GI is the most common specialty in terms of case volume and the sixth most popular specialty with management companies, according to data from VMG Health and HealthCare Appraisers. Here are 32 notable surgery centers that perform a majority of GI & endoscopy procedures. Note: Surgery centers are listed in alphabetical order. Centers do not and cannot pay to be selected for Becker's ASC Review lists. The list is not an endorsement of any organization or individual's clinical abilities.
Advanced Endoscopy Center (Bronx, N.Y.). Advanced Endoscopy Center opened in April 2007 as a joint venture between a group of physicians, Physicians Endoscopy and a local hospital in the Bronx. Twenty-two physicians use the facility, with 10 physicians owning interest in the center. Advanced Endoscopy Center is an AAAHC-accredited center and an ASGE Center of Excellence and performed over 10,000 procedures in 2011.
"We have a great team of physicians and staff, and they work really hard to make sure patients are processed efficiently and quickly," says administrator Steve Housberg. "Our average wait time is an hour and a half from start to finish, and we have state-of-the-art equipment." He says the surgery center just "put money back into the facility" by purchasing a million dollars worth of endoscopes and reprocessors.
Alabama Digestive Health Endoscopy Center (Birmingham, Ala.). Alabama Digestive Health Endoscopy Center, a three-way joint venture between Tenet Healthcare's Brookwood Hospital, local physicians and Practice Partners in Healthcare, performs colonoscopies, EGDs and flexible sigmoidoscopies. The facility administrator, Jackie Harrison, RN, has been with Practice Partners since the opening of the center and has led the facility in what Practice Partners president and CEO Larry Taylor calls "incredible clinical and non-clinical work on a daily basis to provide the physicians and patients the highest care."
The center opened in March 2008 and currently employs 35 staff members, 26 of which are RNs or LPNs. In 2011, the center achieved an excellent average turnover time of 10 minutes per case and updated its equipment with the latest scopes. The center has also continued same-store growth on an annual basis since it opened. In 2012, Mr. Taylor says the center will "continue to add physicians to our center, utilizing the combined resources of the center and the hospital to provide the finest clinical care."
Ambulatory Endoscopy Clinic of Dallas (Dallas, Texas). The Ambulatory Endoscopy Clinic of Dallas opened in April 1993 as the first licensed free-standing surgery center exclusively for GI procedures in North Texas. According to the center's site, the facility was opened by a group of physicians who wanted to create a facility that provided efficient, easily accessible care for patients and featured a staff dedicated exclusively to GI health.
In Jan. 1995, Healthcare Corporation of America joined the center as its general partner, and the facility is currently operated under Ambulatory Surgery Division of HCA. AECD has been accredited by AAAHC since 1995 and named a "substantially compliant" facility every year since its initial accreditation. Featuring one OR and two procedure rooms as well as nine practicing physicians, the center states its mission is "[providing] economical, high-quality ambulatory care in a manner consistent with the needs of the community we serve."
Arkansas Surgery & Endoscopy Center (Pine Bluff, Ark.). Arkansas Surgery & Endoscopy Center opened in 1995, the project of sole physician owner Syed A. Samad, MD, FACP, FACG, AGAF. The single-specialty surgery center has two operating rooms and performs approximately 1,500 cases per year. According to Ahmed Samad, MD, "Dr. Samad is a very well-educated physician who saw the great benefit to providing outpatient care in the form of an ASC." He has achieved the CASC credential as well as his board certification in internal medicine, gastroenterology and managed care medicine and serves as a full adjunct clinical professor of medicine with University of Arkansas for Medical Sciences.
In 2005, 10 years after opening his first surgery center in Pine Bluff, Dr. Samad opened a second ASC in Little Rock. The Pine Bluff location was the first GI ASC to serve southeast Arkansas, and its owner has "always strived to provide the highest level of quality care to its patients while running an efficient ASC," according to Dr. Samad. "ASEC has been in the forefront when it comes to successful GI-driven ASCs in the state of Arkansas," he says. "With the decreasing amount of single physician owner ASCs, ASEC continues to strive."
Amarillo Endoscopy Center (Amarillo, Texas). Amarillo Endoscopy Center is a Medicare-approved, GI-driven center that performs a variety of procedures, including colonoscopy, upper endoscopy, capsule endoscopy and remicade treatments. The ASC features two GI physicians —Amit K. Trehan, MD, and Srinivas Pathapati, MD. According to Freida Toler, administrator of Amarillo Endoscopy Center, physicians have input about every staff member hired at the center, effectively building cohesion between physicians, nurses and other staff members.
