Transcript
Speaker: Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guest, and then we'll close the episode by recapping the latest news impacting surgery centers.
Speaker: We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Speaker: Hey everyone, here's what you can expect on today's episode. I sat down with Amy Swaffer from Knoxville Surgery Center during HST Connect to talk about what it really takes to build and lead an ASC from the ground up. Amy spent 22 years working at a level one trauma center before making the jump into the ASC industry and helping launch a brand new surgery center.
Speaker: We talked about what that transition was like, what she had to learn along the way, and why building the right team around you is so important. We also get into some of the lessons Amy learned while opening the center from building workflows and choosing technology to creating a culture where employees actually feel supported.
Speaker: And one of the most interesting parts of the conversation is how Knoxville Surgery Center ended up building its own anesthesia group after their original anesthesia partner could no longer provide coverage.
Speaker: So if you're new to the ASC industry, in the process of building a de novo center, or you've ever considered building your own anesthesia group, this episode is definitely for you. Make sure to stick around after my conversation with Amy because we have a lot to cover in this week's news.
Speaker: We're talking about insurers getting more aggressive, about steering procedures toward ASCs, a major new CMS model that could impact the future of outpatient joint replacements,
Speaker: and what increased regulatory scrutiny of ASC acquisitions could mean for the industry as a whole. Plus we'll wrap things up with a much lighter story involving stroke rehabilitation and a few very good dogs. I hope everyone enjoys this episode and here's what's happening this week in surgery centers.
Speaker: So 22 years ago, I started at a level one trauma center at UT Medical, and I've worked with the same group of surgeons this whole time. They had an idea to open an ambulatory surgery center and approached me with that and thought that I might like the transition from trauma to an ambulatory setting since I've done trauma for so long. So, and I'm honored that they have, they trusted me with this brand new baby that they're that they were opening. So it's been a fun adventure.
Speaker: I bet it has. It's also sound that sounded like it's been a ah stressful and a lot of work for you. oh yeah. All the things. Yeah. and So talk about that transition from working at a level one trauma center, you said? Yeah. To to an ASC. What was that like? I think it gave me a lot of tools to use to transition to ambulatory surgery centers. so In trauma situations, you have to learn to anticipate, to think quickly on your feet, to communicate with different departments, different personalities, and take care of a patient at the same time. So those things I had going for me. yeah The other things that I had to learn were
Speaker: what I'm used to having the hospital do. So they have huge departments that deal with quality, departments that deal with the pharmacy situations, things like that, that you are now dealing with. So it's a lot.
Speaker: It's a lot. And it makes you appreciate those departments doing those things for you when you're in the hospital. But it's also really cool to be able to customize them and to kind of pare it down to what you're focusing on at your center. So That makes sense. I mean, it sounds like you you basically had to put on your entrepreneur hat.
Speaker: Yes. And learn a bunch of skills and wear a bunch of hats and kind of step outside your comfort zone to some degree. and Oh, absolutely. Absolutely. But I had a lot of people that helped me out. So I've been a long-term member of AORN and...
Speaker: recently in the last few years, an ASCA member, going to conferences, building up those friendships with other people that do what I do and reaching out to them and leaning on them pretty hard. And that's really helped the whole process.
Speaker: So I bet. Yeah. Networking is huge. So if you if you haven't done that, you should really do that because you never know when you're going to need it in the future too. So and that's helped a lot. Well, it sounds like that's how you got this opportunity was based off of who you knew and your network. yeah Yeah. Otherwise, you know, you may never have gotten the opportunity. That's exactly right. Because, i mean, coming from a level one trauma, who would think somebody like that did open a center? So i felt very honored that they knew i had it in me to do it. so Yeah.
Speaker: Yeah. Yeah. Well, don't you think that's you're kind of like the perfect fit for maybe opening up an ASC, having that much experience inside of a hospital or Yeah, definitely the interoperative portion of things. So it's helped me with a lot of things. It's helped me with the materials management part of things, building our trays and the clinical work that happens in the operating room. The the rest of it, I tried to hire people that were way smarter than me and other areas. So like pre-op area.
