#1 Priority for Your Front Office Team

A surgeon can be the best surgeon in the area or the world, for that matter. But, if his/her front office isn’t doing its job right, this expertise means nothing. It’s the equivalent of having the best quarterback on the field, but the front line can’t block, the running back can’t run and the receivers can’t catch. A team simply can’t win, with only one effective player. So how effective is your team?

As in football, a front office must know the drills and apply them daily. First, they need good people skills. It’s a MUST that they always put the patient first. As the saying goes, “if Mama ain’t happy, ain’t nobody happy!” How does this apply to your patients? Think about it, if your staff mishandles an issue in the front office, they’ve not only upset the patient, but the patient’s family/friends and everyone sitting in your front office, i.e. other patients and potential customers. If you can do one thing for your staff, teach them how to handle difficult situations. First, train them to live and breathe the two rule standard as an initial reaction to a disgruntled patient: “Rule #1 – The patient is always right, Rule #2 – If the patient is wrong, refer to Rule #1.” By making the patient feel that they are right, the anger and emotions surrounding the situation are diffused immediately. Second, in resolving a patient issue, take them to a private area and work through the patient’s issue in a positive manner. If a staff member has done something wrong, require that the staff resolving this issue with the patient do 4 things: (1) admit wrong doing, (2) openly acknowledge what was done incorrectly, (3) apologize for the mistake, and (4) come up with an action plan that you will implement immediately to ensure this doesn’t happen again. If your staff does this, it’s a guarantee that your patients will come back, as well as become life-long customers and most importantly, tell their family and friends of the great experience they had at your office and/or surgery center and what a top notch ophthalmologist you are.

The second most important duty of front office staff is how they treat each other. The Golden Rule is always a good place to start. This rule is “treat others, as you would like them to treat you.” If you instill this in each and every one of your people and let them know that you expect them to live this daily, your personnel issues will be minimal. In the last year, one of cataract outsourcing team members violate this rule. Rather than treat it as an isolated incident and address with only this particular staff, the supervisor gathered the entire group together the day after the episode and presented them with a one page statement. He read it out loud and had discussions with them what this meant on an individual level, as well as a team. He went over points about how our society, as a whole, has become less professional and respectful of each another. They discussed this and it was agreed that the team needs to work harder in making sure these types of behaviors/attitudes don’t permeated their work environment. They discussed how they could have handled the situation differently. In the end, the supervisor, along with each staff member, signed this document acknowledging their pledge to treat each other professionally and with the utmost respect, at all times.

Another aspect of front office service applies to your facility staff. If you haven’t already done so, you need to encourage, promote, and require your facility staff to treat your office staff with the upmost respect and view them as a key customer. In addition, they need to do the same for all surgeon users’ office staff. Your people must view these groups of people as key customers, i.e. same top notch customer service, as the staff gives the patients. Granted not all physician offices have the greatest customer service-oriented people working their front desks. But, encourage your staff to look beyond this and to keep reminding themselves that a surgeon’s staff is the gatekeeper of the facility’s patients. Again, if these key people are happy, I’ll guarantee you the facility case load will increase.

Finally, your staff needs to be dutiful in completing the tasks of scheduling, pre-certing, registering, preparing patient for surgical protocol and expectations, billing and collecting payments. However you might remind them that if poor customer service exists and/or prevails, there will be no need to pre-cert, register, etc…, as customers will be non-existent. Therefore, the #1 priority must always be customer service to both external and internal customers.

Teamwork with pride

The OR can be “brought to life” by all of the people that spend their daily work hours involved with it.  The attitude of the OR “life” is made by each person that comes in contact with the room.  This can make it a beast or a gentle giant.

The best practices for running an OR start with teamwork and pride.  Each person involved should be able to work with the others in the room and know the daily routine. Each person has to take pride in the work that they do.  The circulator must be ready to be in charge and know where all items are.  The room has to be kept stocked – this keeps the running and the down time to a minimum.  The scrub tech must know what the physician needs and anticipate this at all times.  All of the instruments must be processed and available as needed.  The CRNA must be able to keep the patient at ease and comfortable during the procedure.

When all of the members of the team work together it shows in other ways also.  Our number one reason for being in the healthcare field – the patient – is pleased and less stressed to be in an unfamiliar environment.  The patient that sees the staff getting along and working together will be able to feel more at ease.

Room turnover time is minimized by each person doing their share in a timely manner.   This can only be accomplished when each staff member takes pride in the job that they do and knows that each duty is an important one.

When all of these people are able to work together to keep the OR organized and running smoothly the physician seems to keep a positive outlook.  This positive outlook can make the whole process a “gentle giant”.

Quality Models

Five years ago, Aetna and several large employers confronted Virginia Mason Medical Center in Seattle over how much it was charging for treatment of migraine, severe acid reflux and narrowed aortic valves, and other conditions. Virginia Mason, a not-for-profit hospital system that employs about 400 salaried physicians, took the message to heart.

Working with the employers and Aetna, doctors and staff began to re-engineer care protocols. For example, the system ensured back pain patients same-day access to a physical therapist and physical medicine physician and sharply reduced medically unnecessary MRI tests and physical therapy visits. From 2004 to 2007, the changes yielded a 50% reduction in lost employee work days due to back pain, almost $2 million in cost savings and high patient satisfaction scores.

Following the overhaul, however, Virginia Mason’s spine clinic was losing revenue because of fewer billed tests and services. To offset the loss, Aetna boosted reimbursement for appropriate physical therapy sessions. With the higher payments and the greater volume of patients it could handle under the more efficient system, Virginia Mason covered its costs—while payers achieved a significant net savings.

President Obama and health policy experts have specifically touted integrated delivery systems, such as Virginia Mason, Geisinger Health System, the Mayo Clinic and others, as national models for innovation. Dartmouth University researchers have found, for instance, that Mayo spends one-third to one-half less than other top hospitals to care for similar patients with equal or better results.

Geisinger has gotten so much attention from politicians that it reportedly hosted tours for more than 70 visiting payers and providers last month.

Leaders of integrated delivery systems say the model won’t work just anywhere. It’s challenging to build a culture of high quality and low costs through contractual relationships. Independent delivery markets don’t have the dynamic of salaried doctors and instead must manage the powerful fee-for-service forces.

Robert S. Mecklenburg, MD, medical director of the Center for Health Care Solutions at Virginia Mason, says his system’s experience shows how health plans and employers can benefit from collaborating with an integrated hospital-physician group. But, he adds, moving away from fee-for-service to payment models that reward better patient outcomes, higher patient satisfaction and lower costs is key.

“[Innovative providers] want to be paid for value,” he says. “That’s very important in straightening out U.S. healthcare.”

Mayo Clinic CEO Dr. Denis Cortese describes integrated systems as having high levels of physician engagement, teamwork, connectivity and greater use of industrial efficiency and quality controls. All this is hard to achieve in contracted networks.

At the same time, experts say, non-integrated systems haven’t felt the pressure—or been given the financial incentive—to change because payers have been slow to revamp payment methods to encourage coordinated delivery. The current fee-for-service model simply rewards greater volume of services.

So far, Dr. Mecklenburg says, no health plans have agreed to pay Virginia Mason based on actual patient outcomes, except on a temporary experimental basis. He believes the system should realize a positive margin when it meets its quality targets.

“You won’t get system reform without changing the reimbursement dynamics,” says Andrew Webber, president of the National Business Coalition on Health in Washington, D.C. “I’m sure the leaders of integrated delivery systems are frustrated with the current payment system.”

ALIGNMENT OF INCENTIVES

At the state level, Massachusetts, with its individual mandate, now is eyeing a shift from fee for service to bundled payments to control spiraling costs.

In line with that, Blue Cross & Blue Shield of Massachusetts continues to leverage its Alternative Quality Contract with episode-based global payments, which pushes providers to work together on improving patient outcomes and cost-effectiveness, according to Jim Conway, senior vice president of the Institute for Healthcare Improvement in Cambridge.

The alternate contract sets specific outcome measures provider groups must achieve in managing patients with chronic conditions. For the first few years, provider groups won’t face financial penalties as long as they meet the process standards, but down the line, they’ll take a financial hit if they don’t meet the outcome targets.

“It took a while for the first hospital and physician group to sign up,” Conway says. “But now a lot of people are signing up because they see this as the direction the industry is going—away from fee for service to a system that takes care of overall global health.”

In other parts of the country, Blue Cross & Blue Shield of Minnesota also has started paying providers for care of the whole patient rather than for specific services, Conway says.

Self-insured employers are testing new reimbursement approaches as well.

Members of the Colorado Business Group on Health are paying providers additional reimbursement on top of fee-for-service payment to manage the care of diabetics and other patients with chronic conditions, according to Webber. They’re using a program developed by the Bridges to Excellence industry partnership. Similarly, the Employers Coalition on Health in Rockford, Ill., is experimenting with paying providers a bundled case rate for patients with chronic conditions, using the PROMETHEUS Payment System, of which Bridges to Excellence is the operational partner.

Webber says health plans and employers should offer financial incentives to patients to get their care from integrated systems, taking advantage of emerging value-based benefit designs.

“There will be opportunities to say to patients, ‘We’re willing to reduce your premium share if you’re willing to participate in more integrated, high-performance delivery systems,’” he says. “I think more and more consumers would be willing to join more closed-panel systems if they could reduce their premium share. Then we can reward high-performance providers in two ways: with payment differentials and with more patients.”

HOME TEAMS

Some health plans and employers around the country are working with provider organizations—and even small physician practices—to support the emerging patient-centered medical home model.

In the model, a primary care physician leads a team of allied health professionals to provide or facilitate each patient’s care needs, including self-care and prevention. The team uses data to proactively manage care for its entire patient population as well.

The Geisinger Health System in Pennsylvania and Group Health Cooperative, a Seattle nonprofit health plan that employs salaried doctors, have reported that their medical home pilots have reduced emergency room use and preventable hospital admissions, improved outcomes for chronic care patients and boosted patient satisfaction. They’re expanding the model to all primary care sites, but it’s costly to properly staff, train and equip practices to become effective medical homes. The practices must be adequately reimbursed to cover the extra patient management services and the forgone fees for service.

Health plans and Medicare have moved slowly on implementing the model, waiting to see evidence of cost savings and quality improvement.

“The medical home is a very important element, and we need to reward primary care doctors, because this can move us toward more integration of care,” Webber says.

Beyond the medical home initiative, Geisinger Health System has taken another step in aligning payment. The not-for-profit system, which includes three hospitals, a multispecialty group practice with 700 doctors and a health plan, is beginning to re-engineer care protocols, starting with coronary artery bypass surgery. Its payment methodology for the re-engineered services, called ProvenCare, bundles comprehensive care for the procedure at a fixed price, instead of piecemeal services and costs. Essentially, by bundling services and paying a flat rate, some risk is shifted to the provider, so it’s in the provider’s interest to deliver the best care, not more care.

Geisinger and its doctors identified 40 factors that produce the best outcomes for bypass operations and built a checklist that ensures those best practices are performed every time. Since its redesign went live early in 2006, Geisinger reports markedly improved patient outcomes for bypass surgery, including a 44% reduction in the 30-day readmission rate, a 21% reduction in patients with any complications, and a 55% reduction in re-operations for bleeding.

Geisinger similarly has redesigned care for hip replacement, interventional cardiology procedures, cataract surgery, obesity surgery and perinatal care.

Duane Davis, MD, chief medical officer of Geisinger Health Plan says Geisinger has gotten a “marketing buzz” out of ProvenCare. Employers like the fact they pay once for the product, just like for other goods and services. But surprisingly, no other health plans have taken Geisinger up on its ProvenCare guarantee deal, except for Geisinger’s own plan. Dr. Davis says he isn’t sure why that’s the case.

“That’s stupid,” says Jeff Goldsmith, a veteran industry forecaster based in Charlottesville, Va. “If a provider group is organized well enough to give you a guarantee they won’t have to readmit, I would rush to sign a contract like that. Maybe some attitudes need to change.”

Goldsmith says that health plans and provider organizations are leery about working together on global payment contracts because of the disastrous experiences with capitated contracts back in the 1990s. Many physician groups and hospitals formed joint ventures to accept these fixed-fee deals and suffered big losses. New structures aim to even out the economics with gainsharing.

WATER UNDER THE BRIDGE

However unfortunate, private practice is collapsing, and more hospitals are employing doctors and creating their own multispecialty, integrated delivery systems. That, Goldsmith says, will allow hospital systems to manage care with their employed doctors. Likewise, health plans may be ready to return to working with provider groups to manage their patient populations because current cost-control methods, such as external utilization review and patient cost-sharing, aren’t sufficient.

“I can’t tell you whether that mindset has changed and whether plans have decided they’ve run out of tricks and are ready to return to working with providers in a constructive way,” Goldsmith says.

Scott Armstrong, president of Group Health Cooperative, says, “our whole industry is in the process of trying to come up with an answer to how health plans can work with providers. How can [global payment] create alignment around common goals? We have to overwhelm the skepticism based on bad experiences in the past.”

Even beyond that, however, Geisinger’s Dr. Davis says it’s going to take time to make healthcare better and cheaper. While integrated systems like his offer important lessons, there are no “big bang” solutions. The primary care medical home is a good place for health plans to start aligning payment incentives for improved care.

“There’s a huge opportunity for the insurance industry to use its skill sets and work in partnership with the clinical side to coordinate very fragmented care,” he says. “If we don’t figure out how to do primary care and coordination better, in the long run, payers will lose anyway.”

While private-industry payers can work on reducing fragmentation, government-supported coverage continues to face budget challenges. As a result, even the highest quality, most efficient providers stand to lose further reimbursement as rates decline.

The Mayo Clinic announced early last month that its Rochester, Minn., clinic, which has treated patients from the Midwest and West, will only accept Medicaid beneficiaries from Minnesota and the four states that border it. Meanwhile, its Arizona location no longer accepts Medicare for patients seeking primary care at its Glendale facility after reviewing results from a two-year pilot project. Mayo leaders made the decisions to limit service based on the low payment rates in Medicare and Medicaid.

We’re All In This Together

As a physician, Reed Tuckson, MD, has seen his share of suffering. He specifically recalls a hospital patient he treated who had congestive heart failure and diabetes. The woman was discharged home, but many social services in her community had been cut, leaving her without meal delivery, transportation or health aid.

When Dr. Tuckson saw her again, she was in the emergency room, septic and malnourished with decubitus ulcers. She had missed every one of her follow up appointments. Medical science could certainly help treat her conditions, however, what the woman truly needed was support beyond the scope of medicine alone.

Dr. Tuckson, who today serves as executive vice president and chief of medical affairs for UnitedHealth Group, believes optimal healthcare delivery requires pulling the pieces of medical and social services together in a comprehensive way, “so that lovely, wonderful woman is not in a wheelchair at two in the morning, unable to breathe, hungry and in pain.” He says the experience with that particular patient still resonates with him.

During his first week on the job with UnitedHealth Group in 2000, he listened in on telephone support calls between care coordinators and plan members and heard them working to solve complex health and social issues not unlike those of his former hospital patient. As he listened in, he heard the insurer’s resources at work. He says the mission to improve health of populations as well as individuals is what drives him.

“The highest level of our mission requires us to find the common connection with the missions of the other stakeholders, because none of us can do alone what actually has to be done on behalf of each individual person,” Dr. Tuckson says. The insurer’s role—which he believes is generally misunderstood by those outside of the industry—is one of collaboration with providers, employers, patients and policymakers. Insurers have experience with the types of value determinations and cost-effectiveness strategies that many are insisting on to reshape the healthcare system overall.

Making Decisions

Dr. Tuckson believes the industry must be more explicit about what patient-centered healthcare delivery should look like and how it should function, then share the vision beyond the purview of its own ranks. That vision isn’t clear enough now to influence change. In order to generate a meaningful conversation that might lead to improvements in the system, the nation must take a long hard look at making choices and engaging consumers, he says.

“What’s so frustrating about the health reform debate in Washington,” he says, “is that it is so completely uninformed about the real issues: How do we make decisions that are personally appropriate that advance our chance for affordable access for the services that we need as individuals—both medical services and medically necessary social services?”