She says she also cross-trains employees and moves them through different departments in order to encourage collaboration and break down walls between physicians and employees. "Periodically staff members move through different areas of the ASC they haven't been in for a while to maintain competency in all areas, as well as to ensure they aren't working with the same people all the time," she says. "Surgical teams tend to form cliques, so we try to make sure everyone gets a chance to work with different people."
Barkley Surgicenter (Fort Meyers, Fla.). Barkley Surgicenter opened in 1993 as the project of a group of gastroenterologists. The center is currently owned by seven physician-owners — Nick Sharma, MD, Brian Feiock, MD, Brian Longendyke, DO, Michael Weiss, MD, Michael Bays, DO, Ramesh Koka, MD, and Srinivas Raju, MD. The center contains one operating room and three procedure rooms and is utilized by nine physicians, all in the field of gastroenterology.
According to administrator Keri Gantt, the center leaders recently performed an entire crosswalk of the ASC's policies and procedures and made sure everything fit with Joint Commission standards and Medicare regulations. She says the success of the center can be attributed to "great communication between management, physicians and staff."
Berks Center for Digestive Health (Wyomissing, Pa.). Berks Center for Digestive Health opened in 2001 and is currently owned by 11 physicians and Physicians Endoscopy. The center includes three procedures and 13 practicing GI physicians. According to administrator John Gleason, a strong relationship between the physicians' offices and the ASC leadership has enabled BCDH to drive strong volume to the center.
"We had a slow start to the year and were off-budget in terms of volume and revenue," he says. "Thanks to some innovative scheduling through open endoscopy and a sense of urgency to fill the schedule, we were able to make up all the lost volume and revenues in the final three months of the year."
Burlington County Endoscopy Center (Lumberton, N.J.). Burlington County Endoscopy Center opened in Nov. 2008, a partnership between a Gastroenterology Consultants of South Jersey and Physicians Endoscopy. Physicians Endoscopy had previously worked with the practice starting in 2006 and was involved with the physician group through the development process.
There are currently seven physicians with financial ownership in Burlington County Endoscopy Center, with an additional two physicians using the center for cases. In 2011, the physician GI practice added an eighth fellowship-trained GI specialist, which administrator Elaine Lang says was a significant advantage for the practice as well as the center.
Bux Mont Endoscopy Center (Sellersville, Pa.). Bux Mont Endoscopy Center was founded by Bux Mont Gastroenterology Associates and is currently owned by four physicians — Jerome Burke, MD, William O'Toole, MD, Michael Cassidy, MD, and Ira Kelberman, MD. The center averages 350 procedures a month, with colonoscopies being the most frequent procedure. The center is run by administrator Penny Jacobs, RN, BSN and medical director Dr. Burke. Since opening in April 2008, the center has opened a second room, with the possible expansion of a third room in the future. Due to the center's quality improvement program, the ASC has also been granted an exception from the state to perform procedures on ASA III patients.
The center has also added BRAVO pH monitoring and is considering adding hemorrhoid banding in the near future. The center is staffed by 16 nurses and techs, six GI physicians, one colorectal surgeon and 10 anesthesiologists. "Our physicians are very involved in the day-to-day operations of the center," says Wendy Freed, RN, DON. "Their commitment to the center is evident in their weekly meetings with the administrator. There is a true presence and concern for all aspects of the operation of the facility."
Digestive Health Center (Madison, Wis.). Digestive Health Center is a 50/50 joint venture between SSM Healthcare of Wisconsin and Dean Health System, the latter of which is 95 percent owned by physician shareholders. The Digestive Health Center opened in 2004 — initially performing only GI procedures but expanding to include pulmonology procedures in 2010. The center's primary procedures at this time include colonoscopies, upper endoscopies and bronchoscopies.
According to Jonathan Lewis, RN, MBA, vice president of ambulatory surgery centers for St. Mary's Dean Ventures (the center's corporate name), the center implemented an endoscopic bronchial ultrasound program in 2011 and converted its colonoscopy prep protocol to the split prep for patients. The center has also fully implemented an Epic electronic medical record that includes nursing and physician documentation, computerized physician order entry and billing.
Eastside Endoscopy Center (Bellevue, Wash.). Eastside Endoscopy Center opened in 1995 and specializes in upper endoscopies and colonoscopies, which are performed in three procedure rooms. The center, which is managed by Physicians Endoscopy, has been accredited by the AAAHC since 1996 and was the first endoscopy center in Washington to achieve AAAHC accreditation. According to Michelle Steele, administrator of Eastside Endoscopy, the ASC recently implement an electronic medical record, allowing staff to track times and easily identify areas of delays and target them for improvement.