Speaker: sterile supply, those things I knew a little bit about, but not not to be able to make policies and procedures around those things. And so that helps too to hire people that are smarter than you in the areas that you are lacking in. So that's huge.
Speaker: Absolutely. So which parts of hospital leadership prepared you the best, would you say, for running an ASC? I think just my role in the intraoperative area, because the the materials management part of things is huge. So when you know the physicians and their procedures, what they like to use on their procedures and the instrumentation that they like to use, that's huge. And even in the cost savings portion of things, instead of just buying in bulk, just in case, let's use this. I was really in tune to what they used and was able to kind of build materials management around that. So I think that that was my biggest part. Everything, a lot of other things I've just kind of learned on the way and went to classes and webinars and conferences and continuously learning and building on that that I didn't know. So yeah. And i know in previous conversations you've mentioned
Speaker: learning the language of ASCs was something that was was like a sticking point for you. Yeah, ASC folks speak in acronyms. So when I first went to my very first conference, it was really strange. I looked up a lot of acronyms because that's just, that's how they spoke. But after a couple of years, it's become normal to me. And know what they're saying now. It's so nice. I can speak the language now, but it is definitely something that you have to get used to. All of the acronyms.
Speaker: Yeah, it is. It took me quite some time learn everything and still learning. yeah There's new ones that pop up almost every day. Absolutely. Absolutely. Yeah. i still look up a few from time to time. Whenever one comes up, it's I try to go to ChatGPT as soon as possible. Yeah, that's super handy. So yeah, I do that too.
Speaker: That's funny. And so what would you recommend to someone that would want to move over to an ASC setting? What would you recommend that they get into first? They learn. What should they consider? I feel like when you first step into the role, it's super overwhelming just because there's so many things to do. And ah feel when you first go over, you you don't need...
Speaker: You kind of feel like you need to do everything, but you don't. You don't need to know everything. You don't need to do everything. Like I said, you need to hire people that know other things that you don't know. You need to go to conferences and webinars and figure the other pieces out. But it's definitely, you're kind of building the plane while you're flying it the whole time. So just you don't feel like you have to do everything at once. Learn little pieces at a time. But it is quite overwhelming at first. So I can see where people would get really frustrated at it.
Speaker: that it just takes time to get used to things. Yeah. And learn. Totally. And i guess as you moved over and you were building the plane as you you were flying it and you were looking for people that could fill in the gaps for you, how did you go about finding those people and sort of determining what those gaps or your knowledge or your expertise were? And you kind of have to re it's, it's sobering realize, okay, I really don't know this. How did you kind of go about that?
Speaker: Actually, I think I got really lucky. i got really lucky. Friends with the right people that brought people to me and were like, this person does a really good job and you might need to talk to this person. And we sent out ah messages through Indeed to try to find people to filter through some of those resumes. And just for example, the lady that we have that runs our sterile supply department, she's amazing. Came from California, knows all the rules and regulations.
Speaker: And wants to do the best job possible and follows all the rules so we don't get in trouble with it. Because I don't know the rules and I'm lean leaning on her to know those rules.
Speaker: but We sent her to AAMI, I think is the sterile processing. So just standing behind those people and supporting them, sending them to conferences as well so they can learn more about that side of things. i think that's great. You got to support your people. Totally. Yeah.
Speaker: I mean, that's what I think the best leaders in the world are able to realize that they aren't an expert in everything. that's what the best CEOs do. That's what leaders of of our governments do. yeah You have to have your subject matter experts. so You do, for sure.
Speaker: You know, that makes you an expert for being able to do that. So we were talking earlier and this is kind of a sidestep, but You mentioned that you guys started your own anesthesia group. And I think that's something really interesting that we should talk about.
Speaker: So what sort of led you guys to going down that path as opposed to continuing to partner another anesthesia group? So funny enough, we were at the ASCA conference and we were socializing and learning and doing all the things.
