In 1996, most providers in the West Palm Beach, Fla., area practiced in hospitals or hospital outpatient departments. When 13 physicians decided to pursue the construction of an ambulatory surgery center, community members were skeptical: it couldn't be done for a profit, they said. Fifteen years later, Northpoint Surgery and Laser Center is one of the most profitable healthcare facilities in the area, staffing 82 employees and featuring five operating rooms, two endoscopy procedure rooms and a pain management center. Connie Casey, administrator of the center, explains how the physicians' widely doubted plan turned from an idea into an unquestionable success.
Planning and development
When the center's original physicians started building the center, they met with opposition from local residents and licensure organizations. "They started building it and it took a while to build because they had to jump through hoops with licensure," Ms. Casey says. "Some people opposed the center because they didn't want it to be built." Before the center was even built, the physicians hired Ms. Casey as a clinical director, and she worked out of their offices, buying equipment and supplies and credentialing the physicians.
The group of original physicians included several ophthalmologists, an ENT physician, three GI physicians, one podiatrist and three ob/gyns. But it quickly became clear that the physicians' best intentions wouldn't be enough. "We quickly realized, after we started doing cases in Sept. 1996, that we wouldn't make enough money to function with employees in the building," Ms. Casey says.
In order to ensure Northpoint Surgery Center would turn a profit, its leaders researched what various payors paid for each potential case. "We realized it was going to be orthopedics and ENT that were going to bring in the best money," she says. "That was [accomplished] just by doing a lot of research, looking at a lot of graphs and spending a lot of time on financials."
Once the center isolated the most profitable cases, physicians could make sure to concentrate on profitable cases and specialties and schedule fewer cases that would make the center less money. Ms. Casey credits the early success of the center to the obvious partnership and collaboration between physicians. "The first doctors built the center on [the sense of teamwork], and now when they forget it, I go to them and say, 'If you don't bring cases here, you're not being a team player,'" she says. For example, if a physician starts taking more cases to the hospital instead of the center, the other physicians approach their colleague and address the issue. "They all say, 'What are you doing? This should be your number one priority and the first place you go with a case,'" she says. Because of this high expectation from physicians and ASC leaders, Ms. Casey says around 98 percent of her physicians bring 100 percent of their ASC-appropriate cases to her center.
Since its initial implementation, Ms. Casey's center has experienced challenges and successes. Here are her five tips on running a successful surgery center and retaining quality team members in a tough economy:
1. Consider an equity partner that fits with your values. Northpoint Surgery and Laser Center is a partner with National Surgical Care, a company that operates four surgery centers in Florida and many more across the country. According to Ms. Casey, the center was approached many times by other equity partners before the ASC chose National Surgical Care. "We were a very profitable center and people knew that and would come to us, but we never felt it was a company who would come in and look at employees as a very beneficial part of the facility," she says. "It was all about the business." When the center chose National Surgical Care, Northpoint physician leaders were clear to communicate their desire to have the center's employees remain in place. Additionally, it was important that the existing leadership remain in charge of important decisions about the future of the facility. "NSC did not object. They said, 'We don't want to come in here and change everything. We want you because what you do is good,'" Ms. Casey says.
She said choosing an equity partner was good for the center: National Surgical Care helped keep malpractice insurance, supplies and other costs down as the economic climate was driving those prices up. Additionally, the center had a backing of financial stability, as well as help with financial work, facility management and other areas. But the most important factor to Ms. Casey was that NSC fit with the values of her center.
2. Choose an anesthesia group that will let your center expand. Ms. Casey says her center used an anesthesiologist partner for the first five years of operations. When the physician left and the center had to replace him, she interviewed several companies to determine which anesthesia group would be right for Northpoint. The group she ended up choosing were very well-known in the local community and included two pediatric-certified anesthesiologists. "All the doctors [who practiced at the center already] knew the anesthesiologists very well and were very comfortable with them, and my nurses had worked with them too," she says. "They also brought pediatric excellence, so we felt very comfortable because we perform a lot of pediatric cases."
