At least nine ASCs opened in Florida last year, cementing its place among the states that experienced the most ASC growth in 2019. Here, Ashlie Cramer, MSN, RN, nurse administrator at Delray Beach (Fla.) Surgical Suites, explored why new ASC development was booming in Florida and shared insights into the future of the market.
Note: Responses have been edited for style and content. Ms. Cramer's responses are her own opinion and are not necessarily reflective of the opinions of any entity affiliated with Delray Beach Surgical Suites.
Question: Why is Florida a good place to start a surgery center?
Ashlie Cramer: The weather is great in Florida, which also means that the population is high and increasing as Northerners get tired of the cold and want to live in paradise. Therefore, the increased population inevitably means more people needing surgery.
The population age also indicates the need for orthopedic interventions as people tend to be older, yet still more physically active. There are also many patients that are willing to travel to a better climate to recover, so "concierge" surgery seems to be popular. I wouldn't say that reimbursement is better, as I know in certain areas Florida isn't as high as other states, and I wouldn't say regulatory-wise there is an advantage.
Personally, I feel if [physicians] are able to provide a high level of quality care, they are going to stand out in Florida. [If] a center can ensure that they have top-notch doctors and employ top-notch staff, they are going to be successful. [Word-of-mouth] recommendations in this area mean more to the population than any amount of advertising can do. I have had so many patients come to my center multiple times. Some of them have had a procedure completed and then asked for the name of another surgeon that operates here, just so they can come back for their next procedure.
I honestly do not feel as if we offer anything out of the ordinary, but I have had multiple patient satisfaction surveys returned telling me that my center is leaps and bounds better than any other facility, ranging from other surgery centers to the hospitals in the area.
Q: What is the average caseload of your center? How do you expect it to change in 2020?
AC: My center opened in August 2017 and we saw 1,642 cases in 2019. We average 135 cases per month and [are] growing. We perform total joint procedures and with Medicare's inclusion of total knee replacement, anticipate a major growth in our total knee procedure volume.
Q: Are there concerns the market could become oversaturated? Why or why not?
AC: I am not concerned with "oversaturation" of the market. My center is physician-owned, and those physicians have a financial interest in this center. As long as we continue to provide a high level of quality care, our surgeons are not going to have interest in another center, therefore, there could be 10 centers opened within the block, but we shouldn't lose any cases.
Q: What do you view as the biggest threat to surgery centers in the region?
AC: The largest external threat is the weather and natural disasters, like hurricanes. Economically speaking, the largest threat [concerns] payer reimbursement. [The president's proposed budget is threatening to cut CMS'] budget drastically, mainly through physician and hospital reimbursement. Medicare reimbursement isn't always the most profitable currently; cuts to this reimbursement will increase the urgency to contain medical supply and overhead costs, but also [lead to our] physician owners performing their cases in the hospital setting, where there is no personal financial interest.