THIS WEEK'S ARTICLES
How to Plan for an Orthopedic ASC - Sponsored Content
New ASC Embraces Minimalist Design
The result is a center built to accommodate profitable procedures right away while accounting for growth opportunities down the road.
Reprocessing techs should identify and address broken, missing or incorrect instruments before sending sterilized sets to surgery, according to recent research.
A large, open, sleek design was the ideal for the team that designed and built The Center for Advanced Ambulatory Surgery in Malta, N.Y., which opened in September 2021. The $19.1 million facility — a joint venture among The Bone & Joint Center, Albany Med Health Center and Saratoga Hospital — is an example of a new construction project focused on making complex orthopedic procedures easier to perform as payers, patients and surgeons embrace outpatient total joint replacements.
David Quinn, MD, one of the physicians who was instrumental in the project, says it's difficult to hit the sweet spot of building a surgery center large enough to accommodate future growth but also able to run profitably from the get-go. Some new facilities aren't outfitting all of their ORs until demand or a changing procedural mix warrants it. With equipment costs for a single OR often more than $1 million, that prudence makes sense.
The Center for Advanced Ambulatory Surgery's eight ORs are 24 by 24 feet, slightly larger than traditional ORs. This makes room for robotic-assisted knee surgery systems, tables for hip replacements that allow for hyperextension and external rotation, and advanced tools and devices for spine surgery.
Interestingly, arthroscopy towers and other heavy or bulky equipment, which is often mounted to ceiling booms at other facilities, instead is placed on mobile carts at the center to keep ORs as minimalist as possible. As a result, ample storage room near the OR suites was part of the design, says Dr. Quinn, who also recommends clustering physician dictation rooms, locker rooms, breakrooms and restrooms in one area of the facility to prevent inconvenient walks from one common area to another.
While a sparkling new facility is wonderful, Dr. Quinn emphasizes that a good staff using sound protocols and procedures is more important. "What we have here is a shiny new coin that cost a pretty penny that will be worth every cent," he says. "That said, with the right team in place, amazing work can be done in a two-OR facility that appears to have suboptimal physical circumstances. Caring people who are eager to learn, fun to work with and serious at the same time, combined with excellent processes, will always make for a very successful surgery center."
New Surgery Center Aims to Address Healthcare Inequity
Increased demand for outpatient ortho and other cases drives UI Health's expansion.
The upcoming UI Health Outpatient Surgery Center & Specialty Clinics in Chicago is not only designed to address healthcare inequities in the city, but also is appropriately employing a diverse set of contractors to build the structure.
With approximately 500 individuals employed to raise the building over the course of the two-year project, approximately 30% of construction costs are being spent with businesses owned by local minorities, women, persons with disabilities and veterans. "This is a significant undertaking to support not just the communities, but the economic health of communities — not just medical health, but economic health," says University of Illinois Hospital & Clinics CEO Mike Zenn, who estimates that operations of the new building and expanded clinical services will create more than 100 full-time positions.
"All of this gives us a better platform to address the community health needs and continue our service as a market share leader in communities throughout the West and South sides of Chicago," says Mr. Zenn. "It is a significant tool in our drive to address the inequities of access, which are at the core of disparities in health outcomes."
Donors Bruno and Sallie Pasquinelli pledged $10 million through the Pasquinelli Family Foundation for the project, creating the UIC Pasquinelli Outpatient Surgery Fund. The Pasquinellis' contribution also supports IGNITE: The Campaign for UIC, a program launched in 2017 that seeks to expand access to comprehensive, compassionate health care for populations throughout Illinois. IGNITE is now more than two-thirds of the way to its $750 million goal.
Construction of the new facility, UI Health's first since 2014, is additionally funded through a public-private partnership between UIC and Provident Resources Group, a 501(c)(3) corporation that will finance nearly three-quarters of the $194 million cost through tax-exempt bonds. Provident will lease the facility to UI Health during a 30-year bond term.