She said the center also successfully implemented anesthesia services, contracting with a local anesthesia group to administer propofol in the facility. "One of the reasons I believe patient satisfaction is high is because our patients are now awake and alert after the procedure and are able to remember discussing their procedure results with the gastroenterologist," she says. She calls the center "a family" and credits its success to the combination of great physicians, RNs, medical assistants, techs and its corporate partner, Physicians Endoscopy.
The Endoscopy Center at Bainbridge (Chagrin Falls, Ohio). The Endoscopy Center at Bainbridge opened in Oct. 2007 and currently partners with University Hospitals, which owns a minority interest in the center, and management partner Physicians Endoscopy. The surgery center has six physician-owners who are currently the only providers to use the facility and perform colonoscopies and upper endoscopies. The center, which is an ASGE-recognized unit, received its AAAHC accreditation renewal in September and will be up for ASGE renewal this spring. Speaking on the success of the center, administrator Jean Neading says, "The nurses [at our center] have worked with these physicians for 20-25 years prior to opening our facility. When the center opened in October, the physicians brought these nurses with them, so they're all very seasoned and experienced and know their physicians very well."
Fleming Island Surgery Center (Orange Park, Fla.). Fleming Island Surgery Center was founded in Jan. 2007 and currently performs approximately 8,000 cases per year, 65 percent of which are GI. The center features five GI specialists who routinely use the ASC and between four and five general surgeons who perform GI cases at the center. The center is accredited by the AAAHC and is affiliated with Borland-Groover Clinic, the largest gastroenterology clinic in the Southeastern United States.
According to Lindsay Allen, special services coordinator for Borland-Groover Clinic, the center added an additional GI physician in 2011 and was able to decrease its expenses by 5 percent over the last year. "[This] was a huge accomplishment for us," she says.
Gateway Surgery Center (Edwardsville, Pa.). Gateway Surgery Center, which was purchased by Covenant Surgical Partners in July 2010, opened in 2007 and performs approximately 5,800 cases every year. The center is open from 6:30 a.m. until 3:00 p.m. and performs colonoscopies, endoscopies, peg tubes, bandings and dilations. The center is licensed by the Department of Health, accredited by AAAHC and recognized by ASGE for promoting quality in endoscopy.
According to Kathryn M. Hummel, "The patients and families who come to the center daily tell us how warm, friendly, efficient and professional the entire staff is. We use CRNAs for our sedation, and again, the patients think this is 'wonderful.'" The center is at street-level and is handicap-accessible, with plenty of available parking. "We do think we are the best!" Ms. Hummel says.
Hackensack Endoscopy Center (Hackensack, N.J.). The ownership at two-OR Hackensack Endoscopy Center has stayed relatively similar for the last 10 years, according to administrator Aaron Shechter. The center opened in 2001 and has stayed 100 percent physician-owned since then, performing an average of 7,000 procedures a year.
"The center is very focused on providing high quality patient care, but also a very high level of service to the patients," Mr. Shechter says. "We offer valet parking for patients and we provide a nice, pleasant place for patients and families to come when patients require a procedure." He says the center tries to keep up with recent technological developments by purchasing new Olympus high-definition instruments and scopes.
Jacksonville Center for Endoscopy (Jacksonville, Fla.). The Jacksonville Center for Endoscopy was established in 1998 and is currently a state-licensed, Joint Commission-accredited, AHCA-certified ASC owned and operated by the physicians of Borland-Groover clinic. The center, which has two locations in Jacksonville, performs colonoscopies, upper endoscopy and sigmoidoscopy and staffs only nurses trained specifically in endoscopy. The center performs more than 32,000 procedures annually.
Since its inception, JCE has been determined to implement health information technology to improve quality and safety, as well as streamline workflow, increase patient throughput and maximize revenues. JCE administrator Cindy Hall says the center aimed to "ensure that our physicians had access to patient information that was up-to-date to the minute." Since the implementation of an EMR, JCE has saved more than $26,000 and is now completely paperless, according to Ms. Hall.
Lincoln Endoscopy Center (Lincoln, Neb.). Lincoln Endoscopy Center opened in July 1998 to house the cases of physicians from Gastroenterology Specialties, P.C. The surgery center has three suites equipped with state-of-the-art Olympus equipment, and patients have individual restrooms and lockers in the pre-op and post-op bays. Lincoln Endoscopy Center was also the first free-standing endoscopy center in the state of Nebraska.
