8 Steps for Opening a Spine ASC on a Tight Schedule

Written by Laura Dyrda | April 19, 2012 | Print  |
Richard Kube, MD, an orthopedic spine surgeon, formed Prairie Spine & Pain Institute in Peoria, Ill., three years ago with the goal of becoming a comprehensive integrated care spine center. This month, he got one step closer to his goal by opening an ambulatory surgical treatment facility, fully accredited by the Accreditation Association for Ambulatory Health Care. Prairie SurgiCare was designed for exclusively spine and back pain patients, and with a strict timeline Dr. Kube and his team were able to open the center only three months after beginning the project.
"Demolition on our building started on Jan. 4 and we had the certificate of occupancy by Feb. 15," says Dr. Kube. "We began doing small cases by the beginning of March. The AAAHC survey was at the end of March and we received approval on April 3. That's a short timeline." Also of note, is that the AAAHC accreditation surveyor found zero defects and praised the facility as one of the best he had ever seen.

As the facility received accreditation without any deficiencies, Dr. Kube commenced performing minimally invasive lumbar fusion procedures on-site in early April 2012. His current schedule includes patients for cervical disc replacements, fusion procedures and pain management treatments. "I could convert about 80 percent of my practice outpatient using minimally invasive techniques," says Dr. Kube. "I don't do major reconstruction of the spine in outpatient facilities, but there are other types of procedures where patients can go home the same day."

There were several factors allowing Dr. Kube and his team to open the center on such a short timeline and experience success despite the recession. Here, Dr. Kube and Chief Operating Officer of Prairie SurgiCare Scott R. Anderson discuss the key elements of their success.

1. The goal was clear.
Dr. Kube's goal was to have the surgical facility up and running by the beginning of April, and everyone understood their roles in making it happen. In the long term, Dr. Kube's goal was to create a comprehensive integrated care spine center, which means significantly expanding the services his group currently provides. He also wanted to increase the number of physicians working out of the center and expand to satellite offices throughout Illinois.

"Being able to bring on more spine and pain specialists will add a ton to the practice," says Dr. Kube. "We are also opening up satellite sites and depending on how well that works we'll be duplicating our services in each of the new satellite office locations. The patient volume is there and the satellites are spread out far enough that it makes sense to move forward."

In addition to spine surgeons, Dr. Kube would like to bring on interventional pain physicians, occupational therapists, physical therapists and social workers for patients who deal with chronic pain.

2. Decisions were made quickly and efficiently. At some facilities, it takes an entire committee to make decisions, especially when it comes to spending money. These committees take time and energy away from the practice, making the group less nimble. However, when surgery centers have fewer people who are all empowered to make decisions, the process goes much more smoothly.

"A committee of one doesn't hurt when you need a decision made," says Mr. Anderson. "The decision can be made in one minute flat. Dr. Kube provided our entire team with the latitude to make decisions about the project. That was a big part of the equation; he knew what he wanted and we were able to implement it fast."

For example, there is often a lot of discussion around which implants surgeons use and whether surgeons can purchase a more expensive device for certain cases. For Dr. Kube, this decision is easy.

"When it comes to whether we can use products that will cost us $15,000 to $20,000, most places have a committee to figure that out, but we figured it out on the same day," says Dr. Kube. "There was another issue about which air flow system to use to make sure air being pumped into the operating room was clean and sterile. We have a rule of thumb that we will always error on the side of patient care. Even if a better system costs extra money, we can usually recoup that in the 12 month cycle."

Everyone on the team was able to make the appropriate decisions quickly so the project could move forward on the compressed timeline. "There are little challenges but our goals are to solve the challenge in real time and move forward," says Dr. Kube. "Otherwise, the challenges will back up and become more daunting so we wouldn't be able to adjust them to our goals."

3. Leadership was experienced.
Before joining Prairie Spine & Pain Institute, Mr. Anderson had experience opening multiple medical facilities, including pain management facilities, and was able to draw upon that expertise throughout the process. "We had an experienced COO and his perspective was very beneficial," says Dr. Kube. "It's crucial to have someone with experience and the ability to guide a variety of people and skill sets."

Mr. Anderson had experience with the accreditation process in the past and was able to equip Prairie SurgiCare with the appropriate policies and procedures to ensure the survey went on without a hitch.