For example, preventive medicine, which many believe can lead to reduced costs and improved health if encouraged more widely, is often dependent on community situations. And the issues are twofold. First, an individual’s community environment plays a role in health. Lack of affordable and healthy food, unsafe neighborhoods and negative media images create inherent challenges to healthy lifestyles. Also, a lack of health clinics to deliver needed prevention can compound the problem.

It’s unreasonable to expect individuals in traditionally underserved populations with little optimism for the future to make healthy lifestyle choices a priority. Many skip preventive health services because they are struggling simply to get a hot meal on the table each night, Dr. Tuckson says.

“If gunshots are ringing through your community, it is very difficult to think about going jogging in the evening or planting a community garden, if there’s no actual earth in which to plant,” he says. “Those are real challenges that are stated the most dramatically.”

It Can Be Done

United Health Foundation, which was established by UnitedHealth Group in 1999, has committed $23 million to four community health centers in Miami, New Orleans, New York City and Washington, D.C., since 2003. Published studies from the George Washington University Medical Center have documented that these clinics, which are located in medically underserved communities, provide high-quality care that equals or exceeds care provided in the private sector, based on national quality benchmarks without risk adjustment.

The clinics have transformed from “centers of last resort to centers of choice,” according to Dr. Tuckson, who serves on the foundation’s board. In September, the university reported that three of the clinics had exceeded the national average of 30% for the percentage of diabetes patients with blood pressure under 130/80 mm Hg. New York (46%), Miami (40%) and New Orleans (39%) beat the benchmark. The same three also exceed the national average of 73% for the percentage of patients with diabetes receiving at least one LDL-cholesterol test—Miami reached 84%, New York reached 82%, and New Orleans reached 98%.

Through innovation, the clinics have been able to serve patients with chronic conditions who need a high level of comprehensive care. There’s no reason why the model of care, which has been able to make the most of scarce resources, should be limited to just one project, one population or to a certain type of coverage category, Dr. Tuckson says.

“The lessons we learn from the health centers ought to be applied to the rest of society and vice versa,” he says.

When considering underserved populations, he also says it’s important to recognize that absolutely every person in every community has a set of unique issues—medical and social—that require multidimensional responses from the healthcare system overall. Individualizing care for each person has become an emerging trend that complements the opportunity for managing care from a population perspective, regardless of what that population might be.

“When it comes to healthcare, it is exceedingly important to realize we’re all in it together,” he says. “The sense of ghetto-izing or segregating certain people, ethnicities or cultures is becoming inappropriate.”

Bringing It All Together

Three emerging factors are accelerating the ability for health plans to push comprehensive care forward:

Improved data analytics now afford opportunities to identify members with a variety of health needs;

Improved health data can also indicate the health needs proactively and with greater specificity; and

Consumerism is increasing members’ engagement levels in their health.

Certainly much of what enables comprehensive care stems from technology, but the tools still have yet to provide for true integration of care delivery among the healthcare silos. While the pace of such progress is frustrating, Dr. Tuckson says the partnership among payers, providers and other stakeholders is helping to overcome the siloed infrastructure more than ever before. The idea of integrated delivery of care has been talked about conceptually for more than a decade, but only now is the healthcare industry beginning to stitch the fragments together, he says.

For example, medical home projects nationwide are bringing care teams together and offering appropriate reimbursement for coordinated clinical approaches. The coordinated approaches are supported by data analytics that provide a snapshot of the comprehensive health needs of each individual person, he says.

“Putting that data into the primary care physician’s office as part of their traditional clinical capabilities and working in partnership allows for more comprehensive management of the individual,” he says. “That’s the next area. That will be defined, obviously, by how fast we can move the health information technology infrastructure.”

UnitedHealth Group launched a patient-centered medical home pilot in February in which it provides technology, infrastructure and care-coordination support to select primary care physicians in Arizona. There are more than 100 medical home pilots underway nationally, and tracking the data over time will inform plans’ future strategies.

Financial Footing

While furthering integrated care, population management and individualization is all well and good, the benevolent side of the mission only tells half the story. Healthcare has become an economic strategy in the United States. The bleak statistics of runaway costs on pace to reach $4 trillion are repeated so often that average Americans have begun to recite them by heart.

Dr. Tuckson says legitimate value determinations are needed to evaluate the relative cost and quality of medical procedures, drugs and devices. Once the value picture is sketched out with some degree of quantification, the individual member or patient is enabled to make clinically and economically smart care choices with his or her providers.

“There has to be a way in which people and society choose what they want and what they are willing to afford within the reality that there has to be controls,” he says. “The easiest part of that conversation would be that people should have access to care that works and is cost-effective. That ought to be a given, however, we also know we have a very suboptimal research infrastructure available to answer that question for expensive and increasingly important interventions, especially given the pace of discovery.”

The genius of America’s inventors and scientists has produced a difficult dilemma in which medical advances that save lives, improve quality of life and reduce pain and suffering also create an unaffordable inflationary spiral. New and improved treatments don’t come cheap. Likewise, the discrete evaluation of emerging procedures and products might prove that each has merit but fails to judge each one’s merit against comparable treatments.

Comparing the effectiveness of treatments head-to-head through scientifically sound research—comparative effectiveness research (CER)—has become cx. Federal health agencies have just begun to dole out $1.1 billion in stimulus funding for CER.

According to Dr. Tuckson, CER will also need to be taken a step further to create protocols in real-world clinical practice based on research results. He says CER funding is promising but it’s not likely to produce the scope of research needed nor the speed at which it must be delivered to improve the health of Americans affordably. His plea is that stakeholders fight “so much harder for the research infrastructure that delivers the answers to these questions.”

Clinical Expertise

Once the federally sponsored CER begins drawing conclusions, specialty societies, such as the American Academy of Pediatrics for example, could then take a lead role in translating research into best practices then in communicating the guidance to physicians. Specialty societies will need more support for that to happen, however, because they currently don’t have the resources to turn that kind information around in a timely manner.

“It is terribly inappropriate to leave those kind of choices to our industry, uninformed by the best of our nation’s clinical science expertise,” Dr. Tuckson says. “At United, we put our money where our mouth is by putting money into these societies, but with the level of scale that’s needed, no one company can do this by itself.”

He says he is “deeply saddened” when health insurers use their experience to make value decisions, then are criticized for it. Other stakeholders need to be involved, and he says he looks forward to having honest conversations at the national level to address the shared goals of value determinations and controlling the rising cost trends.

No one wants their insurer to exclude any service from the benefit package, Dr. Tuckson says, but on the other hand, no one is pleased by the amount of waste and misuse of services that are prevalent in the U.S. system. The fundamental contradiction of these two attitudes have become more evident in recent policy discussions. It makes for a frustrating process when trying to bend the cost curve and design benefits appropriately.

That’s why Dr. Tuckson believes when it comes to healthcare, everyone is in it together. No matter what operational challenges health plans must confront, sensible contracting, providing affordable access, and maintaining dynamic partnerships with providers and community organizations remain the plans’ responsibility.

“All pieces of that puzzle must all work together,” he says. “And we have to be part of that, acting on behalf of the needs of the person. If we lose sight of that, we do so at our peril.”

Reed Tuckson, MD, on…

The politics of health reform

“Health reform is talked about almost as if it were a political football game, and you’re either on one side or you’re on another. People use terms—public plan, health exchange, single payer—and that sort of lets you know if you’re on this team or that team…I refuse to be on any of those teams. It’s silliness.”

Holding down costs

“You have to get at controlling the inflation of unit costs for physician and hospital reimbursement. You have to get at the issue of appropriateness in the access to services and controlling waste and inefficiency in the delivery.”

Health insurers as stakeholders

“We in our industry clearly understand what it means to try to control unit costs and be fair to the hospitals and physicians who are delivering the care. We absolutely understand what it means to try and take the waste out of the system and all the challenges that come from doing that every day. We also know the anger and the frustration that occurs when you do it. We bring a set of experiential knowledge that is essential when trying to find solutions to problems, more so than anyone.”

Health insurance exchanges

“The health insurance exchange concept today as discussed is a philosophical placeholder for a political or social agenda, as opposed to being something that everyone understands what it means, how it would work and the ways in which it is going to deal with the two fundamental issues on the table: How will it deal with unit cost pricing and how will it deal with utilization and the control of utilization of healthcare services?”

Expansion of Medicaid

“Expanding Medicaid, public insurance, is an important part of the mosaic. It will take a mosaic to achieve our goals, and public insurance is going to be very important in that regard, just as private insurance will be important in that regard.”

Insurers being called ‘dishonest’

“When it comes to health and human survival, this is a profound social ethic that requires and demands the best of all of us. To deliberately and mean-spiritedly deny the participation and challenge the ethical integrity of a major stakeholder in the solution to this problem is to do potential violence to the opportunity for optimal solutions and thereby optimal health of the nation.”
Reed Tuckson, MD, UnitedHealth Group, Executive Vice President and Chief of Medical Affairs
Reed Tuckson, MD, has more than 25 years of experience in healthcare leadership and has been a member of several bipartisan federal advisory committees on genetics, infant mortality, children’s health, violence, radiation testing and healthcare reform. Previously he served as senior vice president for professional standards for the American Medical Assn. In February, Black Enterprise named him one of the “100 Most Powerful Executives in Corporate America.” He earned a bachelor’s degree in zoology from Howard University and his medical degree from the Georgetown University School of Medicine.

Staying Motivated & Proactive in Today’s Ophthalmic World

Elective case volumes are down in this poor economy; government healthcare plan is reducing Medicare reimbursements even further; and your house hasn’t recovered in value since the 2008-09 real estate down turn. What’s a healthcare person to do?!?  

Like our forefathers, we need to adapt and modify the way in which we do business and expend monies during poor economic times. Perhaps to counter the decrease in cases, you might look to provide added value services to your patients. An example would be to provide hearing tests and hearing aids to your patients. To elaborate on hearing services, here are some little known facts; (1)  50%+ of all senior citizens have significant hearing loss, (2) 80% of them have never been tested for such loss, and (3) hearing aids are the only effective treatment for 90% of such patients.  So think about it — for every 100 patients who come through your waiting room, 50 of these patients have a hearing problem and 40 have done nothing to address it. Baby-boomers’ hearing loss is far greater than earlier generations. Plus, this group is more apt to seek treatment. Hearing services could prove to be a natural fit in ophthalmology.

Another step forward would be to engage the creative side of you & your staff by having brainstorming sessions with your key people. The objective for these meetings would be to come up with ideas for added services, ways to improve efficiencies, and areas for cost cutting.

Most importantly, remember to focus on your blessings, not your misfortunes. It’s a known fact that positive people are more successful (and with less health problems) than negative thinkers. If you have difficulty staying positive, I would encourage you to give yourself daily pep talks and keep telling yourself “I can’t change this bad situation, but I can certainly change my attitude toward it.”

We’re All In This Together

As a physician, Reed Tuckson, MD, has seen his share of suffering. He specifically recalls a hospital patient he treated who had congestive heart failure and diabetes. The woman was discharged home, but many social services in her community had been cut, leaving her without meal delivery, transportation or health aid.

When Dr. Tuckson saw her again, she was in the emergency room, septic and malnourished with decubitus ulcers. She had missed every one of her follow up appointments. Medical science could certainly help treat her conditions, however, what the woman truly needed was support beyond the scope of medicine alone.

Dr. Tuckson, who today serves as executive vice president and chief of medical affairs for UnitedHealth Group, believes optimal healthcare delivery requires pulling the pieces of medical and social services together in a comprehensive way, “so that lovely, wonderful woman is not in a wheelchair at two in the morning, unable to breathe, hungry and in pain.” He says the experience with that particular patient still resonates with him.

During his first week on the job with UnitedHealth Group in 2000, he listened in on telephone support calls between care coordinators and plan members and heard them working to solve complex health and social issues not unlike those of his former hospital patient. As he listened in, he heard the insurer’s resources at work. He says the mission to improve health of populations as well as individuals is what drives him.

“The highest level of our mission requires us to find the common connection with the missions of the other stakeholders, because none of us can do alone what actually has to be done on behalf of each individual person,” Dr. Tuckson says.

The insurer’s role—which he believes is generally misunderstood by those outside of the industry—is one of collaboration with providers, employers, patients and policymakers. Insurers have experience with the types of value determinations and cost-effectiveness strategies that many are insisting on to reshape the healthcare system overall.

Making Decisions

Dr. Tuckson believes the industry must be more explicit about what patient-centered healthcare delivery should look like and how it should function, then share the vision beyond the purview of its own ranks. That vision isn’t clear enough now to influence change. In order to generate a meaningful conversation that might lead to improvements in the system, the nation must take a long hard look at making choices and engaging consumers, he says.

“What’s so frustrating about the health reform debate in Washington,” he says, “is that it is so completely uninformed about the real issues: How do we make decisions that are personally appropriate that advance our chance for affordable access for the services that we need as individuals—both medical services and medically necessary social services?”

For example, preventive medicine, which many believe can lead to reduced costs and improved health if encouraged more widely, is often dependent on community situations. And the issues are twofold. First, an individual’s community environment plays a role in health. Lack of affordable and healthy food, unsafe neighborhoods and negative media images create inherent challenges to healthy lifestyles. Also, a lack of health clinics to deliver needed prevention can compound the problem.

It’s unreasonable to expect individuals in traditionally underserved populations with little optimism for the future to make healthy lifestyle choices a priority. Many skip preventive health services because they are struggling simply to get a hot meal on the table each night, Dr. Tuckson says.

“If gunshots are ringing through your community, it is very difficult to think about going jogging in the evening or planting a community garden, if there’s no actual earth in which to plant,” he says. “Those are real challenges that are stated the most dramatically.”

It Can Be Done

United Health Foundation, which was established by UnitedHealth Group in 1999, has committed $23 million to four community health centers in Miami, New Orleans, New York City and Washington, D.C., since 2003. Published studies from the George Washington University Medical Center have documented that these clinics, which are located in medically underserved communities, provide high-quality care that equals or exceeds care provided in the private sector, based on national quality benchmarks without risk adjustment.

The clinics have transformed from “centers of last resort to centers of choice,” according to Dr. Tuckson, who serves on the foundation’s board. In September, the university reported that three of the clinics had exceeded the national average of 30% for the percentage of diabetes patients with blood pressure under 130/80 mm Hg. New York (46%), Miami (40%) and New Orleans (39%) beat the benchmark. The same three also exceed the national average of 73% for the percentage of patients with diabetes receiving at least one LDL-cholesterol test—Miami reached 84%, New York reached 82%, and New Orleans reached 98%.

Through innovation, the clinics have been able to serve patients with chronic conditions who need a high level of comprehensive care. There’s no reason why the model of care, which has been able to make the most of scarce resources, should be limited to just one project, one population or to a certain type of coverage category, Dr. Tuckson says.

“The lessons we learn from the health centers ought to be applied to the rest of society and vice versa,” he says.

When considering underserved populations, he also says it’s important to recognize that absolutely every person in every community has a set of unique issues—medical and social—that require multidimensional responses from the healthcare system overall. Individualizing care for each person has become an emerging trend that complements the opportunity for managing care from a population perspective, regardless of what that population might be.

“When it comes to healthcare, it is exceedingly important to realize we’re all in it together,” he says. “The sense of ghetto-izing or segregating certain people, ethnicities or cultures is becoming inappropriate.”

Bringing It All Together

Three emerging factors are accelerating the ability for health plans to push comprehensive care forward:

Improved data analytics now afford opportunities to identify members with a variety of health needs;

Improved health data can also indicate the health needs proactively and with greater specificity; and

Consumerism is increasing members’ engagement levels in their health.

Certainly much of what enables comprehensive care stems from technology, but the tools still have yet to provide for true integration of care delivery among the healthcare silos. While the pace of such progress is frustrating, Dr. Tuckson says the partnership among payers, providers and other stakeholders is helping to overcome the siloed infrastructure more than ever before. The idea of integrated delivery of care has been talked about conceptually for more than a decade, but only now is the healthcare industry beginning to stitch the fragments together, he says.

