OWENSBORO Perhaps one of the most impactful advancements in the field of surgery has been the advent of technology allowing so many inpatient procedures to become outpatient ones. In 1970, the first freestanding ambulatory surgery center (ASC) opened its doors in Phoenix, Arizona. It was not until 1982 that Medicare approved payment to ASCs. The following year, in December 1983, Owensboro Surgery Center opened its doors.
The Owensboro Surgery Center was founded by a group of 18 physicians and two non-physicians and began as autonomous from the Owensboro Health system. According to Tom Maddox, MD, one of the original investors who is still a partner in the center today, “We primarily started the surgery center because the hospital wanted to do a lot of procedures [as inpatients] because the reimbursement was higher, when the surgeries could be done as an outpatient.” The physicians soon decided to seek the business expertise of a management company partner, and it was in the late 1980s or early 1990s, says Maddox, that the hospital expressed interest in becoming a partner in the surgery center as well.
The resulting ownership structure became a triumvirate of physician partners, Owensboro Health, and a management company. Over the years, the management company changed hands and names several times but today is Surgical Care Affiliates (SCA).
The partnership model allows the physicians to have a limited partnership interest, while the hospital and SCA are general partners, taking the majority of the liability. Currently the center has three physician owners, although that number is in flux as physicians retire and employment statuses change. In February 2001, the center moved to its current location on the Owensboro Health Parrish Avenue campus.
SCA is a full-service management company that operates 185 surgical facilities in 34 states. Their services include a wide array of business and clinical tools and systems that have positioned SCA as an ASC industry leader. The center uses a breadth of metrics to benchmark their operating and clinical outcomes with other SCA facilities and to other centers across the country. Collective bargaining positions and streamlined business practices mean SCA provides cost savings to the surgery center. According to SCA’s web site, their patients pay an average of 40 percent less for identical procedures performed in hospitals nationwide.
All of the surgery center’s team members are employed by SCA. The physicians are independent of the facility but are credentialed on the center’s medical staff.
Another original member of the Owensboro Surgery Center staff is Lyzette Galloway, RN, who began as a recovery room nurse and is now the facility’s administrator. Galloway’s multi-tasking role includes providing leadership to meet the vision and mission established by SCA and the partnership, handling licensing and regulatory issues, assuring the team and facility meet established goals, and assisting with clinical and business issues whenever help is needed.
“At SCA and at the surgery center, we put ‘Clinical First™,’” says Galloway, emphasizing the center’s focus on patient care. In addition, she says, “We try to take really good care of our doctors while we’re taking really good care of our patients.” It’s that attitude that has physicians raving about the care their patients receive while at the center.
The majority of surgeons in Owensboro are credentialed on the center’s medical staff. Galloway estimates about 30 to 35 physicians actively use the center, with 10 to 15 utilizing it occasionally. The number of cases at the center is fluid, changing based on the season and particularly on weather conditions this past winter. The center averages 20 to 25 procedures a day and 450 to 500 a month.
Galloway is not the only staff member with longevity. “Many, many of our teammates have been with the center for greater than 10 to15 years,” she says. “That level of experience speaks for itself.”
Janet Clark, the surgery center’s business office manager, who is Galloway’s right-hand woman on all business matters, has been with the center for 28 years. Her responsibilities include admitting, billing, collections, scheduling, accounts payable, and overseeing all financial communications and reporting between the center and SCA.
The surgery center offers a broad range of surgical procedures. The three most common areas are ophthalmology, endoscopy, and general surgery. Other specialties covered include ENT, oral surgery, pediatric dentistry, gynecology, urology, orthopedics, pain management, podiatry, and plastic surgery.
The entire center’s nursing and support staff is trained to handle every procedure and every patient. “That’s one thing our surgery center really prides itself on: when everyone’s cross-trained, efficiency, customer service, and teammate satisfaction are enhanced,” says Galloway.
Serving a Rural Population
Owensboro is the third largest city in Kentucky with a population of 58,000. The surgery center has a service area that incorporates a seven-county Kentucky Green River District and parts of southern Indiana, including Perry and Spencer counties.
Owensboro Surgery Center Medical Director and physician partner Thomas Furgason IV, MD, is an Owensboro native and an ophthalmologist with Physicians Eye Center. Furgason went to medical school at the University of Kentucky (UK), completed his internship at The Christ Hospital in Cincinnati, Ohio, and his residency at the University of Wisconsin. Following the completion of his residency in 1998, he welcomed the opportunity to return to Owensboro to practice.
Furgason sees Owensboro as a regional medical center and a referral center for the western part of the state. “We have pretty much everything we need for the population in the surrounding area,” he says. Given their service area, Furgason contends the surgery center has a “very high percentage of rural patients.”
“The Staff Here Makes Me Look Good”
Maybe the most telling mark of the center’s success is the ease with which physicians, and staff alike, praise its efficiency, convenience, and affability.
Maddox is a native of Owensboro, who did his residency at UK and spent a couple of years as chief of ophthalmology at the naval hospital in Charleston, SC, before returning to Owensboro in 1975 to found Physicians Eye Center.