She says the anesthesia group also did pain management procedures, which allowed the center to expand its services to include pain management. If your center is planning to add further specialties in the future, it can help to find an anesthesia group who already has experience with those procedures.
3. Allocate a team member to tackle accreditation and licensure challenges. Ms. Casey says one of her biggest concerns in running Northpoint has been the yearly challenge of meeting accreditation and licensure regulations. The demands have grown over the years, and in the ASC setting, it can be difficult to find the time to review yearly changes to regulations and make the necessary changes. Ms. Casey says she has eased the burden on her staff members by contracting a licensed risk manager who works 20 hours a week for the center. Her contracted risk manager works on performance improvement and quality assurance to make sure the center meets the required standards every year.
4. Set clear expectations with employee candidates. Ms. Casey says she has also had difficulty with staff members whose work expectations do not match her own. "Everybody has employee challenges, and I think I'm very lucky in my facility because I have a great deal of baby boomers who are very hard workers, have excellent work ethics and give me no problem about staying late and coming early," she says. She says historically, some younger employees have been more difficult about putting in extra time, so she makes sure to set clear expectations during the job interview process.
"I let them know what is required," she says. "I say you may be working until 5:00 or 6:00 pm this day, you may be staying later or you may be going home," she says. "I have to have people who cannot be a headache for me."
5. Look to every area of expense for cost savings. Most ASCs cut costs in several major areas, but Ms. Casey says there may be additional potential cost-cutting measures that administrators overlook. Her center saves a significant amount of money by using American Express for every feasible purchase, meaning the center accrues points over time to pay for hotels, plane fare, rental cars and other expenses when employees travel for work. "Just last year, we had four million points sitting in our bank," she says. "It makes such a difference. You can spend $1,500 going to a seminar otherwise."
She says while she rarely loses employees, she takes a close look at staffing and payroll every time an employee retires. "I really look at that position and say, 'Do I really need that position?' before I rehire," she says.
Read more advice on operating a successful ASC:
-3 Common Complaints From ASC Physicians -- and How to Avoid Them
-4 Steps to Make Your Surgery Center Surgeon-Friendly
-3 Ways Surgery Center Physicians Can Increase Case Volume
Planning and development
When the center's original physicians started building the center, they met with opposition from local residents and licensure organizations. "They started building it and it took a while to build because they had to jump through hoops with licensure," Ms. Casey says. "Some people opposed the center because they didn't want it to be built." Before the center was even built, the physicians hired Ms. Casey as a clinical director, and she worked out of their offices, buying equipment and supplies and credentialing the physicians.
The group of original physicians included several ophthalmologists, an ENT physician, three GI physicians, one podiatrist and three ob/gyns. But it quickly became clear that the physicians' best intentions wouldn't be enough. "We quickly realized, after we started doing cases in Sept. 1996, that we wouldn't make enough money to function with employees in the building," Ms. Casey says.
In order to ensure Northpoint Surgery Center would turn a profit, its leaders researched what various payors paid for each potential case. "We realized it was going to be orthopedics and ENT that were going to bring in the best money," she says. "That was [accomplished] just by doing a lot of research, looking at a lot of graphs and spending a lot of time on financials."
Once the center isolated the most profitable cases, physicians could make sure to concentrate on profitable cases and specialties and schedule fewer cases that would make the center less money. Ms. Casey credits the early success of the center to the obvious partnership and collaboration between physicians. "The first doctors built the center on [the sense of teamwork], and now when they forget it, I go to them and say, 'If you don't bring cases here, you're not being a team player,'" she says. For example, if a physician starts taking more cases to the hospital instead of the center, the other physicians approach their colleague and address the issue. "They all say, 'What are you doing? This should be your number one priority and the first place you go with a case,'" she says. Because of this high expectation from physicians and ASC leaders, Ms. Casey says around 98 percent of her physicians bring 100 percent of their ASC-appropriate cases to her center.