For example, medical home projects nationwide are bringing care teams together and offering appropriate reimbursement for coordinated clinical approaches. The coordinated approaches are supported by data analytics that provide a snapshot of the comprehensive health needs of each individual person, he says.

“Putting that data into the primary care physician’s office as part of their traditional clinical capabilities and working in partnership allows for more comprehensive management of the individual,” he says. “That’s the next area. That will be defined, obviously, by how fast we can move the health information technology infrastructure.”

UnitedHealth Group launched a patient-centered medical home pilot in February in which it provides technology, infrastructure and care-coordination support to select primary care physicians in Arizona. There are more than 100 medical home pilots underway nationally, and tracking the data over time will inform plans’ future strategies.

Financial Footing

While furthering integrated care, population management and individualization is all well and good, the benevolent side of the mission only tells half the story. Healthcare has become an economic strategy in the United States. The bleak statistics of runaway costs on pace to reach $4 trillion are repeated so often that average Americans have begun to recite them by heart.

Dr. Tuckson says legitimate value determinations are needed to evaluate the relative cost and quality of medical procedures, drugs and devices. Once the value picture is sketched out with some degree of quantification, the individual member or patient is enabled to make clinically and economically smart care choices with his or her providers.

“There has to be a way in which people and society choose what they want and what they are willing to afford within the reality that there has to be controls,” he says. “The easiest part of that conversation would be that people should have access to care that works and is cost-effective. That ought to be a given, however, we also know we have a very suboptimal research infrastructure available to answer that question for expensive and increasingly important interventions, especially given the pace of discovery.”

The genius of America’s inventors and scientists has produced a difficult dilemma in which medical advances that save lives, improve quality of life and reduce pain and suffering also create an unaffordable inflationary spiral. New and improved treatments don’t come cheap. Likewise, the discrete evaluation of emerging procedures and products might prove that each has merit but fails to judge each one’s merit against comparable treatments.

Comparing the effectiveness of treatments head-to-head through scientifically sound research—comparative effectiveness research (CER)—has become cx. Federal health agencies have just begun to dole out $1.1 billion in stimulus funding for CER.

According to Dr. Tuckson, CER will also need to be taken a step further to create protocols in real-world clinical practice based on research results. He says CER funding is promising but it’s not likely to produce the scope of research needed nor the speed at which it must be delivered to improve the health of Americans affordably. His plea is that stakeholders fight “so much harder for the research infrastructure that delivers the answers to these questions.”

Clinical Expertise

Once the federally sponsored CER begins drawing conclusions, specialty societies, such as the American Academy of Pediatrics for example, could then take a lead role in translating research into best practices then in communicating the guidance to physicians. Specialty societies will need more support for that to happen, however, because they currently don’t have the resources to turn that kind information around in a timely manner.

“It is terribly inappropriate to leave those kind of choices to our industry, uninformed by the best of our nation’s clinical science expertise,” Dr. Tuckson says. “At United, we put our money where our mouth is by putting money into these societies, but with the level of scale that’s needed, no one company can do this by itself.”

He says he is “deeply saddened” when health insurers use their experience to make value decisions, then are criticized for it. Other stakeholders need to be involved, and he says he looks forward to having honest conversations at the national level to address the shared goals of value determinations and controlling the rising cost trends.

No one wants their insurer to exclude any service from the benefit package, Dr. Tuckson says, but on the other hand, no one is pleased by the amount of waste and misuse of services that are prevalent in the U.S. system. The fundamental contradiction of these two attitudes have become more evident in recent policy discussions. It makes for a frustrating process when trying to bend the cost curve and design benefits appropriately.

That’s why Dr. Tuckson believes when it comes to healthcare, everyone is in it together. No matter what operational challenges health plans must confront, sensible contracting, providing affordable access, and maintaining dynamic partnerships with providers and community organizations remain the plans’ responsibility.

“All pieces of that puzzle must all work together,” he says. “And we have to be part of that, acting on behalf of the needs of the person. If we lose sight of that, we do so at our peril.”

Reed Tuckson, MD, on…

The politics of health reform

“Health reform is talked about almost as if it were a political football game, and you’re either on one side or you’re on another. People use terms—public plan, health exchange, single payer—and that sort of lets you know if you’re on this team or that team…I refuse to be on any of those teams. It’s silliness.”

Holding down costs

“You have to get at controlling the inflation of unit costs for physician and hospital reimbursement. You have to get at the issue of appropriateness in the access to services and controlling waste and inefficiency in the delivery.”

Health insurers as stakeholders

“We in our industry clearly understand what it means to try to control unit costs and be fair to the hospitals and physicians who are delivering the care. We absolutely understand what it means to try and take the waste out of the system and all the challenges that come from doing that every day. We also know the anger and the frustration that occurs when you do it. We bring a set of experiential knowledge that is essential when trying to find solutions to problems, more so than anyone.”

Health insurance exchanges

“The health insurance exchange concept today as discussed is a philosophical placeholder for a political or social agenda, as opposed to being something that everyone understands what it means, how it would work and the ways in which it is going to deal with the two fundamental issues on the table: How will it deal with unit cost pricing and how will it deal with utilization and the control of utilization of healthcare services?”

Expansion of Medicaid

“Expanding Medicaid, public insurance, is an important part of the mosaic. It will take a mosaic to achieve our goals, and public insurance is going to be very important in that regard, just as private insurance will be important in that regard.”

Insurers being called ‘dishonest’

“When it comes to health and human survival, this is a profound social ethic that requires and demands the best of all of us. To deliberately and mean-spiritedly deny the participation and challenge the ethical integrity of a major stakeholder in the solution to this problem is to do potential violence to the opportunity for optimal solutions and thereby optimal health of the nation.”

45 ASC Administrators to Know

This article profiles some outstanding administrators at surgery centers across the country.

Peggy Alteri, RN, BSN, MPS, CASC (Holdings, Syracuse and Camillus, N.Y.). Ms. Alteri is the administrator and CEO of Holdings, which operates two freestanding ASCs located in Syracuse, N.Y., and Camillus, N.Y. The centers are both multi-specialty and include orthopedics, plastic surgery, general surgery, ENT, ophthalmology, GI, podiatry, GYN and pain management. According to Ms. Alteri, the Syracuse center was the first multi-specialty surgery center in New York State.

Ms. Alteri is the president of the New York State Association of Ambulatory Surgery Centers and is a surveyor for AAAHC. In addition, she owns her own consulting company and offers guidance to freestanding ASCs all over New York State. “I have gone from nurses’ aide in a nursing home to ICU supervisor to vice president of clinical services to CEO and administrator of the surgery centers,” she says. “I have definitely found my niche in ASCs.”

When thinking about the successes her centers have had over the years, Ms. Alteri can’t name individual initiatives that have impacted this success. “I believe that the ongoing relationship building and immediate availability to the surgical and ASC staff has probably had a lot to do with the success of the center,” she says.

The relationship she sees between her staff and her surgeons is one of her favorite aspects of being administrator at the two centers. “They clearly work together to the patient’s benefit. I am always in awe of these relationships and how well they work together,” she says.

Ms. Alteri enjoys many parts of her job as administrator, including the flexibility her position allows her, so that she can be responsive to the needs of the staff and surgeons at the centers. “Also, the board of directors fully supports my efforts in running the centers and this clearly makes the job more enjoyable. I love to read the patient satisfaction surveys and share them with the staff,” she says.

Brent Ashby (Audubon Surgery Center, Colorado Springs, Colo.). Mr. Ashby is the administrator of Audubon Surgery Center, Audubon ASC at St. Francis and Women’s Surgical Center, all located in Colorado Springs, Colo. The two Audubon centers are multi-specialty and have 15 operating rooms and four procedure rooms between them. Women’s Surgical Center specializes in gynecology and has two operating rooms. The centers perform together an estimated 19,000 cases annually.

Mr. Ashby has been with Audubon Surgery Center since it opened in June 2000, and he opened the two other ASCs in Sept. 2008. Previously, Mr. Ashby was the administrator of the Provo (Utah) Surgical Center for seven years. He practiced law at a large firm in Phoenix.

Under Mr. Ashby’s leadership, the surgery centers have been able to undertake several initiatives that have led to their success. “We have a staff profit-sharing program that allows the employees to feel like owners when it comes to profit distributions. They have a greater sense of ownership with this program,” he says. Mr. Ashby and the centers have also refused to contract with payors who are unwilling to offer reasonable payment rates, particularly for orthopedic procedures and implants.

Mr. Ashby enjoys is the level of physician involvement in the operations at all of his ASCs. “It is not difficult for me to get the support I need from the physicians for any critical decisions,” he says.

Mr. Ashby’s favorite aspect of serving as an administrator is developing and maintaining a vision for the future in a market that is constantly on the move. “Because healthcare is ever-changing, I find it a challenging and stimulating endeavor to plan ahead to better position our facilities for success,” he says.

Lisa Austin, RN, CASC (Peak One Surgery Center, Frisco, Colo.). Ms. Austin is the administrator for Peak One Surgery Center facility located in Frisco, Colo. The multi-specialty, joint-venture center serves the local community as well as international patients.

Ms. Austin also serves as vice president of operations, Western region for Pinnacle III and has opened a variety of surgery centers. She started out at Pinnacle III as a director of operations, serving as an administrator for many of the company’s new centers. As she moved up the corporate ladder, she remained administrator at Peak One. Additionally, Ms. Austin is a board member of the Colorado Ambulatory Surgery Center Association and chairs the emergency preparedness committee for ASCs in Colorado. She is currently serving a term on MedAssets’ Surgery Center Advisory Board.

According to her colleagues, “Ms. Austin effectively interacts with physicians, hospital management, employees and vendors by establishing a personal, unique rapport with each individual.”

Recently, with the help of her staff, Ms. Austin prepared Peak One for AAAHC accreditation. “We were able to transition a staff that had no ASC experience, only hospital, and have them understand ASCs as a cost-effective alternative to surgery in the hospital,” she says. “Now, people truly understand and are proud of the concept of the center.”

Ms. Austin is proud of the charitable contributions her center has made to the Frisco community. “We donate to the local foundation and community care clinic,” she says. “We also provide the highest amount of charity care in the area.”

Ms. Austin credits the center’s success to her staff. “We have a great, mature group of nurses who have been in the community for many years,” she says. In addition, the staff and physicians have no “class system,” meaning that no staff member feels more important than any other member, according to Ms. Austin. “When everyone comes into work, they are focused on patient care. It’s a close-knit community.”

When it comes to working as an administrator, Ms. Austin enjoys the opportunities and challenges that changes such as preparing for accreditation or the new CMS Conditions for Coverage pose. “There is always a sense of panic, and then we plan how we can make it happen,” she says. “I love to be involved and learning from the staff. Not a day goes by where I don’t learn something.”

Louise Barker, RN, BSN (Central Louisiana Ambulatory Surgical Center, Alexandria, La.). Ms. Barker is the administrator and CEO of Central Louisiana Ambulatory Surgical Center in Alexandria, La., a multi-specialty facility with six operating rooms, two GI suites and one procedure room. CLASC performed 15,000 procedures in calendar year 2008. The specialties at the facility include orthopedics, interventional pain management, ENT, plastic surgery, gastroenterology, podiatry, urology, ophthalmology, neurosurgery, gynecology, general surgery and dental surgery.

Ms. Barker began her career in nursing and gained valuable supervisory and surgical experience at two large hospitals in Alexandria. She joined CLASC in March 1985 as the director of nursing CLASC and helped the facility begin operations. In the early years of the center, Ms. Barker achieved CNOR status and assisted in all clinical nursing areas. She quickly worked her way up to her current position.

In 2005, CLASC transitioned from a 10,000 square-foot facility to a 30,000 square-foot facility. In addition to managing the surgery operations, Ms. Barker was instrumental in overseeing the development and construction of the new facility. “It is due to her organization and planning skills that the facility experienced no loss of operating days during the move from one building to another,” says Linda Wright, CFO of CLASC.

Mrs. Barker places high priorities on patient safety and quality service while maintaining high patient, staff and physician satisfaction. She is admired by staff, physicians and those in the community.

Glenda Beasley, RN (Kentucky Surgery Center, Lexington, Ky.). Ms. Beasley is the administrative director of the Kentucky Surgery Center in Lexington, Ky. The multi-specialty center, which opened in 1986, has grown to seven operating rooms and three procedure rooms and specializes in ENT orthopedics, gynecology, plastics, podiatry, oral surgery, endoscopy, pain management, urology and general surgery. In 2008, the center performed more than10,000 cases.

Ms. Beasley has been with the center since July 1990. With a background in nursing, she has worked in many hospital departments throughout her career, including oncology, medical surgical floor and emergency department. She started her career in outpatient surgery as a circulating OR nurse and worked her way up to administrator.

Over the years, Ms. Beasley has overseen a lot of growth at KSC. The biggest challenge she says was the building of their current facility in 2006. “The KSC board of directors allowed me to have a large part in the development of the building and its patient flow and design,” she says. “I was involved in all aspects, including procurement of equipment, supplies, flooring paint and windows. It was exciting and a lot of work but definitely worth all the extra hours and anxiety.”

Ms. Beasley says that her staff plays a significant role in making KSC so successful. “In an outpatient surgery center, the atmosphere is much more structured and organized, and the staff thrives on routine,” she says. “The staff has the ability to deliver the best patient care that can be offered in a healthcare setting.” Additionally, she considers many of her staff to be “sisters and family.” “I depend on these key people each day. The center would not be as successful as it is currently without the entire management team and the hard work of all the employees,” she says.

Most of all, Ms. Beasley enjoys sharing in the success of the center. “Life as an administrator can lead to long hours on a daily basis, and sometimes the stress associated with that is taxing,” she says. “However, if I step back and look at the center, I have pride in its accomplishments and the high quality of care we provide.”

Sandy Berreth, RN, MS, CASC (Brainerd Lakes Surgery Center, Baxter, Minn.). Ms. Berreth is the administrator of Brainerd Lakes Surgery Center located in Baxter, Minn., a multi-specialty ASC that performs general surgery, gynecology, orthopedics, ophthalmology, facial plastics, ENT, urology, podiatry and pain management. She has been with the center since it opened in 2005.

Ms. Berreth has been in ASC management for 10 years, but her career has spanned many facets of the healthcare industry. She worked as staff nurse for a few years and then moved to the OR. She worked for 12 years in the “open heart room,” and for 10 of those years in she was in a middle manager position. After earning another degree, she started an ASC for the hospital where she worked before earning yet another degree and arriving at her current position.

When it comes to managing her staff, Ms. Berreth says, with a sense of humor, “I’m obsessive-compulsive, and I expect my staff to feel the same passion I feel about the highest quality healthcare and customer service.” She notes that she has a list of accountabilities and competencies that her staff is held responsible to know and implement. “The best and smartest [people] will work their hardest if they know they are valued. They will be your resources for best initiatives that will lead to the best and safest care.”

Ms. Berreth considers her staff the greatest attribute to her center. “The power of an ASC is the staff,” she says. “They must be recognized for the champions they are.”

She also says that her favorite part of working as an administrator is having the “ability to change what needs to be changed.” “It’s the Serenity Prayer in practice: Change what can be changed, accept what has to be accepted and have the wisdom to know the difference,” she says.

Steven Blom, RN (Specialty Surgery Center, San Antonio, Texas). Mr. Blom is the administrator at the Specialty Surgery Center in San Antonio, Texas, a multi-specialty surgery center that specializes in ENT, ophthalmology, podiatry and pain management. The center opened in 1998 and moved to a new location in Oct. 2005. Currently, the centers perform around 9,400 procedures annually, according to Mr. Blom.

Prior to coming to the Specialty Surgery Center in Oct. 2000, Mr. Blom started his career as an ICU nurse and progressively moved up the management ladder. He spent most of his career in critical care and cardiac catheterization labs.

Mr. Blom oversaw the construction of the center’s new facility in 2005. “It was a great opportunity to start from scratch,” he says. He also notes that the project was completed on time, cutting down on the amount of time the surgery center was closed. “We were shut down for a weekend,” he says. “We closed the doors on the old location on Friday and were back to work at the new location on Monday.”

