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 Letter From the Editor: Surgeons' Wish List Is Simple: Convenience, Efficiency, Ease of Practice; 41 Things You Should Know About ASCs; Letter From the Editor: 5 Legal Developments; 15th Annual ASC Conference; Launch of The Hospital Review; 27 Tips to Get Paid Fairly By Medicare and Third-Party Payors; Letter to the Editor: Doc-Owned Facilities Aren't the Bad Guys; Office of Inspector General Issues Advisory Opinion — Physician/ Hospital Joint-Venture; 10 Things You Should Know About Construction; Lessons from 3 Construction Projects; Cost to Build: Sample 2-OR ASC; Four Current Issues in Real Estate Development; Lease Vs. Own: Cost Estimate Sample for 2-Surgery-Suite ASC Development; The Future of Spine: Freestanding Spine Centers; Cost of Doing Orthopedic Surgery; 40 Physicians to Know

Brent Ashby. The opening of Audubon ASC at St. Francis in Colorado Springs, Colo., in Sept. 2008 presented Brent Ashby, administrator of the facility, with a challenge. The ASC, a second joint-venture between local physicians and Penrose-St. Francis Health Services, became necessary when Audubon Surgery Center, eight miles away, started reaching capacity. Mr. Ashby, who is also administrator of Audubon Surgery Center, wanted to be able to monitor both facilities regardless of which he was working in, otherwise he would be forced to travel between sites to check on operations.

Mr. Ashby found a vendor that offers ASC clinical and financial software, which was able to link the IT systems in the two facilities, letting him manage both with a software program. The system lets staff at the facilities receive and enter payments for either facility. Staff members can also access patient accounts from either facility, which lets them address any questions from patients without forcing patients to contact the other center.

Here are four other IT-related projects that Mr. Ashby has overseen at the two facilities.

• Physician office access to schedule. A high-volume pain management physician has direct access to Audubon ASC’s scheduling system, letting his staff to schedule the thousands of cases annually when they are booked, rather than doubling the work by having the ASC staff enter them later. It’s an experimental program at the moment, but Mr. Ashby says there is consideration to give other physicians’ offices access as well.

• Web site as a patient tool. The Audubon Surgery Center is using its Web site as a tool to help patients while helping the center at the same time. On the Web site, patients can fill out a pre-op questionnaire for their procedures. Mr. Ashby says the center’s use of the Internet will continue to grow as a tool for patients. He eventually pictures the ASC’s Web site letting patients access their account, view its status and possibly to make payments online.

• Reduction of paper records. To deal with rapidly accumulating paper records, Audubon Surgery Center purchased a scanner. A person comes to the ASC several times each week and scans charts that are about two to three months old (if patients do not have outstanding balances). The charts are scanned and then those medical records are stored on a CD and labeled by patient numbers. The CDs are searchable and the patient records are easily retrievable.

• Development of EMR/paper hybrid. To help less-tech-savvy nurses feel comfortable with the EMR, Mr. Ashby has developed a hybrid method — a cross between an EMR and a paper record. The takes all documents sent to it by physician offices, labs or other locations (which are generally faxed to the facility) and physician operative reports (which are often e-mailed to the center) and, instead of printing these documents, the center stores them in a digital format in a folder linked to the patient. So nurses can create and use paper medical records, but at the end of the day, the center scans the medical record into the system, links it to the patient and the digital folder, then destroys the paper record.

Chuck Brown, MBA, MHA, Stacey Benson and Christa Hall, RN. Multi-specialty Bidwell Surgery Center, a joint-venture between local physicians, Atrium Medical Center and Children’s Hospital of Dayton, just received Medicare certification May 23, but it is fully equipped for electronic documentation of everything that happens in its five ORs and one procedure room.

Bidwell is outfitted with a software package that comprises workflow management, scheduling, registration, A/R control, claims, statement processing, and automated patient collections and insurance follow-up, denial tracking and job scheduling, among other tasks. While the center is not yet ramped up to its full projected case volume, the technology is already making an impact.

“We have minimal staff and are trying to hold off on hiring more FTEs while we get fully ramped up,” says Stacey Benson, the facility’s business office manager. “But this has let us not worry about that — we don’t need to have someone handling the time-consuming job of dealing with forms. I can just push a button and get what I need and handle it myself while we’re in this startup phase.”

In addition, Bidwell chose an ASC-specific electronic medical records system that could also save one FTE by freeing clinical staff from having to sit and do charts, in addition to the various other benefits (see “5 Things You Should Know About EMR in ASCs on p. 47”).

“We wanted something robust yet user-friendly,” says Chuck Brown, MBA, MHA, administrator. “The thing I really like about the company we chose is its willingness to listen to clients and make adjustments in the software updates based on that feedback. Our EMR can do things bigger players can do, but at a lower cost; and others cost less, but their packages were not comprehensive enough for us.”

