25 ASC Administrators Offer Insight on Joint Venture Leadership

A joint venture ambulatory surgery center, whether a partnership between a small number of investors or many, requires talented guidance.

Here 25 administrators of joint venture ASCs share their thoughts on career accomplishments and advice on leadership.

Jesseye Arrambide, RN, BSN, CNOR, Oregon Outpatient Surgery Center (Tigard). Ms. Arrambide has served as the executive director of Oregon Outpatient Surgery Center since October 2003.  The center opened in 2004. The center began with three physician partners and grew to include seven. Oregon Outpatient Surgery Center became a joint venture with Providence Health and Services in 2006. The facility was Providence Health and Services' first ASC joint venture. That partnership allowed other surgeons to bring Providence cases to the surgery center and grew case volume. "I feel accomplished in building a strong team of professionals with a shared vision for excellence in patient care," says Ms. Arrambide.  She also serves as the president of the Oregon ASC Association. "I am excited that we have embraced our trade association OASCA." She suggests that joint venture administrators use the resources of professional organizations and network with their colleagues to strengthen their centers.

Beverly Baker, Timberlake Surgery Center (Chesterfield, Mo.). Timberlake Surgery Center is a joint venture between Symbion and seven physician partners. The center opened in 2003 and partnered with Symbion in November 2004. Ms. Baker has been the center's administrator for more than six years. "While it is easy to listen to only the loudest or the strongest voices, I strive to remain impartial and ensure that I hear all sides," she says. "My goal is to be more than just a manger, but a trusted leader to both my employees and my employer." Ms. Baker works to keep an open line of communication between all partners in her center. For other joint venture administrators, she advises placing trust in the center's staff. "Although I am engaged in all activities of the center, my staff has a level of autonomy that shows them my trust in their skills and abilities to keep our center successful."
Scott Butterfield, Lakeside Surgery Center (Omaha). Lakeside Surgery Center is a joint venture partnership between Alegent Creighton Health and a group of independent physicians. Surgical Care Affiliates manages the center. The center opened as a joint venture nearly eight years ago. Mr. Butterfield has been the administrator for three years. "Our team has worked very diligently on achieving many successes during my time here," says Mr. Butterfield. He believes the overall patient, physician and staff satisfaction has been one of his team's greatest accomplishments. When taking on leadership of a joint venture center, he suggests that administrators strive to work with all partners. "Develop relationships with each of your stakeholders and gain a perspective on what drives each of their engagements," he says. "The perspectives you gain from these interactions will help to guide continuous improvement of your care delivery model."

Susan Carocari, River Valley Ambulatory Surgery Center (Norwich, Conn.). River Valley ASC is a multispecialty center owned by 15 physicians in partnership with Merritt Healthcare. River Valley Surgery Center received its state license this year. Ms. Carocari started as the center's of director of nursing, but due to a change in management became administrator shortly afterwards. "I don't know that I can really take sole credit for any accomplishments since I truly believe it has all been a team effort. I am very pleased with the staff we have hired. They are all well experienced and are excellent at what they do," she says. "My advice to anyone else taking on the same role would be to take it a day at a time so it doesn't get too overwhelming."

