From Hospital to ASC: The Transformation of Shriners Children's Hospital of Erie to Erie Ambulatory Surgery CenterAbout three years ago, Shriners Hospital for Children Erie, Pa., was forced to reevaluate its model of service.
The 30-bed inpatient facility had served the hospital well since the late 1920s, says hospital administrator Chuck Walczak. But over the last 10 years, the numbers began shifting away from historic inpatient services. Shriners' average patient length of stay began steadily dropping, and few children needed overnight care.
"We had to ask ourselves, 'Is this the best practice of care?'" Mr. Walczak says. "We were trying to find the most efficient way to deliver care."
Fueled by an increasing demand for outpatient procedures and fiscal tightening by its parent company, hospital leadership decided to transform the 30-bed inpatient facility into a dual ambulatory surgery center and outpatient specialty care center.
Mr. Walczak and Mary Jane Antoon, the facility's chief operating officer and director of patient care services, spearheaded the transition, which was completed in May.
Shriners Hospital consisted of a three-floor, 117,000-square-foot facility. For the transition, the hospital contracted with the University of Pittsburgh's Children's Hospital of Pittsburgh to rent out the building's second floor and create a specialty care center.
Shriners then established an outpatient care clinic, an ambulatory surgery center, a physical and occupational therapy area and a movement analysis lab.
"We looked at this as a strategic breakthrough," Mr. Walczak says. "Erie is a beautiful town, but it had a limited pediatric subspecialty infrastructure, and there were a number of subspecialties that were underserved or totally not available for the population." By bringing in the Children's Hospital of Pittsburgh as an anchor tenant, Shriners created "the perfect piggybacking strategy in terms of an ASC change over," he says.
The partnership and the elimination of inpatient care allows the now-Erie Ambulatory Surgery Center and Outpatient Specialty Care Center to provide a full spectrum of multidisciplinary musculoskeletal and general orthopedic services.
In addition to transitioning its services, Shriners had to switch its certification from hospital to ASC. Ms. Antoon took the lead on this task and worked to get the center ASC-certified by the state of Pennsylvania, CMS-certified and additionally certified by the Joint Commission.
As per state guidelines, the ASC was the only licensed portion of the business. The outpatient clinic and rehabilitation centers did not require licensure.
"The regulations and standards are stricter for a hospital in most cases," Ms. Antoon says. "We were looking at the regulations and seeing what policies and procedures [we had] and what needed to be revised or changed to an ASC."
One of the biggest challenges was the lack of precedent for a similar move. "There wasn't any model we could go from," she says. "This was a lot of trial and error on our part to do what needed to be done."
On April 24, Shriners was officially de-licensed as an acute care hospital and licensed as an ambulatory surgery center.
Shriners developed a large-scale public relations campaign as the transition was being considered, in order to solicit feedback and educate the community about the hospital's intentions.
Robert Howden, director of public relations, managed the marketing, and showed residents that the ASC transformation could save the facility from shutting down completely, a move which had been considered by Shriners corporate office in 2009.
"There was a fervor in the community to save our Shriners," Mr. Walczak says. "People rallied around [the hospital] big time. Once they learned of the plan, they embraced it across the community."
The Shriners staff also worked to make sure the community members realized it wouldn't be an elimination of services as much as an increase in specialty and outpatient care.
Though only a few months into the new care model, the Shriners ASC has maintained its outpatient volume, and its total activity has grown by more than 7 percent, Mr. Walczak says. They have also substantially reduced their operating costs with the elimination of all inpatient-associated services and supplies.
The effort was so successful that Mr. Walczak has been asked by Shriners International to work a similar process at the Shriners Hospital for Children in Springfield, Mass.
An industry trend?
Transitioning from an inpatient hospital to an outpatient surgery and care center was the right choice for the Erie facility, executives say, but the plausibility for other hospitals depends largely on the market and area of location.
"[All] Shriners hospitals provide niche subspecialty services with narrow scope and big depth," Mr. Walczak says. "Orthopedic musculoskeletal has been one area that much more rapidly migrated from inpatient to outpatient than others."
Mr. Walczak also says the partnership with the University of Pittsburgh and the availability of nearby inpatient services for children afforded Shriners the opportunity to make the switch without neglecting any patient needs.
"We had evolved in the past 10 years and most of our activity became outpatient," Ms. Antoon says. "It was a logical evolution for us to choose this model."
For any inpatient facilities considering a similar transition, the executives at the Shriners in Erie have a few tips.
Ms. Antoon recommends open communication with all staff, physicians, board members and other stakeholders. "It was a huge culture shock for some of the staff and physicians long-tenured here," she says. Communication helped them understand what was going on and why for them to be on board with the transition.
Mr. Walczak recommends looking openly at your strategic planning and finding the best fit for your patients and population.
"Be honest with yourself in terms of what you are truly doing and what is the best model," he says. "We knew that it was only cosmetic; we are still here to provide our mission as we've always done. The mindset going forward from an inpatient facility is not moving to something less but to something different."
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8 Qualities of Forward-Thinking ASC Administrators
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