Although some physicians are taking advantage of the opportunity to invest in and be an owner of an ASC, those who have been involved in the startup process of constructing, equipping and opening new ASC facilities know that it can be daunting.
Becker’s ASC Review recently spoke with Dawn McElhone, RN, administrator at Riverfront Surgery Center in Chattanooga, Tenn., about her team’s experience developing and opening a new ambulatory surgery center and how partnering with an experienced solutions provider like Stryker has simplified the process.
Riverfront Surgery Center was created to provide a patient-centered approach to surgery
About four years ago, Jay Jolley, MD, and David Wiles, MD, were discussing how Chattanooga had very few surgery centers compared to other major cities in Tennessee. At the time, Chattanooga only had two surgery centers that did orthopedic procedures and one was closed to physicians outside of the associated practice.
Prior to joining Dr. Jolley’s practice, Dr. Wiles did many procedures at a surgery center in Johnson City, Tenn. The ASC model was attractive to him, since surgery center procedures are less expensive than those performed in the hospital setting.
According to Ms. McElhone, “Dr. Jolley and Dr. Wiles asked other independent physicians in the Chattanooga area if they would be interested in joining an ASC and they got a positive response. Most of these doctors had never worked at a surgery center before and they liked the idea of investing in a patient-centered approach to surgery that would benefit the community.” Today, 14 physicians perform surgeries at Riverfront Surgery Center, seven of whom are owners.
Riverfront focuses primarily on spine, orthopedics and pain management. As Ms. McElhone noted, “We do total joints, sports medicine cases and any type of arthroscopy. We also are doing podiatry and we have a heavy emphasis on spine procedures. Our physicians do microdiscectomies, laminectomies, cervical fusions, lumbar fusions and total disc replacements.”
Given the complexities of opening an ASC, physicians need knowledgeable administrative staff
Riverfront Surgery Center was incorporated in 2019 and physicians then had to obtain a certificate of need. In early 2021, the construction team broke ground for the building. As the administrator for Riverfront Surgery Center, Ms. McElhone was the first employee on board, starting in June 2021.
“I have been a nurse for 12 years. Ten years ago, I moved to Tennessee and worked as a floor nurse, caring for patients who had just had surgery,” she said. “After a few years on the postop floor, I started working at a local hospital in Chattanooga, where I met several of the doctors who are involved with Riverfront Surgery Center. Dr. Jolley approached me to work at the center as the administrator.”
In her role as administrator, Ms. McElhone has been involved in building the ASC from the ground up with the physicians. She oversees daily operations and every step needed to open the ASC’s doors, from writing policies to meeting with physicians, purchasing equipment, implementing the EMR system, finalizing insurance contracts and more.
During construction of Riverfront Surgery Center, pandemic-related supply chain issues created various challenges. “We anticipated opening in September 2021, but that was delayed until January 2022,” Ms. McElhone said. “We had an incomplete HVAC system for a couple of months and our fire doors were on backorder. Fortunately, we were able to implement temporary fixes that didn’t delay us significantly.”
In January 2022, Riverfront Surgery Center obtained its state license and started seeing patients. “You have to treat 10 patients before you can begin the accreditation process,” Ms. McElhone said. “We have now been accredited by the Accreditation Association for Ambulatory Health Care. In June of this year, we received our Medicare status and are working toward Medicare Advantage.”
Now the ASC is focused on obtaining commercial insurance contracts which will expand the number of patients that physicians can see. Riverfront Surgery Center is currently serving a lot of workers’ comp and Veterans Administration patients. The near-term goal is to work with all the insurance companies that the ASC’s 14 physicians already accept. “We want to match that, so we can serve as many of our doctors’ patients here as possible,” Ms. McElhone said. “We hope to have our insurance contracts completed in the next couple of months.”
To address its capital, implant and disposable needs, Riverfront Surgery Center partnered with Stryker
Even in the early stages of Riverfront Surgery Center’s development, the physicians were in conversation with Stryker about how Stryker could help with their capital needs, and those discussions continued after Ms. McElhone came onboard.
“A lot of the doctors had used Stryker products within the hospital, but they weren’t familiar with everything that the company offered,” Ms. McElhone said. “Stryker hosted a product showcase for our physician owners and talked to them about the surgery center’s capital needs. They also discussed different financing options.”
Following this meeting — as well as other due diligence by Riverfront — Stryker and Riverfront Surgery Center entered into a seven-year agreement including implants and disposables for joint replacement, sports medicine, foot and ankle, spine and neurosurgery. The agreement also included capital equipment Riverfront would need on day one: operating room infrastructure, stretchers, waste management, endoscopy towers, arthoroscopy towers and more.
“It was the service that sold me on Stryker,” Ms. McElhone said. “Even though every single ASC is different, Stryker offered us only the products we needed. They didn’t try to sell us on things we didn’t need. They have also helped us during the entire process of opening the ASC. On move-in day, the Stryker team was here unloading [their equipment] with us and putting things together in the new building.”
So far, the partnership has clearly been the right decision for Riverfront Surgery Center. “Stryker offers great products,” Ms. McElhone said. “The team had already used a lot of Stryker equipment at the hospital, but some of the implants were new for some of the physicians. They’ve had great results after trying them out and getting a feel for how they work.”
The Riverfront physicians use Stryker products as much as possible. According to Ms. McElhone, “We focus on Stryker products and show the surgeons the cost advantage of using those products. Our local Stryker reps have been more than helpful with everything we need. They are constantly reaching out to the doctors and showing them different ways to do things that will save money.”
Lessons learned when opening a new ASC: Do your research and network with other ASCs
Reflecting on her experience developing and opening Riverfront Surgery Center, Ms. McElhone recommended that other ASC administrators conduct thorough due diligence when deciding on a partnership. It’s important to read through contracts, pay close attention to the fine print and understand the “whys” and the “hows” behind contracts before you sign them.
“I questioned everything in our agreement with Stryker and had it explained to me three different ways, so I understood it properly,” she said. “If you don’t understand the fundamentals, you will miss something.”
With regard to the importance of networking, Ms. McElhone noted that there are many people who have experience opening ASCs and most are willing to help. “Find people you can rely on to ask questions, even if you think those questions are silly,” she recommended. “All you have to do is ask. The Stryker team has connected me with ASC administrators and other resources when I have questions.”
Conclusion
Launching a new ASC isn’t easy. But the Riverfront team is excited about transforming its vision into a reality. Its leaders expect to have its insurance contracts finalized and over the next year or two. The team also hopes to have all four of its operating rooms running every day, serving far more patients.
In addition to its committed staff, Riverfront appreciates the valuable support it has received from Stryker. “It’s been a great relationship,” Ms. McElhone said. “We aren’t just another facility to Stryker. We are an important partnership to them and it shows in the way they treat us. Their customer service has been outstanding.”
Dawn McElhone is a customer of Stryker. The opinions expressed by Ms. McElhone are those of Ms. McElhone and not necessarily those of Stryker.