Joseph Colbert, North Coast Surgery Center (Oceanside, Calif.). North Coast Surgery Center is a joint venture between physician partners, Surgical Care Affiliates and Tri-City Medical Center. The center opened in 1986 and became a joint venture in 2010. Mr. Colbert has been the North Coast Surgery Center administrator for 13 years. "We are still able to maintain a day-to-day operational autonomy that allows us to stay nimble and respond to physician and patient needs quickly, which we enjoyed prior to the JV. Tri-City Medical Center has been highly supportive of the joint venture," says Mr. Colbert. He believes a successful joint venture requires vision, persistence, physician champions and patience.   
Daniel Cresco, Wauwatosa (Wis.) Surgery Center. Mr. Cresco has served as the group administrator of his center for nearly three and a half years. The center opened as a joint venture between eight physician partners and Surgical Care Affiliates. He believes his greatest accomplishment thus far has been "growing case volume in a small non-health system related surgery center in a very competitive market." Mr. Cresco advises other joint venture ASC administrators to "strive for excellence in clinical care by making a quality job number one with your team and make sure to involve your joint venture partners in every decision you make."
Lana Davis, Specialty Surgical Center of Thousand Oaks (Westlake Village, Calif.). Specialty Surgical Center of Thousand Oaks is a joint venture partnership between Symbion, 16 physicians and two non-physician investors. Ms. Davis has been administrator at the ASC for just under two years. "I place a good deal of my focus on sales and marketing, which has resulted in a more robust practice, by adding new specialties and surgical procedures," says Ms. Davis. She suggests that joint venture administrators "value their staff and remember to thank them often for a job well done."
Angela Erosenko, CMMP Surgical Center (Jefferson City, Mo.). Ms. Erosenko has been with CMMP Surgical Center for 17 years and served as administrator for 14. The multispecialty center is a joint venture between Symbion and nine physician partners. The center opened in 1995 and became a joint venture with Physicians Surgical Care, which merged with Symbion in 2002. The center was the first freestanding ASC in Mid-Missouri to earn AAAHC accreditation and Medicare certification. "One of the greatest accomplishments in my tenure at CMMP Surgical Center has been retaining talented and dedicated staff to support our surgeons, which enables us to maintain our commitment to providing quality care to our patients," says Ms. Erosenko.
Michael Galvin, The Christ Hospital Spine Surgery Center (Cincinnati). The Christ Hospital Spine Surgery Center is a joint venture between The Christ Hospital, United Surgical Partners International and 17 physicians from The Mayfield Clinic. The center opened in 2007 as a 100 percent physician-owned center and became a joint venture in 2010 with the addition of USPI and the hospital. Mr. Galvin began as the center's administrator in 2009 and helped transition the ASC into a successful joint venture model. "Since the inception of the joint venture, we have positioned the center as a leader and innovator in providing minimally invasive, outpatient spine surgery with outstanding clinical outcomes by a team that focuses on exemplary customer service," says Mr. Galvin. Since the formation of the joint venture partnership, the center has exhibited EBITDA growth and continued to offer a wide variety of outpatient spine procedures. The Christ Hospital Spine Surgery Center is the third joint venture center Mr. Galvin has led. "Your two most important jobs [as a joint venture leader] are to listen closely to your stakeholders and maintain enthusiasm for the center through constant communication and education," Mr. Galvin.  
Debbie Hall, High Plains Surgery Center (Cheyenne, Wyo.). High Plains Surgery Center is a joint venture between 25 physician partners and a local hospital. High Plains Surgery Center is managed by Regent Surgical Health. The surgery center took on its hospital partner on Dec. 31, 2012. Ms. Hall has served as the center's administrator since 2002. "I feel my greatest accomplishment is facilitating the merger of two ambulatory surgery centers and the joint venture with a local hospital," she says. Ms. Hall also recommends that other joint venture administrators "have open, honest and frequent communication with all of the partners."
Ann Hurd, Advanced Surgery Institute (Santa Rosa, Calif.). Advanced Surgery Institute is a partnership between Regent Surgical Health and Santa Rosa Memorial Hospital, a St. Joseph Health System facility. Ms. Hurd has held the role of administrator since November 2011. She also serves as director of nursing. Prior to her leadership, the surgery center had three different administrators and directors of nursing over a period of a year and a half. "I helped to create a consistency for the center than it had not previously had," she says. Ms. Hurd also assisted the Advanced Surgery Institute in the partnership process with its hospital partner, which took more than a year, multiple contract discussions and the transition to a new culture of care. "They [Santa Rosa Memorial Hospital] had not previously been involved in a joint venture with another facility, so this was new ground for all of us." Immediately after the completion of the joint venture agreement, the Advanced Surgery Institute underwent a successful Joint Commission accreditation survey. Ms. Hurd recommends that joint venture administrators exercise flexibility, learn the values of all involved organizations, collaborate with everyone at the center and keep in regular contact with all leadership parties beyond the regular board meetings.  

James Kamps, RN, MBA, CNOR, Surgery Center at Tanasbourne (Hillsboro, Ore.). The Surgery Center at Tanasbourne is a joint venture between Providence Health Systems, a number of physician investors and Blue Chip Surgery Center Partners. Mr. Kamps has served as the center's administrator for more than a year. In the past year, the number of physician owners has doubled, percentage of physician ownership increased more than 300 percent, case volume rose by more than 100 cases per month and the center added a new specialty. "These achievements have been possible because of the great team we have at the center," says Mr. Kamps. "The staff, the physicians, Blue Chip and Providence Health Systems all have played a huge part in our recent success." Mr. Kamps understands that all joint venture partners bring different skills to the table. "I would tell any administrator of a joint venture to understand that each entity of the joint venture will have different strengths and weaknesses. One of the entities may be able to provide the administrator with all of the support needed for day to day operations, while another can help improve your relationships with local providers," he says. "Lastly, I would recommend that every administrator to get involved in their state and national association."

