to ensure future growth. “We’ve always provided good care,” says orthopedic surgeon and investor Suresh Nayak, MD. “But now we have a trustworthy management company with a proven track record that’s helped us become a successful business.” — K.D.

Even before its first birthday, the Surgery Center of Evendale was planning for growth. A year after opening in June 2004, the center was averaging 1,000 procedures monthly in five ORs and four procedure rooms. When a 17,000-square-foot expansion is complete, the center will house 10 operating rooms, seven procedure rooms, and an expanded lobby, preoperative area and PACU.

Profitability came quickly at four months, and dividends were paid after eight months. Physician investors had learned from involvement in previous ASC ventures. “Our surgeons have experienced firsthand what works and what doesn’t when it comes to quality patient care,” says orthopedic surgeon and investor Stephen Autry, MD. “With a state-of-the-art facility and top quality personnel, we’ve created a recipe for patient satisfaction, efficient care, and an enthusiastic physician partnership with patients and the surrounding community.”

Surgery Center of Evendale is part of Prexus Health Partners in Cincinnati, a 100-percent physician-owned company that owns and manages ambulatory surgery and imaging centers and surgical hospitals. — K.D.

Bill Hazen, RN, administrator of the Surgery Center at Pelham in Pelham, S.C., enthuses over the potential for his new center. The ASC, which is half-owned by Spartanburg Regional Health System and half physician-owned, uses Surgery Consultants of America as its management team. It is the first building of many at the Village at Pelham, which sits on 100 acres and is complemented by a medical office building which will eventually be accompanied by a 48-bed hospital, walking trails, bike trails, a joint day care with a local industry, retail shops, health-oriented supermarkets, and gym.

The center, whose design blends in seamlessly with the Tudor-style neighborhood, originally intended to open only two and a half of the four ORs and two GI rooms, but demand was so great that all the ORs were outfitted. However, there was a limited capital budget, so Hazen negotiated with vendors to offer deals on new, state-of-the-art equipment in exchange for using the ASC as a “showcase” for potential clients.

In addition, Hazen says, “We worked with the staff to make them understand that patient satisfaction is everything. This is not my surgery center; this is their center, and they need to take ownership. I spend a lot of time out of my office; I don’t want them to have to wait until there’s a problem to talk to me. We work very hard to have an open door policy, and I feel that if you’re in people’s faces, you don’t have the problems you’ll have later on, because they feel they can talk to you. Work’s a great place to have fun as long as you get your job done.”

The staff is encouraged to think proactively about costs. “For every dollar you bill, you get back 40-some cents, but for every dollar they save, you save a true dollar. I think by breaking it down into those terms, the staff can truly get a handle on it,” Hazen explains. — K.D.

This ASC opened in November 2002 to serve a booming area in suburban southwest Chicago. Jointly owned by a group of individual physician/surgeon shareholders and Advocate Health Care, the Tinley Woods Surgery Center is part of Phase I of what will be a complete “one-stop” facility for healthcare needs. HDR Inc. is planning, programming, and designing all major facilities on the campus, referred to by some as the gateway to the “Medical Mile.”

Advocate did an extensive amount of “homework” to prepare the way for this facility. Following the market assessment, Advocate conducted phone surveys and interviews with the public to validate its findings.

“I’ve never seen a more comprehensive owner-driven facility assessment in my 24 years in the healthcare industry,” says Mike Doiel, HDR senior vice president and healthcare principal. The southwest market was chosen for its population explosion and favorable demographics, favorable payor mix, the large market for ambulatory services, and potential development including interstate and street improvements.

The end result is a 14,000-square-foot surgery center with four operating suites and a special procedure room. It features a contemporary, patient-friendly, interior design with fully private pre-operative and recovery rooms, plus private discharge, and many elements of a “healing environment.”

Its medical staff and state-of-the-art equipment support anesthesiology, dentistry, gastroenterology, general surgery, gynecology, ophthalmology, oral surgery, orthopedics, otolaryngology, pain management, plastic surgery, podiatry, and urology. — K.D.

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