Bringing Total Joint Replacements, 23-Hour Stays to Surgery Centers: Q&A With Jessie Scott of Presidio Surgery Center

Presidio Surgery Center, an affiliate of Sutter West Bay and managed by Surgical Care Affiliates, opened in 1989 with four operating rooms and one procedure room where surgeons performed approximately 3,000 cases per year in general surgery, spine, orthopedics and podiatry. Since then, the surgery center has grown to add an additional OR, and increase the volume to 6,000 cases per year by incorporating more complex procedures such as anterior cervical fusions and they are just beginning to perform total joint replacements there as well.

Jessie Scott, administrator of Presidio Surgery Center in San Francisco, discusses how her ASC built a total joint replacement program with 23-hour stay capabilities and where she sees opportunities for success in the future.

Q: What was the impetus for bringing a total joint replacement programs and 23-hour stays to the surgery center?

Jessie Scott:
We feel as a surgery center, that the reason to bring patients and surgeons here out of the hospital is because we can make the total experience better than where they currently are. They should experience higher quality, and greater service or there is no reason for them to move. We strive in everything we do to create a care delivery model that is safer, more efficient, and provides greater service than the patients and surgeons would receive elsewhere. For example a patient spending the night with us has two ACLS RNs and a security guard, a much higher staff to patient ratio resulting in more individualized care.

Q: How are you differentiating your surgery center to drive that transition?

JS: We've done several different things to show we have higher quality service than at the hospital. Patients have a choice to order meals from anywhere across the city and we have it delivered to them.  As I mentioned, the nursing ratio is also better because we have two nurses overnight and typically we only have one to two patients staying the night, so they have more nursing attention.

Our overnight rooms also have NetFlix and Hulu so patients can watch TV shows or movies. Our patients and surgeons have a very high satisfaction with the program on surveys.

Q: What challenges have you faced in bringing total joint replacements into the ASC?

JS: There were a few different changes we went through in the surgery center. We had to bring back 23-hour stays; we had done them in the past and stopped because there wasn't a high enough case volume to warrant hiring employees to stay overnight. If you don't give staff members enough hours, they won't stay with you. Another challenge we have is to make sure we don't schedule overnight cases too early in the day; we never let them start at 7:30 am because those patients would have to leave too early the next morning.

Next we had to decide who would be responsible for the overnight call — either the anesthesiologist or surgeon. We decided it would be the surgeon. Finally, we had to create a good safety plan for the overnight stays. As there is not a physician immediately on site at night a lot of work went into the safety plans in the event of any kind of event.

Q: What does the total joint replacement program bring to the surgery center?

We are working with our local orthopedics group to make sure the total joint program is running smoothly without any kinks. Phase two would be to recruit new surgeons who could potentially bring cases into the ASC. What we would ultimately like to do is move the program off site to a center dedicated to total joint replacements.

Q: Overall, what successes have you experienced with your surgery center throughout the past several years that allow a joint replacement program to be possible?

We've been able to steadily grow our business by about 5 percent per year for the past few years. We have recruited new physician partners, which allow us to bring in new procedures. We also focused strongly on our quality programs and even had a Joint Commission survey recently with zero deficiencies.

I am also proud of our hospital partner and I feel that partnership has been successful. Sometimes hospitals and surgery centers don't have the best relationship, but ours has been a success. The hospital is very hands off and lets the surgeons run their ASC. Our program takes cases out of the hospital, but they have been supportive, and assist in making sure we are creating high quality, safe programs.

Q: How were you able to build and maintain such a positive relationship with hospitals?

JS: I went over to the hospital and worked with them for the first few years of our partnership. During the first full year, there were monthly meetings with the hospital administration and medical department chiefs to talk through what the relationship would be, how it would be set up and how it functioned. It was a really big learning curve for the hospital leaders because they were used to the executives making decisions without as much involvement from the physicians. We were teaching them a new approach; executives and surgeons sit together and make decisions. It has become a true partnership with a balance of power, and each side doing what they do best. Once they got it that became part of our culture. It took a year, but it was a year well spent.  

Q: Beyond total joint replacements, where do you see opportunities for your surgery center to grow in the future?

JS: I talk about growth at every board meeting and management meeting; it's a continuous daily focus. We want to grow by case volume, case type and case revenue. The surgeon partners are actively involved in the growth process, and understand it is the lifeblood of their center.

More Articles on Surgery Centers:

7 Steps to Kick-Start a Positive Surgery Center Culture

Are Bundled Payments Near for Surgery Centrs? Q&A With Dr. Jason Hwang of Innosight Institute

7 Ways for Surgery Centers to Make More Money Now

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