One of Mr. Blom’s favorite aspects about being an administrator is the people he gets to works with on a daily basis. The Specialty Surgery Center has a very high staff retention rate, he says. “It seems like the only time we lose people are when they move out of state,” he says. Mr. Blom has also been able to recruit new physicians to the center. “We started at nine and currently have 23 physicians who use the center,” he says.

Aside from the people, Mr. Blom enjoys the variety his job allows. “I can work on contractual issues with payors or provide back up when we’re short,” he says. “You never know what the day will bring.”

Nancy Burden (Trinity Surgery Center, Tampa Bay, Fla.). Ms. Burden is the administrator for Trinity Surgery Center and director of ambulatory surgery for BayCare Health System, which operates four surgery centers in Florida. Trinity Surgery Center, located in the Tampa Bay, Fla., area, is a multi-specialty, joint venture center with 16 physician owners and one hospital partner. The center has two operating rooms and two procedure rooms.

Ms. Burden started with Trinity when it opened in 1996. Prior to joining the center, she was a nurse manager and a PACU and quality improvement nurse at a freestanding ASC. She also held other PACU and ICU nursing positions before moving into the ambulatory surgery industry.

An emphasis on adding a personal touch and responding to physician needs is just a few of the ways which Ms. Burden says her center has found success. “Our staff and anesthesiologists care about our physicians, so it is a friendly and efficient place for them to work. No hassles, smiling faces, quick turnovers and happy patients all go to making their day a success,” she says.

Ms. Burden notes that because of the efficiency and kindness of her team, Trinity’s patient satisfaction rates have consistently remained above 97 percent.

Ms. Burden and her staff focus on helping the physicians to “grow their own businesses through introductions and relationship building with referring physicians in the community.”

“We help plan meet and greets, patient lectures and events and suggest other opportunities for our medical staff,” she says.

Aside from working with her staff, Ms. Burden also thrives on the organizational side of her duties as administrator. “Call me crazy, but I’m an organizer, so it suits me to oversee contracts, policies, board communications and the like. I actually like to analyze, implement and communicate regulatory requirements,” she says.

Ms. Burden foresees continued growth for her center under her guidance. She hopes to add more operating rooms to the center and increase surgery procedures in the near future in order to facilitate this growth.

Nancy Calhoun, RN, CNOR (Roanoke Ambulatory Surgery Center, Roanoke, Va.). Ms. Calhoun is the administrator at Roanoke (Va.) Ambulatory Surgery Center, a multi-specialty, physician-owned center. The center opened in Dec. 2003 and performs 350-400 cases per month. It is managed by Woodrum/ASD. The center has three operating rooms and one procedure room, and specializes in orthopedics, ENT, pain management and urology.

Ms. Calhoun has been with her center since it opened. Prior to coming to the ASC industry, she spent 21 years as a nurse hospital, serving in a variety of roles including OR nurse, head nurse of ENT and neurological surgery and clinical team leader of neurology, plastics and GYN. Ms. Calhoun then accepted a position as clinical team leader at an off-site ASCs.

One way in which Ms. Calhoun has helped improve efficiency at her center was adding a materials co-coordinator and maintenance co-coordinator to the staff. “I originally assumed responsibility of both roles as well as helping with staffing and juggling my administrative responsibilities,” she says. “We are saving tons not having to call the hospital for all of the things that need to be fixed, and we have also implemented an inventory management system that allows us to order supplies and consignment items on line and to maintain a daily inventory.”

Ms. Calhoun notes that because of the size of Roanoke, the staff is very close-knit and works in a “family atmosphere,” which adds to the success of her center. “We are not lost in the politics and vastness of the hospital setting. We work together as a team, and I receive a lot of support,” she says

The positive feedback Ms. Calhoun receives from patient survey cards and personal notes of thanks are her favorite aspects of her job as administrator. “We are compared to the hospital all of the time, and the patients are so grateful to have the positive experience here that they say they do not or have not had there,” she says. “That is the greatest reward ever, when you feel you are appreciated by those that you care for. We never had that personal communication when at the hospital.”

Ms. Calhoun also notes the appreciation her physicians have for the center. “They love it here and are like different people than what I experienced when working with them at the hospital,” she says.

Brenda Cyrulik (Eastland Medical Plaza Surgicenter, Bloomington, Ill.). Ms. Cyrulik is the administrator at the Eastland Medical Plaza Surgicenter, in Bloomington, Ill., a joint venture between St. Joseph Medical Center in Bloomington and 26 physician investors. The center opened in 2001 and has four operating rooms dedicated to multi-specialty surgery and four procedure rooms dedicated to endoscopy and pain management. The center performs an average of 7,200 procedures annually.

Ms. Cyrulik has been at Eastland since 1999, when the center was fully owned by St. Joseph. Prior to coming to Eastland, she served as a surgery manager at BroMenn Medical Center in Normal, Ill., and worked for two years as a circulating staff nurse at Gailey Eye Surgicenter in Bloomington, Ill.

At Eastland, Ms. Cyrulik makes every attempt to balance the needs of the patients, physicians and staff that have any association with the center. “I consider all three of these groups as having equal importance and continually put all the energy I have into actively seeking input and feedback, really listening, openly communicating the needs as I understand them and serving as an agent for change when needed,” she says. “I recognize those who contribute to the success of making desired outcomes happen. Over the years, frank conversations have typically lead to solid, trustworthy relationships and created a positive energy [at the center].”

When it comes to working at her center and serving as administrator, Ms. Cyrulik notes that “contagious enthusiasm is alive and well in our positive work environment.”  This attitude starts at the board level and continues down through to the management, staff and physician investors, according to Ms. Cyrulik. “Everyone involved looks more for ways to make ideas work than looking for reasons why they won’t,” she says. “The managing board members and physician investors actively support continuing education and provide appropriate rewards and recognition for the goals achieved.”

Ms. Cyrulik sees continued success for Eastland. “Although we have competing facilities in the area, I am confident the dedicated team we have will rise to any occasion and is certain to persevere,” she says. “The quality of care we deliver and the manner in which it is delivered can’t be outdone!”

Eric Day, MBA, ATC, LAT (The Center for Special Surgery, San Antonio, Texas). Mr. Day is the administrator at The Center for Special Surgery at the Texas Center for Athletes medical complex in San Antonio, Texas. The center opened in March 2007 and has six operating rooms, eight preoperative bays and 19 recovery bays. The center specializes in orthopedics, hand surgery, pain management, ENT, podiatry and plastic surgery. He has worked at the ASC since its inception and moved from Austin to open the center.

Mr. Day started his career as an athletic trainer, working with athletes and doing sports medicine outreach activities in the Austin market for HealthSouth Corp. He made the transition into administration with the help and support of those he worked with and began to work with outpatient rehabilitation and diagnostic imaging centers. From there, he made the transition into working with orthopedists at ASCs and was able to learn about the different aspects of the business.

At his current center, Mr. Day credits his “dedicated staff that provides great care to our patients” for its success. He notes that the center is always willing to try new things. “I have managers whom are very motivated and get the jobs done in a timely manner,” he says. “I have physicians whom are very supportive of the staff and the goals that we have set for the center. No day is exactly like the other at our center.”

Mr. Day loves his daily interaction with the people at the center and ensuring that patients leave the ASC happy with their experience. One way he attempts to make the experience a positive one is by following newly formed values from Regent Surgical Health — RISE (respectful caring, integrity, stewardship and efficiency).

The Center for Special Surgery is doing well in a market that is “full of ASCs,” according to Mr. Day. “We are lucky that we are supported by the physicians in our building, and they keep the center going.”

Jean Day, RN, CNOR (Boulder Community Musculoskeletal Surgery Center, Boulder, Colo.). Ms. Day is administrator of the Boulder (Colo.) Community Musculoskeletal Surgery Center. According to her colleagues, she provides unparalleled leadership to the surgery center, which specializes in orthopedics and pain management.

A colleague said, “Her unique collaborative management style affords surgery center personnel a rare opportunity to execute day-to-day operations under team leads in the pre-op, OR, PACU, and pain management clinic. When faced with difficult decisions, Jean gathers the necessary data, presents the information to the board and is more often than not asked to ‘do what appears to be most appropriate,’ underscoring the level of trust she has garnered from physician and hospital investors alike.”

Gregory P. DeConciliis PA-C, CASC (Boston Out-Patient Surgical Suites, Waltham, Mass.). Mr. DeConciliis is the administrator of Boston Out-Patient Surgical Suites in Waltham, Mass. The multi-specialty center opened in July 2004 and performs more than 500 orthopedic and pain management procedures a month in its three operating rooms and one procedure room. The center is partially owned by a group of surgeons, Ambulatory Surgical Centers of America, the New England Baptist Hospital in Boston and the center’s anesthesia group.

Mr. DeConciliis has served as administrator of Boston Out-Patient since its inception. He is a licensed physician assistant and worked at New England Baptist prior to assuming the role of administrator at the center. He continues to remain on staff at the hospital and assists with surgical procedures at the center.

Mr. DeConciliis says he tries to practice the “success from the top” model of management. “I treat my employees as family, and I feel like because I care for them so much, they are willing to go the extra mile for me,” he says. He also instills the “ASC mentality” in his staff and surgeons, keeping them aware of costs and ensuring that the staff goes “the extra mile” for one another.

At his center, Mr. DeConciliis enjoys working with his staff. “We are very fortunate to have a nursing and technical staff that are not only intelligent and extremely proficient in their respective areas but also have an uncanny ability to make every single patient feel as if they are a family member. This has led to extremely high levels of patient satisfaction, with, on average, over 97 percent of patients rating their experience as ‘excellent’ and over 99.99 percent of patients rating their experience as at least ‘good,’” he says.

The surgeons at the center also share this positive attitude and are very skilled at what they do, according to Mr. DeConciliis. Additionally, they pay attention to the business aspect of the center, from cost to efficiency. “I think this is a crucial component. You must have your surgeons buy into an ownership philosophy of the center, not only monetarily but also as a business in general. They must realize that how they treat the staff and run the business, directly affects the bottom line,” he says.

Mr. DeConciliis says he enjoys coming to work every day. “It’s the strangest thing. We can have over 40 cases in a day, and it’s a Friday, and the staff is excited, motivated, and just an overall joy to be around,” he says.

Mr. DeConciliis notes that no two days are the same at the center, a part of his job that he loves. “I find that every day I learn something new from someone or something but also hope that my close interaction with the staff and the surgeons help to keep them on track and add to their happiness in their jobs and also help to provide the best possible patient care that we all can as a team,” he says.

Joan M. Dispenza, MSN, CASC (Ambulatory Surgery Center of Western New York, Amherst, N.Y.). Ms. Dispenza is the administrator of the Ambulatory Surgery Center of Western New York in Amherst, N.Y. The center is multi-specialty, and physicians there perform ophthalmology, orthopedics, plastic surgery, ENT, podiatry and pain management. It opened in Oct. 1999.

Ms. Dispenza has been with the center since it opened. In her role as administrator, she functions as the chief operating and financial officers. She is responsible for day-to-day operations and strategic and long-range planning.

Prior to her current position, Ms. Dispenza was the director of ambulatory care services at Kaleida Health in Buffalo, N.Y., and director of nursing at the Millard Fillmore Gates Circle Hospital in Buffalo. Ms. Dispenza received her master’s of science in community health administration and her bachelor of science in nursing from D’Youville College. In 2002, she is took the first national exam for surgery center administrators and is CASC certified. She is also a surveyor for AAAHC.

Under Ms. Dispenza’s leadership, her center expanded from two operating rooms to six rooms. Additionally, she maintains 48-52 percent profitability annually.

Carolyn Evec, RN, CNOR (The Surgery Center at Beaufort, Beaufort, S.C.). Ms. Evec is the administrator at The Surgery Center at Beaufort (S.C.). The multi-specialty center is a hospital-physician joint venture and specializes in ENT, general, GI, GYN, ophthalmology, oral surgery, orthopedics, pain management, podiatry, urology and plastic surgery. Ms. Evec has been with the center for eight years, and, under her leadership the center has been accredited by AAAHC.

Prior to coming to The Surgery Center of Beaufort, Ms. Evec opened a surgery center in Missouri and served as the nurse manager at that location for 2.5 years. She has 30 years of nursing experience and primarily worked in the OR. She has held various management positions including director of surgery, director of medical and surgical services, vice president of patient services and director of rural health clinics.

Ms. Evec has helped improve efficiency at her center in many ways. “With the help of the staff, we developed an ordering system for supplies that now involves all of the staff and eliminated a part-time staff position,” she says. “We now order supplies two days a week, and it takes only about an hour to complete the process.”

Additionally, she worked with the business manager to reorganize the business office and implement new practices that reduced the number of days in A/R from 100 to 43. She worked with the clinical and anesthesia staffs to help pre-op and the PACU run more efficiently and to reduce the number of day-of-surgery cancellations.

Regarding her favorite aspect of being an administrator, Ms. Evec says, “I love the privilege and challenge of being involved in all aspects of the operations of the center.  Coming from a clinical background, I have really enjoyed learning and being responsible for the business side of operations as well. I enjoy the fact that every day is different and that I have the ability and support of the medical staff to effect change when needed.”

Most of all, Ms. Evec enjoys working with her staff at the center. “We have a great team — one of the best I’ve ever worked with.  They provide outstanding care to our patients and physicians and at the same time have fun doing it,” she says.

Michael Gossman, BSBA, CASC (Cedar Lake Surgery Center, Biloxi, Miss.). Mr. Gossman is the administrator at the Cedar Lake Surgery Center in Biloxi, Miss., a multi-specialty center which includes ENT, plastics, GI, orthopedics, podiatry, pain management, GYN, general surgery and ophthalmology. The 16,000-square-foot center has six operating rooms, two procedure rooms and performs around 7,500 procedures annually.

Cedar Lake has been in the forefront of new surgical technology and, according to Mr. Gossman, the center was involved in the first clinical trials of balloon sinuplasty, a new form of functional endoscopic sinus surgery utilizing a balloon. The ASC also performed the first live telecast of a sinuplasty procedure from an operating room at the center to an ENT society in Toronto.

Before coming to Cedar Lake in 2005, Mr. Gossman served as administrator at Methodist Ambulatory Surgery Center in New Orleans, where he oversaw the start-up of the center, overseeing construction, staffing, writing policies and establishing supply levels. He also established the Lake Forest Surgery Center in New Orleans. Both of these centers were destroyed by Hurricane Katrina, says Mr. Gossman.

In 2004, Mr. Gossman founded the Mississippi Ambulatory Surgery Association with a small group of supporters and served as its president from 2004-2008. “During that time, we managed to introduce a bill into the legislature regarding prompt payment of insurance claims,” he says. “While it did not pass, it allowed all of us to understand the process. We also successfully halted some major negative changes to workers’ compensation reimbursement for ASCs and are now able to sit with the Mississippi Workers’ Compensation Committee as they make their decisions which will affect us.” Currently, the association includes 18 centers and is a major sponsor in the Gulf States ASC Conference & Trade Show, now in its second year.

The experience of developing and establishing surgery centers has helped Mr. Gossman become successful in many areas of operating Cedar Lake, including managed care contracting, staying cost effective in all areas including staffing, supplies and equipment purchasing, and keeping a good relationship with physicians and staff.

According to Mr. Gossman, the staff at Cedar Lake easily makes decisions as a group, which adds to the efficiency and success of the center. “In some of my past positions, decision making was committee-based and a lengthy process,” he says.

Mr. Gossman enjoys working with the “great group of professionals who are constantly striving to do their jobs better,” he says. “We get an unbelievable number of complimentary patient survey cards which we post for all to see. It’s very satisfying to have patients want to come to your center for surgery. My staff makes my day everyday.”

Sherry Hardee, RN (Upper Cumberland Physicians Surgery Center, Cookeville, Tenn.).Ms. Hardee is the administrator at Upper Cumberland Physicians Surgery Center in Cookeville, Tenn., a multi-specialty center with two operating rooms and three procedure rooms. The center opened in 2004.

