Operating a Unique ASC: Q&A With The Center for Specialty Care Managing Director Lucinda Hay"Impatient? Yes that was my father," says Lucinda Hay, Managing Director of the Center for Specialty Care and daughter of James W. Smith, MD. "Aren't all surgeons? They hate to waste time or to have their OR time pushed back or, worse yet, cancelled. Of course, we all understand that there are emergencies, but doctors just don't like it when it affects their OR time and their patients. Perfectionist? That describes him too. He wanted only the best for his patients and to do everything he could to ensure an outstanding surgical result.
"When my father found a beautiful older building that he could outfit with completely modern ORs and endoscopy suites he couldn't resist. That is how the Center for Specialty Care was born."
The Center for Specialty Care, established in 1985, was the first freestanding ambulatory surgery center in Manhattan to be licensed by the New York State Department of Health. The Center was conceived by Dr. Smith, a world-renowned plastic and reconstructive surgeon, to offer outstanding outpatient surgical care in a setting that relieves surgeons from the inconveniences posed by overcrowded operating rooms in New York City hospitals. With on time starts, efficient room turnover and ease of scheduling, physicians benefit from enhanced efficiency resulting in the ability to treat more patients.
"He wanted surgeons and their patients having elective surgery to be assured that their surgeries would start on time and be performed efficiently with well-trained, experienced staff to ensure excellent patient care," says Ms. Hay. "He was concerned about the repercussions for the elective surgeries caused by OR delays and cancellations resulting from emergencies taking priority and thus disrupting the elective surgery schedules in the hospital setting. He had an architect design the space at the Center for Specialty Care to exceed the accepted standard. We continue to maintain that by having the best quality equipment for our surgeons."
Here, Ms. Hay discusses what makes the Center for Specialty Care unique and how it can maintain success in the future.
Q: What about your surgery center's place in the market attracts surgeons to bring their cases?
Lucinda Hay: An exciting advantage of our multispecialty model is the ability to have two or more surgeons scrub in on the same case. We have some excellent team surgery. For example, with breast surgery a general surgeon will remove damaged or diseased tissue and a plastic surgeon will then immediately perform a reconstructive surgery. Or on a face where a patient has some skin cancers removed and a reconstructive surgeon closes. This collaboration gives patients improved results.
There is also a wonderful collegiality of the surgeons in the same and different specialties. There are opportunities to discuss interesting or challenging cases amongst colleagues. This produces increased patient referrals, many educational discussions and opportunities to solicit information about new procedures or to discuss interesting cases.
The surgery center has no hospital or physician ownership. It's quite an effective arrangement. We can make decisions quickly. For example, if we want to purchase equipment for a new surgeon, we can do that quickly. There are many surgery centers where there is friction between various surgeons when it comes time to purchasing equipment because something might be very expensive but only a few surgeons at the ASC plan to use it. This is especially true at a multispecialty surgery center. We don't have that problem because as a non-hospital, non-physician owned business, we are able to look at the big picture and make decisions efficiently and effectively. These decisions can be implemented rather quickly in some cases within hours.
Over 150 physicians are credentialed at the Center and over 6,000 patients are cared for annually. With a track record now approaching 30 years, the Center is a medical landmark which combines ease of scheduling with on-time delivery of services by an attentive and highly qualified staff.
We also have office and exam room spaces available for doctors to rent at fair market value either as full time tenants or as ‘virtual tenants’.
Q: Your model of renting out consulting and exam room space to surgeons is very unique; have you found any advantages to your ownership model?
LH: Our surgeons like our upper east side location and the fact that they can do surgeries in the same building as their office.
We have virtual tenants who rent out exam room space for a day or half a day per week. Virtual tenants are often surgeons based in surrounding areas, such as Connecticut or Westchester, and who want to build a practice in New York. These surgeons can rent exam rooms and consulting rooms for as little as a half day per week and see their New York patients in New York. They can then use the ORs and endo suites for their cases. This way the virtual tenants can have a presence in New York without renting a full time office; they can just rent the space for the times they need it.