Wendy Kelley, CASC, Cool Springs Surgery Center (Franklin, Tenn.). Ms. Kelley has served as the administrator of Cool Springs Surgery Center for eight years. The multispecialty center is a joint venture partnership between seven physicians, Symbion and Vanderbilt Health Services. The surgery center began in May 2000 as a joint venture between Symbion and Vanderbilt Health Services and added physician partners shortly after. "Since joining Cool Springs Surgery Center in 2005 as its facility administrator, we have nearly doubled case volume from approximately 4,600 cases to over 8,300 cases in 2013," says Ms. Kelley. "Our partnership's willingness coupled with our team's outstanding clinical abilities allowed us to introduce higher acuity cases into our specialty mix accounting for this dramatic increase in case volume." She also successfully led the center through "no findings" Joint Commission surveys in 2010 and 2013 and earned her CASC certification in 2010. "Take advantage of all resources offered by your corporate and hospital partners – clinical expertise, managed care contracting, favorable financing options for capital – the partnership can accomplish more together than apart," she says.
Julie Lineberger, Treasure Valley Surgery Center (Nampa, Idaho). Treasure Valley Surgery Center is owned by local physicians in partnership with Surgical Care Affiliates and St. Alphonsus Health System. Ms. Lineberger has served as the center's administrator since September 2012, a few months after the center reopened under its current model. "The greatest accomplishment has been working hand-in-hand with our hospital and physician partners to expand outpatient surgical services in our community," says Ms. Lineberger. She has successfully recruited both independent and employed physicians to bring new cases to Treasure Valley Surgery Center. "A key responsibility of the administrator is to align the goals of physicians and the hospital partner with the needs of the center," she says.

David Moody, Knighstbridge Surgery Center (Columbus, Ohio). Knightsbridge Surgery Center is joint venture between a group of physician partners, Regent Surgical Health and OhioHealth.  Mr. Moody has served as the center's administrator for 11 years. Knightsbridge Surgery Center entered into a joint venture partnership in 2007. "I think my greatest accomplishment has been that I've hired and developed a staff that has become a team of empowered individuals," says Mr. Moody. "It is all about the people." Mr. Moody created a stable staff five or six years after he began at the center. Now most staff members remain with the center until retirement. He is pleased with the high levels of patient, physician and staff satisfaction. "This joint venture has been the best thing we ever did as a business," he says. Mr. Moody recommends other joint venture administrators always know the players and how their role fits in with the dynamics of the partnership. 
Penny Nicarry, Endoscopy Center at Robinwood (Hagerstown, Md.). Partners in Endoscopy, a partnership between physicians from two separate gastroenterology practices, own an 80 percent stake and Physicians Endoscopy owns a 20 percent stake in the Endoscopy Center at Robinwood. The current ownership structure has been in place since June 2012.  Ms. Nicarry has been the center's administrator since it opened in October 2002. "During my 11 years as administrator the center has been awarded several accreditations from AAAHC, Medicare and ASGE, all of which speak to the quality of care that's delivered at the center," says Ms. Nicarry. She also takes pride in the center's patient satisfaction scores, low staff turnover and ability to remain profitable despite rising costs and reimbursement pressure. "The advice I would offer to administrators taking on a leadership role at a joint venture ASC is to remain neutral and fair with the partners involved and base your decision on what's best for the center, patients and staff," she says.

Kecia Norling, RN, CNOR, CASC, Northwest Ambulatory Surgery Center (Portland, Ore.). Northwest Ambulatory Surgery Center is a joint venture partnership between 17 physicians, Legacy Health and United Surgical Partners International. Ms. Norling has been with the center since construction in 2004 and took on the role of administrator in 2006. She has also served as clinical director during much of her time with the center. "My greatest accomplishment as administrator has been taking the center through the joint venture process. We were an independent surgery center for the first four years," says Ms. Norling. She feels fortunate to have had experience leading both an independent ASC and a joint venture ASC. "I have absolutely loved the opportunities that USPI has given me to grow as a leader at the local, state and national level," says Ms. Norling. "There is an endless abundance of knowledge to learn from the corporate side of the business and I encourage future leaders to take advantage of their resources."

Jeff Peacock, Rochester (N.Y.) Ambulatory Surgery Center. Mr. Peacock has been the administrator of Rochester ASC for nearly three years. The center is a joint venture between Rochester General Health System and Lattimore Community Surgicenter. Rochester Health System partnered with Lattimore Community Surgicenter in 2011. The ASC was renamed, relocated and opened its doors in October 2013. "We were able to relocate a busy center without the loss of a single case. Since opening, our volumes have grown 14 percent and continue to grow," says Mr. Peacock. He understands that large health systems operate differently than ASCs, but works to align the different partners' goals. "The biggest challenge is understanding what strengths each organization brings to the joint venture and capitalizing on those strengths."