The new building will include six floors of patient care space, including the eight-OR Bruno and Sallie Pasquinelli Outpatient Surgery Center, an eight-room outpatient endoscopy and procedure suite, 48 pre-op and PACU bays, clinic space for gastroenterology, ophthalmology, ENT, transplant and urology services, and pharmacy services across 200,000 square feet of space. The specialty clinics, among some of UI Health's top-ranked clinical programs, had outgrown their current space due to increasing patient demand, as had surgical services. About half of UI Health's surgical cases are now outpatient, with a significant emphasis on orthopedic, ophthalmologic and head and neck procedures.
"We are operating at or beyond capacity," says Enrico Benedetti, MD, UIC professor and Warren H. Cole Chair of Surgery. "The Pasquinellis' generous gift will allow us to give patients needing outpatient surgery in a more comfortable, state-of-the-art space and it will free up our inpatient operating rooms to take on additional, more complex cases." He adds that the gift also will allow UI Health to expand use of minimally invasive robotic surgery techniques for outpatient procedures.
UI Health expects to welcome patients to the new building this fall. To get a better sense of what the completed facility will look like, take a virtual tour with this architectural previsualization video.
How to Plan for an Orthopedic ASC
Choosing the right equipment, educating surgeons and planning for controlled growth are all part of the process.
Taking the plunge to build or renovate and outfit an ambulatory surgery center takes a lot of thought and planning. With so much at stake for the entire team, from stakeholders to owners to staff, selecting a partner to take the journey is critical. Dr. Jason Snibbe, a board certified orthopedic surgeon practicing in Beverly Hills, offers some insights into the process for an orthopedic facility and how to approach the goal of launching a new ASC in the community.
Q: Outfitting an ASC is a big project. What do you think the biggest challenge is when starting a new ASC or undertaking a renovation?
The biggest challenge opening an ASC is the upfront cost of all the capital equipment and disposable equipment. It takes a large investment to get the ASC ready for surgery and procedures. It is important to unify the physicians so there is limited duplication of equipment and implant companies. This unification can allow an ASC to drive down costs and create efficiencies. This also makes the staff less confused when common cases are scheduled with different surgeons. For example, using Stryker for all joint replacement surgeries creates a streamlined efficiency for the staff and surgeons.
Q: What do you think surgeons should look for in an equipment and solutions provider when starting a new ASC, undertaking a renovation or financing equipment?
When an ASC is selecting a capital/equipment provider, the essential part is a global contract. An ASC should select a company that has quality products that can be used for a variety of procedures. For example, arthroscopy towers, power equipment, surgical robots, sports medicine and arthroplasty implants and sports medicine tools. A global company that can provide all of these products can be very creative with financing and rebate programs. This allows a company to provide up front capital and disposable products at a discounted cost. As the ASC grows, rebate programs can be expanded to other products or locations. This can be a very powerful tool to fuel growth.
Q: What would you say are the top three things to keep in mind as the project progresses?
The top three things to keep in mind as the project progresses, first is the surgeons. The culture of the ASC is critical to its survival. Surgeons are the engine that drives business in the center. The ASC management, either physician, hospital or corporation, should always be in close communication with the surgeons. Always listen to what they need now and in the future to allow for growth. This growth should be in the form of increased cases from existing surgeons and encouraging the recruitment of new surgeons. All of the surgeons should meet regularly and keep a transparent view of the workings of the ASC.
The second thing to keep in mind is that this is a business. A business is primarily for making money. The surgeons should all be educated in the structure of how an ASC makes money, the overhead structure and understanding the billing process. Physicians do not have any training in this. As owners of the ASC, the surgeons should come together and educate themselves on the business of the ASC. This creates a culture of understanding and avoids surgeons feeling like they are being taken advantage of. This also stimulates a structure where surgeons want to help drive down the overhead and increase profits. Keeping surgeons in the dark is never a good idea.