The facility performs three procedures — colonoscopies, upper endoscopy and flexible sigmoidoscopy — and all GI physicians are board-certified by the American Board of Gastroenterology. According to clinical director Becky Johnson, the center is careful to work with physicians on needed equipment and come to a reasonable conclusion about final purchases. She says she also visits at least one conference every year focusing on GI to keep up with technological advancements in the industry.
Manhattan Endoscopy Center (New York City). Manhattan Endoscopy Center was opened by a group of 17 physicians and Frontier Healthcare in January, one of New York state's largest ambulatory surgical centers. The facility expects to see more than 15,000 patients in its first year. The center provides services such as colonoscopy, upper endoscopy and endoscopic ultrasound and brings together 17 gastroenterologists from hospital systems such as Lenox Hill Hospital, New York University Hospital and New York Presbyterian Hospital.
"We are seeing the ASC setting as the future for outpatient procedures, particularly in specialties like GI," says Peter Kim, MD, board member of the center. "The center will provide a site of service that matches, if not exceeds, the stringent safety requirements and infection controls seen in a hospital setting and achieved through an efficient, cost-effective model, while providing for a thoroughly personalized patient experience."
Memorial Mission Surgery Center (Chattanooga, Tenn.). Though a multi-specialty center, Memorial Mission Surgery Center performs around 60 percent GI procedures — 6,600 out of 11,000 total cases in 2011. The center, which opened in 2003, is owned primarily by GI and orthopedic physicians, as well as two general surgeons and one ENT. The center is owned 70 percent by physicians and 30 percent by the local health system.
According to administrator Brent McLean, the center managed to cut costs in 2011 by streamlining GI supplies so they're not located in multiple areas. In the previous set-up, GI materials were kept in all three GI procedure rooms, and staff members tended to hoard the supplies to make sure they had enough for their cases. Now, the materials are stored in a central location in the GI lab, and staff members only stock their procedure rooms for the next day's cases.
Michigan Endoscopy Center (Farmington Hills, Mich.). Michigan Endoscopy Center opened in March 2003 as a joint venture between 16 physicians and corporate partner Physicians Endoscopy. The center includes three operating rooms and three procedure rooms and is used by 19 physicians — 15 GI physicians and 4 colorectal surgeons. According to administrator Brien Fausone, MEC is a very busy surgery center, with average daily procedures at 62 and high-demand days at more than 80.
"We were a low cost/high volume provider with an outdated and cramped waiting room," he says. "In 2010, we made the decision to acquire an additional 3,000 square feet of adjacent space to build out a new waiting room and business office. The patient response — and more importantly, the physician referral response has been overwhelmingly positive." The surgery center also created an environment with Wi-Fi, HD TV and quiet areas for escorts to wait or work in comfort.
Midtown Endoscopy Center (Atlanta, Ga.). Midtown Endoscopy Center, a center affiliated with Atlanta Gastroenterology Associates, was established in 2001 and currently performs approximately 10,620 cases a year. The physician-owned center staffs 18 physicians and recently added hemorrhoid banding (2008), liver biopsy (2009) and Bravo pH (2010). According to Steven Morris, MD, managing partner, and Jana Baker, practice administrator with AGA, the center's success can be attributed to "skilled, experienced physicians and staff" and "attention to individual patient needs." The surgery center contains four ORs and is accredited by the AAAHC.
Mirage Endoscopy Center (Rancho Mirage, Calif.). Mirage Endoscopy Center is a single-specialty endoscopy center managed by Health Inventures that opened in March 2003. The surgery center has two procedure rooms and is used by eight gastroenterologists. According to administrator Dana Folstrom, the center was recently successful with the help of Health Inventures' contracting department in renegotiating several of its key commercial contracts, ensuring increases in reimbursement for the next three years.
"Given the current economic environment and its impact on volumes, along with recent cuts in Medicare, we consider this a key accomplishment in maintaining center revenue and maintaining our high level of service and care to the community." Mr. Folstrom says the center's key to success is the employees' commitment to patient welfare and satisfaction. "As a single-specialty in a high Medicare environment, we have a particular need to operate very efficiently, and without the buy-in from the staff, this would be difficult, if not impossible," he says.
New York GI Center (Bronx, N.Y.). New York GI Center is a single-specialty GI ASC in Bronx, N.Y. The center opened in March 2007 and has since earned AAAHC accreditation, implemented electronic medical records and expanded to 18 gastroenterologists on staff. The center contains five ORs and performs approximately 10,800 cases a year, according to NYGI president James. C. DiLorenzo, MD. He says the center's initiatives for 2012 include an expansion, which will involve enhanced facilities for staff and patients and two additional ORs.