In order to ensure that the facility was wired for success from the beginning, Bidwell worked with an IT consultant that established infrastructure, hardware and networking components.

“We wanted to hit the ground running on our IT efforts,” says Mr. Brown. But he and his colleagues don’t plan to leave well enough alone. “We’re going to make the most of our capabilities as we move toward accreditation and as we develop and under take QI studies. Those things are very difficult to do, from a paper copy standpoint, and our technology will help us do them thoroughly and efficiently.

“ASCs are geared toward efficiency and keeping costs low — employing HIT certainly fits in with those aims.”

Anthony Coletta, MD, MBA, FACS. Many facilities shy away from EMR implementation because of the price tag. But Anthony Coletta, MD, MBA, FACS, president of The Surgery Center of the Main Line in Bryn Mawr, Pa., encouraged his partners to invest in EMR from the beginning of their de novo project.

“It was obvious to me at the outset that we should institute EMRs from day one,” Dr. Coletta says.

He identifies the following four reasons investing in EMR was the right decision for The Surgery Center of the Main Line.

• “First and foremost was the fact that I saw paper records as archaic and, given that there was no hospital system in our area with an electronic record, this was an opportunity for us to differentiate ourselves in a very tangible way,” he says.

• “The second was the efficiency a good EMR would provide especially if it could be linked to our financial systems,” he says.

• “It seemed to me that, if we ever were in a position to sell the enterprise, a fully integrated EMR along with a knowledgeable staff would clearly increase our market value,” Dr. Coletta says.

• “I knew that we had the 15 busiest surgeons in the region working at the center and if we wanted to keep our records current, the EMR provided the most efficient means to do that,” he says.

While it wasn’t easy to bring all of the surgeons on-board with the idea, the decision has certainly paid off for the organization.

“At first the partners objected to the added expense, but once I convinced them, we made the investment and have never regretted it,” says Dr. Coletta.

Stephanie Diem, RN. For the past six years, Stephanie Diem, RN, has acted as administrator, clinical director, project manager, nurse manager, and all-around go-to-person for PHGI Associates’ Washington Square Endoscopy Center, located in the heart of Philadelphia.

After practicing for years in a suite of procedure rooms rented from the University of Pennsylvania Health System, the PHGI group made plans to build a new, state-of-the art Endoscopy Center on hospital grounds. With this move, the group was intent on starting fresh and refining less-than-efficient documentation workflows and processes. Ms. Diem led the charge to select, implement and drive utilization of the endo center’s scheduling, billing, EMR and procedure documentation systems. She was critical in developing the IT infrastructure for both the endoscopy center and the physician practice, and has led the center’s efforts to maximize the ROI on its IT investments. She is still responsible for maintaining day-to-day information system functionality.

Among the IT projects Ms. Diem has undertaken:

• She spearheaded implementation and use of the facility’s documentation software to shorten reporting and billing cycles, deliver faster, more comprehensive reporting to referring doctors, and meet regulatory standards set forth by organizations like The Joint Commision, AAAHC and the Office of Inspector General (OIG).

• In 2005, Ms. Diem measured results to find that her implementation of her chosen vendor’s software had increased patient throughput from 6,400 cases to 7,400 cases annually, eliminated an average of $3 per procedure in Mavigraph printing, and significantly increased documentation compliance. Measuring against an internal performance scale based on standards of care, CMS requirements, and state licensure requirements and accrediting standards, Ms. Diem found that her efforts to leverage the site’s IT investment had resulted in a 10 percent improvement in physician charting, a 39 percent improvement in anesthesiologist charting, and a 39 percent improvement in nursing and technician charting.

• More recently, Ms. Diem lead a project to build a full forms repository on the Washington Square Endoscopy’s intranet, which has significantly minimized the need for paper storage and increased staff member efficiency across the board. She has been deeply involved in the development of a patient portal, as well as the facility’s external Web site (www.pennsygi.com).

• In addition to and in conjunction with her IT efforts, Ms. Diem is responsible for maintaining Joint Commission accreditation and licensure and patient safety standards, facilitating competency programs for clinical staff, overseeing professional staff credentialing, and performance improvement activities, including monthly monitoring activities, managing performance measurement data and reporting.

Peggy Alteri, RN BSN, MPS, CASC. Peggy Alteri is the administrator and CEO of Holdings, the owner/operator of two freestanding surgery centers in Syracuse, N.Y. She is also president of her own consulting firm, MMAE, which specializes in ambulatory surgery development and accreditation. As president of the New York State Association for the past 13 years, Ms. Alteri has worked with the Department of Health in the development of regulatory requirements and standards for ASCs throughout the state. She is also a surveyor for the Accreditation Association for Ambulatory Health Care. Ms. Alteri's previous experience includes the position of vice president for clinical services, overseeing all of the clinical services at a 225 bed acute-care facility.