The third is have a one-year plan for the first year. Avoid the temptation to buy too much equipment that is not needed. Create goals for the first year as well as the next several years. It is helpful to create surgical volume goals and cash flow goals. This will help control costs and prevent the ASC from costing too much at the beginning. As the volume grows, the ASC can buy more equipment and expand the surgical cases. For example, start an outpatient total joint program but start with a lower volume. Then slowly expand the cases to a higher volume to allow the staff to learn systems and surgeons preferences. This creates less stress on the system and allows the growth to be efficient and controlled.
Q: What factored into your decisions about equipment for your ASC specifically for the service lines your ASC offers?
My decision for equipment centered around robotic total joint surgery and quality equipment from a global company. Instead of using multiple companies with different contracts and sourcing, I used one company that had the majority of the equipment I needed and had the premier implants as well. I also wanted to use the best robot in the market that would provide excellence in outcomes and patient safety. In my opinion, the only company that can fulfill these goals is Stryker. They are truly a leader in so many facets of the business and can provide excellent product, capital equipment and service. Stryker created communication lines between product divisions that allows a global rebate and contract system. This allows different implants, disposables and capital purchases to be under one contract, so rebates can be across many divisions.
Q: How does your ASC benefit your local community?
Our ASC benefits the local community by providing excellence in orthopedic, spine and pain management. The global pandemic created a fear of hospitals and created a desire for patients to want procedures performed in ASCs. The pandemic heightened the understanding of how safe an ASC is but also how elevated the patient care is. Patients continue to have better outcomes objectively and subjectively at an ASC. The community continues to support our ASC because we can perform complex cases with accuracy and safety. Patients drive business to the ASC by communicating to friends and family regarding their experience.
Q: What advice would you give to someone before they decide to go build, or renovate/expand an existing facility?
The best advice is to create a strong core of surgeons that have a common goal. The key to success is surgical volume and surgeons that drive business to the ASC. There should be transparency in the volume and revenue so all the surgeons can hold each other accountable. This can create a culture of healthy competition to position the ASC for maximum growth.
Before someone builds or renovates a new facility there should be a understanding of the need for an ASC. Are there enough surgeons to support the facility? Are the contracts with insurance companies in the community adequate to support a successful ASC? The best way to understand this is to seek out the most successful ASC in the area and have a deep discussion with the management and top surgeons. Learning from leaders in your community is very helpful and can provide critical insight into the business. ASC business can be very regional with insurance reimbursement. Understanding the insurance profile of the community that you're deciding to build in is critical.
Q: How is your ASC doing today?
My ASC is doing very well. We had a powerful robotic outpatient total joint program with high volume. Patients continue to seek out the surgeons that are using the latest robotic technology that provides faster recovery and better outcomes. We also have a robust spine program with outpatient disc replacements, fusions and decompressions. We are fortunate to have highly skilled surgeons that perform spine and joint replacements in the ASC with efficiency and safety. We also have a growing pain management group of physicians that feed the spine surgeons surgical cases and provide excellent care.
Q: Is there anything you'd like to add about the process of finding the right equipment and partner for your ASC?
I feel very fortunate and blessed to have Stryker as a strategic partner with my ASC. They have integrity and honesty with everything they do. They have continued to help us grow our business by helping with marketing of the ASC and our robotic program. They have held various community outreach programs to increase the exposure of the ASC to patients, physical therapist, chiropractors and primary physicians. The global rebate program helps drive down cost, which increases our bottom line. I cannot express enough how having a partner like Stryker has changed our business for the better and continues to make us treat patients better.
Note: For more information visit Ambulatory Surgery Center (ASC) | Stryker
Dr. Jason Snibbe is a consultant of Stryker. The opinions expressed by Dr. Snibbe are those of Dr. Snibbe and not necessarily those of Stryker.