Ms. Hardee has been at Upper Cumberland for two years and has 30 years of nursing experience. Prior to coming to her current ASCs, she has held positions in operating rooms, office nursing, risk management and home health. She also has 20 years’ experience in supervision and management positions.

Kenny Spitler, senior vice president of development for HealthMark Partners, says, “Sherry does an excellent job balancing the countless demands of being an administrator in a growing multi-specialty ASC. At any moment, Sherry could be checking in a patient, working in the recovery room, or meeting with a physician. She is genuinely concerned about every patient and every member of her staff. No matter what happens in a day, Sherry leaves you with the comfortable and calming feeling of ‘everything will be okay.’”

Ms. Hardee credits her success and the success of the center to her “knowledgeable, dedicated and efficient” staff. With their assistance, Ms. Hardee enjoys that as administrator she can “ensure we give high quality, cost effective care to our community.”

As for the future of her center, Ms. Hardee says, “Hopefully, we will be adding new physicians and work hard to become one of the top surgical facilities in the Middle Tennessee area.”

Carolyn R. Hollowood, RN, BSN, CNOR, RNFA, CASC (City Place Surgery Center, Creve Coeur, Mo.). Ms. Hollowood is the administrator of City Place Surgery Center in Creve Coeur, Mo., which is located in West County of St. Louis. The center is housed in a medical office building and has four operating rooms. The physician-owned, multi-specialty facility focuses on orthopedics and pain management.

City Place opened in Dec. 2000 and moved to its current location in April 2006. Ms. Hollowood has been a part of the center for 10 years, since it was at its original location. Prior to coming to City Place, she was a RN first assistant at an acute care center. She has 20 years of nursing experience.

Ms. Hollowood’s colleagues say that one reason she is a terrific administrators is because she keeps costs in line and isn’t afraid to make the hard decisions. “She has great communication skills, not only with doctors but knows how to encourage and motivate staff,” one colleague says. “She helps out in all perioperative areas when needed. She has a great sense of humor and can help others see the bigger picture when needed. She has been in the position for 10 years has helped design the new center and has taken the center to new heights — it is now very profitable for the physician owners.”

Designing and building the new center has been one of the highlights of Ms. Hollowood’s career. “I oversaw construction for half a day, everyday, wearing a hard hat, safety glasses and a vest,” she says. She is also proud of the fact that she oversaw a smooth transition to the new center.  When orchestrating the move, she proudly says that the ASC only lost one half day in cases.

Ms. Hollowood’s accomplishments also include standardizing the equipment that the surgeons use at the center as part of a cost control measure. “We also do a lot of quality assessment at the center,” she says. “The whole staff is involved.”

Ms. Hollowood says that what she enjoys most about City Place is working with a great clinical and business office staff and committed physician owners. “They give highly skilled quality care,” she says. “It is much more individualized and patient-centered care than you would receive in an acute care hospital setting.”

Ms. Hollowood says another element of her job that she loves is the opportunity to introduce new procedures and concepts into the daily operations at her center. “The autonomy you have as an administrator is a great thing, especially when you see that you can implement something that will make a positive difference in the care of the patient,” she says. “It’s very rewarding to see the results.”

Jennifer Hunara (Surgery Center of Allentown, Allentown, Pa.). Ms. Hunara is the administrator of the Surgery Center of Allentown (Pa.). The multi-specialty center opened in April 2007 with five operating rooms and 25 staff members. It has grown to become one of the largest surgery centers in Pennsylvania with seven ORs and more than 55 staff members. The center is a joint venture between 27 physicians and the Ambulatory Surgery Centers of America.

Ms. Hunara has been with the center since its inception and came on six months before its opening. Her prior roles were as the executive director of surgical services for Robert Wood Johnson University Hospital Hamilton, and the business manager of perioperative services for Lehigh Valley Hospital & Health Network. Both of these jobs have provided her with the skill set to be successful in her current role.

Ms. Hunara lauds her management team as critical to the success and growth of the center. “We’ve all been in it together since the beginning,” she says. “Each of us brings different strengths to the table, which makes us an incredibly cohesive group. Getting the privilege to work with these three individuals everyday makes this the greatest job I have ever had and makes it possible for our center to run as well as it does.”

Ms. Hunara also notes the “Commitment to P3″ program designed by management and staff, which focuses on the center’s dedication to its three customer groups — patients, physicians and personnel. “It was an effort in culture building,” she says. “We sat down as a group and discussed what we liked and didn’t like from our past jobs, and from that made a commitment to be different in how we looked at service to our customers.”

Part of Ms. Hunara’s management philosophy is that in healthcare, your job cannot become routine, because not only is every patient different, but surgery is often an emotionally tense process for a patient to go through. “We have developed an exceptional team that truly cares about what they do and goes above and beyond every day for our patients,” she says. As a result, the center consistently has a high rate of patient, physician, and staff satisfaction.

Ms. Hunara foresees see continued growth for her center through the addition of new procedures and working with new physicians. “Every person who works at our center has an impact on a person’s health and quality of life,” she says. “I am proud to lead a group that practices this philosophy everyday and does it while smiling and having fun.”

Lisa Kelley, RN, MBA (Summerlin Bend Surgery Center, Ft. Meyers, Fla.). Ms. Kelley is the administrator at Summerlin Bend Surgery Center, a multi-specialty center that performs podiatry, orthopedics, spine, ENT, pain management and neurosurgery. The center has two operating rooms and is connected to the medical office building of the Foot & Ankle Group, whose four physicians serve as partners in the center along with 13 other physicians. The center is also partnered with the Ambulatory Surgical Centers of America and opened in Sept. 2006.

Ms. Kelley has been with the center since before it opened, joining the group in July 2006. Prior to coming to Summerlin Bend, she served in a variety of positions in hospitals, including HCA, serving in rules such as chief nursing officer, COO, director of quality management and regional director of quality and resource management in Florida and the northeastern states.

One of the ways in which Ms. Kelley has led her center to success is by assuring the quality program of the facility is a product of everyone, including patients, staff and physicians. “I always follow through on the suggestions or comments or constructive criticism and make decisions involving everyone’s input,” she says.

Another approach she has taken to ensure the success of her center is to “find the smartest, enthusiastic staff possible,” Ms. Kelley says. “People with great attitudes are a joy to work with in such a high energy, intensive atmosphere.” As a result, she enjoys walking in every morning knowing the center staff is engaged with the patients and that the surgeons providing quality care in a cost effective, time-efficient manner for each patient.

“We are very excited to be here,” Ms. Kelley says. “Our physicians are satisfied. The patients have given us a 94 percent excellence approval rating. We want to contribute more to our community by not only providing excellent care but more satisfying positions for local healthcare professionals.”

Ms. Kelley enjoys the autonomy her position as administrator provides. “Every day there is a new challenge to stretch your critical thinking and problem-solving skills, and you learn from each experience,” she says.

Cindy Ladner, BSN, CAPA (Shawnee Mission Surgery Center, Shawnee Mission, Kan.).Ms. Ladner is the administrator at Shawnee Mission (Kan.) Surgery Center and Shawnee Mission Prairie Star Surgery Center in Lenexa, Kan. The Shawnee Mission location opened in Jan. 2002, and is a multi-specialty center that performs 7,000 cases annually including orthopedics, plastics, ophthalmology, ENT and general surgery. The Prairie Star location opened in Oct. 2008.

Ms. Ladner has served as administrator of Shawnee Mission for five years. Prior to entering the ambulatory surgery industry, she served as a nurse and nurse educator at a day surgery center before “falling into” her role as administrator, she says. Ms. Ladner has also served as a nurse in the PACU area and in various surgical services throughout the hospital setting.

One initiative Ms. Ladner is proud of is leading her center through Joint Commission accreditation. “When we made the decision to become Joint Commission-accredited, the whole staff became engaged in the process. They really stepped up to accomplish this goal,” she says. “Our first survey went well, and the surveyor was appreciative of the care that went into operations at our center.”

Ms. Ladner is proud of the quality care that her center provides and the great customer service her staff gives to each patient. “Everyone — the staff, physicians and board members — is engaged and wants the center to be successful,” she says. This is accomplished by putting the patient first. “We all have the same goal of working together to achieve this level of care,” she says.

According to Ms. Ladner, sharing this common goal has encouraged staff to stay at the center, and she notes that her center has nearly zero percent turnover. “The only staff that left went to open the new center,” she says.

When it comes to serving as an administrator, Ms. Ladner says her favorite part of the job is that there is always something to learn, especially in a multi-specialty center. She says the building and opening of a new center was a rewarding learning experience. “I also like being accountable for the total operations of the center,” she says.

Rosemary Lambie, RN, MEd, CNOR (SurgiCenter of Baltimore, Ownings Mills, Md.).Ms. Lambie is the administrator at the SurgiCenter of Baltimore, located in Owings Mills, Md. The center opened June 1989. It has five operating rooms and two procedure rooms, and, according to Ms. Lambie, is expected to perform 4,500 cases this year.

Ms. Lambie has been with the SurgiCenter of Baltimore for 16 years, starting out as the director of surgical services and then moving into the role of administrator three years ago. She has been a perioperative nurse for the past 35 years and began her career as a staff nurse in an inpatient OR, moving up to become the head nurse of a hospital OR.  Prior to coming to SurgiCenter of Baltimore, she was the head nurse of a 20-room OR in a regional medical center in Baltimore.

The ability to provide quality care while staying efficient and cost effective is what Ms. Lambie believes is the key to her center’s success. She also notes that the center has been able to add new procedures and revitalize specialties by embracing new technology.

As an effort to help staff members remained invested in the success of the center, Ms. Lambie and her team developed an employee incentive bonus program in 2006. “It enables the staff to earn bonuses based on meeting certain operational targets,” she says. “This program allows the staff to reap the benefits of the center’s profitability thereby providing them with a real sense of ownership in the facility.”

Ms. Lambie says that one aspect of the ASC which is critical to the overall quality of patient care is the staff. “We are blessed with the best and brightest medical and nursing staff in the area,” she says. Additionally, she notes her center experiences very low turnover rates. “The average tenure among the staff is 11 years. In fact, five of my staff are celebrating their 20th anniversary this year along with the center,” she says.

Ms. Lambie also understands and has experienced challenges an ASC faces when it runs into tough financial obstacles. “Success is not always easily achieved,” she says. “Over the course of the past 20 years, we have had to make some difficult decisions including downsizing when volumes shifted.”

In spite of some difficult decisions she has had to make, Ms. Lambie enjoys her job, especially her involvement in both the clinical and business aspects of the center. “I am actively involved in the decision making process and have the support of my corporate and physician investors,” she says. “As compared to leadership role in a hospital setting, there is much more autonomy and trust for leadership in an ASC setting.”

Diane Lampron, RN (The Surgery Center at Lutheran, Wheat Ridge, Colo.). Ms. Lampron is administrator of The Surgery Center at Lutheran in Wheat Ridge, Colo. She took over the administrative role of this ASC approximately one year ago.

Her colleagues speak highly over her leadership skills. One says, “Underlying her quiet, calm demeanor is a woman who clearly knows where she’s headed and how she intends to get there.”

Ms. Lampron works closely with physicians, hospital leaders and employees to create a culture that affords patients affordable, high quality care. One of her strengths is the ability to assess cost per case and mentor materials management personnel to assist with expense reduction.

A colleague says of her, “She works diligently with physicians in the surrounding area and has recently recruited a valued spine surgeon to add additional volume required to transition the center from one that is merely surviving to one that is thriving.”

Robert McDavitt, RN, MBA, CASC (Spring Surgery Center, Montgomery County, Texas). Mr. McDavitt is the administrator of the Spring Surgery Center in Montgomery County, Texas. The center, scheduled to open in May 2009, will be multi-specialty and offer GI, followed by pain management, orthopedics, plastics and spine as the center becomes established.

Prior to joining Spring Surgery Center in Feb. 2009, Mr. McDavitt worked in many aspects of the ASC industry. He has been an administrator since 2003, and has worked with National Surgical Care and assisted a center enter into a corporate partnership with AmSurg. Mr. McDavitt is also a registered nurse and worked in the emergency department and ICU. Before coming to the ASC industry, he was a COO assistant administrator for a long-term acute care hospital chain. “I guess you could say I have worked with the longest- and shortest-stay patients,” he says.

Part of what Mr. McDavitt thinks makes him a strong leader is his willingness to examine other industries for examples of effective business practices.

“I usually try to look outside of healthcare to other business models for inspiration,” Mr. McDavitt says of his leadership style. He has attended several training programs offered by Disney and has applied what he learned to the ASC industry. “The other thing that I have figured out is that building strong partnerships with credible, qualified vendors and great physician relationship skills are critical to success in the surgery center business.”

Mr. McDavitt appreciates the bonds he has created with physicians, staff and companies that he has worked with, especially while building Spring Surgery Center. This appreciation has carried over into his management style. “I try to stay humble and help others whenever I can because, goodness knows, I have been blessed with people helping me,” he says.

Most of all, Mr. McDavitt enjoys working with the patients, employees and physicians. “I try to take my clinical knowledge, use good financial judgment and make decisions as a team, rather than an individual,” he says. “You are close enough to the delivery of care that you can make a difference in patient’s, employee’s or physician’s life.”

Kelli McMahan, RN (Litchfield Hills Surgery Center, Torrington, Conn.; Bone & Joint Orthopedic Surgery Center, Wausau, Wis.; Northwoods Surgery Center, Woodruff, Wis.).Ms. McMahan serves as the administrator for three facilities in two states: the Litchfield Hills Surgery Center in Torrington, Conn.; the Bone & Joint Orthopedic Surgery Center in Wausau, Wis.; and the Northwoods Surgery Center in Woodruff, Wis. She is also the vice president of operations, Eastern region, for Pinnacle III.

Prior to joining Pinnacle III, Ms. McMahan developed and managed a large physician-owned orthopedic surgery center for 13 years in Fort Wayne, Ind. She joined Pinnacle III in 2006 and began as director of operations and assisted with several development projects.

Of Ms. McMahan, a colleague says, “Because she has actively served in many of the roles she currently supervises, Kelli relates well with the members of the facilities she oversees, providing them with the support they need through her own unique style.”

Ms. McMahan says one of the highlights of her job is working with the employees at all three of her centers. “The employees love caring for the patients and also enjoy keeping our physicians happy,” she says. “I enjoy working with the employees and having them take ownership of their facilities and their work practices. Once the staff understands the goals for the surgery center, they put every effort into making their work environment the best possible for their patients and their physicians.”

Ms. McMahan also enjoys the challenges of the administrator role. “There are always new regulations and standards to implement, whether state directed, CMS directed or AAAHC directed,” she says. “There are always new improvements to be made and patients that need our attention.”

Joe Majerus (Lakewalk Surgery Center, Duluth, Minn.). Mr. Majerus is the administrator of Lakewalk Surgery Center in Duluth, Minn., a multi-specialty ASC that specializes in orthopedics, plastic surgery, gastroenterology, oral surgery, ophthalmology and pain management. He has been with center since it opened in 1999 and oversaw its building and development. Prior to coming to Lakewalk, Mr. Majerus served as a CFO for a hospital in Minnesota.

Mr. Majerus has seen success in creating an efficient ASC by training his nursing staff to work both in the center’s six operating rooms, three procedure rooms and 18 private recovery areas. “Building our six ORs exactly the same along with providing quality and technically current equipment in each has kept our scheduling of multi-specialty cases flexible and efficient,” he says.

Mr. Majerus has created annual stipends for staff as compensation for rotating “officerships” to help accomplish many of Lakewalk’s accreditation needs and requirements. “This has been educational and interesting for staff and helpful for me in obtaining our accreditations over the past 10 years,” he says.

Mr. Majerus reads every patient survey that is sent to his center. “They remind me of the quality of the surgeons and staff here at Lakewalk,” he says. “We have, and pretty much have always had, a 97 percent approval rating, which we proudly publish on our Web site.”