Brian Rye, BS, ATC/L, CASC, CEO, Melbourne (Fla.) Surgery Center. Mr. Rye is the CEO and administrator of Melbourne Surgery Center, which was created by the merger of two separate facilities. The joint venture partnership of the merged LLC is between Surgical Care Affiliates and a number of physicians. He led the integration of two ASCs and two physician partnerships at a rapid pace, capitalizing on all efficiencies and through put opportunities, says Mr. Rye. He advises other administrators to keep a close watch on nearby ASCs and opportunities for complementary opportunities. "Scan your territory frequently, analyzing all neighboring ASCs and what specialties they perform identifying what best compliments your existing specialties and case volume," says Mr. Rye.

James Sergeant, East Portland (Ore.) Surgery Center. Mr. Sergeant has been the administrator of East Portland Surgery Center for a year. Over the past 12 years, he has served as the CEO of two surgical hospitals. East Portland Surgery Center is a partnership between 12 physician owners, Legacy Health System and United Surgical Partners International. "My greatest accomplishment with EPSC has yet to be discovered. Converting from surgical hospital operations to the ASC arena has opened many new doors and responsibilities," says Mr. Sergeant. All of the organizations Mr. Sergeant has worked with were joint ventures. "I can unequivocally say grass roots knowledge of your partners' operations is critical," he says. "Become an expert on how you fit into your partners' business plan. Strive to be a conduit, not a bottle neck."

Aaron Shechter, CASC, Endoscopy Center of Hackensack (N.J.) and Paramus (N.J.) Endoscopy Center. Endoscopy Center of Hackensack and Paramus Endoscopy Center are joint ventured with multiple physicians, Hackensack University Medical Center and United Surgical Partners International. The joint venture partnerships began in 2012. "My greatest accomplishment recently has been to transition from freestanding, 100 percent physician-owned centers to becoming part of the USPI family of 200 plus centers and surgical hospitals," says Mr. Shechter. Through the transition, he has helped to successfully integrate systems amongst the partners, gain significant savings, increase revenue and realize improved managed care contract negotiation with the help of HUMC and USPI. "Patience, as well as vigilance, are equally important traits when transitioning to a joint venture ASC," says Mr. Shechter. "All partners bring value and experience to the venture."
Jo Ellen Stoll, The Surgical Center at Tenaya (Las Vegas). Ms. Stoll has served as the administrator of The Surgical Center at Tenaya for two years. The center is joint venture between Surgical Care Affiliates and Nevada Orthopedics. "The hardest part of a joint venture is changing the practice patterns of the surgeons and his scheduler. You need to form a working relationship with the scheduler right away so that they will begin to utilize the surgery center," she says. Ms. Stoll also suggests that administrators actively participate in day-to-day activity at their centers. "Being visible in the center when physicians are doing their cases is another part of a successful partnership. This is a great time to visit with physicians and hear their concerns or praise them for the way things are going at the center," says Ms. Stoll.
Joanne Taormina, Endo-Surgical Center of Florida (Orlando). Endo-Surgical Center of Florida is a joint venture between Physicians Endoscopy, Srinivas Seela, MD, Seela Ramesh, MD and Harinath Sheela, MD. The surgery center is Joint Commission-accredited and recognized for quality by the American Society of Gastrointestinal Endoscopy through its Endoscopic Unit Recognition Program. "Accept the help and knowledge of all parties involved," says Ms. Taormina. "They are all owners and want their facility to be the best by following standards and guidelines of all entities, such as CMS, AHCA and any accreditation organizations." Ms. Taormina worked with a new staff to build Endo-Surgical Center from the ground up. In addition to her role as administrator, Ms. Taormina serves as the director of nursing.
Donna Tweed, The Endoscopy Center of Bucks County (Newton, Pa.). The Endoscopy Center of Bucks County is a joint venture between several physician owners and Physicians Endoscopy. Ms. Tweed has served as the center's administrative director for a little less than a year. "The joint venture company offers a significant benefit for both clinical and operational resources," she says. During her time as administrator Ms. Tweed has "improved infection the infection prevention program, identified and monitored several physical plant repairs, improved staff communication and initiated the professional development of the existing DON."

Scott Williams, Administrator, Carnegie Hill Endoscopy (New York). Carnegie Hill Endoscopy is a joint venture between Physicians Endoscopy and Mount Sinai/Beth Israel Medical Center. Mr. Williams started as the center's administrator in December 2011, prior to its opening in March 2012. "I believe my greatest accomplishment so far has been to put together a team of nurses, technicians and business office staff  that share the physicians' vision for the center; 'Providing the highest level care with quality and compassion,'" says Mr. Williams. He recommends taking advantage of all of the resources joint venture partners bring to the table. "The joint venture partners bring a level of regulatory, financial, human resource, marketing and IT expertise, etc., that might not normally be available and can only enhance an administrator's individual skill set."

If you have any questions about this list please contact Carrie Pallardy at cpallardy@beckershealthcare.com.

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