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ASC Industry Leader to Know: Lori Ramirez of Elite Surgical Affiliates

When Lori Ramirez started with United Surgical Partners International in 1999, the company had two surgery centers in Houston. By the time she left in 2007, she oversaw more than 15 surgery centers in joint venture with Memorial Healthcare System in Houston, Christus Healthcare System in Corpus and Seaton Health System in Austin.  As a matter of fact, in less than 10 years, she had helped grow the Houston area to the second-largest market within the company.

Ms. Ramirez joined USPI in 1999, when her surgery center was acquired by the company. She joined as a regional director and then moved into positions as regional vice president and divisional vice president. When she started with USPI, the company was focused on developing new surgery centers in Houston, so Ms. Ramirez was tasked with building a management team to oversee development. "I was slowly but surely able to assist in building a team of four regional vice presidents, an IT person, a director of business office operations, a central business office and two people in development, "she says.

Carving out a Houston market
The team developed multiple new surgery centers in its first years in Houston, much of its success stemming from a newly-minted relationship with Memorial Hermann. "They had an interest in working with our physicians for outpatient surgery, so we basically went into all their existing campuses and developed surgery centers with the physicians," Ms. Ramirez says.

Surgery center joint ventures taught Ms. Ramirez that hospitals and physicians do not always agree on operational decisions. "Oftentimes, what's in the best interest of the health system may not be in the best interest of the physicians and vice versa," she says. "I think the most important thing [as a management company] is being able to act as a liaison between the two and tweaking each party's interests to make the whole thing work." She says the management company can't just service the physicians or just service the health system; the team has to weigh the perspectives of both groups and then make a decision that benefits the ASC.

As a division vice president for USPI, Ms. Ramirez "became the vision" for her area of the company, spending time assisting the regional vice president, running successful operations and identifying areas of potential growth. She says while leadership has its perks, each rung on the ladder exposes a manager to a greater level of scrutiny and conflict. "If a physician had an issue, by the time it got to me, it was a really big issue," she says. "A lot of my day was spent dealing with customers to make sure they were happy."

Forming Elite Surgical Affiliates
Ms. Ramirez left UPSI in 2007 and spent a year working with attorneys to form her new company: Elite Surgical Affiliates. In June 2008, she started the company officially — four months before the credit market crashed. "Our strategies and our way of doing business shifted significantly," she says. "Prior to starting Elite, I was never worried about financing because the surgery center industry was very lucrative and stable as it related to getting financing. I was more worried about having access to enough physicians to make a deal." Suddenly, the market was different: all her relationships at the large banks that had traditionally funded ASC deals were useless, and financing was scarce.

To generate immediate cash flow, Elite went into existing, failing surgery centers and leased them for a period of time to generate money. While the company had access to physicians, they had less access to significant money or real estate.

Ms. Ramirez eventually acquired financing for her centers by developing relationships with small, local banks — "the banks that were traditionally locked out of surgery center deals in the past and wanted a chance to be part of it," she says. Because Elite focused solely on orthopedics and spine, she was able to carve out a market that nobody had previously claimed. "Every surgery center had one or two orthopedic docs or spine docs, but we said, 'We really want to be centers of excellence for orthopedic and spine in Houston,'" she says. "Surprisingly, there's really no other company doing that."

She says while orthopedics has become relatively saturated in Houston, spine still presents opportunities for growth. "We have relationships with a few spine docs in Houston that are focused on minimally invasive spine, and they assist us with training and recruiting new surgeons," she says.

She credits Elite's rapid success to the company's "country club mentality." The company focuses its energy on servicing the physician and providing services that might not be found at a traditional surgery center. "We roll out the red carpet," she says. "We are a surgery center company that operates equivalent to the hotel industry, in that we provide concierge services that go above and beyond for our physicians." She says surgery center staff members make sure to learn personal details about each surgeon so the company can develop a closer relationship with its partners. "We make each of them feel like they are the only surgeon we work with when they operate at Elite," she says. "We live and breathe by our motto 'Elite, where every customer is treated like an Elite customer.'"

Related Articles on Surgery Center Leaders:
10 Steps for Surgery Center Administrators to Maintain Great Physician Relations
10 Steps to Making Your ASC a Better Place to Work


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