Mr. Majerus’ favorite aspect of being an administrator is the variety of subjects he tackles and the range of responsibility he has on a daily basis. “We are an independent ASC and contract out very few things, so I end up managing our very own version of surgery center operations,” he says.

Mr. Majerus sees a bright future for Lakewalk. “We are constantly trying to expand those specialties we already have by doing more complex procedures and adding more providers, while exploring new specialties that are under served in our area,” he says. “This constant searching has helped in our growth, kept us productive and contributed to our success over the past 10 years,” he says.

Melody Mena (Spivey Station Surgery Center, Jonesboro, Ga.). Ms. Mena is the administrator of Spivey Station Surgery Center in Jonesboro, Ga., and the managing director of surgical services for Southern Regional Health System, based in Riverdale, Ga. The center originally was opened 1998 by Georgia Baptist Health System. In 2000, the center became a joint venture between Southern Regional Health System and its physicians. The center performs more than 5,000 cases annually and has recently moved into anew state-of-the-art facility. The multi-specialty center specializes in GI, general surgery, urology, ENT, gynecological surgery, orthopedics, podiatry and pain management.

Ms. Mena has been the administrator at Spivey Station since 2005. Prior to coming to the surgery center, she owned co-owned a company that offered first assistant services to physicians and another company that provided services related to turning around healthcare companies in distress. Ms. Mena has a clinical background in perioperative nursing.

One approach that Ms. Mena says has been valuable to her success as an administrator is to write four-year strategic plans for her businesses, including the surgery center. “We are beginning our second four-year strategic plan this year,” she says. “Our first four-year plan was focused on operational and financial improvements such as resolving issues of nonpayment for implants, lowering expenses, addressing aggressive management of our contracts, automating the center by going paperless and implementing business intelligence tools, and finally re-branding and marketing the center effectively. We did so well, we grew right out of our existing space and opened our new facility in April.”

Ms. Mena’s says the favorite component of her ASC is the staff and physicians who “believe in being the best and make it happen everyday.” She also enjoys being an administrator because she is “able to implement a vision that raises the bar of the future of healthcare.”

Linda Baxley Millard, RN, BS, CPHQ (Vail Valley Surgery Center, Vail, Colo.). Ms. Millard is the administrator of the Vail Valley Surgery Center in Vail, Colo., a multi-specialty surgery center which performs mostly orthopedics procedures. The center, which opened in 2002, treats “some of the world’s top athletes” in its four operating rooms, according to Ms. Millard.

Ms. Millard has been at Vail Valley since Jan. 2006. In her 25 years in the healthcare industry, she has served as the CEO of a surgical hospital, administrator at another ASC, a government auditor and a critical care nurse. She has also held leadership positions in the insurance industry.

At Vail Valley, Ms. Millard has worked hard to improve staff recruitment and retention, and undertake new projects to improve the efficiency of the ASC. She recently led an initiative to convert monitors to high definition within the center, and developed a program to significantly enhance block utilization and case volume. Additionally, she has facilitated significant improvements to the revenue cycle. Coming up with these solutions is one part of her job that she enjoys. “I love the constant challenge to improve in all areas — clinically, operationally and financially,” she says.

Another aspect of her job that Ms. Millard enjoys is the opportunity she gets to work with “world-renowned surgeons who are continuously on the cutting edge,” she says. “The expectations are extremely high, but the rewards are absolutely worth it.”

Ms. Millard sees continued expansion and success for her center. “In spite of the current economic challenges, the center is continuing to experience growth in surgical volume,” she says.

Beth Miller, RN, CASC (Eastside Endoscopy Center, St. Clair Shores, Mich.). Ms. Miller is the administrator of the Eastside Endoscopy Center in St. Clair Shores, Mich. The center opened in 1996 and was the first endoscopy center in Lower Michigan, according to Ms. Miller. The center opened a second location in 2007. There are six procedures rooms between the two facilities and the two ASCs perform around 9,230 procedures monthly

Ms. Miller started as the nurse manger with Eastside when the center opened. She moved her way up to become the business manager and finally to her current position as administrator. Prior to coming to Eastside, she worked at a local hospital for 16 years, working nine or those years in endoscopy where she served as assistant manager. Ms. Miller is the first administrator in Michigan to receive CASC certification.

Under Ms. Miller’s leadership, Eastside has implemented many programs that have helped the ASC succeed. For example, she and the medical director developed a staff incentive plan in which the staff receives a percentage of the centers’ profits if certain goals are met. Other initiatives include a successful, comprehensive quality assessment program. “The staff participates in and is committed to the program and takes pride their accomplishments,” she says.

Ms. Miller is proud that her centers have been able to remain financially successful in spite of reimbursement cuts for GI procedures. “This is due to an increasing case load and by finding creative ways to cut expense without compromising patient care,” she says.

Ms. Miller enjoys working with her staff, physicians and medical director on a daily basis. “As anyone walking into our center can see, the staff is a group of dedicated, happy, caring, highly trained individuals, and this shows in the way they take care of their patients,” she says. Ms. Miller also likes to celebrate the many successes of the centers. For example, Eastside held a bowling party when they won the Summit Award for patient satisfaction provided by Press Ganey. The ASC has received the recognition two years in a row.

Ms. Miller hopes that her day-to-day interactions demonstrate how much she truly enjoys her job. “Eastside Endoscopy Center has allowed me to grow and learn and have so many unique experiences, which I feel have made me a better person,” she says.

Elaina Milliken (Eastern Orange Ambulatory Surgery Center, Cornwall, N.Y.). Ms. Milliken is the administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y. — a joint venture with Facility Development & Management and community physicians at St. Luke’s Cornwall Hospital System — and has served in this position since its inception. According to her colleagues, she has been instrumental in turning the center, which consists of four operating rooms and two procedure rooms, into a superb operational entity.

Before arriving at Eastern Orange, Ms. Milliken previously worked as an administrative director for a prestigious New York City medical center. According to her colleagues, her talent and experience has contributed to the successful implementation of operations at Eastern Orange, which includes the pivotal participation with the successful New York State Department of Health inspection and the three-year accreditation from AAAHC.

Ms. Milliken works in collaboration with FDM staff and strives to identify opportunities with her team to maintain the center at optimum operations as well as balancing the needs of the members of the joint venture. A colleague says, “She accomplishes these goals by utilizing her talents for organization coupled with her awesome sense of humor and her flair for exceptional people skills. Her can-do attitude enables her to maintain the many aspects of running the center in an efficient and cost effective manner.”

Melodee Moncrief, RN, BSN, CASC (Big Creek Surgery Center, Middleburg Heights, Ohio). Ms. Moncrief is the administrator for the Big Creek Surgery Center in Middleburg Heights, Ohio. The multi-specialty center has four operating rooms, two procedure rooms and performs around 2,500-3,000 cases annually. Specialties at the center include orthopedics, spine, ENT, pain management and pediatric dentistry. The center opened in March 2006 and is a member of Foundation Surgery Affiliates.

Ms. Moncrief has been with the center since Oct. 2005 and helped with the development, initial staff hiring and start-up of the center. She has more than 15 years of experience in the ASC industry after previously serving as a nurse’s aid and an ICU nurse at a hospital. Ms. Moncrief served as an administrator of another center for 3.5 years before coming to Big Creek.

The center received a three-year accreditation from the AAAHC six months after opening, which Ms. Moncrief attributes to how well the staff works together as a team. “We’re like puzzle pieces,” she says. “Individually, we don’t work as well, but put us together and we are best as a team.”

Ms. Moncrief tries to stress to the staff at the center the importance of devoting full attention to anyone — other staff, physicians or patients — who are speaking with them. “I tell the staff to really listen and to make eye contact with the person because what they have to say is important to them. It is one way to really make their day,” she says.

For each of the 20 physicians working at the center, Ms. Moncrief and her staff try to make each one feel as though they are the only surgeon at the center. “We try to make it our whole team approach. Not one person’s idea is any better or more important than another’s,” she says.

Ms. Moncrief and her staff also take this approach with patients. “We make each patient feel as though he or she is the only patient here,” she says. This has led to a positive patient response, especially when it comes to the pediatric cases at the center. “We have children who come into the center and are screaming, but by the time they leave they are smiling,” she says. “Many people ask how we do that, and it is due to our knowledgeable and friendly staff.” Ms. Moncrief also notes that satisfied patients are more likely to return to the center if they need surgery or refer others to the center.

Ms. Moncrief says she truly enjoys being a part of the team at her center. She prefers the term “facilitator” to “administrator,” when describing her duties. “I’m no different than the receptionist, except for the title,” she says. “I want to be someone who works with you and makes sure that what needs to get done gets done.”

Ms. Moncrief wants her center to be focused on showing why ASCs are important in the community from a safety, cost and economic standpoint. “I’d like to spread the message in the community and see our center grow,” she says.

David Moody, RN, BA (Knightsbridge Surgery Center, Columbus, Ohio). Mr. Moody is the administrator at Knightsbridge Surgery Center in Columbus, Ohio. The center opened in 2001 and is multi-specialty with four operating rooms and performs around 275 procedures monthly. Mr. Moody has been with the center for five years. Prior to coming to Knightsbridge, Mr. Moody, who also has a background in nursing, operated a number of refractive centers that performed LASIK eye surgery. He was also an administrator at a hospital in Columbus.

Recently, Mr. Moody assisted the center in a merger with Ohio Health System, which purchased 49 percent of the center. “We’re beginning our second year with Ohio Health, and it’s been a great merger,” he says.

Mr. Moody enjoys the latitude his job allows him and likes that he has the ability to “wear multiple hats.” “I’m not just an administrator,” he says. “I can be a scrub nurse or an OR nurse. I love interacting with the physicians.”

He also notes that he enjoys working with everyone at his center, from the management company, Regent Surgical Health, to the physicians, to the clinic staff. “I have a great group of physicians who I consider friends and professional partners,” he says. “I can go on vacation and trust that my incredible staff runs everything the way it should be run.”

Mr. Moody sees continued growth and profitability for his center through enriching its relationship with the hospital and adding new surgeons to the center. Most of all, he finds his work at Knightsbridge “fulfilling.” “I love to come to work in the morning,” he says.

Michael Pankey, RN, MBA (Ambulatory Surgery Center of Spartanburg, Spartanburg, S.C.). Mr. Pankey is the administrator of the Ambulatory Surgery Center of Spartanburg in Spartanburg, S.C., a multi-specialty center with seven operating rooms and two endoscopy suites. The center opened in April 2002 and is a joint venture with Spartanburg Regional Hospital.

Before coming to the Ambulatory Surgery Center of Spartanburg, Mr. Pankey served as administrator and clinical resources manager at different locations. His background is in nursing, and he worked in the operating room at several hospitals. He served for 10 years in the U.S. Army Reserve. Mr. Pankey also served as the president of the South Carolina Ambulatory Surgery Center Association.

Mr. Pankey has seen his center through many successes. One achievement that he is particularly proud of is the addition of GI to his center in its second year. “We introduced propofol anesthesia to the specialty in our area,” he says. “This makes our patients more comfortable and our GI practitioners more efficient. This specialty now accounts for 30 percent of the business in the center.”

For Mr. Pankey, running an efficient business and providing quality care to the community are his favorite aspects of his job. “My clinical director has told me that she can tell that I enjoy watching an efficient process,” he says. “I guess she is right. I love to watch the staff at Waffle House. They seem to have an ability to control confusion.  I guess looking at a busy surgery center must look a lot like that to an outsider.”

Aiding him in running this efficient center is his entire staff. “The environment is one of cooperation and teamwork. This makes an administrator’s job much easier,” he says.

Mr. Pankey sees expansion in his center’s future, as they are currently performing 11,500 cases annually. “The great staff here has shown that our efficiency and organization can increase the output in the existing footprint,” he says.

Linda Rahm (Pioneer Valley Surgicenter, Springfield, Mass.). Ms. Rahm is the administrator at Pioneer Valley Surgicenter in Springfield, Mass. The multi-specialty center performs GI, ENT, orthopedics, general surgery, urology and plastics procedures in its two operating rooms and four procedure rooms.

Ms. Rahm has been with the center since it opened in 2003. She has worn many hats in the medical field throughout her career. Previously, she served as COO for multi-specialty group, CEO of a specialty hospital and skilled nursing facility, the administrator of an assisted living complex, regional director for a rehabilitation company and was an occupational therapist for a traumatic brain injury center.

Currently, Ms. Rahm serves as the president for the Massachusetts Association of Ambulatory Surgery Centers. Additionally, she enjoys the opportunities she has had with her involvement in National Quality Collaborative projects.

A colleague said of her leadership, “She is an extremely talented woman, well versed in negotiations, efficiency and overall cost savings measures. She is very active with the legislation in Massachusetts legislature and has done a tremendous amount of work for the MAASC fighting legislation, holding fundraisers and speaking at the State House and working to improve our overall well-being.”

Ms. Rahm enjoys the affordable care that her center provides to the patients. “We keep the cost of healthcare in check with the service we provide,” she says.

Ms. Rahm also loves working with the staff at her center. “I get to work every day with the excellent business office staff and highly specialized clinical and medical staff,” she says.

Ms. Rahm sees continued success for her center. “I see a lot for the future of my center, including adding ophthalmology, expanding ENT and moving into an EMR. Most significant is getting our state license, allowing us to finally serve the Medicaid population equal to those under private insurance or Medicare,” she says.

Anne Roberts, RN (Surgery Center at Reno, Reno, Nev.). Ms. Roberts is the administrator at the Surgery Center at Reno (Nev.), which she says “represents a success story of a turnaround facility from a poorly performing center to a very profitable multi-specialty ASC.”

Surgery Center at Reno focuses on spine, orthopedics, pain management, ENT, general surgery and bariatric surgery, as well as several other specialties. In addition to performing surgeries in its five operating rooms, the center has two procedure rooms and offers 23-hour stays for patients. The surgery center also has a unique ownership model which consists of physician partners with a majority ownership, a hospital partner — Saint Mary’s Hospital in Reno — and a managing partner — Regent Surgical Health.

Ms. Roberts came to the Surgery Center at Reno in Feb. 2006 when it opened and became administrator in Oct. 2006. She began her career as a nurse in the emergency department, spending 16 years as a staff nurse and 10 years as the manager of a busy ED seeing 55,000 patients annually. “The experience in the ED setting has provided me with the ability to multitask, manage multiple, often competing priorities while fostering the provision of patient care, managing a complex budget, mentoring of employees and continuous assessment of the services being provided,” she says.

Over the past few years, Ms. Roberts has overseen significant growth at her ASC. Recently, it obtained AAAHC accreditation and went through all of the process changes necessary to receive this recognition of patient safety excellence. In addition, the center has created a “progressive spine program, pain management program and excellent orthopedic service line,” she says. “We started an outpatient bariatric program shortly after we took over the facility.”

“I am very proud of the excellent care we provide to our patients with a focus on exceeding the physician and patient’s expectations,” Ms. Roberts says. “During the past three years, we have made some very difficult changes in the center to be a premier provider of patient care. I love the challenge!”

Marcy Sasso (Ambulatory Surgical Center of Union County, Union, N.J.). Ms. Sasso is the director of operations at the Ambulatory Surgical Center of Union County in Union, N.J. The multi-specialty center has been open for eight years and offers orthopedics, pain management, podiatry, general surgery, gynecology, chiropractic and oral surgery.

Ms. Sasso joined the ASC of Union County in May 2004. Prior to her current position, she held various roles at other surgery centers including operations manager, pain management liaison and administrator, financial and legal administrator for a physician private practice, and office manager for an outpatient physical therapy facility.

In 2000, Ms. Sasso and a fellow administrator started, and now co-chair, a surgery center coalition of administrators. “The fellow administrator and I felt we needed others to help with our day-to-day questions,” Ms. Sasso says. “Now, we have over 65 other centers as members. We share amazing information which ultimately benefits all of the centers.”

Ms. Sasso says efficient communication is critical to her success as an administrator. She tries to “say what I mean, mean what I say, but not say it mean.” Some of the ways in which Ms. Sasso has demonstrated her communication skills are by creating an informative Web site for the center and a patient satisfaction program that is conducted in both English and Spanish. Additionally, she has an open-door policy for all of the ASC’s staff.