4. They weren't afraid to hire consultants. There are several aspects of healthcare business that benefit from the knowledge of experts, which in some cases means hiring consultants. Dr. Kube hired a consultant to produce policies and procedures for the center that would give his center a professional edge.

"The policies and procedures are very important pieces of the process," he says. "We used existing polices and procedures to start the project and received example policies and procedures from consulting firms as well. I hired a consultant to make sure everything was professional." We used Bell Design Technologies (Dr. Edith Bell) as well, as they specialize in rapid deployment of a wide variety of business performance and process improvements.

The center also had a consultant on equipment and supplies. "Our consultant for materials acquisition made sure everything was available and in place when we were ready to go," says Mr. Anderson. "We brought everyone in and shared our plan. We let them know the value of time and set key milestones to make it happen. If they couldn't hit those milestones, we used someone else."

5. The community was supportive.
Many of the vendors and contractors working on the Prairie SurgiCare project were local, and the city of Peoria really supported Dr. Kube's vision. "We were very fortunate to have a local government that worked closely with us," says Mr. Anderson. "The city of Peoria is very pro-business."

Local companies were able to provide all of the mechanical work, electrical installation, plumbing, oxygen systems and building design. The team's architect and general contractor worked with the "Physical Environment Checklist" that was provided by the AAAHC to make sure the facility included all the right components for accreditation and overall patient safety.

6. Incentives were provided for construction to stay on time. One of the biggest hurdles for any company trying to open a new facility occurs when the construction company runs behind. Appropriate incentives can make sure the construction company and workers are on the same timeline as the ASC.

"The key was putting a Gantt Chart in front of them telling them what we wanted to do and asking whether they wanted to be a part of it," says Mr. Anderson. "We gave them a contract with significant deducts if the construction wasn't finished on time. There was a 15 percent profit if the project was done on time; that was cut to 10 percent if the project was finished one week late and 5 percent if they were two weeks late. If they were three weeks late, they were to be paid equal to their costs. You can't always do that, but sometimes it works." The good news for the contractors is they were paid according to their full rate, as they got everything done according to schedule. Incentives can be a powerful tool to get a project done on time.

A construction supervisor was hired that worked for Prairie SurgiCare to rapidly implement all of our requirements. Dr. Kube was willing to invest more upfront to have the project done quicker because the return from having the center open and doing cases would recoup the cost. "If the building takes an extra two or three weeks to complete, that's a loss of revenue," he says. "The extra we spent to make sure it was done on time was easily off-set by having the center open."

7. Employees were valued throughout the process.
Having a strong support staff is crucial for success with any new surgical facility. "We hired a phenomenal Director of Nursing (Ms. Nicole Dentino, RN) who worked on credentialing and certifications, to make sure all the pieces of the puzzle were together," says Dr. Kube. "Every single person has to feel valued in the equation if you are going to do this."

Staff members quickly committed themselves to the project and were able to overcome any obstacles set in their path. The standing joke was that no one would ever work more than seven days a week, no matter what….

"To be successful you have to put in the effort and perseverance to do the job," says Dr. Kube. "Being on a team that really kept their eye on the ball for the entire 12-week process was crucial — the genie in the bottle. You need a lot of people who are interested in staying positive; we didn't have any negative energy."

It's also important to maintain that level of quality. Throughout the process of opening the center and achieving accreditation, staff members met daily so everyone was on the same page. "There were lots of checklists and coordination during those daily meetings," says Mr. Anderson. "We wanted to make sure we reviewed every issue at the beginning of the day and then reviewed it the next day to make sure it was fixed."

8. They were willing to invest in new staff members.
Hiring new staff members can be a challenging process and you also want your staff members to stick around because employee turnover drains resources from the center. To find quality personnel, surgery centers must look beyond the resume and invest in their new employees.

"We have never placed anyone in our center based on their resume alone," says Dr. Kube. "We also consider their personality, work ethic and culture. We aggressively interview people and see if they flinch; when they flinch, we know they won't fit into our group."

Even though the most qualified people command higher salaries, paying for good staff members who will stick around is often less expensive than paying for mediocre staff members who may be gone within a few years.

"There is a tendency for a lot of folks to try to squeeze the overhead down by a few percent by paying employees less," says Dr. Kube. "At the end of the day, having a quality staff that is paid well eliminates turnover and promotes employee satisfaction. Positive energy is worth several percentage points in overhead."

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