Bonnie Benkula, BSHA, IAC. Bonnie Benkula is administrator/CEO of River Oaks Surgical Center, an RMC MedStone Capital alliance, in Houston. Ms. Benkula has more than 15 years’ experience in hospital and ambulatory surgery management. Her track record of success in both single and multi-site business operations gives her a strong foundation and insight to continually move her organization forward. Before joining MedStone Capital, she led a team supporting the financial management of 42 not-for-profit outpatient clinics and eight inpatient medical divisions that reduced processing days by 53 percent and maintained a data accuracy of 99 percent, setting new standards for the department and earning her and her team outstanding achievement.

Regina Boore, RN, BSN, MS. Regina Boore is the principal/CEO of Progressive Surgical Solutions. Ms. Boore has more than 25 years of clinical, administrative, teaching, and consulting experience in ambulatory surgery. The breadth and depth of her “hands-on, real world” experience in both single-specialty and multi-specialty ASCs has equipped her with meaningful insights and practical approaches to the operational and organizational issues and challenges in the ASC environment. Her goal is to equip her clients with functional tools and strategies to increase efficiency, improve outcomes, and enhance the quality of life in the work environment.

Kathy J. Bryant, JD. Kathy Bryant is the president of the ASC Association and leads the activities of the nation’s largest ASC membership association. Ms. Bryant also serves as president of the Ambulatory Surgery Foundation. Ms. Bryant oversaw the development and implementation of the first ASC-specific credential — CASC (Certified Administrator Surgery Center). Between 1998 and 2007, before accepting her current position with the ASC Association, Ms. Bryant led FASA, one of the two organizations that came together to form the ASC Association in 2008. Previously she headed the government relations program of the American College of Obstetricians and Gynecologists. Before her 13-year stint with ACOG, Ms. Bryant worked for the American Medical Association and the Iowa State Senate.

Marilyn K. Christian, RN, BSN, CNOR, CASC. Marilyn Christian is president/COO of Advantage Surgical Partners. Ms. Christian previously served six years as vice president of clinical operations and regulatory compliance for a leading ASC company. This followed four years as administrator and director of nursing for a multi-specialty ASC. Ms. Christian’s responsibilities in these positions, as well as others she has held in diagnostic imaging centers and surgical hospitals, have included all phases of startup, development, perioperative services, business office procedures, budgeting, contracting, quality assurance, benchmarking, plant operations, regulatory compliance, national accreditation, personnel management and vendor relationships. She is known across the country for the value she has contributed to the ASC industry for 20-plus years.

Rebecca S. Dean, MA, FACMPE. Rebecca Dean currently serves as executive director of Sportsmedicine Fairbanks (Alaska) and as a healthcare executive consultant and owner of Management Solutions. Ms. Dean has 20-plus years’ experience in senior healthcare management. Before her current management positions, she served as CEO for Alaskaís largest multi specialty clinic. Ms. Dean holds the distinction of being the first Alaskan to attain Fellow status from the American College of Medical Practice Executives in 1994. She currently serves as chair-elect for the American College of Medical Practice Executives and will move to chair of the ACMPE in October 2008. She is past president of the MGMA Ambulatory Surgery Management Society, past chair of the western section of MGMA and past president of Alaska MGMA. Ms. Dean currently serves on boards for national business industries and often works as a consultant for a national ASC development firm.

Joyce Deno. Joyce Deno is the COO, eastern region, for Regent Surgical Health. Ms. Deno has been working in the healthcare industry for 32 years. Before joining Regent, she provided private consulting for a turnaround ASC and for a center seeking accreditation. She developed, opened and served as the executive director of Loveland Surgery Center in Colorado. She worked for HealthSouth Corporation as a regional director of quality improvement and as an administrator. She was also director of surgical services for a hospital.

Barbara P. Draves, CASC. Barbara Draves is the administrator for The Surgery Center in Middleburg Heights, Ohio, and The Surgery Center Pearl in Cleveland. She has opened and run surgery centers for over 20 years and was a valued administrator and regional director for Medical Care International in the 1980s and 1990s. She was operations coordinator for three surgery centers from 1990-2002. Ms. Draves has held several senior positions including president/chairwoman of the Ohio Association of Ambulatory Surgery Centers and is a board member for the ASC Associations’ Board of Ambulatory Surgery Certification. She is an asset to the ASC industry.

