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October 6, 2021
OSD Staff
Publish Date: October 5, 2021   |  Tags:   Facility Construction and Design
eNews Briefs October 6, 2021


How Suite It Is for These ASC Patients

Focus on the Back of the House at GI Centers

Taking On an ASC New Build or Expanding Your Facility Takes Collaboration

Shifting Procedures to ASCs Adds Up to Significant Savings

ASC's Marketing Leads With Plain Talk About Pricing


How Suite It Is for These ASC Patients

Pioneering programs provide an alternative to going home after hip and knee replacements.

Kitchen CREDIT: Twin Cities Orthopedics
LIKE HOME The recovery suites at Twin Cities Orthopedics reside somewhere in between an overnight stay at an inpatient hospital and a relaxing night at home.

Same-day total joint replacement surgeries are becoming increasingly popular among patients and ASCs thanks to improved techniques and technology. However, some patients still could use professional monitoring overnight, while others just want the night after their surgery to be more peaceful and less stressful. Enter the concept of ASC recovery suites.

Twin Cities Orthopedics in Minneapolis is a pioneer in this area. Its EXCEL Orthopedic Surgery and Recovery Program not only offers a publicly stated price for its joint replacement and spine procedures, but it includes an overnight stay at one of its care suites as part of that bundled package. The suites include a walk-in shower, a sleeper for an overnight guest, a flat-screen TV and a wireless internet connection. Also included is in-room monitoring of the patient, which provides the nursing staff with constant feedback on vitals such as blood pressure, heart rate and oxygen levels.

Brian O'Neill, MD, FAAOS, an orthopedic surgeon who specializes in hip and knee replacements at Twin Cities Orthopedics, says some of his patients spend the first night after surgery in one of the care suites, which are connected to the surgery center. "Having this post-op care option available is a safe alternative for patients who aren't ready for same-day discharge," he says. "A nurse is assigned to care for every two patients, who are monitored overnight and visited by a physical therapist. Patients spend the night in a large, comfortable room and can even order food for delivery."

Gregory Lervick, MD, a fellowship-trained orthopedic surgeon with Twin Cities Orthopedics who specializes in treating shoulders and elbows, echoes Dr. O'Neill's satisfaction with the private suite concept.

"To ensure safe recoveries with our shoulder replacement procedures, we keep patients for less than 24 hours — but not in a PACU bay," he says. "Patients and their companions stay the night in one of our private care suites, complete with kitchenettes, which we own and operate. Patients love it because they stay out of the hospital and enjoy a much quieter environment in which to recover — more like a hotel room or apartment than a hospital room. They have 24-hour access to nurses on site, and their vitals are monitored, so we're able to give them safe medical care at a moment's notice."

Currently, its posted EXCEL prices are $24,250 (total knee), $20,500 (unicompartmental knee), $25,000 (total hip) and $24,500 (total shoulder or total ankle). The center also offers the recovery suite stay to certain spine surgery patients. Current prices are $34,500 (single level lumbar fusion or single level transforaminal lumbar interbody fusion), $25,000 (single level anterior cervical discectomy and fusion), $31,700 (two level anterior cervical discectomy and fusion) and $26,000 (single level cervical disc replacement.)

Focus on the Back of the House at GI Centers

In this high-volume, fast-paced specialty, the reprocessing room that makes everything go should be built for efficiency and safety.

GI CREDIT: Pamela Bevelhymer
BEHIND THE SCENES GI centers should focus on creating a reprocessing area that provides enough space to safely clean scopes while staying on schedule.

Many new surgery centers put a lot of thought and effort into taking patients other places mentally, incorporating stunning views, exciting artistic flourishes and innovative design — especially in their waiting areas. One industry observer says that can be wasted effort in the gastroenterology specialty.

"If you're renovating your existing GI center or building an entirely new space, avoid the understandable temptation to pour resources into the lobby, exterior and eye-catching extras," says Suraj Soudagar, principal and project executive in the healthcare unit at IMEG, a design and engineer¬ing consulting firm. "Instead, focus on function over form by creating back-of-the-building spaces that won't impress patients, but will help your facility run smoothly, safely and smartly."