Speaker: And in the middle of it, we received a phone call and it was a phone call from the group that we had in place to start our ambulatory surgery center. And unfortunately they were not able to commit to that. And so we lost that group and we were crushed about it and didn't really know what to do about it. And so We had fun at the conference and learned a lot. And then when we got back home, it was time to start thinking about what we really wanted to do. And that was the next logical step, be honest. So started that it's been the best thing. It's been the best thing. We can control the controllables.
Speaker: Our anesthesiologist that is taking care of all of our patients, he actually does the pre-op phone calls. Patients love that. And also it's great too, because he already knows all the patients when they come in.
Speaker: He's had a conversation with them. And if there's something that's wrong and they need additional testing, that's addressed right then, right when he makes that phone call. So it also helps with delaying a surgery, a possible delay. You can go ahead and send them for the testing and make sure everything's okay.
Speaker: And if they're okay to come to the surgery center, that's great. But if they need a higher level of care, then we know that and we can go ahead and send them. And it makes the process a little bit quicker, I think. That makes sense. I mean, there's just less on tag, basically.
Speaker: And it also helps me too. So say if we had incidents with urinary retention or something, and it was a PACU situation, how can we help prevent this? Or i don't have to go through a lot of, I just go straight to him and we have a discussion about it. And then we bring in other team members to see what we can do to fix the problem because but he's the communication. It's amazing. i love it.
Speaker: So had you guys already started? You had already opened your doors and the previous group, they had dropped it before you guys started. What was the reason for that, if you don't mind sharing?
Speaker: I think that it was staffing. Okay. I do believe. so it was just a limitation of what they could actually cover. They were covering a major hospital and then they were also covering several ambulatory surgery centers. And i think it was us and another ambulatory center while they weren't able to pick up.
Speaker: And you were saying that this is sort of becoming a more and more common thing for ASCs from what you've heard. When I've gone to conferences and anesthesia surely is one of the top conversations. And it is definitely the elephant in the room with a lot of things. And i feel very privileged that we have what we have going for us. It's really working out. And it might not work out for other people, but it works out for us. Interesting.
Speaker: That's, and for most ASUs, that's a struggle. So to hear bringing it in-house sort of, you weren't even planning for it, but it just, it was like a blessing in disguise. I was. any Anything else that you think people should know about starting your own anesthesia group?
Speaker: Well, you have to make sure you have coverage for vacations, lunches, stuff like that. So we do have PRNs in place that come and do those things. So you can't just hire an anesthesiologist and a couple of CRNAs and just go for it. But you have to have breaks and lunches and and vacation time.
Speaker: You have to make sure you're covering all that and that you have people that can come in and do those kind of things for you. So yeah, that's that's probably one of the bigger things. Just make sure because if you don't have anesthesia, you're not really doing any work. So you have to make sure those things are covered and you give those people breaks and We'll change topic a little bit. And I wanted to get back to you starting your center. So in a hospital, leaders are often handed entire system and and just told how to use it. But when you were asked to come and start ASC, you kind of had to build that that whole system up from the ground up. So yeah talk talk to us about what that process was like.
Speaker: Well, we wanted to make sure we chose what we wanted. and And so we did a lot of homework on the back end, but we wanted to make sure we could take care of the patient from the time they entered our doors to the time they left and the workflow was easy to do. I think easy is the biggest thing for me because I'm not that great at computers. So having it be able to chart really easy, you have the green check mark saying that you're completed in that area.
Speaker: As easy as you can make charting is what I like. And I felt like it was pretty easy to use HST. Yeah. Yeah, that makes sense. Yeah. And so when you were, when you were evaluating those, those options out there, I assume you were probably looking at it from a nurse's lens, like this is what I would want in my own system.