Stephanie Ellis, RN, CPC. Stephanie Ellis is the president of Ellis Medical Consulting founded in 1992. EMC is a healthcare consulting firm providing chart audits for coding and documentation issues, business office operational assessments, research of coverage issues, litigation support, reimbursement research, ASC and physician coding/ billing training and the development and implementation of billing compliance programs for healthcare providers. Ms. Ellis has worked with most specialties, assisting ASCs, physician practices,acute care hospitals, surgical hospitals, IDTFs and outpatient clinics around the country in her consulting work. In one of her previous positions, she was a fraud investigator for the Medicaid program in Tennessee, which is helpful in her compliance work.

Judith English. Judith English is vice president of business operations and partner in Surgery Consultants of America and Serbin Surgery Center Billing. She has more than 35 years experience in the healthcare industry and has assisted in the development and management of multiple ASCs. She is the co-author of several articles and columns in industry publications and has been a featured speaker at many national ASC association meetings and seminars. Ms. English is experienced in ASC and medical practice coding, healthcare billing and collections, compliance, HIPAA, credentialing and healthcare billing, and is the collaborative author of ASC policy and procedure manuals.

Gayle Evans, RN, BSN, MBA, CNOR, CASC. Gayle Evans is president of Continuum Healthcare Consultants, a firm that specializes in the planning, development and operations of ambulatory surgery centers. With more than 25 years of multi-speciality surgery experience, Ms. Evans is a seasoned professional with management and operations experience at several leading medical facilities including a 12- room surgery department, mobile lithotripsy services and the first U.S. research unit for biliary lithotripsy. Her background includes management of surgery department operations at Kennestone Hospital and clinical coordinator for the Stone Treatment Center at Crawford Long Hospital of Emory University where she developed and managed the research program for biliary lithotripsy including inpatient and outpatient protocols. She also served as a clinical specialist for the Stone Center at HCA Coliseum Medical Centers where she developed policies and procedures for the first HCA mobile lithotripter.

Ann Geier, RN, MS, CNOR, CASC. Ann Geier is the vice president of operations for Ambulatory Surgical Centers of America (ASCOA). She has worked in ASCs since the mid-80’s. In her various roles, she has worked with controlling costs while maintaining the quality of care provided to patients. Ms. Geier is currently involved on a national level with the Ambulatory Surgery Foundation, AORN and the ASC Quality Collaboration Expert Group in setting standards for quality of care strategies. She teaches in the AORN Ambulatory Surgery Manager’s Certificate Program twice a year and teaches the annual financial management for Ambulatory Surgery Managers course. Ms. Geier is also on the AORN PNDS Data User Base task force, is a surveyor for AAAHC and speaks at national and regional meetings several times a year.

Mary Ann Gellenbeck, RN, CASC, CNOR. Mary Ann Gellenbeck is the COO of Prexus Health, responsible for operations and quality of care. She holds degrees in surgical technology, nursing and healthcare administration She has over 28 years’ experience in the surgical arena. Ms. Gellenbeck is a member of several associations including the ASC Association and AORN, is an advisory board member for Cincinnati State College and her current certifications include BCLS, ACLS and PALS.

Barbara Ann Harmer, RN, BSN, MHA. Barbara Ann Harmer is the senior consultant for Healthcare Consultants International, the for-profit subsidiary of the Accreditation Association for Ambulatory Healthcare. She is responsible for providing national and international consulting services for organizations seeking or maintaining compliance with national accreditation standards and other services such as office-based surgery development, assistance with policy and procedure formation, licensure and Medicare certification preparation. Ms. Harmer has worked in healthcare for more than 32 years and has been involved in ASC development since the late 1970s. Before joining Healthcare Consultants International, she was a director of surgical services for Florida Hospital in Orlando and East Pasco Medical Center in Zephyrhills, Fla.; and executive director of Surgical Services for Kennedy Health System in Cherry Hill, N.J. She has worked as administrative director, administrator and nursing director at surgery centers in Pennsylvania, New Jersey, Rhode Island, Virginia, Texas and Massachusetts. She is the provider chair for the Association of Ophthalmic Registered Nurses and is a consultant for the business resources group of Alcon Laboratories.

Sue Hayes. Sue Hayes is the CEO for Colorado Orthopaedic & Surgical Hospital, a new hospital in Denver. During this inaugural year, Ms. Hayes has been busy wearing multiple hats as project manager and hiring manager, and handling community relations and physician relations. She has led her team, her board and her facility from a shell to becoming a fully operational hospital in 10 months. Colorado Orthopaedic & Surgical Hospital is the latest project in a career spanning 20-plus years beginning as a program/case manager for the Triumph Over Pain Program at the Rehabilitation Hospital in Colorado Springs. In 1994, Ms. Hayes co-founded Pike Peak Pain Professionals, where she served as president and CEO, guiding it through the initial stages to becoming a viable program. From there Ms. Hayes served as the administrator for Dry Creek Surgery Center and then onto Rocky Mountain Surgery Center where, as CEO, she managed the construction, development and operations.