Specifically, Mr. Soudagar encourages GI centers to focus on expanding and fully utilizing their reprocessing areas. "Make sure the reprocessing room has the proper space to clean, disinfect, dry and store scopes without the possibility of cross contamination," he says, recommending three separate areas of at least 100 square feet each for manual cleaning, high-level disinfecting and drying/storage. "The key is to design a space that allows a one-direction flow from workspaces where contaminated scopes are treated to separate work areas where clean scopes are dried and stored," he says.

The procedure rooms likewise should be not too cramped, but not too large either. "Older rooms in some HOPDs and dedicated GI centers are only about 200 square feet to 250 square feet, which must feel like working in a closet," says Mr. Soudagar. "Ideally, GI suites are 300 square feet to 400 square feet, which allows for complete access around the patient."

Mr. Soudagar adds that GI centers should on average have 1.5 prep/post-op recovery spaces for each procedure. For example, a center with six procedure rooms should have nine patient recovery bays.

"It's well worth the effort to expand," says Mr. Soudagar. "Ultimately, the success of a new GI facility comes down to sweating the small stuff, paying attention to the nitty-gritty details and planning for exactly where you hope to be today, tomorrow and 10 years down the road.

Taking On an ASC New Build or Expanding Your Facility Takes Collaboration

Stryker's ASC business offers a customized, flexible program throughout the building or renovation process and ongoing support for success.

Stryker Credit: Stryker

It's been a volatile time for ASCs during the ever-changing challenges of the past 18 months and more, but there's still been a lot of activity happening in the field as facility leaders have built, renovated or expanded their centers.

Procedural volumes, particularly in total joints, have been migrating from the hospital outpatient department to ambulatory surgery centers at an accelerated pace. With the potential to provide more than $55 billion annually in healthcare cost savings in the U.S., this rapid shift is expected to continue over the next few years in the post-pandemic environment. With this comes the great need for collaboration before, during and after a facility takes the significant step to grow to accommodate new business.

With thousands of unique products spanning more than 20 procedural specialties, and a wide range of flexible financial options, Stryker has positioned itself to meet the complex needs of ASCs while continuing to add value to healthcare. Responding to this emerging market, Stryker's ASC business has helped to build, expand and renovate ASCs across the country to meet the growing need. As a one-stop service partner, their team collaborates with ASC leaders to develop tailored solutions for the build, equipment and workflow using a unique eight-step process.

This unique eight-step process offers ASCs access to a deep portfolio of products as well as experts who understand the ASC landscape and the ongoing support that is so vital. Stryker's guidance and partnership, however, go well beyond a single purchase. As an ASC expands to new specialties, Stryker's team also helps businesses grow by providing customized, flexible financial options, ensuring the facility has the equipment and technology required to meet the needs of patients when it's needed. They also conduct regular business reviews to help evaluate current usage, opportunities for growth and future needs.

The eight-step process

Once a facility has acquired a property or made the decision to renovate, Stryker steps in to help with phase 2 by defining the project scope, which Stryker defines as "right-sizing your facility from the very start" to achieve opportunities for future expansion. This step occurs approximately 20 months from opening and utilizes the company's market data and experience to make the right decisions for the specific facility being launched.

Choosing an architect may be the biggest single decision in the ASC design process. Stryker can help find a partner who shares the vision using trusted partners in phase 3, contracting an architect, 18 months from opening. Scheduled 14 months prior to opening is phase 4, equipment and budget planning phase. Here, Stryker works with ASC leaders to identify the right financing model. Stryker's goal during this phase is to allow the ASC to preserve cash flow by balancing the initial investment with options to pay by procedure, leasing or create a customized plan.

Next is phase 5 and 6, critical room layout design and clinical specifications, which occurs 12 months from opening and goes to the heart of Stryker's products and capabilities. The company has been equipping operating rooms for almost 30 years and their broad product portfolio has the right equipment for every part of the ASC. During phases 7 and 8, six months before opening, execution begins. These steps involve executing the construction documents, product installation and staff training as the final steps of an ASC construction or expansion.

Ongoing support

Stryker's ASC program doesn't stop with a tailored solution, it includes services designed to meet the evolving needs of ASCs and ensure the long-term success of the business. Customizable marketing tools are available to help promote the ASC brand in the community, which expands its reach in local markets and positions the new facility as a leader in outpatient surgery. Resources include web banner ads, social media posts, print ads, sample radio scripts and a comprehensive "Marketing Your Practice" guide that equips facilities with the tools and steps to properly and effectively market their practice.

