As ASCs have become a prominent feature on the healthcare landscape, much of the industry debate has centered on physician empowerment, financial implications and the risk that hospitals will lose profitable patients. All of those are important issues that represent big changes. But, from my perspective, the impact of an owning an ASC has been profoundly personal. It has changed the way I practice, and changed it for the better. Clinically, I feel much more able to provide quality care in precisely the ways I think best. I am more in tune with my staff and co-workers and have confidence in our ability to provide an excellent patient experience.
Like other ASC-owners, I have also realized worthwhile benefits in my personal life. There’s less stress, less uncertainty and more time to do the things I love to do. And it’s even possible to eat lunch once in a while.
A change in outlook
In my 20+ years of general surgery, I thought I had seen it all. But once I began to learn about outpatient surgery centers a few years ago and heard the rave reviews of the early adopters (including surgeons I knew and respected), I was greatly intrigued. Eventually, I joined a group of physicians developing (in partnership with Blue Chip Surgical Center Partners) an ASC outside Philadelphia. What I’ve learned and experienced has been nothing short of a transformation.
When I began conducting outpatient surgeries, I realized improvements in clinical techniques and outcomes were well within reach. At our ASC, we have eliminated many variables and can take full responsibility for providing quality care. If we want to invest in better equipment because we think it will lead to better outcomes, we have the freedom and means to do so, without having to beg, plead or cajole administrators who are not clinicians. Many of my partners feel they now have time to stay on top of the latest research in the fields and gain proficiency with innovative techniques, the latest medications and advanced equipment. That’s especially true with spine surgeons and neurosurgeons. Lastly, and perhaps most importantly, I don’t have any doubts about the quality of post-operative care. I know exactly where patients will be and who will be looking after them.
Building the team
Staffing is another big advantage of having your own ASC. I no longer have to introduce myself to the nurses and anesthesiologists before surgery. The contrast with hospitals, where surgeons have little or no control over staffing (or scheduling or post-op care, for that matter), could not be greater. How can you do your best work if you have no idea who’s going to be in the OR with you? I’ve tried a few times to explain this point to hospital executives, asking them how their work would be affected if their support staff changed every day. They never seem to quite get it.
Today, however, I operate with a team of people I know, trust and enjoy working with. Better yet, they are highly skilled and knowledgeable in those procedures in which I and my partners specialize. The entire team shares an outpatient mindset. Everyone understands their role, the schedule for the day and the end goals, and so we all row in the same direction.
With a strong team in place, everything is easier and more predictable. We have set processes based on best practices and we can replicate them easily. Instruments and supplies are arranged for an easy, smooth flow during surgery. The steps for cleaning and OR turnover are pre-determined and proceed quickly. It also helps that the building is designed specifically for efficiency and productivity. This is how it’s possible for me and my colleagues to do three procedures in three hours at our ASC.
Better anesthesia protocols
Another benefit of having the right team in place is that everybody is free to share good ideas. For the first time in my clinical career, I am working with a hand-picked team of anesthesiologists who are focused on my routine and on improving the patient’s outpatient experience. In the OR, our team of anesthesiologists knows when I want my first injection and how to sequence the ensuing phases. It’s easy for us to consult on individual cases beforehand and formulate a game plan. Plus, the anesthesiologists don’t have to err on the side of over-sedation, because patients will be monitored carefully from the minute they leave the OR, not malingering anonymously for hours in a recovery room. Since transitioning most of my cases to outpatient, I’ve begun to use more local anesthetics and non-narcotic analgesics, which I believe are superior.
Recovery room surprises
With a much greater likelihood of staying on schedule, I am able to focus more on post-operative pain management for patients. This is a good thing, but sometimes I’m surprised how easily the post-op phase goes. Typically, when I operate at a hospital, I make it a priority to get to the recovery room to follow up with patients and their families as soon as I can. In most hospital recovery rooms, orderlies and nurses likely don’t know the patients, or when they’ll be discharged or transferred to a room. There can be lots of traffic and background noise. It’s certainly not conducive to a speedy recovery. Patients often are stuck in the recovery room for hours waiting for an available bed prior to discharge. That’s why I feel the need to go track down post-op patients.
Now compare that to our ASC. In our recovery room, the nurses know exactly who the patients are and which possible side effects or complications to watch for. They are prepared with detailed instructions about medication and follow-up care, and have plenty of time to answer questions (including those asked by family members). In the time it takes for patients to even get out of hospital recovery rooms, they are often on their way home from an ASC.
Still, I’ve had to adjust to finding empty recovery rooms. Normally, I block out time to perform three procedures in a row. On several occasions, after completing my third surgery, I have gone to check on my first patient, only to find that he/she has been discharged already. I have no concerns because I know our nurses make excellent decisions, but still … stable, happy patients discharged with detailed instructions just a few hours after surgery? That’s as pleasant a surprise as finding time for lunch, and a far more important one.
Staff and surgeon satisfaction
Like many surgeons, I am something of a creature to habit. Perhaps some people would call me a control freak. Those tendencies resulted from my inability to control everything that affected my patients. I wasn’t always comfortable with nurses or the quality of post-op care, so perhaps I was too specific and demanding about having things done in exact ways. Today, that’s changed. I work with people I trust and therefore don’t have to micromanage, so to speak.
With owning an ASC, personal and professional satisfaction go hand-in-hand. Shorter and more predictable workdays mean my partners and I have more time to watch kids’ soccer games, play golf or take on more patients. Whatever your goals as a physician, owning an ASC is likely to help you achieve them. Because we are more productive, there are financial benefits to share with the whole team. And with a solid support staff, a strong business plan and a skilled partner to manage operations and financial matters, there’s less worry in the off hours. My stress level has gone down by an order of magnitude.
But it’s not just surgeons who are satisfied practicing in our free-standing facility. The nurses and office staff love it, too. For them, it’s a matter of control and freedom to focus on patients, with fewer bureaucratic distractions. They’re incented to work at the highest levels of quality and efficiency. Some of our people set their own hours. As a whole, our team likes coming to work. Patients can tell the difference, of course, and I’ve no doubt that happier, less-stressed staff provide better care. Put another way, staff and surgeon satisfaction lead directly to patient satisfaction.
And that’s by far the best part of owning my ASC – the increased satisfaction that comes with better outcomes. Seeing patients recover more rapidly and with much less trauma is very rewarding. They come back into the office with smiles on their faces. Make no mistake: patients love the outpatient surgery process, which is why many surgeons do, too.
The bottom line: Change is good
The development of outpatient surgery represents a major change in healthcare. Like the general population, physicians can be resistant to change. They have worked hard to establish themselves and have developed very particular ways of treating patients and conducting surgical procedures. Not anxious to learn new tricks, some surgeons are reluctant to explore outpatient environments.
But for me the transition to owning an ASC has been transformative. It’s no overstatement to say it’s changed my life. I have a lot more influence over the big picture of quality care than I do when operating at the hospital, and seemed to have more control over my personal life, too. I’m convinced that the obvious clinical, lifestyle and financial benefits of practicing in facilities they own will become so obvious to physicians in the coming years that outpatient surgeries will become more like a rule than an exception. In other words, there is lot more change to come. The good news is that it’s definitely change for the better.
—Anthony Coletta, MD, is president of Surgery Center of the Main Line in Bryn Mawr, Penn. Visit The Surgery Center of the Main Line.
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