How shall we remember Kathy Bryant? As the hard-charging lobbyist with the shock of bright orange hair and the deep nasal voice who gave the ambulatory surgery center industry a seat at some very important tables during her 12-plus years in Washington, D.C., first as the third president of the Federated Ambulatory Surgery Association and then as the first head of the Ambulatory Surgery Center Association, the national group formed after 2008's FASA-AAASC merger?

Or as a dictatorial egomaniac who was squeezed out of a job that paid her nearly $300,000 a year after she fell out of favor with many she represented and lost the confidence of outpatient surgery's corporate bigwigs, so much so that late last year they essentially seceded from ASCA, hired their own lobbyist and formed their own advocacy group?

In talking to those close to her, the truth probably lies somewhere in the middle. Or, as Ms. Bryant, 57, the soon-to-be departed head of ASCA, says, it was simply time to move on and pursue her other loves.

Maybe she'll marry her boyfriend of 30 years. "I hesitate to call him my fiancé," she says of the man she's been with since 1980, when her 3-year marriage ended. Maybe she'll go to France for a 2-month immersion program and learn to speak French, a girlhood fantasy. A huge baseball fan, maybe she'll get to use more of her Washington Nationals season tickets, 20 rows up between first and home.

Why now?
"There's no particular reason why now," says Ms. Bryant in a telephone interview last month, days after she surprised even those in her inner circle and on the ASCA board when she announced that she was stepping down come Sept. 1. "I've done it for more than a decade. They say the life expectancy of an association president is 7 years, so I exceeded that by a bit. There's a wide range of things I'm considering."

Relocating might be one of them. Once her time is up at ASCA, Kathy says she might move from Woodbridge, Va., to Phoenix, Ariz., to be close to family, including her son and niece, who are on ASCA's 23-person payroll. Shawn Bryant, 38, Kathy's only child, makes about $70,000 a year as meetings manager, helping coordinate ASCA's annual meeting and seminars. Kathy's niece, Ashleigh Phillips, CASC, 29, is a researcher in ASCA's benchmarking service. Kathy's sister, Carolyn Leather, 52, was paid $2,672 in 2008 to provide on-site meeting services, according to tax records.

Hiring a few relatives was nothing compared to Kathy's decision to hire a check forger named Yvette Logan as ASCA's staff accountant (see "Accountant Bilks Ambulatory Surgery Foundation Out of $373K"). When asked if this had anything to do with Kathy's departure, a close associate replied, "Directly? No. I would suspect, indirectly, yes."

Popular or polarizing?
One thing's for sure: Pro or con, people have strong opinions about Kathy Jo Bryant.

The good..."Kathy brought a new dimension to the organization and greatly expanded our ability to represent the members in government activities," says Jack Egnatinsky, MD, a Virgin Islands anesthesiologist and former FASA president. "She brought the ambulatory surgical industry much further forward than before." And this from Marie Edler, ASCA's director of reimbursement policy: "It's unfortunate. I don't think there's anybody who knows more about the industry than she does. She gave us a lot of clout."

The bad..."I work for a very difficult woman," says an ASCA employee, speaking on condition of anonymity. "She's short-tempered, a bit of a screamer and gives mixed directions — do this, no, don't do this. It was obvious over the last couple of years that there was disaffection from a host of folks — frustration by the state associations, clearly frustration by the corporate entities. She was a control person. It had to be my way or the highway. If there's anything you learn in the association business, it's that collaboration is what makes for a successful team effort. And that wasn't a value proposition that she advanced."

Kathy has a message for the backbiters. She's proud of the work she's done and she's ready for a break from a job that in many weeks occupied all 7 days. "People say that I sound the most relaxed in a long time, both friends and people within the association," she says. "Do I feel less stressed, less burdened? Yeah, I guess I do."

Kathy points with pride to these accomplishments:

• CASC credentialing program. This is her baby. Since 2002, nearly 500 ASC administrators have added the CASC (Certified Ambulatory Surgery Center) credential after their names. "This is a real critical step in having the ASC industry recognized as something totally separate from outpatient surgery in hospitals," says Ms. Bryant.
• Federal lobbying. When Ms. Bryant began in 1998, ASCs were barely visible at the federal level. "That has changed immensely," says Ms. Bryant. Results have been mixed concerning improving Medicare payment policy, however. As recently as 2003, Medicare paid ASCs 86%, on average, of what hospital outpatient departments (HOPDs) were paid for performing identical services. A multi-year payment freeze and further cuts have reduced ASC payments in relation to HOPD payments to 59% in 2009.
• Benchmarking. More than 600 ASCs participate in the Outcomes Monitoring Project.
• State lobbying. Rob Schwartz heads up a division of ASCA dedicated to state government affairs. "Kathy really did a major job of expanding what were previously extremely limited activities for our state association members," says Dr. Egnatinsky.

Unified voice?
It was hailed as a smart and long overdue move when FASA and AAASC merged 2 years ago to form ASCA, a national lobbying group that would represent ASCs with a unified voice to lawmakers. Two years later, however, ASCA's influence has been diminished and its voice dimmed by the emergence of another lobbying group that sprouted from within, this one called the ASC Advocacy Committee, made up of 13 for-profit ASC management companies (including SCA, USPI, Symbion and AmSurg) and 4 of the largest independently managed state ASC associations: Ohio, Texas, Florida and California.

"I see this as diluting the industry's ability to speak with one voice," says Dr. Egnatinsky.

While the ASC Advocacy Committee technically falls under the auspices of ASCA, many view it as an indictment against ASCA's ability to lobby at the state and federal level. "The general sense was that the ASC Association wasn't as effective as other associations at lobbying," says an industry insider.

Kathy says the Advocacy Committee is both good and necessary because it coordinates the lobbying efforts of the for-profit ASC management companies, most of which have their own lobbyists. "We're way too small of an industry to have multiple people going to Capitol Hill," she says. She also points out that ASCA is funding half of the Advoca-cy Committee and that "the ASC Association gets full credit for what happens with the Advocacy Committee."

When asked for her biggest regrets, Ms. Bryant cites 2 figures that are too low for her liking: Medicare ASC payment rates and ASCA membership, which is at about 2,600, less than half of the country's ASC total. "It would be nice to get another 10% or 20%," she says, "but a lot of ASCs are small, single-specialty centers in GI and ophthalmology whose physician groups lobby on their members' behalf."

Lobby on members' behalf. For better or for worse, maybe that's how to best remember Kathy Bryant.