Donna Jarmusz. Donna Jarmusz serves as senior vice president for business development and strategic initiatives of Alter+Care, the healthcare development arm of The Alter Group. Her responsibilities include delivering comprehensive outpatient facilities to fulfill the strategic goals of healthcare providers and physicians. As a senior healthcare administrator, Ms. Jarmusz developed numerous healthcare projects such as ASCs; hospital-physician organizations; centers of excellence in cardiology, oncology and orthopedics; and more than a dozen wellness centers. She was previously the founder and president of The IBIS Group, a national facility development company specializing in turnkey medically based health and fitness centers and served as vice president of business development for Edward Health Services.

Milla P. Jones. Milla Jones serves as vice president of communications and government relations for United Surgical Partners International. Ms. Jones has 35 years of healthcare experience, most recently with Baylor Health Care System in Dallas. Her responsibilities include coordinating and managing state and federal advocacy efforts for USPI and its partners and the development of a communication plan that will tell the “USPI story” to the community and USPI employees. Over the last two years — in addition to her responsibilities at USPI — Ms. Jones developed and executed the successful inaugural ASC Charity Day; with the help of 20-plus conference attendees during the 2007 FASA annual meeting in New Orleans, sunflowers were planted outside a school in the 9th Ward. The 2008 ASC Association conference, held in her home state of Texas, gave her the opportunity to involve the industry in the military efforts at Fort Sam Houston. Forty conference attendees volunteered at the Fisher House, where the yard and flower beds were groomed and a Texas BBQ was served to wounded military men and women and their families.

Sandra J. Jones, CASC, LHRM, CHCQM, FHFMA. Sandra Jones is principal and director of management services for Woodrum/ Ambulatory Systems Development and owner and president of Ambulatory Strategies. Ms. Jones has 30 years of experience in the healthcare industry and has overseen or contributed to the successful establishment and development of over 75 ASC nationwide. Ms. Jones has also served as president and COO of ASC consulting firms, administrator of freestanding ASCs, regional risk manager and managed care director for a surgery center corporation and president and vice president of acute care hospitals. She serves on the board of the ASC Association, is an accreditation surveyor with the AAAHC and legislative liaison and past president of the surgery center group of the Medical Group Management Association.

I. Naya Kehayes, MPH. I. Naya Kehayes is the founder and CEO of Eveia Health Consulting & Management (formerly Millennium Health Consulting). She is a nationally recognized expert in the area of reimbursement and managed care and insurance contract negotiations for ASCs and surgical practices. Ms. Kehayes is equally proficient in ASC operations and financial management and serves as a financial advisor to several national ASC corporations. She is intelligent, has a wealth of experience and has (and continues to) made her mark in the healthcare sector by helping her clients dramatically improve their managed care contracts and reimbursements.

Beverly Kirchner, RN, BSN, CNOR, CASC. Beverly Kirchner serves on the AORN board of directors, has authored many AORN manuals and leads research in collaboration with the organization on violence in the nursing workplace. She serves on a Joint Commission task force charged with rewriting ASC standards and has been named to the Ambulatory Surgery Center Quality Collaboration, which is comprised of individuals, healthcare organizations and companies that have joined with CMS and the National Quality Forum to develop improved quality indicators for ASCs. As the owner and CEO of Genesee Associates, Ms. Kirchner has been involved in design, development and management of ASCs since 1985. She also serves on GPO MedAssets’ advisory board for ambulatory care and on the board of directors of celebrity medical.

Susan Kizirian, RN. Susan Kizirian is the chief operating officer for ASCOA. Ms. Kizirian has more than 17 years’ experience in all aspects of ASC operations, serving as executive director and as a consultant for ASC management and development. Most recently, she worked with the University of Virginia Health System ASC program. Ms. Kizirian has 15 years of practice management experience and eight years of expertise with clinical site research. She currently serves as lifetime past president emeritus on the board of directors of the Florida Society of Ambulatory Surgery Centers, and is past treasurer of the American Association of Ambulatory Surgery Centers and past president of the Ambulatory Surgery Management Society of the Medical Group Management Association.

Catherine W. Kowalski. Catherine Kowalski is the executive vice president and COO for Meridian Surgical Partners. Ms. Kowalski has more than 20 years’ experience in the healthcare industry. Ms. Kowalski is the former executive vice president of operations and co-founder of Surgical Alliance Corporation, a specialty surgical hospital company founded in 2001. Before Surgical Alliance, Ms. Kowalski served as a co-founder and vice president, operations and hospital/ancillary services of OrthoExcel, a hospital management company focused on contractual management of orthopedic hospital business lines. Ms. Kowalski has also served as vice president, operations of MedCenter Management Services, a healthcare management organization specializing in the development and management of Orthopedic Centers of Excellence.

