Dr. Cheryl Stanski on finding success with a new rural ASC in 2020

Cheryl Stanski, MD, is a general surgeon and the medical director at Holston Medical Group's Kingsport, Tenn.-based MeadowView Surgery Center.

MeadowView Surgery Center opened in June 2020 and received its Accreditation Association for Ambulatory Health Care accreditation in November, according to a spokesperson. Dr. Stanski spoke with Becker's ASC Review about her experience opening the rural ASC, building trust in the community and what other leaders can learn.

Note: Responses have been lightly edited for style and length.

Question: What have been some challenges of opening your ASC in a rural community?
Dr. Cheryl Stanski: We've had some particular challenges because of COVID-19, which isn't exactly because we're in a rural community. But the virus really did pose some struggles. COVID-19 hit as we were getting ready to open our center.

The biggest thing was getting our inspections done. We had to have inspections and surveys done for certification, and a lot of the inspectors are volunteers and they travel from bigger cities and they just weren't traveling. So we definitely struggled with that a little bit.

I think another thing in the rural community is that sometimes patients aren't used to the idea of a surgery center and have gone to one hospital their whole lives for their healthcare, and they're not sure it's safe. So that was part of our challenge, educating our patients and letting them know that we were performing very high-quality care in a very safe environment in a way that is more efficient and lets them recover at home and have lower costs.

Q: Could you talk more about how you build trust in the community?
CS: Some of it was advertising; we put out there about our center that is opening and what it has to offer. We did a Facebook Live event where I did a tour of the center so they got to see video of this and see what it looked like to see that it looked like an operating room and not just some office somewhere.

Our physicians who work at the center also participated a lot in explaining how the center works to the patients they're bringing there. So that's that's the way we approached that.

Once we do have patients starting to come to the center, we do some things to try to make them feel comfortable. We always call them preoperatively. Part of that is just to get some medical information, but also just to let them know what to expect that day, how things are going to work. Postoperatively, what we call them for postoperative check the day after surgery to make sure everything's going well and you're not having any struggles at home. I think that creates a little bit of sense of safety, and they know we're caring for them in a safe way.

Once you get a few patients in, word of mouth in a rural community is pretty strong. So, you know, people come, they have experience, they tell their friends, and it just spreads pretty quickly.

Q: What went well for your ASC in its first six months of operation?
CS: Even with the pandemic, we were able to get our first cases done in June, which was pretty much in keeping with our timeline, a little bit delayed, but not horrible.

Unfortunately, there's been a pause in elective surgery in our community a few times. And now, again, we are [performing] elective surgery because the hospital needs to divert all its resources to COVID-19 care. But that has really brought a lot of business to our surgery center and a lot of volume, and that's been great.

It has been a little bit of a challenge to ramp up so quickly. Usually there's sort of a slow increase in cases that we've had to really hire some more staff and get mobilized to keep up with that bias. I think we're meeting the challenge.

Q: What are some areas for growth/improvement in 2021?
CS: I think we're really going to focus on our orthopedics program. We are doing a total joints, mostly knees, but we're going to expand that program, do more and more of those. I think that's our biggest area for growth.

Q: Does your ASC plan to adopt robotic technology as part of the total joint program?
CS: No, I don't think so. I think our orthopedic surgeons felt they would do better without robotics. I'm not an orthopedic surgeon, so I can't speak to that exactly, but I know we've discussed it. I think our surgeons did not want to venture into robotics because they felt like they were doing well with what they did. We started very cautiously with patient selection and the most ideal cases. And I think they can bring more and more challenging cases as we get more streamlined in our process.

Q: What lessons can ASCs learn from rural hospital closures?
CS: There are differences between hospitals and surgery centers. I think hospitals are really faced with a lot of challenges that we don't have to deal with as a surgery center. I think the surgery centers do provide a solution to those closures.

When rural hospitals close, patients have to travel long distances to a bigger center to get their procedures done, and now they can stay at home in their community at the outpatient surgery center. They don't have to struggle to find their way around the city they don't know or even find their way around a big hospital building. That's stressful for some people who aren't used to that. And they don't have to travel, you know, especially if it's going home the same day. It's hard to travel after surgery. It's uncomfortable.

I think that's a place that ASCs can really step in and take up some of the slack with our rural hospital closures. I think it also offloads the hospital a little bit. Even if you're in a city where the hospitals are so overwhelmed with COVID right now and they're really strained with their resources. So it's taking some of those less acute, less sick patients and still taking care of them. They can do it in another setting.


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