Development of Freestanding Ambulatory Surgery Centers

In 2016 it was clear that the future of interventional radiology was not confined to the acute care setting. As an independent interventional radiologist, I was consulting patients for a variety of ailments, such as peripheral artery disease, uterine fibroids, pain management, adjunct oncology therapy, dialysis work, and benign prostatic hyperplasia. As treatment therapies for such conditions were successfully being performed outpatient, the idea of opening our free-standing Ambulatory Surgery Center (ASC) was born. With the shift from volume to quality-based payments, the increase of Center for medicare and medicaid services (CMS) migration of procedures to the outpatient setting, and the limitations of a large hospital system, I quickly recognized the need to think outside of the box and create a strategic plan best for stability and growth.

At that time I was the president of one of the largest radiology groups in Nebraska and as an active interventional radiologist had begun encountering challenges in my own clinical practice.

I was treating patients for various procedures in the hospital outpatient department (HOPD) setting and in turn patients were complaining about the cost to be treated at the hospital. I was lucky to find a local ASC to practice at. While practicing at an orthopaedic dominant ASC, I quickly realized that interventional radiology was perfectly suited for an outpatient setting. In very little time, I realized the vast benefits an ASC could deliver. I was completing 5 to 10 cases a week in the ASC with most lasting 30 minutes or less and patients being discharged the same day. It was apparent that a free-standing surgery center would offer many benefits and address the main goal of the quadruple aim: improved patient experience, better healthcare outcomes, lower cost, and improved staff experience.

As a physician leader in a progressive radiology practice that supported an interventional service line, the idea of us creating our own freestanding surgery center became reality. After a long-debated discussion, the group agreed to invest in a center. The first idea was to add a two-room surgery center into our existing imaging center; however, we quickly realized that with the growth potential of the outpatient market and the challenges of running an ASC in an existing clinic justified the need to consider a different option.

At that time, myself, our COO Georgia Blobaum, and my other interventional partner Dr. Eric Vander Woude set out to arm ourselves with knowledge and understanding of what it would take to build a highly specialized center offering innovative care in today's healthcare landscape. While I toiled away dealing with the finances of the project negotiating bids and contracts, Dr. Vander Woude worked tirelessly with the architects and construction team to make sure we had an elite product. The team partnered with Avanza Healthcare Strategies, a reputable ASC consultant to guide us on the steps and legal requirements of an ambulatory surgery center. Ambulatory Surgery Centers have a unique set of requirements that necessitates a thorough analysis, expertise, and guidance. Centers with cardiac and vascular specialty amplify the requirements and providers need to be vigilant with the program development to ensure compliance, quality, and safety in a highly regulated environment.

An economic impact study was completed to ascertain the need for a surgery center in the Lincoln community, determine the physical size and location, and focus on the types of procedures to be performed. Construction of the Advanced Medical Imaging Surgery Center began in August 2018, adjacent to an outpatient imaging center also owned and operated by RA Imaging. The project team included a general contractor, an architect, engineers, and design. The 7.5-million-dollar, 11,500-square-feet surgery center includes one state-of-the-art hybrid operating room, two surgical suites, and three procedure rooms. The one-story building is designed to include a future expansion for future growth.

The most important step came after the realization that we needed someone who had experience in the surgery center market to become the operation leader of the center. The expansive regulation and bureaucracy that went into the startup of the ASC is far beyond the scope of a full-time practicing interventional radiology physician or a radiology practice. With that knowledge we hired the most important cog in our wheel, Karissa Mercurio, MSN, RN, as the director of the surgery center.

The center then successfully completed Deemed Status Accreditation by the Accreditation Associated for Ambulatory Surgery in February 2020 under the leadership of Karissa Mercurio, MSN, RN, director of ambulatory surgery, and myself as medical director, with the help of my diagnostic partners. They understood the value of diversification and collaboration with interventional radiology and saw the potential of long-term success. Our diagnostic partners working alongside Karissa, our director, and myself tweaking contracts and negotiating payor agreements helped move us in a successful and profitable direction in four quarters. After opening in March 2020 and under a global pandemic, Advanced Medical Imaging Surgery Center has quickly become financially profitable and has serviced over 4,500 patients.

To maintain physician independence in the community and enhance the feasibility to quality outpatient services, Advanced Medical Imaging Surgery Center has collaborated with other service lines, such as breast, orthopaedics, podiatry, and plastics. Enhancing service lines was simply inevitable to achieve the goal, provide a better experience to patients, lower cost to both patients and payers, and provide physician entrepreneurs the freedom to operate and provide excellent patient care in a constantly evolving climate.

In summary, if you are considering building an interventional radiology surgery center, my advice to you is: hire a reputable consulting company with great knowledge and experience in the surgery center environment, hire a clinical-based administrator with knowledge and skills in outpatient surgery, complete a detailed feasibility study to assure the need of the community, and focus your operational efforts on the quadruple aim: improved patient experience, better healthcare outcomes, lower cost, and improved staff experience.

Publication History

Article published online:
30 June 2022