Joan Lapham. Joan Lapham is the CEO of Sierra Surgery Hospital, a joint-venture between a physician investor group and a not-for-profit community hospital that was built and opened in 2005.Responsible for comprehensive oversight of the hospital construction from functional design through completion of construction; transition of the organization and staff from a surgery center to a fully operational hospital; licensure, certification, and accreditation; negotiation of the joint venture operating agreement and other required legal documents; arranging financing for the project; and, hiring and development of a competent senior management team. This $21.5 million project was delivered on-time and on-budget.

Julie Lineberger, FACMPE. Julie Lineberger is the administrator of Idaho Urologic Institute and the Surgery Center of Idaho. Ms. Lineberger has focused on medical group practice administration, surgery center administration, consulting and construction project management. She has been responsible for the initial Medicare certification and AAAHC accreditation for an orthopedic surgery center, pain management center and urologic surgery center. She is a certified healthcare executive and a Fellow in the American College of Medical Practice Executives. Ms. Lineberger has been a member of the Medical Group Management Association since 1996 and has served on the honors selection committee, the leadership development committee and survey operations committee. She is the ACPME college forum representative for the ASC Assembly and is a past-president for the Idaho Medical Group Management Association.

Deann Manchester. Deann Manchester is vice president of development for United Surgical Partners International. Before this role, she served in various other roles at USPI, including director of financial modeling and analysis, where she performed valuations and due diligence for many of USPI’s acquisitions and hospital joint-venture de novo projects. She is also the financial operations principal and a licensed registered representative of USP Securities, the broker dealer entity for USPI. Before joining USPI, Ms. Manchester was employed by Columbia/HCA, where she served in various capacities.

Dawn Q. McLane, RN, MSA, CASC, CNOR. Dawn McLane serves as chief development officer for Nikitis Resource Group. Ms. McLane was formerly a vice president for National Surgical Care. She has developed and managed more than 10 surgery centers with Aspen Healthcare, NSC and independently. Ms. McLane has worked in the hospital setting as director of surgical services and as a staff nurse in surgery, ER and OB. She is also a AAAHC surveyor for ASC accreditation and Medicare certification, and is also a book author and frequent speaker.

Melody Mena, RN, CNOR. Melody Mena is director of surgical services for Southern Regional Health System and Surgery Center at Mt. Zion, both located in south metro Atlanta. Ms. Mena began her career as an x-ray technician, graduated in 1995 as a nurse and went straight to the OR. She then ran medical consulting firms for several years. In 2006, Ms. Mena became director of surgical services for the Surgery Center at Mt. Zion, a joint physician/Southern Regional Health System venture. She turned around the struggling ASC and transformed it into a successful profit center, relying heavily on making the center technologically advanced. Her success there (15 percent growth in one year, 98 percent patient satisfaction and a 0 percent infection rate) led to additional responsibilities as she became director of surgical services for the entire Southern Regional Health System in 2008.

Evelyn S. Miller, CPA. Evie Miller serves as the vice president of development at United Surgical Partners International. She is responsible for the company’s strategic direction of USPI’s mergers and acquisitions efforts. She is also responsible for the financial analysis section of the development department, thus overseeing financial projections on all de novo projects. A certified public accountant, Ms. Miller began her career in healthcare as the System Controller at All Saints Health System in Fort Worth, Texas (now a part of the Baylor Healthcare System). Before joining USPI, she was executive vice president of Medway Health Systems, overseeing the financial operations of its medical clinics. Ms. Miller received her BA in accounting and management at York College of Pennsylvania.

Amy Mowles. Amy Mowles is the owner of Mowles Medical Management. Ms. Mowles is the nation’s premier expert with respect to pain management services provided in practices and provided in surgery centers. She is thoughtful and also has strong opinions for what works and what does not work. She is very smart and a talented advisor to pain management physicians. Although she has successfully carved out a niche in the pain management business she also has an incredible depth and breadth of knowledge in general ambulatory surgical services. Her direct, honest and humorous way of answering both general and specific questions has allowed us to efficiently explore a number of new opportunities.

Lori Ramirez. Lori Ramirez is founder and CEO of Elite Surgical Affiliates, which develops, manages and co-owns ambulatory surgical facilities with surgeons. With more than 12 years experience in surgical development, operations and management, Ms. Ramirez has successfully partnered with more than 350 surgeons, has played a critical role in recruiting more than 100 new surgeons and has been successful in restructuring and turning around failing partnerships. She has extensive experience in creating joint ventures with health systems such as Memorial Hermann in Houston and CHRISTUS Health System in South Texas. Prior to founding Elite, Ms. Ramirez was a senior vice president of United Surgical Partners International, where she was directly responsible for developing the second-largest network of surgical facilities for USPI in Houston. She oversaw 20- plus surgical facilities, including two surgical hospitals, one of which included an imaging center and three breast imaging centers.