Ms. Sasso also encourages continuing education for the staff. She says that the center cross-trains all staff, enabling them to take on projects that allow them to use their strengths. “We had a receptionist that used to do infection control for a hospital,” Ms. Sasso says. “She teamed up with one RN who expressed interest in infection control, and it’s a dynamite team.”

Ms. Sasso says she enjoys meeting the many different people she encounters on daily basis, from patients to physicians, to vendors and attorneys. “I also love making a difference in people’s lives, sharing and mentoring staff and wanting everything to be the best,” she says.

Ms. Sasso has taken an active role in the Union community, spearheading charity events including a holiday toy drive, walks for autism and breast cancer, and sending 10 pallets of medical equipment to facilities in Louisiana after Hurricane Katrina hit. “Giving is such a contagious thing,” Ms. Sasso says.

Maria Sample (Roper Hospital West Ashley Surgery Center, Charleston, S.C.). Ms. Sample is the administrator at the Roper Hospital West Ashley Surgery Center in Charleston, S.C. The center opened in Aug. 1987 as a multi-specialty ASC and is a partnership between physicians and a community hospital. Currently, the center performs 6,000 procedures annually.

Ms. Sample has been with the center since its start up and oversaw hiring of the initial staff and set-up of the facility. She spent her career concentrating on surgical services and started out as an operating room nurse, “circulating and scrubbing on all types of procedures in community hospitals and a regional trauma center,” she says. Ms. Sample became involved in perioperative education and then held a supervisory role in a surgical services department within a hospital.

“All of my prior experience helped, but did not fully prepare me for the role of the ambulatory surgery center administrator,” Ms. Sample says.

According to Ms. Sample, the staff is the essential piece to the success of a surgery center. “Although competency is essential, I have found the most important attributes for a staff member to possess is a ‘can do’ attitude and the ability to be a team player,” she says. “Staff can be, and should be, instrumental in streamlining processes that result in operational efficiencies, which in turn result in physician and patient satisfaction.”

With the assistance of her great staff and under her leadership, Ms. Sample’s center continues to be a “shining star” in the community. “We are recognized by our peers for the quality of care our patients receive and the great service we provide to our physicians,” she says.

Ms. Sample enjoys many aspects about serving as administrator, but most of all, she says her favorite part of the job is “the ability to lead or respond to internal and external changes that ultimately impacts the lives of many, including our patients, our physicians and our staff.”

Catherine Sayers, RN (Skyline Endoscopy Center, Loveland, Colo.). Ms. Sayers is the administrator for Skyline Endoscopy Center, a single-specialty GI endoscopy center, in Loveland, Colo. She assisted with development of the ASC, which opened in 2004, and has maintained a management role since that time. Ms. Sayers is also director of clinical operations for Pinnacle III, and in this role she has developed or managed 13 single- and multi-specialty ASCs throughout the country. Prior to working for Pinnacle III, she was director of surgical services at the Orthopaedic Center of the Rockies in Fort Collins, Colo., where she managed the ASC and a 10-bed recovery center.

According to her colleagues, Ms. Sayers, “an astute business woman,” was able to create a profitable center in short order and continues to do so despite the significant cuts gastroenterology centers have experienced under current Medicare reimbursement. Rather than consider this a hindrance, Ms. Sayers says, “This provides constant incentive to find ways to decrease and manage expenses while continuing to provide outstanding patient care and customer service.”

One of Ms. Sayers’ most successful initiatives as an administrator has been implementing an employee-incentive plan. “Through this plan, employees share in the distributions paid to investors,” she says. “They receive a percentage of the distributed amount if they have met pre-established goals and criteria. I believe this program provides incentive for the staff to be cost conscious, efficient and work as a team. They are rewarded as a member of the ASC team; therefore, they truly feel like an integral part of the ASC.”

Ms. Sayers says her staff at Skyline is a crucial asset to the center’s success. “Every staff member is dedicated to providing the highest quality care and excellent customer service,” she says. “They are lead by an exceptional nurse manager, who is a joy to work with, and they function as a dynamic team.”

She says that one of her favorite things about the work of an administrator is her involvement with different physicians and their staffs. “I have truly enjoyed interacting and working with these varying groups, through tough situations and great successes,” she says.

Lisa Schriver, RN, CNOR (Turk’s Head Surgery Center, West Chester, Pa.). Ms. Schriver is the administrator of Turk’s Head Surgery Center in West Chester, Pa. The center is multi-specialty, freestanding surgery center that offers general surgery, GI, orthopedics, ophthalmology, ENT, urology, gynecology and podiatry.

Turk’s Head is a physician-hospital joint venture that opened in May 2005. Ms. Schriver started with Turk’s Head in 2005 as the clinical director and moved up to become administrator. Prior to coming to the center, she had a varied career in nursing and served in various departments including OR, endoscopy and perioperative. From there, she moved to a hospital-based surgery center and became the nurse manager. She has also worked with an anesthesiologist at the hospital that joint ventures with Turk’s Head.

One of the biggest changes for Ms. Schriver and her center has been the transition and re-syndication of her center with Blue Chip Surgical Partners. “Prior to their coming on board, I was frustrated and had actually resigned my previous position to return to a hospital as a staff nurse in the OR,” she says. “I laugh now because that would not have lasted long; based on my background and my need to keep climbing the ladder or to find projects that need spearheading. So Blue Chip identified my potential and recognized my frustration and convinced me to work with them to be where I am today. I would never have believed this a year ago.”

Ms. Schriver enjoys her role as an administrator because of the changing nature of her job. “Everyday is different, and I can use my sense of adventure to tackle each day. Some days this never-ending change is overwhelming, but at a basic level it really very much appeals to my personality and who I really am,” she says.

Most of all, Ms. Schriver says she enjoys the people she works with and their abilities to provide exceptional customer and community service. “I spend more waking hours at the center than home some weeks and I can honestly say that I feel like I am at ‘home’ at my center,” she says. “My family is comfortable stopping in to visit, and they know the employees and are welcomed as members of my ’second family,’” she says.

Dennis Simmons, MBA (Wayne Surgical Center, Wayne, N.J.). Mr. Simmons is the chief operating officer for the Wayne (N.J.) Surgical Center, a multi-specialty surgical center that performed more than 9,700 procedures last year. The center, which opened in 1999, has five operating rooms and acquired the Elite Surgical Center, a one-room location, in May 2007.

Mr. Simmons has been with Wayne Surgical since July 1999, three months before the center opened. Prior to joining Wayne Surgical, he worked for several healthcare management and consultant companies and served in a variety of roles including senior vice president, COO and director. Mr. Simmons also worked as a paramedic in the emergency services department for Austin, Texas, and served as director of the department.

Under Mr. Simmons’ leadership, Wayne Surgical has experienced significant growth, including the acquisition of the Elite center. Wayne Surgical, which is 100 percent physician-owned, started out with seven physician owners and currently has more than 40 owners. The center also began a lithotripsy program several years ago.

Mr. Simmons and Wayne Surgical have also been at the forefront of litigation against insurance companies, such as Garcia, et al. v. HealthNet of New Jersey, Inc., which, according to Mr. Simmons, “challenged the entire ACS industry in New Jersey.” Additional cases are pending against insurance companies and their reimbursement policies, he adds. “Our future at Wayne is working to define reimbursement and ASC regulations in New Jersey with the state and insurance companies and finding a middle ground,” he says.

Of his work at the ASCs, Mr. Simmons particularly enjoys the diverse group of physicians and “talented and experienced” staff who work at the facilities. Patient letters and phone calls after treatment have been very positive. “I must add that I have been a patient at the Wayne location and I know exactly how it feels. That is the best test,” he says.

Lynda Dowman Simon (St. John’s Clinic, Springfield, Mo.). Ms. Simon is the administrator at St. John’s Clinic in Springfield, Mo. The center, which opened in 1988, is the only surgery center in Missouri solely devoted to ENT. The center has one operating suite that is shared among five surgeons who each spend one day a week at the center. Last year, St. John’s performed 2,220 procedures.

Ms. Simon has been at her center since 1994. Prior to coming to St. John’s, she worked for 13 years at a local hospital in the open heart center and urology. “I loved the toys in those departments,” she says. She then spent four years in a telephone triage room before making the move to the ASC industry.

One of Ms. Simon’s most successful programs at St. John’s has been “Hiring for Fit,” an exercise in which she and her staff learned how to ask “negative” questions to potential hires. “It really can tell you a lot about the personalities of the people you are interviewing,” she says. “I want to see how someone can make a positive out of a negative. If they are able to take a challenge and give a nurturing answer, I know they will be good caregivers and are in touch with the needs of the patient.”

St. John’s also works peer reviews into their evaluations. For example, staff members have good ideas for improving patient satisfaction that are incorporated into the center’s policies. “It shows the staff that their opinion counts,” Ms. Simon says. “And if it doesn’t work out, we can always go back.”

The staff at St. John’s is Ms. Simon’s favorite part of working at her center. “I work with the most talented people,” she says. “I try to hire people smarter than me so that I can learn something from them every day.” She also notes that her nursing staff floats positions and they work in every department at the center. “Everyone knows what everyone else is doing,” she says. “It makes for a cohesive group.”

Ms. Simon says she truly enjoys her position as administrator, calling it the “most favorite job I ever had.” “There are so many facets I can get into and wrap my fingers around,” she says. “I get to do so much from helping incorporate changes in service to working shoulder-to-shoulder with nurses in recovery.”

Ms. Simon encourages other RNs who feel like they have something to offer surgery centers to look into management. “There are so many ways to apply what you know and make a better environment for the staff,” she says. “Plus, you get the chance to help out your fellow man, and nothing is better than that.”

Stephanie Stinson, RN, BSN (Strictly Pediatrics Surgery Center, Austin, Texas). Ms. Stinson is the administrative director of the Strictly Pediatrics Surgery Center in Austin, Texas. The center opened in April 2007 and is an exclusive, pediatric-only ASC.

“I am very proud of the fact that there is only a handful in the country,” Ms. Stinson says. The multi-specialty center includes ENT, orthopedics, GI, general surgery, plastics, ophthalmology and urology and has six operating rooms.

Ms. Stinson has served as administrative director at the center since its inception in 2006 and has overseen its growth to a fully functional surgery center that performs more than 400 procedures monthly. She has been a nurse for 16 years and has served as a staff nurse in the neurology/surgical ICU, surgery and the recovery room. She was a surgical technologist in the Mississippi Army National Guard for eight years prior to and while becoming an RN.

One aspect Ms. Stinson enjoys about her center is that it “provides a safe, pleasant and economical place for children to come have surgery,” she says. “It is an atmosphere created here by a very caring staff that tries really hard to provide a fun. non-threatening environment. In fact, when siblings come for their sister’s/brother’s surgery, they leave stating ‘they want to come have surgery.’

“If we have kids leaving here saying things like that, it really makes you proud of your organization, and it gives you a sense of pride that you must be doing something right,” says Ms. Stinson.

Ms. Stinson loves the challenges that she experiences on the job and learns something new every day in her position, she says. She enjoys the administrative and clinical aspects, and says that multi-tasking keeps her busy as day-to-day operations are constantly changing. “One minute you may be recovering a patient, educating the staff on policy and procedure changes, credentialing a new physician or processing HR paperwork on a new employee and that was all in the first hour of your day. I love the fact that you as an individual are always stimulated mentally and physically,” she says.

Handling these challenges enables Ms. Stinson to see that her center keeps growing. Strictly Pediatrics has plans to enclose some of their recovery areas, which will allow the center to keeping some patients overnight. “During that process we will also extend our recovery room area to allow for more volume,” she says. “We have already outgrown ourselves!”

Christine Washick (Orthopedics and Sports Surgery Center, Appleton, Wis.). Ms. Washick is the director of operations at the Orthopedic and Sports Surgery Center, which specializes in orthopedic surgery, podiatry and pain management. The center, which opened in May 2006, has three operating rooms and one minor procedure room, and performs 200-250 cases monthly.

Ms. Washick began working at the center in June 2006 as a staff PACU nurse. In 2007, she was appointed to clinical coordinator before moving to her current position in 2009. “I have had an awesome opportunity to learn about our ASC from the ground up,” she says. Prior to joining the center, Ms. Washick served as an emergency room and PACU nurse at the nearby Appleton (Wis.) Hospital.

In March 2008, the center began performing partial knee replacements, which, according to her colleagues, Ms. Washick was instrumental in. “Since April 2009, we have successfully incorporated total knees into our joint program. We have plans to perform our first total hip by Aug. 2009,” she says.

Ms. Washick loves the comprehensive care that her center can offer their patients. “We offer many entities such as physical therapy, MRI, orthotics and sports medicine in addition to surgical services,” she says. “Patients often mention that they feel welcomed and that they feel that our staff are there just for them.” Additionally, Ms. Washick says that the physicians at the center are open to staff bringing their ideas about personal patient care to them.

“I have to say that I love coming to work every day,” Ms. Washick says, noting that this is mostly due to the staff. “Our surgeons started our center with the philosophy that patient needs and satisfaction, in addition to the highest quality care, are of utmost importance. The staff in the surgery center reflects this philosophy. They are energetic, enthusiastic and dedicated to each other and to our patients.”

Ginger White, RN, BSN, MSHA, CASC (Rockwall Surgery Center, Rockwall, Texas).Ms. White is the administrator of the Rockwall (Texas) Surgery Center, which opened in Sept. 2004. The center has three operating rooms and one procedure room, and physicians at the center perform around 2,900 cases annually.

Ms. White has been at Rockwall for three years. Prior to coming to the center, she served in a variety of roles at hospitals, starting as an OR tech before moving into management and serving as the director of outpatient services for small and large hospitals. She later became assistant director of nursing for a 555-bed hospital before becoming the director of physician services, including physician recruitment, for the hospital. Ms. White also served as administrator of the children’s hospital, located within the facility.

Ms. White has used her hospital experience to help her to institute cost-saving measures at her center in order to increase profits. She also developed new programs to sustain the organization through developing a team to provide quality care. She enjoys working the physicians and staff members she works with on a daily basis and who were critical in making these initiatives successful.

When it comes to her role as administrator, Ms. White says, “I enjoy the challenge [of overseeing operations at the center], mixed with the creativity [needed] to integrate processes and programs with staff, physicians and patient care.”

Ms. White see continued for success for her center. “The future of the center looks very good as the physicians truly support the center and are active in adding new services,” she says.

Cindy Young, RN, CASC (Surgery Center of Farmington, Farmington, Mo.). Ms. Young is the administrator of the Surgery Center of Farmington (Mo.). The multi-specialty center, which opened in 1999, has two operating rooms and two procedure rooms. Physicians at the center perform around 450 cases monthly, according to Ms. Young, and its top three specialties are ophthalmology, pain management and GI. Recently, the center added ENT to its specialties.

Ms. Young has been at the Surgery Center of Farmington it opened, starting as a staff nurse and moving into the administrator position in 2002. Prior to coming to the center, she was a nurse at a rural hospital for five years and served for two years in the OR at the hospital.

“I absolutely love my job,” says Ms. Young. “I love ambulatory surgery. I found my niche.” She credits the success of her center and herself to the staff and physicians. “We work together as a family,” she says.

She also credits a part of her success to the support she receives from Woodrum/ASD, which manages the center. “If it wasn’t for them giving me the administrator opportunity and supporting me, I wouldn’t be where I’m at,” she says.

Ms. Young has succeeded in creating a work place where the staff doesn’t hold grudges. “If we come across problems, we are able to go home and come back the next day, feeling new,” she says. “We make mistakes and move on.”

Most of all, Ms. Young says she considers the staff and physicians she works with her friends. “We have a personal relationship that is separate from our professional relationship,” she says.

Giving Back

On the surface, Kenny Spitler and Marcy Sasso would seem to be from two different mindsets, let alone two different parts of the country. But each has a passion for giving back to their communities — in two distinct ways — that can be infectious. And both stress the importance for ASCs to get involved in their local communities.