Speaker: What other things did you realize in that process that you're like, okay, wow, I, it's not just about charting though. Well, I feel like your computer system is like a roadmap. So like the connective tissue, so to speak, but it gives you a a map on how your patient is supposed to go through your center. And when we were first doing it and we had our first few patients through, and we would stop back and stop and look back and say, what was easy? What was hard? What do we need to change? What was excessive about what we were doing with the computer? And then as we started doing more and more cases,
Speaker: You just ask the people that are working the system. So everybody that works with us, you just stop and ask, where's the model next? What's happening? What are we doing repetitively? what What are we making hard? What can we fix to make it easy? And so you go through and ask all those questions and try to because you customize it and you think, yeah, I'm ready to go. But then when you actually move patients through it, it's a little bit different of a view.
Speaker: and And once you start moving more and more patients through felt like we needed to stop every now and again and just reevaluate what we were doing and and redo some charts. And my pre-op manager, nurse manager. She's great at computers. And those were some of the the things that she would do. She would help us clean things up on that end. So a lot of phone calls to HSD and help on that end too, to try to make it what we wanted it to be. And the least amount of charting, covering everything that we're supposed to cover.
Speaker: get the patients in and out the door as easy as we can while making it easy for the staff to use as well. We had one issue where we were using the system to tell people, the tech system to tell people when to show up for surgery. And we kind of entered everything in and didn't really have a second thought about what time we were sending that out.
Speaker: And we had some complaints. Patients called and were like, oh you're sending me this really early in the morning. And so we had to go back. And what makes sense for us doesn't usually make sense for a patient on the other side of things. and so that, again, is where Prescani kind of helps you, too. You go through and and read those comments. And it's like, well, we can apply that, too, to what we're doing at the center to try to make things better. So you use all your different resources to try to help make your patients EMR of what you want it to be. Totally.
Speaker: And for managing, i'm sure you realize that there was managing inventory and coordinating your cases and just everything that goes along with it. What other lessons did you have during that first six months that came up? Anything else that you want to share?
Speaker: Just to make sure that you're doing everything that's right for the patient and for the safety of the patient. And to, I think we built our surgery center around our patient and around the people that are working there because we wanted to get good place to work. We want to take care of patients and do great clinical work as well. So as long as you have your focus on that, I think everything else kind of works itself out.
Speaker: So... What are some tips for making it a great place to work for your employees and a great place for your patients? yeah What are some things that you guys have done? I'm very much a servant leader. kind of lead from the pack. So most days I'm rarely in my office. I'm in scrubs, taking care of patients too.
Speaker: and Making sure our staff is taken care of. want to make sure everybody gets out at the time that they need to be out. I learned that in the hospital settings. So when somebody gets off at three, or you don't need to let them hang around until five and keep working. you need If that's happening, you need to hire more people or rearrange schedules and things like that. So we want to make sure people still have a great work-life balance. and It takes some hard work to do that, but it really...
Speaker: helps It helps people because you got to have a job. It's hard times. You got to work. I got to work, but you don't have center your life around it. yeah So that I'll go in and if the nurses are in procedure rooms and they're going to be staying late.
Speaker: I'll go relieve them and make sure they go home on time. Wow. And make sure they get lunches if we have call-ins and people on PTO and things like that. So always take, if I take care of my people, and they can take their care the patients. So I feel like that's what I need to work on is to take care of all of my people.