Marcy T. Rogers, M.Ed. Mary Rogers is president and CEO of SpineMark, Management Technology Resources and American Pain Management. For more than 30 years she has worked with leading healthcare professionals, facilities and medical device manufacturers to advance her goals of improving patient outcomes and satisfaction, as well as developing premier Centers of Excellence in multiple specialties. Ms. Rogers began building Centers of Excellence 19 years ago in the field of craniofacial surgery. Her focus on awareness and patient advocacy lead her to spearhead legislation to create a National Craniofacial Awareness Week. Thanks to her efforts, U.S. Congress passed the bill in 1990.

Karen Sablyak, CPA. Karen Sablyak is the CFO and executive vice president of management services at Physicians Endoscopy. With 10 years’ experience in healthcare finance and operations, Ms. Sablyak’s leadership skills and financial acumen have resulted in tremendous results in reporting and management at Physicians Endoscopy. She has particular expertise in billing processes, the development of policies and procedures, and the analysis and interpretation of healthcare financial data.

Molly Sandvig, JD.Molly Sandvig is the executive director of Physician Hospitals of America. She has done an outstanding job for physician-owned hospitals and her leadership on behalf of them has been instrumental in the ongoing debate about the rights for physicians to develop and hold ownership stakes in physician-owned hospitals. Ms. Sandvig also serves as the president of the South Dakota Association of Specialty Care Providers, representing physician-owned hospitals and ASCs in South Dakota. She is currently serving a second term as a governor appointee to the South Dakota Healthcare Commission. Ms. Sandvig is also a co-chair of the governor-appointed subcommittee on Universal Healthcare Access in South Dakota.

Caryl Serbin, RN, BSN, LHRM. Caryl Serbin is the President and founder of Surgery Consultants of America and Serbin Surgery Center Billing. She has developed a tremendous team and provides credible and hard working leadership for her company. She provides consulting services for a variety of ASCs including orthopedic, ophthalmology, gastroenterology, pain management, urology, and multi-specialty. She is one of the best executives in the ASC industry and a leading woman executive in the business. Recently, one client commented on Ms. Serbin’s efforts as follows, “Her team has been very hard working and has dramatically helped us turn around our center.”

Debra Stinchcomb, RN, BSN, CASC. Debra Stinchcomb is the director of operations preparation and transition management for Health Inventures. She has 25 years of healthcare experience including development, clinical, administrative, operations and sales. The last 14 years have been focused exclusively in the ASC industry with a particular emphasis on multispecialty centers. In that time, she has held positions as an ASC administrator, assistant regional vice president and regional vice president. Her responsibilities have included budget development and management, revenue and expense management, contract negotiation, licensing/certification/accreditation compliance, marketing, and risk management, quality improvement and benchmarking. Ms. Stinchcomb is a current board member of the Ambulatory Surgery Foundation, past chair of the Foundation of Ambulatory Surgery in America and past board member of FASA. She was an AAAHC surveyor from 2001 through 2007 and is currently a member of the ambulatory Joint Commission Professional and Technical Advisory Committee.

Donna St. Louis. Donna St. Louis currently serves as a vice president for diagnostics and outpatient services for BayCare Health System. Before joining BayCare, Ms. St. Louis was a group president for Symbion, with responsibility for over 45 surgery centers. She presently serves on the board of the ASC Association.

Alsie Sydness-Fitzgerald, RN, CASC. Alsie Sydness-Fitzgerald is chair of the ASC Association and served on the team that negotiated the merger of the two national ASC associations (FASA and AAASC). She has worked hand-in-hand for more than 30 years with ASC professionals throughout the country, including some of most highly regarded ASC leaders and advocates from the industryís earliest days. Previous experience includes serving in a large number of volunteer ASC leadership and advocacy roles, including serving on Certified Administrator Surgery Center Exam Committee and chairing the FASA Annual Meeting Program Committee. Ms. Sydness-Fitzgerald retired from full-time employment as the director of clinical operations for HCA Ambulatory Surgery Division in 2005 and presently she owns and operates her own healthcare consulting company, Alsie Fitzgerald Consulting.

Stephanie S. Tarry. Stephanie Tarry is senior vice president, physician partnerships, for Nueterra Healthcare. Ms. Tarry lead’s the Nueterra’s physician business development team. Since joining Nueterra in 2000, she has successfully recruited physician partners and syndicated 22 ASCs and real estate private placement offerings, of which six have been joint ventures with hospitals. Ms. Tarry is a licensed securities representative knowledgeable in Reg “D” offerings. Her extensive background in finance and accounting allows her to thoroughly understand and explain the financial structure of the partnerships. She began her career with 12 years of banking experience. Before joining Nueterra, she served as the director of treasury for a major Midwestern integrated health system and, before that, as the treasurer for the largest school district in Missouri.