The key to sustaining success is ongoing education for the team and Stryker tailors educational programs to the specific needs of the staff, whether they are getting started or need a refresh on current equipment and workflow. Education includes in-depth programs across all specialties, site visits, peer-to-peer mentoring and product-specific educational events such as Mako SmartRobotics™ certification training.

An eye on the future is part of the vision, too, with a partnership with Stryker. They facilitate collaborative business reviews post-launch which include discussions post-implementation on product and service performance thus far and provide ASC leaders the information they need to evaluate their ongoing business and pinpoint opportunities for future growth.

Note: Learn more about Stryker's ASC business here.

Shifting Procedures to ASCs Adds Up to Significant Savings

UnitedHealth Group claims consumers can save more than $680 on average.

TA new analysis by UnitedHealth Group provides additional evidence that not only can moving procedures from inpatient hospitals to outpatient facilities save consumers and the healthcare system money, but that additional savings can be realized by moving those procedures from hospital outpatient departments (HOPDs) to ambulatory surgery centers (ASCs).

The data analysis brief, available for download here, focuses on routine procedures and surgeries such as colonoscopies and cataract removal that are commonly performed in HOPDs at what UnitedHealth calls "substantially higher prices" than if they were performed at ASCs.

"Shifting outpatient procedures for non-complex commercially insured individuals to ASCs would reduce spending by 59% and save consumers $684 on average per outpatient procedure," writes the healthcare and insurance company. Powerfully illustrating that point, UnitedHealth Group says the average price of common procedures performed in HOPDs in 2019 was $7,716, which was 144% more than the $3,517 average price of the same procedures performed in ASCs.

The company also notes that of the more than six million routine outpatient procedures performed in HOPDs, only 10% involve "complex" patients such as those with morbid obesity or those suffering from end-stage renal disease. In 35% of those six million outpatient procedures, the patients involved did not have an ASC near their homes. While ASCs continue to open at a robust pace, these numbers suggest that opportunities remain for freestanding surgical centers to serve additional areas and patient populations.

ASC's Marketing Leads With Plain Talk About Pricing

Cost transparency combines with value-oriented message for Indiana patients.

Go to the website of WellBridge Surgical of Zionsville, Ind., and the first thing you'll see won't be the typical list of procedures they perform, the surgeons who perform them or a history of the facility. Instead, you immediately see the words "Would you buy a car without knowing the price first?" in large, bold letters.

The ambulatory surgery center, slated to open this fall, is "leading" in marketing-speak with its primary value proposition: transparently low pricing. Its website speaks frankly:

"We deliver high-quality surgical services, directly to patients, saving them money through transparent, fixed, upfront pricing. The healthcare system is broken… But we're changing the game. We cut out the intermediaries, provide surgical care for what it costs, and pass the savings onto the patient." Elsewhere, it states, "WellBridge tells you up front what your procedure will cost. Total. There are no hidden costs. No surprise charges."

The messaging will likely resonate among some Indiana consumers, as WellBridge Surgical, citing a Rand Corp. study, says the state has the fourth highest surgical facility costs in the country. Local general-interest magazine Carmel Monthly led its story about the facility by calling it "a drastically new Indiana healthcare concept."

WellBridge Surgical stated in that article that it will be the only Indiana ASC to offer upfront, transparent, all-inclusive outpatient surgery pricing. (Click here to see its current pricing information.) WellBridge Surgical expects its model will appeal especially to patients with high-deductible plans or who are paying out of pocket, and self-funded employers. According to the local article, the center's prices will range from 30% to 60% below market average.

The facility, founded by two anesthesiologists who say they will partner with local surgeons, will focus on general surgery, orthopedics, gynecology, otolaryngology, urology, podiatry and gastroenterology procedures.

"Over the past several decades, by unnecessarily complicating health care, many intermediaries intentionally created our unsustainable, overpriced system that runs on smoke and mirrors," cofounder Eric Inman, MD, told the local magazine. "We circumvent these middlemen by providing consumers with a competitive alternative to purchase surgical services just like other products or services."