We also have full tenants who have permanent offices in the building and have access to consulting and examination rooms, as well as the operating rooms and endoscopy suites. Our regular tenants, like our virtual tenants, will often see patients for office hours in the morning and do surgeries in the afternoon. That's efficient for them and works nicely for us as well.
Q: How does a surgeon schedule a case?
LH: Our scheduling is flexible, which the surgeons like. We work to accommodate their schedules and their patients' schedules. If a surgeon has only one case, we will fit that case in. We also arrange for regular block time for surgeons with sufficient volume.
Q: As a surgery center that has been operating for more than 30 years, are there any tricks to the trade you've discovered to improve the ASC's performance?
LH: There are several factors that contribute to our ongoing success. Firstly, our experienced staff are involved from the start. We pride ourselves on our scheduling department's ease of scheduling. Our billing department, registrar and clinical staff ensure that the appropriate insurance certifications are in place, the patient admission paper work has been completed and the patient is prepped and ready to go for an on-time start.
In addition, our materials manager and clinical staff make sure all the necessary equipment and instruments are readily available for the surgeon. Efficiencies are increased as surgeons become comfortable with our highly trained staff and the team becomes a 'well-oiled machine.' Lastly, our ORs and endo suites are set up efficiently which allows for a case to proceed smoothly and our staff to provide quick turn around time between cases.
We have a terrific group of anesthesiologists, Northeast Anesthesia, who are full time at the Center. They have many years of experience and make sure the patient receives just the right amount of anesthesia to be comfortable for a particular procedure which allows for quicker recovery and less post-procedure complications.
Q: With the volatile healthcare environment, what are the biggest challenges your center had come across over the past few years?
LH: Right after 2008, we saw a change in the make up of our surgeries although volume remained steady. In 2011, we had our highest volume ever.
For ASCs generally, I think the biggest problem is insurance reimbursements and disparity between what the insurance companies will pay for a procedure at an ASC and what that same insurance company will pay for the same procedure performed by the same doctor at a hospital. Medicare rates for ASCs are set at a fraction of the commensurate hospital reimbursements. Since most other insurers base their rates on a percentage of Medicare we have a very large discrepancy across the board. Given the fact that many patients are more comfortable in the smaller surgery center environment than that of the larger hospital; the low infection rate (we have a well-patient population); the efficient procedure times; and the quick recovery times I, personally, have a tough time justifying the discrepancy in reimbursement. I know the hospitals have a higher overhead because they have to maintain equipment for other types of procedures, but in my view such a large disparity isn't right. Perhaps the 'correct' model for insurance reimbursement for ASC should be cost based as it is for hospitals
Q: Reimbursement certainly is a big concern for surgery centers across the country. From your perspective, what needs to happen for surgery centers to overcome this challenge?
LH: ASCs provide our society with the benefits of cost savings and a high quality of care. Our healthcare system should encourage the shifting of cases to an ambulatory setting by making rates more equitable to sustain economic viability.
Many other cities, states and, indeed, other countries are turning more toward ambulatory centers as a faster and more effective way of giving care to patients. I think New York should do the same.
Q: What are your goals for The Center for Specialty Care five years down the road?
LH: The healthcare environment is always changing and we have the ability to respond to those changing circumstances quickly. We are in an advantageous position because we are a multispecialty ASC; if volume in one specialty declines — one of the surgeons might retire or the surgery becomes less of a priority for the public at large — we have other specialties we can focus on.
Because healthcare is an ever-changing environment, we are always happy to look at new surgeons and specialties and see if they are compatible with us and our mission to render superior quality healthcare to our community and keep up with an ever-changing market.
More Articles on Ambulatory Surgery Centers:
7 Core Concepts to Leverage ASC Data in Payor Negotiations
Leading a Surgery Center During a Time of Change: Q&A With John Wipfler and Linda Ruterbories of Orthoapedic Surgery Center
12 Steps to More Robust Reimbursement in a Surgery Center
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