Dr. Jason Snibbe is a board certified, orthopedic surgeon practicing in Beverly Hills with fellowship training in Sports Medicine and Joint Replacement Surgery. He performs surgery on the shoulder, elbow, hip, and knee and his practice has a special focus on hip preservation and reconstructive surgery. Dr. Snibbe has been a team physician for the University of Southern California since 2003. He is also an orthopedic consultant for the Los Angeles Lakers, Sparks and Kings. Currently, he trains the fellows from Kerlan-Jobe Orthopedic Clinic in advanced hip arthroscopy and other sports related surgeries.
Dr. Snibbe attended medical school at the Medical College of Wisconsin, completed his residency at the University of Rochester Medical Center and completed a Sports Medicine fellowship at the world-renowned Kerlan-Jobe Orthopedic Clinic. He completed a joint reconstruction fellowship with Dr. Brad Penenberg and additional training in hip arthroscopy under the supervision of Dr. Marc Philippon. As a fellow, he served as an assistant team physician for the Lakers, Dodgers, Angels, Kings, Mighty Ducks, LA Avengers, Galaxy and LMU sports.
The Two Most Important Aspects of ASC Projects
Relevant partner experience and explicit expectations are key to successful openings.
Joan Dentler, a veteran healthcare consulting expert who specializes in the design space, says you should focus on these important foundational aspects of surgical construction, whether you're expanding an OR or overhauling your entire facility.
Partner with experienced experts. A lack of direct ASC experience among your outside collaborators can lead not only to major delays, but to a poorly functioning, inefficient and unnecessarily costly facility, says Ms. Dentler, founder and president of Austin, Texas-based Avanza Health Strategies. "Work with ASC experts when it comes to facility design, expansion or renovation," she says. "You won't regret it."
She knows of several facilities that, in fact, regretted it. For example, a handful of ASCs were designed by residential architects who were not aware of life safety requirements and other mandatory regulations ASCs must follow. In another instance, the physician-owners' spouses were asked to choose the final furniture and fixtures for a new ASC, result in carpeting and dried flower arrangements in pre-op and PACU.
Set clear and realistic expectations. Surgical leaders should provide explicit timetables, expectations and terms from day one. "If stakeholders interpret terms differently, it can lead to confusion, mistakes and delays," says Ms. Dentler, who cites the term "open date" as a prime example. Does this term describe when staff can get into the facility, when the first patient will be seen, or when the facility is fully licensed and accredited?
Ultimately, the responsibility lies with surgical leaders to make sure all participants in a design or renovation are on the same page, and to fill in knowledge gaps as soon as they are identified.
Ortho ASC Planned to Relieve Hospital System's ORs
The facility could capture thousands of procedures from the maxed-out inpatient space.
The $19.3 million Bronson Outpatient Surgery Center in Kalamazoo, Mich., expected to open in spring 2023, will feature four large ORs mainly serving patients undergoing outpatient orthopedic and sports medicine procedures. As with many new surgery centers, the facility is leveraging the latest technologies to provide access to needed services in the communities where patients live.
"Advancements in orthopedic surgery and anesthesia techniques and technology have made it possible for surgeons to perform a growing number of bone, joint and spinal procedures safely and effectively in an outpatient surgical setting," says Bernard Roehr, MD, an orthopedic surgeon with Bronson Healthcare. "Patients and surgeons alike appreciate the ease and efficiency a freestanding surgical facility provides while still achieving excellent outcomes."
The new construction is responding to an acute need within the Bronson Healthcare system, as the total number of surgeries performed at Bronson Methodist Hospital has increased 15% over the last five years. More than 5,000 orthopedic-related cases performed each year at the hospital could eventually shift away from its 21 ORs to the freestanding facility. "Our new outpatient surgery center will offer many new conveniences for our patients that will make their day of surgery experience a smooth one," says Bronson Healthcare President and CEO Bill Manns.
A number of outpatient surgeries already are currently performed at an existing ASC in the system in downtown Kalamazoo. That facility will undergo renovations next year to prepare it for continued use.