“We’re in the healthcare industry and in particular, in economic times that are tough as what we’ve been going through, the healthcare industry has still been strong,” says Spitler, senior vice president of development for HealthMark Partners in Nashville, Tenn. “So giving back to the community is essential, in my mind.”

Sasso, director of operations at the ASC of Union County, in Union Township, N.J., explains that giving back is paramount for ASCs, and not just to serve the community, either. “We as surgery centers, are often thought of as ‘cherry pickers,’ that we take the best cases from the hospitals. But we can provide exemplary service to everyone involved, physicians as well as patients.”

ASCs 2009

Spitler was given the task of organizing a volunteer project as part of the Ambulatory Surgery Center Association’s 2009 annual meeting held in Nashville last April. Previous projects had volunteers planting sunflower seeds in New Orleans to remove lead that had seeped into the soil around the city after Hurricane Katrina, and cleaning up the grounds at the Fisher House in the Brooke Army Medical Center in San Antonio, Texas. But he wanted to do something that would give some tangible results to the volunteers participating.

“My biggest goal was I wanted to do something that’s going to endure,” notes Spitler. “I wanted something that would have a little more lasting effect for the Association.”

So he took 20 to 25 volunteers apiece in two shifts and went over to the Boys & Girls Clubs of Middle Tennessee in nearby Antioch, to help decorate and landscape an outdoor play area for the 105 children who utilize their afterschool program. The groups built and stained benches and picnic tables, installed bird feeders and a bird bath, planted shrubs and flowers, and prepared a vegetable garden for the children to grow their own vegetables.”

“What they did was a fantastic beautification process,” states John Hamilton, Club director of the Boys & Girls Clubs of Middle Tennessee, “one (that) the kids really love and the community sees it, too.”

And the impact on the children was almost immediate, says Hamilton. “I have heard the children say a few times since then, ‘This is our Club now. This is our home now because it looks like a Boys & Girls Club.’”

“Doing the work was great, but seeing the kids’ faces after it was all done, was really what it was all about,” Spitler declares. “Just complete joy.”

Hamilton also notes the enthusiasm of the volunteers was a key in making the project a success. “They really took the project, and were gung ho (about it.) They began work from the time they got off the bus, until the time they had to leave.”

“We probably wouldn’t have gotten this project done if it wasn’t for them, based on the economy and funding,” says Bob Jacobs, vice president of resource development for the Boys & Girls Clubs of Middle Tennessee. He also points out that so much of this type of service relies on volunteers, which translates into these same children becoming more involved in these types of projects in the future.

Health Fair

When Sasso learned that Union Township, N.J., no longer had its annual community health fair due to the local hospital closing 18 months ago, she saw an opportunity for her ASC to get involved.

“Within three days, I had a unanimous vote from the owners to green light hosting the health fair,” says Sasso. The success of the health fair was due to the participation of physicians, staff members, family members and the Gateway Chamber of Commerce. “It turned a marketing event into an opportunity for saving lives and providing education for the community. The health fair was organized within a two month time frame, although she feels that six months preparation is optimal.

Sasso’s infectious attitude was able to rub off on to the community, where many of the medical and healthcare-related organizations contributed to the event. Twenty booths displayed health screenings, visual demonstrations for surgeries, fingerprinting and bike safety information for children, and most importantly, the chance for her ASC physicians to interact with the community.

“I had a woman tell me afterward that she was so grateful to talk with one of our surgeons for 15 minutes,” Sasso articulates. “Most people don’t get that amount of time, even in a consultation.”

In the end, hundreds of attendees paid a visit to the health fair over an afternoon that gave Sasso plenty of ideas on how to make next year’s event an even greater success.

“If anything, I think if I had six months to prepare, it will make a tremendous difference. I can attract more groups that weren’t able to participate this year,” she reveals. “We just have to communicate to various agencies to attract a broader audience, which of course we will. “This will definitely become an annual event for the ASC Give Back! I know it changed people’s lives. The staff feels very proud of the interaction and positive response from the community.”

Getting Involved

Spitler feels there needs to be a continued effort nationally from the ASC industry to participate in volunteering events like his. “If asked, most of the people in the industry are willing to give back. If there were an ongoing effort to perpetually do something from a charitable standpoint from the industry as a whole, I think it would be well received.”

He points to an event at this year’s annual meeting as an example. A couple of volunteers from the project were given the chance to speak to the general audience, asking for donations for the Boys & Girls Clubs. “There was $2,800 collected that day for the Boys & Girls Clubs,” says Spitler. “Another group bought toys and other items for the club.”

For local ASCs, Sasso suggests to start small. “You always have a little bit to give. Even if you don’t think you have the time, once you start this, hopefully you’ll have the same feelings that my staff and I have.” To go along with the health fair, the ASC of Union County has participated in such things as holiday toy drives, walks for autism and breast cancer patients, a bike ride for multiple sclerosis.

“Giving is such a contagious thing,” Sasso says.

Top Five Hiring Pitfalls

Employers make many mistakes, for a multitude of reasons, when hiring employees. These consequences can hit hard on the bottom line of the business as well as effect moral and or patient perception of the practice. Heed these top five hiring pitfalls listed below and you will save on time, money, energy and reputational risk.

• Don’t hire too quickly and out of desperation
• Have a clear job description
• Prepare for the interview
• Include valued members of your team in the process
• Utilize references and confirm credentials

Pitfall 1: Don’t hire too quickly and out of desperation
Do you feel like you need that nurse, office manager, assistant now? Do you feel if you do not hire someone now your office will collapse? Adopting the mindset of “finding the appropriate individual” for the job will help you avoid pitfall number 1. Hiring a “Head Hunter” is a short-term band-aid for hiring. The solution is your practice either takes the time for a careful search or alternatively engages a medical specialist firm, such as SpineSearch, for the complete search and the perfect fit.

When hiring, we are often in a rush to fill the position. However if you just think about how quickly hiring the “wrong” person will affect your business’ bottom line, you may take a step back and look at the big picture. Consider the cost of hiring and training an employee only to learn after a short time that he/she lacks the skills needed for the job. Not only will you find yourself back to square one but you will also have the arduous task of firing, and rehiring, another employee. This will quickly lead to frustration, loss of resources and negative office morale. Don’t rush an interview or candidate. If more than one interview is needed to determine the best fit for the position, bring the candidate back again for another interview.

If you find yourself in a pinch, hire a temporary employee (very cost effective). You can accomplish this through word of mouth (from respected professionals) or by utilizing a full service recruitment firm. A temporary employee will help maintain balance in the practice while you take careful time and consideration in searching for a permanent employee to join your team. Adopting these procedures will aid in your ability to find the right fit for your organization.

Pitfall 2: Have a clear job description
Are you creating a new position? Has someone left your office and you are replacing an existing position? Have you written a job description? Is it clear and concise? Does it meet all of your needs?

A job description is a map for the employer as well as the employee and is crucial in the hiring process. Without a job description the employer cannot appropriately represent the job he/she needs filled. In addition, a job description gives the employee an understanding of their role in the office. Without this clarity a successful hire is left to chance, and the possibility of confusion, lack of productivity and dissatisfaction is greatly increased. In writing and presenting a full job description, the employer may only uncover a specific skill set or expertise that may be vital to help maximize efficiency and profitability for the office. Take the time to create or revise a job description prior to a new hire. This will ensure the responsibilities of the employee are clear and concise. In addition, it will give the employer the opportunity to confirm those duties needed to run the office are being performed. It also gives a yardstick that is useful in judging if a new employee is completing all expected aspects of the position — both for the employer and employee. NO GUESSING!

Pitfall 3: Prepare for the interview
Are you, the employer prepared for the interview? Have you reviewed the resume prior to the candidate’s arrival in the office? Did you leave enough time in your schedule for the interview?

No matter what your position — surgeon, physician or office manager — you have taken many years to train and prepare for your specialty. On a daily basis you prepare for meetings, presentations and patient consultations. So don’t fly by the seat of your pants when you interview someone to join your team. They are a representation of you and the quality you expect and deliver. Review their resume prior to the interview so that you can appear educated and interested about their background. If you don’t appear interested in the candidate, why would they want to work for you? Take heed of yearly job changes on a resume and be prepared to question this if necessary. Identify gaps in work periods and inquire. As an employer, taking the time to be educated for an interview shows the employee your interest in your practice and your employees.

Of course, you want to give the interviewee an opportunity to be prepared as well. This can be achieved by presenting him/her with some information prior to the interview, such as your Web site. Then, during the interview learn what the interviewee did with that information. Throughout the interview you can have carefully planned questions to uncover the candidate’s use of the information. This will give you a better idea of how the employee will utilize the tools given to him/her in their daily job. Allow the candidate the opportunity to speak as this will help you learn a lot about the individual. Remember, you want to leave the interview with a good picture of how this candidate will fit in the position and within the organization.

To simplify the process and make it as methodical as possible, I recommend making a S.O.P., “Standard Operating Procedure,” much like a physician has a standard diagnostic procedure when treating a client. It creates an efficient, easy environment for the interviewer to conduct his interview.

Pitfall 4: Include valued members of your team in the process
Do you do all the hiring by yourself? Do you have good, effective and efficient people in your organization now? If you answered “yes” to both questions, try and utilize your current staff in deciding which candidate is the best fit to join the team.

When working in an organization there is no “me.” An individuals’ personality, work ethic, behaviors and attitudes will affect all the employees and clients he/she has contact with. It is important the candidate is a fit not just with skill set, but with the office environment as a whole. Before the interview, share with the staff that there will be an interview and invite some to engage in conversation with the candidate. Provide the applicant a tour of the office given to them by a trusted employee. This frees up physician time and allows the physician to get feedback from the person providing the tour (second opinions are invaluable). Candidates are usually less guarded when they move away from the interviewer. Don’t hesitate to do a second interview and include or have it conducted by another trusted staff member. You can also invite the candidate to attend a meeting and share in staff discussion.

Pitfall 5: Utilize references
Have you hired someone without a reference check? If so, an inadequate reference check could set you up for disaster. A medical office with unconfirmed credentials could be exposed to litigation.

Anyone can misrepresent themselves on a resume. Some can even eloquently tell untruths and conjure up great misrepresentations of the facts. Utilize those references you required from the candidate. Make sure YOU make the phone call to the preceding employer. You can gain a wealth of information from the managers’ tone of voice on the phone and the manager’s description of the candidates’ performance.

With the candidates authorization you can also perform a background check to guard from unfortunate mishaps.

Hiring the right person is the biggest benefit you can give to yourself, your staff and your practice. Ask yourself if you are guilty of any of these hiring pitfalls. If so, make a commitment to change your current hiring practices. The strategies mentioned can help avoid hiring pitfalls, and help you find the right track and the right fit for your practice.

Ms. Hawkinson is the CEO and founder of SpineSearch, a recruitment and educational firm that specializes in services for spine professionals. Learn more about SpineSearch.

5 Challenges Currently Facing Orthopedic and Spine Practices

The current struggling economy has impacted many industries, including orthopedic and spine practices. As a result, many practices are facing challenges to remain profitable and efficient. Here are five major challenges identified by industry experts that orthopedic and spine practices may face in this economy.

1. Increase in high-deductible healthcare plans, low reimbursement rates and uninsured patients. As the economy continues to struggle, copays and deductibles on many patients’ healthcare plans also continue to rise. Alan Davidson, executive director of the Orthopedic Institute of Pennsylvania in Camp Hill, says that this trend can lead to many patients not paying their copays at the time of their procedures.

Don Love, administrator of an orthopedic practice in Roanoke, Va., mentions several ways in which practices can help collect payments from patients, including pre-screening each patient’s insurance benefits prior to the office visit to determine coverage eligibility and collecting copays at the time service is rendered. “It is important to help patients understand and be aware of what their copays and deductibles will be,” he says.

Mr. Davidson agrees that increased attention to the workings of the revenue cycle will help combat this problem. “Staff must be trained to collect these payments at the time of service,” he says. “Some insurance contracts provide obstacles to timely collection, and these clauses must be negotiated out of payer contracts.”

Ken Austin, MD, an orthopedic surgeon in Airmont, N.Y., also notes that insurance companies can “place obstacles in the way of healthcare for both the patient and the practitioner.” These obstacles include underpayments for procedures and excessive paperwork.

In addition, Dr. Austin notes that many patients have employers who constantly switch healthcare providers, and oftentimes the patients are not aware of what their requirements are as they change from plan to plan. “Insurers make it as difficult as possible for patients to understand,” he says.

As the unemployment rate increases, practices will see the number of uninsured patients rise as well. Mr. Love says that his practice saw uncompensated procedures increase significantly from 2007 to 2008. According to him, it is important for physician practices to evaluate the amount of uncompensated care they can provide without creating a strain on the financial condition of the practice.

2. Hospital lobbyists and potential new legislation. One challenge orthopedic and spine practices may face in this economy is the work of lobbyists in the federal government. “This economy strengthens the resolve of the American Hospital Association to lobby hard to remove physician free-enterprise rights, dubbed by the AHA as ’self-referral,’” says Mr. Davidson.

According to Mr. Davidson, recent media coverage (such as this N.Y. Times article “Good or Useless, Medical Scans Cost the Same,” published March 1) has included statistics provided by lobbyists to make the case that orthopedic imaging procedures are “high cost, high volume and clinically unnecessary.” 

In addition, he notes that there is a real concern about ancillaries and short-stay hospitals, and even ASCs have been attacked in the press. “There are studies that have shown that specialist physicians tend to order appropriate images and consequently fewer repeated images,” he says. “Additionally, a Blue Cross Association study showed that competition among imaging centers tends to lower pricing (Blue Cross plans negotiate lower payments to providers), and this negates any effect of increased imaging volumes. These studies and accurate factual information need to be disseminated to the public.”

Mr. Davidson also says that studies show that physician-owned hospitals provide cost-effective, high-quality services. These studies need to be pushed to the forefront to counter the information that has been manufactured to support anticompetitive positions. 

“Physicians who have exercised free-enterprise rights and who have invested in hospitals and equipment stand to lose those investments and their free-enterprise rights with the strokes of legislative pens,” says Mr. Davidson. “Patients stand to receive lower quality and, in many cases, higher costs with decreased access consequent to the eradication of these well-organized and focused orthopedic services.”

In order protect their free-enterprise rights, Mr. Davidson encourages orthopedists to become more active in politics and to improve their own lobbying efforts. “Physicians need to reeducate legislators concerning the central role of the physician in healthcare,” he says. “They need to dispel the notions that have been fostered by lobbyists and are imbedded in some politicians that physicians are untrustworthy because they wish to foster competition in healthcare.”

Dr. Austin agrees that there is a trend in politics today for the government to take more control over healthcare. “Some politicians tend to think, ‘we’re the government; we know better,’” he says. “However, that can be the quickest way to create problems.”

3. Demonstrating quality care. As patients become more cautious with their money, they will put higher stake into finding the best quality of care. Web sites, such as HealthGrades.com, make it easy for patients to find reporting of a physician or hospital’s quality of care. Mr. Love suggests that practices should take a proactive approach to collect their data to demonstrate quality, efficiency and level of patient satisfaction.  

4. Retaining staff. A struggling economy may cause orthopedic and spine practices to closely monitor their staffing expenses, which may lead to salary cuts and layoffs. In addition, many practices may be faced with choosing savings over the quality of their staff.

Mr. Love says that “highly motivated and competent staff are one of the keys to a practice’s survival.”

Dr. Austin agrees.

“It can be an ongoing challenge to maintain high-quality staff in a time of diminishing reimbursement,” he says. He says that administrators and surgeons should stay in touch with their staff and handle any issues as they arise.

5. Managed care contracting. The state of the economy may make negotiating managed care contracts more difficult for orthopedic and spine practices. According to Mr. Love, health insurance payors who have more than 25-30 percent of a given market will make it increasingly difficult for practitioners and physicians to negotiate those contracts. “Those payors will have a take it or leave it attitude with physicians.”

Mr. Love sees no easy solution to this problem, but it is important for practices to be aware of what this challenge will mean in terms of cost and revenue.

This article originally published @ Beckers ASC Review

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