Wauwatosa (Wis.) Surgery Center, an affiliate of Surgical Care Affiliates, made its decision to construct a recovery center in November, 2014. The recovery center opened on Sept. 15, 2015, and it has already had an impact on ASC operations.
"We have been able to develop a total joint reconstruction program," Michael J. Lucey, MS, HSA, administrator of Wauwatosa Surgery Center. "Additionally, general surgeons are now bringing laparoscopic cholestectomy patients, knowing that the 23-hour stay is available, should their patients require that level of care post-surgery."
Making the call
According to Mr. Lucey, the leadership team at Wauwatosa Surgery Center decided to open a recovery care center because several patients and physicians requested a lower cost outpatient alternative joint reconstruction program be offered in the Milwaukee market. The multispecialty surgery center already offered ENT, general surgery, OB/GYN, orthopedics, pain management, podiatry and urology; however, the leadership team was looking to diversify its existing scope of practice to increase patient volume, attract additional surgeons to the center, lower the cost of surgery for patients and payers and for marketing purposes.
Before deciding to open a recovery care center, key questions to ask include:
• Is there enough space on-site for a recovery center? If so, will space need to be reconfigured or built-out?
• Do you have enough nurses with recent recovery experience beyond a typical day surgery stay?
• How will meals be provided?
• During a renovation of existing space, where do you temporarily go with teammates and the workstations that are displaced, as well as store equipment, linen, etc.?
• Is there enough need in your market to warrant a recovery center?
Getting started
Establishing a recovery care center can be an overwhelming experience. ASC administrators can ensure they are covering their bases by taking the following steps:
1. Review regulations and select an architect. Conduct a comprehensive review of any regulatory body, local, state and federal construction regulations and codes, says Mr. Lucey. Take into account infection control considerations. When it comes to choosing the right architect and contractor for the project, look for those with good track records, who have experience in healthcare construction.
2. Calculate expenses and begin negotiations. Develop a project pro-forma to include expenses and revenue by procedure for the project, suggests Mr. Lucey. Stakeholders will want to know how long it will take to pay off the cost of the project and when they can expect their return on investment. Begin the negotiation process with insurance companies and implant manufacturers as soon as possible.
3. Enlist a physician champion and develop the clinical team. Select a well-respected physician as champion who will help ensure the project is a success. In addition to the physician champion, select a team of clinical staffers who have preferably had prior recovery and total joint reconstruction experience.
"Ours was a total joint reconstruction team, which included the physician champion, a pre-op health history nurse, OR charge nurse, OR lead surgical tech and a post-op recovery nurse," says Mr. Lucey. "Also, there is no need to re-invent the wheel. Have your team tour at least three other recovery centers outside of your market — to minimize the competitive factor — to see how others have approached their programs and recovery centers."
4. Establish proper patient admission criteria. Mr. Lucey says that at his surgery center, the administrative staff reviewed what other ASCs were doing and had surgeons and anesthesiologists discuss and come to agreement on criteria.
5. Plan for meal-times. Patients staying for up to 23 hours need meals. Wauwatosa Surgery Center does not have a kitchen on-site and by regulation is not allowed to prepare or process food for patients. But the center does provide patients with menus from seven local restaurants and either has food delivered or picked up.
6. Plan for staffing the recovery care center. Wauwatosa Surgery Center had to establish a new staffing model to provide appropriate care for patients requiring overnight stays.
"We hired several nurses with recent recovery experience from hospitals and had them collaborate with our experienced post-op nurses. Then we established teams of new nurses with our established nurses to cover evenings and nights," says Mr. Lucey.
These teams then spent a day with recovery teams at other locations with established 23-hour recovery care centers and observed the recovery care process all the way to the point of discharge. This visit also covered managing the patients' pain post-discharge with follow-up calls. Finding nurses willing to staff evenings or nights may be a challenge, however. Many nurses leave hospital positions and join ASCs to get away from evening, night and weekend duties.
"We are covering a full 23-hour stay at this time, but our physicians and nurses are reviewing and touring other facilities where most of the total joint and other overnight patients are now being discharged later on the same day of their surgery, unless they clinically have a need to stay longer," he says. "We may transition from the 23-hour model to a same day discharge model and have on-call personnel in place, should a patient require an overnight stay ."
ROI of a recovery care center
According to Mr. Lucey, not only have general surgeons started bringing in more complex cases into the center, but spine surgeons have also started seeing the value in doing certain spine procedures at the ASC facility now that it has a 23-hour stay capability.
"While we have experienced an increase in dollars for supplies due to these new product lines, the costs are more than offset by the revenues," says Mr. Lucey. "Significant communication and meeting time is necessary when setting up the 23-hour stay care center and total joint reconstruction program. Communication is key to success of the program and is easily worth the additional time and cost in the long run."