Palos Surgicenter: 7 Points on Significantly Increasing Orthopedic Case Volume

Rachel Fields -  
Over the last two years, Palos Surgicenter in Palos Heights, Ill., has helped his center almost triple orthopedic case volume with the help of Administrator Thomas Holecek. He discusses seven points on significantly increasing orthopedic case volume in surgery centers.

1. Used renovation as a marketing tool.
In Sept. 2009, Mr. Holecek's center started a 12-month, $2 million renovation construction project. The renovation turned out to be a valuable tool in attracting new physicians: When Mr. Holecek found out that several surgeons were leaving facilities in the community, he used the renovation to his advantage and showed surgeons the benefit of using a recently updated facility. "Once the renovation is done, it's a great tool because surgeons and patients want to come where it's new, clean, functional, upgraded and updated," he says.

The project renovated the center's waiting room and recovery area, adding more pre- and post-op cubicles to improve efficiency, moving GI out of the sterile corridor and updating safety features. Mr. Holecek says the renovation worked as its own marketing tool; with minimal advertising work on his part, patients and surgeons would stop by the facility and ask to see the new building.

2. Kept abreast of changes in the market. Mr. Holecek's ASC partners with Regent Surgical Health for management services, and he says this connection was invaluable in keeping track of newly available surgeons. "A senior vice president from Regent is originally from this area, and although he travels frequently, he still knows, every aspect of every center that's going up, opening, closing, changing or renovating," he says. If a surgeon leaves his or her position at another facility, Mr. Holecek is one of the first to know, meaning he can start recruiting before other facilities find out about the move. Part of the center's success in almost tripling case volume came from the knowledge that several surgeons were leaving their posts at local facilities — and that a recent graduate was moving to the community to join a large orthopedic group.

3. Researched physicians before approaching them. Mr. Holecek advises administrators not to walk into a meeting with a surgeon unprepared. Early on, you need to have some firm ideas about if, and how, this physician will work at your center. Mr. Holecek researched all potential physicians thoroughly to find out their needs, preferences, schedules, case loads and backgrounds. "My approach is to really do all the research you can before you reach out and market to various individuals," he says. "You should strive to learn as much as you can about them, such as where they have been, what they have done and what their preferences are."

By the time you approach physicians to talk seriously about your center, you are in a better position to emphasize your center's strengths and how they are consistent with the surgeon's needs. It also helps if you have already established a connection with the physician's office, as the scheduler and office manager typically serve as 'gatekeepers' to the physician's schedule.

4. Calculated expected case volume for incoming physicians.
Depending on your center's specialty mix and case volumes, some surgeons will be a better fit than others. Before you start talking to physicians about opportunities at your center, do your homework and get a sense of the physician's ASC-appropriate case volume. "With spine surgeons, you can't do any and all spine cases in a [surgery center] setting," Mr. Holecek says. Further, it is just not possible for surgeons in some specialties to bring a large volume of cases per year.

He says ASC administrators must think about the number of cases that can realistically be moved to the surgery center setting. If a physician is bringing high volumes with reasonable reimbursement potential or low volumes with high reimbursement per case, you may want to pursue recruitment. If, on the other hand, a surgeon's volumes will be detrimental to the center, either due to insurance issues, risk or high expense, you may want to wait for another provider.

5. Looked for opportunities to expand sub-specialties. Mr. Holecek had been advised that a new physician was joining the large orthopedic practice that utilizes Palos Surgicenter. "We knew that he was coming and that he had a focus on sports medicine, and I thought that would be a great, great asset to the surgery center," he says. "We really didn't have anyone with a focus on sports medicine here." He gained the support of the orthopedic group and then stayed in close communication with the physician as he made the transition to the new community.

"We met frequently, and I got a sense of what his needs would be early on," Mr. Holecek says. He says this approach is essential when a center is adding a new sub-specialty. If the ASC will need new equipment and additional staff training, talk to the physician beforehand to determine where upgrades are necessary.

6. Refreshed ASC staff on incoming procedures. If you want to impress and please new physicians at your ASC, make sure your staff is well-versed on the incoming procedures, Mr. Holecek says. Nothing will hurt a new ASC-physician relationship like a staff that is unprepared to handle the new cases. "The challenge is having staff that can adapt right away and know the demands of a shoulder operation or an ACL case," Mr. Holecek says. "These are all things you have to start planning a long time in advance before that doctor hits the ground." It helps greatly to have experienced OR nurses on your team, along with a talented director of nursing. He says staff members should be comfortable with the new procedures before the physician's first day.

At Palos Surgicenter, some nurses had previous experience with orthopedics, but their day-to-day work at the center revolved around ophthalmology, pain and GI. In order to prepare them for growth in orthopedic case volume, the director of nursing helped the nurses refresh their knowledge of the more complicated orthopedic procedures. He says cross-training staff members as much as possible makes it easier to schedule cases because providers can transition from specialty to specialty and fill staff absences when needed.

7. Achieved buy-in from existing owners. While Mr. Holecek's center currently has a healthy volume of orthopedic cases, the ASC was originally founded to perform ophthalmology, GI and pain. "Those are the specialties that built this center and made it successful," Mr. Holecek says. He says when the center decided to increase its orthopedic case volume, he made sure to get support from the original physician owners.

"We did have a deliberate goal in mind to ramp up orthopedics, but not at the expense of our foundation specialties," he says. "The physicians knew the potential for growth, and they knew that if we could do this successfully, all could benefit from it." Costs for orthopedic instruments and implants can be overwhelming; consequently, you must be methodical in your approach, he says. Having an established case-costing tool at your disposal can also help explain purchase decisions to physicians.

Learn more about Regent Surgical Health.

Related Articles on Increasing Case Volume:
9 Proven Strategies to Grow Surgery Center Case Volume
4 Steps to More Satisfied Surgery Center Physicians
5 Worst Specialties for Surgery Centers

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