Since its initial implementation, Ms. Casey's center has experienced challenges and successes. Here are her five tips on running a successful surgery center and retaining quality team members in a tough economy:
1. Consider an equity partner that fits with your values. Northpoint Surgery and Laser Center is a partner with National Surgical Care, a company that operates four surgery centers in Florida and many more across the country. According to Ms. Casey, the center was approached many times by other equity partners before the ASC chose National Surgical Care. "We were a very profitable center and people knew that and would come to us, but we never felt it was a company who would come in and look at employees as a very beneficial part of the facility," she says. "It was all about the business." When the center chose National Surgical Care, Northpoint physician leaders were clear to communicate their desire to have the center's employees remain in place. Additionally, it was important that the existing leadership remain in charge of important decisions about the future of the facility. "NSC did not object. They said, 'We don't want to come in here and change everything. We want you because what you do is good,'" Ms. Casey says.
She said choosing an equity partner was good for the center: National Surgical Care helped keep malpractice insurance, supplies and other costs down as the economic climate was driving those prices up. Additionally, the center had a backing of financial stability, as well as help with financial work, facility management and other areas. But the most important factor to Ms. Casey was that NSC fit with the values of her center.
2. Choose an anesthesia group that will let your center expand. Ms. Casey says her center used an anesthesiologist partner for the first five years of operations. When the physician left and the center had to replace him, she interviewed several companies to determine which anesthesia group would be right for Northpoint. The group she ended up choosing were very well-known in the local community and included two pediatric-certified anesthesiologists. "All the doctors [who practiced at the center already] knew the anesthesiologists very well and were very comfortable with them, and my nurses had worked with them too," she says. "They also brought pediatric excellence, so we felt very comfortable because we perform a lot of pediatric cases."
She says the anesthesia group also did pain management procedures, which allowed the center to expand its services to include pain management. If your center is planning to add further specialties in the future, it can help to find an anesthesia group who already has experience with those procedures.
3. Allocate a team member to tackle accreditation and licensure challenges. Ms. Casey says one of her biggest concerns in running Northpoint has been the yearly challenge of meeting accreditation and licensure regulations. The demands have grown over the years, and in the ASC setting, it can be difficult to find the time to review yearly changes to regulations and make the necessary changes. Ms. Casey says she has eased the burden on her staff members by contracting a licensed risk manager who works 20 hours a week for the center. Her contracted risk manager works on performance improvement and quality assurance to make sure the center meets the required standards every year.
4. Set clear expectations with employee candidates. Ms. Casey says she has also had difficulty with staff members whose work expectations do not match her own. "Everybody has employee challenges, and I think I'm very lucky in my facility because I have a great deal of baby boomers who are very hard workers, have excellent work ethics and give me no problem about staying late and coming early," she says. She says historically, some younger employees have been more difficult about putting in extra time, so she makes sure to set clear expectations during the job interview process.
"I let them know what is required," she says. "I say you may be working until 5:00 or 6:00 pm this day, you may be staying later or you may be going home," she says. "I have to have people who cannot be a headache for me."
5. Look to every area of expense for cost savings. Most ASCs cut costs in several major areas, but Ms. Casey says there may be additional potential cost-cutting measures that administrators overlook. Her center saves a significant amount of money by using American Express for every feasible purchase, meaning the center accrues points over time to pay for hotels, plane fare, rental cars and other expenses when employees travel for work. "Just last year, we had four million points sitting in our bank," she says. "It makes such a difference. You can spend $1,500 going to a seminar otherwise."
She says while she rarely loses employees, she takes a close look at staffing and payroll every time an employee retires. "I really look at that position and say, 'Do I really need that position?' before I rehire," she says.
Read more advice on operating a successful ASC:
-3 Common Complaints From ASC Physicians -- and How to Avoid Them
-4 Steps to Make Your Surgery Center Surgeon-Friendly
-3 Ways Surgery Center Physicians Can Increase Case Volume