As a founding partner in the Owensboro Surgery Center, Maddox’s support comes down to a simple reason: “People ask me why I use the surgery center, and I say, ‘The staff here makes me look good.’ We get compliment after compliment from patients on how well they think they are treated here.” He adds that he has always been extremely pleased with the anesthesia coverage at the center as well.
When the surgery center began, there were not many eye procedures that could be done as an outpatient. Today, ophthalmology cases make up the surgery center’s highest volume of cases. “The use of the center has evolved as technology has improved in different areas, whether it’s orthopedics, gynecology, pain control, or ENT,” he says. Ophthalmology procedures performed at the Owensboro Surgery Center include cataracts, corneal transplants, strabismus, infants with blocked tear ducts, and retinal procedures.
Maddox estimates most surgeons in his practice do 45 to 60 cases a month at the center, plus the retinal surgeon, C. Mark Millsap, MD, who does 20 to 25 cases a month.
Retinal surgery is one of the aspects the surgery center has added over the last several years. “One of the good things about having the hospital and SCA as partners is they have always been willing to purchase whatever we really need,” says Maddox.
Alan Mullins, MD, is a general surgeon from Louisville, who attended medical school at University of Louisville (UofL) and did his residency at the Carolinas Medical Center in Charlotte, North Carolina. He came to Owensboro in 1996 and practices with Owensboro Health Surgical Specialists, an eight-person general surgery group that became employed by Owensboro Health last year.
Mullins is one of the few physicians in western Kentucky who has completed a fellowship in head and neck oncology surgery, which he did in 1996 at Roswell Park Cancer Institute in in Buffalo, New York. He regularly performs endoscopy, skin excisions, breast surgery, laparoscopic surgery, and hernia repairs at the surgery center. As a “smaller, more nimble” facility, the surgery center is more flexible and personable, with good turnover and less bureaucracy than a hospital environment, he says.
“The surgery center has been a real asset to our practice,” says Mullins. “There is an important role for ambulatory surgery centers in the state.”
Roger Humphrey, MD, has been practicing general surgery for 31 years, the last 16 of those in Owensboro with Owensboro Health Surgical Specialists. Humphrey went to medical school at the University of Texas and completed his internship and residency at UofL. He has seen the community’s medical capabilities grow in his tenure there. “There is less that patients have to leave for as time goes on,” he says.
Humphrey, along with colleague Brad Cornell, MD, subspecializes in thoracic and vascular surgery. According to Humphrey, the practice’s volume at the surgery center has increased since it was bought by Owensboro Health last year because of a licensing category change, compelling them to move some in-office procedures to the surgery center.
Of the surgery center, Humphrey says, “The service is top notch. They almost never run late.”
It appears Medical Director Furgason’s vision for the center – “to ensure the quality of care in a more homelike environment, where people are treated in a friendly manner” – is being fulfilled. A key aspect of that quality is the staff’s expertise, which Furgason attributes to familiarity and ongoing education. “We concentrate on doing a large volume of the same types of surgeries, so they are all familiar with exactly the way things are supposed to go,” he says. This results in an experience that is pleasant for both the physicians and the patients.
An Uncharted Course
By now, the uncertainty of the Affordable Care Act (ACA) is a ubiquitous refrain. However, Furgason points to an already positive outcome of the Kentucky Medicaid expansion. “There has been a large surge of previously uninsured patients under 65, who now have insurance, who had terrible blinding eye disease … and have started coming in and getting cataracts removed.” For example, Furgason has seen patients with mature cataracts completely covering their eye and has been able to remove them in an outpatient procedure. “We can get them seeing as well as 20/20 the next day,” he says. Furgason attributes the high percentage of severe cataracts in the area to financial and geographical access issues in western Kentucky.
Business Manager Clark confirms an influx of new Medicaid patients since January but says the center has only seen three exchange patients so far. Clark’s long history with the center gives her a unique perspective on the evolution of payment models. “When I first started here 28 years ago, we had Medicare, Medicaid, and commercial insurance, no contracts, nothing like that,” she says. “Now with the ACA, we don’t just have Medicare and Medicaid, we have the exchange … We also don’t just have Kentucky Medicare and Kentucky Medicaid, but there have also been insurances that have bought Medicare and Medicaid products.”
Clark and the staff are preparing for changes through education efforts, such as seminars and conference calls with SCA. “From what I’ve read and what I’ve heard, it’s going to be the biggest change since Medicare was implemented in 1960,” she says.
Regardless of who’s paying for the procedures, Furgason believes ambulatory surgery centers represent a growth opportunity for the future. He says, “I think they provide a lower cost alternative to main hospital ORs. I really think surgery centers will become more popular in an effort to maintain cost.”
WE TRY TO TAKE REALLY GOOD CARE OF OUR DOCTORS WHILE WE’RE TAKING REALLY GOOD CARE OF OUR PATIENTS.– LYZETTE GALLOWAY, RN, ADMINISTRATOR
THE ACA IS GOING TO BE THE BIGGEST CHANGE IN HEALTH CARE SINCE MEDICARE WAS IMPLEMENTED IN 1960.
SURGERY CENTERS PROVIDE A LOWER COST ALTERNATIVE TO MAIN HOSPITAL ORS.