As healthcare providers look to continue to offer the best in quality care while being watchful of the expenses, and as patients need low-cost alternatives to addressing healthcare needs and maintenance, ASCs fill this much-needed space. And especially in the Massachusetts market dominated by impressive hospital care, The Surgery Center at Shrewsbury helps to set a new benchmark of what great outpatient care can be.
Nationally, hospitals are increasingly seeking joint venture opportunities focused on the ASC model. ASCs offer them an alternative to higher-cost hospital care, while still offering the ability to provide the same level of quality. Hospitals recognizethe reimbursement rate at an ASC is roughly 30-50% of what it is for a hospital, making it a favored choice for payers and patient. Hospitals understand that although the facility obtains significantly less reimbursement, this is made up for by the reduced overhead costs and increased surgical volumes, and the potential of an improved overall patient experienced at an ASC.
To address the need for high quality and cost-effective ambulatory care, The Surgery Center at Shrewsbury came into being – it’s a joint venture between Shields Healthcare Group (which operates on a model of efficiency, autonomy, and higher volumes), UMass Memorial Medical Center (which is the region’s premier academic medical center and saw the surgery center as an opportunity to free up space on its campus for higher acuity inpatient surgical procedures), and Reliant Medical Group (which recently became a part of Optum and is the largest independent, ambulatory-integrated health system in Central and Metro West regions of Massachusetts).
This new, ~35,000-square-foot, $31-million, state-of-the-art Surgery Center at Shrewsbury (https://www.surgerycentershrewsbury.com/), designed by JACA Architects, offers an example of what outpatient care should look like and act like, by providing high quality care at lower costs. The planning for this type of joint venture required the design team to provide a level of certainty in the number and utilization of operating rooms to right-size the project. This was accomplished in part by creating proprietary software that analyzed the various surgical case types and volumes that needed to be accommodated. Bill Epp, JACA’s new president, led the effort to develop a dashboard system for understanding volume data. “In this type of joint venture there are many different providers and modalities to be accommodated,” said Epp. “The dashboard system includes important variables such as procedure duration and room turnover time as set standards and then the number of operating rooms and hours of operation and anticipated case volumes applied as dials. By increasing one dial, the others are adjusted to meet the need. This provides a graphic method for translating targeted case volume into required physical space and hours of operation.”
The focus of the design for this facility is on patient comfort which was achieved through creating a seamless flow to and within the building and with an exterior and interior aesthetic that is hospitality-based. From easily and clear access off a major highway to the beautifully landscaped parking lot and grounds, the facility has high visibility and character. Patients and their guests walk into a sunlit waiting room where they are received; families are invited to remain in the waiting area which includes a coffee bar and Wi-Fi access while patients are taken to their individual bay in the pre-op area. From there, the flow from pre-op to surgery to recovery locations is seamless. The flow in and around the operating rooms is focused on efficiency for patients, providers, and materials. Each operating room has separate doors ensuring that there is no crossing of patients and materials. Matthew Bluette, the project’s medical planner, strove to create the most efficient planning concept. “This is a completely different model from a hospital surgical suite,” he said. “There’s a learning curve for providers that are used to a traditional hospital layout and some education for local regulatory agencies to assure them that a high level of care can be provided in a smaller, efficient space.”
The facility includes a separate discharge and pick-up area, ensuring that patients still feeling effects from their procedure have direct access to reconnect with their awaiting family members and avoid the need to cross back into the waiting room. This flow also ensures that the waiting area is focused on the movement of new patients and accommodating waiting family members.
There is also a separate entrance for the staff and providers, maintaining the model of separate and one-directional flow within the facility. This idea is brought from the hospital experience, and shows an understanding of allowing the medical staff to enter and prepare for their day’s work without unnecessary distractions.
According to Prashanth Bala, administrator for The SurgeryCenter at Shrewsbury, patients love the building as well. “They love the free parking, and also love the natural light in the lobby,” said Bala. “It doesn’t feel like a typical hospital/healthcare environment, which was the aim, especially given how much anxiety is associated with healthcare of this nature. The design specifically works to avoid compounding anxiety with specific considerations reflected through the color palette, LED lighting, and the interior finish choices of this modern facility.”
For hospitals with limited on-campus expansion opportunities and a growing inpatient surgical volume, decanting procedures to a more efficient setting is the best choice. When considering the design of such facilities, the focus must be on staff and provider efficiency, which will ensure patients’ flow and experience, and will achieve the goal of providing high quality care in a lower cost setting.
Matthew A. Bluette, AIA, AICP, LEED AP, ACHA is an Associate at JACA Architects (www.jacaarchitects.com); William Epp is Associate Principal and President of JACA Architects; and Prashanth Bala is Administrator/CEO of the Surgery Center at Shrewsbury.