Speaker: And if I do that, then everything else is easy. i mean, they're going to take care of the patient. That makes so much sense. that You're paying it forward. And I know when I'm happy, I'm my best self for sure. Yeah. And our anesthesiologist, he helps too. He's definitely a part of leadership as well. And he gets in there too and helps and helps take care of patients and relieves some of that off of folks too. So he's always, yeah he carries his laptop around and he moves around the center and he's always available in there. And so he we're a lot alike in that realm. So helping helping each other out and helping our folks out. And I think good leadership really is the key to making a successful business and successful ASC. wouldn't even know how to micromanage. i have no idea. I mean, micromanaging is, it's a common thing because. have no idea. Yeah, it's tough. It's tough working. I've worked in those settings before. I wouldn't know how do it. makes you want to rip your hair out. yeah I wouldn't know how to do it. So that's part of hiring good people too, is you can trust them to just do the work that they know how to do. Yep. You got to take care your people, support them, and send out education. So we're getting ready to start doing some lumbar fusions here in the near future. And we're partnering with a ah nearby rehab physical therapy group. And they're going to come in and do some education for our nurses, show them how to
Speaker: walk walk patients with a walker. i feel like PACU and other areas may not do that. When you're in a hospital setting, you have PT that comes and does it. So to make sure they have their appropriate education and feel good about walking those patients after they have surgery done. So things like that, you got to make sure they have the education and the foundation to be able to do the job that you're asked to yeah And so that's another way So knowing what you know now, what would you do differently if you were to go start an ASU from scratch again? Oh, so many things. I mean, we had someone helping us along the way, which was, I don't know how we would have done it with without them. So we had it as someone leading our path, which was amazing. But everything takes longer than you think it's going
Speaker: Whether it's ordering equipment, Seesaws took a long time, but just plan for those things to take a minute. It's going to take a little bit. So that is one thing. And he kind of told us that too. He was like, need to start on this because it's going to take a little bit. so So he gave us that heads up, but i had no idea it was going to take as long as it did. but yeah So definitely that, watching what takes so long, equipment.
Speaker: Seesaw's was huge. That took a long time. I think just planning for those gaps and what you can do in those gaps. We only hired a small group of people. So there was about five of us that was actually doing the startup on things with the policies and procedures and going through the building and making sure everything was the it needed to be and ordering supplies and buying the racks and putting them together and doing all that stuff so we didn't really start with a huge staff of people and we started with a very small we started with myself our pre-post-op manager our spd manager okay and oh a couple other folks and that was about it yeah i mean you got to start scrappy and small and hire as you go yeah or you don't have anything to do it's hard to spread all that out i mean there's plenty to do but it's hard to delegate certain things because there's certain things you really need to do yeah but but yeah they're
Speaker: We were all really busy. So, yeah. oh I bet. But it did and There was a lot of things that took a lot longer than we thought. So I think that's the biggest thing is to get going on those things early in the process. So.
Speaker: Makes sense. Yeah. And we do this last question. What's one thing that our listeners can do this week to improve their surgery centers? I think the biggest thing is to listen to your people. The people that that work in the or the ones that run the front desk, the ones that are in pre-post-op, interop.
Speaker: What are they running into that is that needs changing? You can learn a lot from just a sit-down conversation with everybody to to see what changes need to be. What are your frustrations?
Speaker: What are we not doing good? What can we do better? yeah so just having those frank conversations and having an open-door policy to those kind of things I feel like anybody on my team would come into my office and tell me anything they wanted to tell me. So that, but you learn from that and you can fix things and ease those frustrations and smooth things out a little bit. And it doesn't just help everybody that you're working with. it helps your patients too. So yeah, absolutely. Yeah. Well, great advice, Amy. Thanks so much for coming on. Thank you.
Speaker: Thanks again to Amy for joining me at HST Connect and sharing what she's learned from building and leading Knoxville Surgery Center. I really liked her point at the end about listening to your people, whether you're opening a new center or trying to improve one that's been operating for years.
Speaker: The people doing the work every single day usually have a pretty good idea of where the friction is and what could actually be better in your center. But before we get into this week's news, I wanna ask a little support from everyone listening.
Speaker: HST Pathways has been nominated in several categories for the inaugural Ambulatory Surgery Center News Product of the Year awards, and voting is now open through September 30th.
Speaker: If you'd like to support us, we'll include a link to the voting page in this episode's description. You do need to be subscribed to Ambulatory Surgery Center News in order to vote, but subscribing is completely free. And once you're subscribed, you can review this year's nominees and cast your ballot.
Speaker: And if HST has helped your surgery center, we'd really appreciate you taking a minute to vote for us. And as always, thanks so much for listening and supporting the show. Now let's go ahead and take a look at the latest news impacting the ASC industry. First, we're seeing another sign that payers are getting more aggressive about steering appropriate procedures towards ASCs.