Dianne B. Wallace, RN, BSM, MBA. Dianne Wallace is executive director of Menomonee Falls (Wis.) Ambulatory Surgery Center. Her career as a healthcare executive has included leadership roles in hospitals, home health agencies, medical groups and ambulatory surgery. During the past ten years she has served as executive director of a large, freestanding multi-specialty surgery center. During her tenure she has helped grow the facility to a volume of more than 13,000 cases annually. She has presented nationally on issues ranging from leadership to managing a profitable surgery center. Ms. Wallace, a registered nurse, also holds an undergraduate degree in management and a graduate degree in business administration. She is current president of the ASC Assembly of MGMA, past-president of the Surgery Center Association of Wisconsin and has served on several boards.

Lisa Weston, CPC-H, LHRM. Lisa Weston is the director of the ASC coding division for The Coding Network. She employs 20 certified and ASC-experienced coders who code and audit for over 100 ASCs across the country. Ms. Weston personally selects, trains, tests the proficiency of, and provides quality assurance reviews to these coders. Ms. Weston and her coders serve as the "insourced" coding staff for a number of regional and national ASC management firms, providing them with a corporate-wide level of uniformity and accuracy, ongoing coding, continuous quality improvement and compliance audit reviews of the accuracy of coding performed by others.

Peggy Zampetti, RN. Peggy Zampetti is senior vice president of facility development for Titan Health. Ms. Zampetti joined Titan in 1999 from HealthSouth where she served as administrator and regional coordinator for Joint Commission accreditation. Previous positions include administrator and director of nursing for ASC Network. With more than 20 years’ experience in ambulatory surgery development and operations, Ms. Zampetti has extensive experience in ASC design and construction to ensure compliance with regulatory requirements. She has personally developed 30 centers nationwide from design and construction to first case and has intimate knowledge of ASC licensure, accreditation and Medicare certification.

With the advent of the updated CMS 2008 fee schedule, orthopedic surgery now becomes an even more viable option for the ASC. 183 Orthopedic CPTs were added to the list, including a uni-compartment knee replacement (CPT 27446). In addition, ASCs can now realize up to a 92 percent increase in reimbursement from Medicare on average for all orthopedic procedures.

Spine care comes from many sources — standalone practices, partners in group practices, hospital outpatient procedures, specialties in surgery centers — but the future of spine care and surgery is freestanding centers that offer "one-stop shopping," says David Abraham, MD, co-founder of the Reading Neck and Spine Center in Wyomissing, Pa.

David J. Abraham, MD. Dr. David Abraham is a brilliant and entrepreneurial at The Reading Neck & Spine Center in Wyomissing, Pa. Dr. Abraham is board certified in Orthopedic Surgery and is a member of the American Academy of Orthopedic Surgeons, North American Spine Society, and the Pennsylvania Orthopedic Society.

When starting an ASC, it's easy to get caught up in the construction side — after all the building structure is the tangible element surgeons, staff and patients will have to live with day in and day out. But the choices your group makes regarding the real estate can have an equally long-lasting impact, both directly and indirectly, on the financials of the ASC business.

Usually running about $1 million per OR, a small, single-specialty center with two surgical suites ranges from $2 million to $3 million, with larger-multispecialty ASCs costing $4 million to $8 million, according to calculations provided by Meridian Surgical Partners, which partners with physicians seeking to develop new ASCs in addition to acquiring interests in existing physician-owned facilities.

Here, a physician and two administrators discuss their experiences with construction projects, representing various stages, building types and project types, and give their best advice for ensuring your project runs smoothly.

Within hospitals, surgeons are the least satisfied of all specialty physicians, according to a new Press Ganey Associates report. The firm surveyed 27,671 physicians practicing at 302 hospitals/ facilities nationwide between Jan. 1 and Dec. 31, 2007 to compile Hospital Check-Up Report 2008: Physician Perspectives on American Hospitals.

This continues to be a fascinating time in the surgery center area. There continues to be growth, although it is slightly slower. There is also an increasing variety of legal issues and concerns that are facing ASCs. There have also been a number of interesting legal developments.
Current legal developments. Current legal developments include these issues:

There are many misconceptions about ASCs and the best ways to run them. This is a list of 41 things that you should know about surgery centers.

The decision by CMS to move ASCs to the new Medicare payment system created numerous opportunities and challenges for reimbursement. Add this major changes to the many issues ASCs were already facing, and getting the payments you want, and rightly deserve and earn, from both Medicare and third-party payors, is no easy task. Here are 27 tips to help you make the most of your reimbursement opportunities and overcome the challenges you face.