Executive Director: Stan Grissinger
Nursing Director: Philomena Glowka, RN, BS, CNOR
Types of Surgeries: Multi-Specialty
Staff: 50 full-time or equivalent; 25 part-time
Procedure rooms: 2 (one dedicated to pain management)
ORs: 7
Operating surgeons: 165
Monthly case volume: 500 surgical, 500 pain management
Years in operation: 14
Ownership: The center is a joint venture between 3 physician owners and the community hospital

Situated in a sprawling outpatient services campus in Willow Grove, Pa., Abington Surgical Center looks very much like any number of freestanding surgery centers found today in the United States. The difference, though, is that the ASC has been around to see most of those surgery centers pop up: Abington Surgical opened its doors in June 1989, just before the ASC market boom of the last decade-plus. While ASCs were hardly unknown in the late 1980s, they were relatively still few. Seeing an opportunity to handle caseloads more efficiently, serve patients in a more customer-friendly manner and, yes, make some money in the process, physicians Mark Etter, MD, Barry Glaser, MD, and David Junkin, MD, set out to create their own venue to perform surgery.

"Back then, there was not the type of competition between practices or the insurance environment that there is today," says executive director Stan Grissinger. "The timing was right for opening an ASC here, both from clinical and entrepreneurial standpoints."

Finding the balance
The hospital roots of the ASC have always run deep, however. Abington Surgical is a joint venture with the community hospital, and Mr. Grissinger was a hospital administrator before taking the executive director post at the ASC.

Nevertheless, "an ASC only presents a benefit if it is run as such, rather than like a hospital. What I mean is that it's efficiency and procedure-focused rather than bureaucratic, and customer-service oriented rather than institutional," he says.

The biggest challenge, then, in running such a large multi-specialty center - 500 surgeries and 500 pain management procedures are performed monthly - is responding to the changing needs of patients, surgeons and staff while retaining that hallmark ASC efficiency. Abington Surgical handles ophthalmology, urology, general surgery and ENT, to name just a few. In all, 165 surgeons are credentialed to operate in the facility's seven ORs, and Abington Surgical employs 50 full-time (or full-time-equivalent) and 25 part-time staff members.

Maturing gracefully
There are two keys to long-term success, says Mr. Grissinger: the ability to change with the times and a top-notch nursing staff.

First, to meet growing demand for pain management services, the facility devoted an ever-increasing strategic focus to meeting the need on site. "We've always had anesthesia people using our procedure rooms to do pain management," says Mr. Grissinger, "but the demand has grown so much in the last few years, we realized that we needed to dedicate more space to keep it from outgrowing our facility."

Today, pain management operates as a discrete full-time service within the facility and comprises about one-half of the monthly case volume. The pain management practice now has its own business office, and a procedure room is dedicated strictly to pain cases. The anesthesia providers have their own supply room as well.

A second key to staying on top is nurse staff development and quality improvement. For example, one characteristic of a successful multi-specialty ASC staff is that the nurses and techs are cross-trained and proficient in a several specialties; individual staff do not excel only on "ophthalmology days" or "ortho days." Mr. Grissinger credits the facility's nursing director, Philomena Glowka, RN, BS, CNOR, with crafting a clinically flexible staff that understands the challenge of keeping cases moving smoothly without sacrificing the human touch.

"Our nurses keep the place operating smoothly and are tremendous representatives of our facility to our customers - our patients and their families, as well as our surgeons," he says. "Without a strong nursing program, no facility can build or maintain a good reputation."

One way the facility tries to reward staff is by offering a free-lunch program. "It costs us about $35,000 per year, but it's money well spent. First, it's good for building staff camaraderie. Secondly, the lunch program makes staffing issues such as break coverage, reliable relief and perioperative support less of a hassle because people stay on site rather than leaving," says Mr. Grissinger.

Coping financially
Every detail counts in an increasingly competitive and restrictive marketplace for outpatient surgery. "There's no question that our costs go up complying with the increasing regulation of our industry while the reimbursement dollars are tighter for everyone, especially with managed care and an outdated ASC Medicare payment system still in place," says Mr. Grissinger. "It's frustrating because payments don't reflect actual costs and, with Medicare patients, our hands get tied because Medicare's ASC list excludes clinically safe and medically necessary procedures from reimbursement."

But fiscal life is not all bad for Abington Surgical. In today's outpatient surgery environment, says Mr. Grissinger, it pays to be so well known in the patient community and among payors and doctors. "We have an advantage because we're well-established. It would be much harder to build the type of practice we have now if we had to start from scratch."

- Bill Meltzer