Speaker: Independence Blue Cross and Highmark have both implemented policies designed to favor ASC, blah, blah, blah. Independence Blue Cross and Highmark have both implemented policies designed to favor ASCs for certain elective procedures.
Speaker: The reasoning is pretty straightforward. ASCs can provide many of these procedures at a lower cost than hospital outpatient departments while still delivering high quality care, if not even better care.
Speaker: What's especially interesting is how health systems are responding to this. According to Ambulatory Surgery Center News, some health system leaders see the shift as an opportunity to move appropriate cases into a more efficient setting.
Speaker: Others, on the other hand, are pushing back because they can receive higher reimbursement for those same procedures inside of a hospital outpatient setting. But for ASC leaders, the bigger takeaway here is that site of service isn't just being driven by patients, physicians, or even CMS anymore.
Speaker: Payers are actually becoming more active participants in deciding where appropriate procedures should actually happen. And that makes payer relationships, contracts, available capacity, and your ability to demonstrate quality even more important as the shift to outpatient care continues.
Speaker: Next, there's a major new development in joint replacement reimbursement. CMS has finalized an expansion of its comprehensive care for joint replacement model called CJR-X.
Speaker: Beginning January 1st, 2028, most eligible hospitals nationwide will participate in the model for hip, knee, and ankle replacements performed in inpatient and hospital outpatient settings.
Speaker: Hospitals will be financially responsible for the quality and cost of that care through the first 90 days of a patient's recovery. Now, ASCs aren't directly participating in CJR-X, but I still think it's worth paying attention to.
Speaker: The model puts even more emphasis on coordinating the entire episode of care and determining where that care can be delivered efficiently. For ASC leaders doing total joints, it's another example of reimbursement moving toward accountability for the full patient journey rather than just the individual procedure.
Speaker: And as these models evolve, understanding your costs, your outcomes, and where your center fits within that broader care continuum is only going to become more and more important.
Speaker: Our third story is another sign of just how closely the ASC market is being watched from an investment and regulatory perspective. The Federal Trade Commission has finalized the divestiture requirements tied to Ascension's $3.9 billion dollars acquisition of As part of the final order, Ascension is required to divest six AMSURG-owned surgery centers across Tennessee, Oklahoma, Texas, and Kansas to SCA Health.
Speaker: Another ASC was required to be sold as part of the broader transaction. And the FTC's concerns were that owning those centers could reduce the competition in certain local markets.
Speaker: For the industry overall, I think it's another important reminder that ASCs become a larger part of healthcare care delivery, deals involving surgery centers are going to attract more and more attention from regulators.
Speaker: We're seeing more investment in the space, more consolidation, and more organizations competing to build their outpatient footprints. But growth of that scale also means regulators are going to look closely at how individual transactions affect competition within local markets.
Speaker: And finally, let's end with something a little bit lighter. Researchers at Mayo Clinic recently looked at whether therapy dogs could actually improve inpatient stroke rehabilitation. Patients who participated in rehabilitation sessions with therapy dogs showed greater engagement, increased physical activity, and spent more of their sessions being mobile.
Speaker: And when you think about it, it makes total sense. Instead of just asking a patient to walk down a hallway, they might be walking with a dog, playing fetch, or interacting with the animal as part of the therapy.
Speaker: So apparently one strategy for getting patients more excited about physical therapy is pretty simple, just to add a dog. I'm not sure that solution obviously translates directly to the ASC setting, but I'm guessing there's probably at least a few people listening out there who wouldn't complain about having a therapy dog roaming around their center. And on that note, that's all we have for this week.
Speaker: Thanks again for listening to This Week in Surgery Centers. If you found this episode at all helpful, you enjoyed listening to it, we'd really appreciate it if you share it with a friend or a colleague. It's the best way to support the podcast and help us grow.
Speaker: We'll see you again next week.