He also says the center plans to expand its charity care initiative and participate in GI QuIC. 2010. A joint venture between private practice physicians and a major academic medical center, NYGI contains "safety-based technology," such as 100 percent disposable endoscopic accessories, end tidal CO2 monitoring and a video laryngoscope for emergency intubations, according to Dr. DiLorenzo.
North Memorial Ambulatory Surgery Center (Maple Grove, Minn.). North Memorial Ambulatory Surgery Center is a multi-specialty surgery center with seven operating rooms. The center is a joint venture between physicians and the local hospital and is managed by Surgical Management Professionals. The center originally opened its doors in 2008, running four rooms with no endoscopy procedures. In Aug. 2011, the center integrated over 400 endoscopy cases per month from a center that closed within the same building. These 400 cases account for over 50 percent of total volume performed within the center today.
"This is the most efficient place I work," says Isaac Felemovicus, MD, a partner and practicing physician at the center. "It is not only elegant and visually attractive, but is a modern example of how a surgery/endoscopy center should work. There is nowhere else in the Twin Cities I can go where I can perform 17-18 colonoscopies from 7:30-3:00 on a routine basis."
Northwest Endoscopy Center (Marietta, Ga.). Northwest Endoscopy Center opened in Marietta in 2010 and has since received accreditation from the AAAHC. The physician-owned center staffs three physicians and contains three operating rooms, where the providers perform an average of 2,322 cases every year. According to Dr. Morris and Ms. Baker, the center is equipped with high-definition scopes and a fully functional electronic medical record, and propofol is always administered by anesthesia staff to improve patient care and quality. The surgery center expanded its list of services by adding hemorrhoid banding in 2010.
Northwest Michigan Surgery Center (Traverse City, Mich.). In 2004, 36 Northern Michigan physicians partnered with Munson Medical Center to create Northwest Michigan Surgery Center, an ASC that performs 17,400 multi-specialty cases per year aimed at addressing the expanding outpatient needs of the region. The center contains six ORs, three endoscopy suites and one minor procedure room, and eight GI specialists and nine general surgeons performed 9,500 GI procedures in the last year. The surgery center went live with EHR on Aug. 11, 2011, a feat that was accomplished during the center's busiest month to date without disrupting patient care.
Physicians Endoscopy Center (Houston, Texas). A joint venture with HCA Ambulatory Surgery Division, Physicians Endoscopy Center has 18 physician owners and eight procedure rooms and performs around 1,100 cases every month. The ASC was founded by several physicians who wanted "a centralized, convenient and patient-focused center to perform procedures at lower cost than hospitals," says PEC administrator Nancy Le Nikolovski. The AAAHC-accredited center opened in Dec. 2002 and performs GI procedures exclusively. Ms. Nikolovski says in 2011, the surgery center successfully added a hemorrhoid ligation clinic and propofol anesthesia. "This year marks our 10-year anniversary in serving the community and saving lives through colorectal cancer screenings, so we're planning a big celebration," she says.
Skyline Endoscopy Center for Health (Loveland, Colo.). Skyline Endoscopy Center for Health opened in Dec. 2004, a joint venture between McKee Medical Holdings, a hospital that owns 25 percent, and Loveland Endoscopy Enterprises, a physician group that owns 75 percent. The center was developed by Pinnacle III and has been managed by the company since its inception. Skyline is a single-specialty GI/endoscopy center that performs colonoscopies and EGDs and performed 4,163 procedures in 2011.
According the center's administrator, the center continues to increase case load incrementally by negotiating and improving payor contracts, as well as purchasing all new endoscopes and an HD video system to improve polyp detection. The center has also upgraded its electronic procedure documentation system to improve physician satisfaction and efficiency and implemented the use of CO2 to reduce patient discomfort post-procedure.
Stateline Surgery Center (Galena, Kan.). Stateline Surgery Center started as a primarily orthopedic surgery center, until administrator Jenny Morris pursued a GI physician in the Joplin, Mo., area. "This practitioner was interested in using our center one day a week to perform GI procedures at our center," she says. "The managed care situation in the Joplin, Missouri area is restrictive due to exclusivity arrangements with the local hospitals and large payors, which prompted the discussions as the physician was interested in performing cases at an in-network facility." She says the center conducted a feasibility analysis to determine whether GI would be a good fit for the center, and the board voted to add the specialty.
In May 2011, a tornado hit Joplin and severely damaged Four States Surgery Center, in which the new GI physician was an owner. The physician needed another three days a week to perform procedures at Stateline, which ramped up GI volume, and a few months later, the center added another GI physician to perform cases three afternoons per week. At this time, the center averages 60-70 GI procedures weekly.
Surgery Center at Tanasbourne (Hillsboro, Ore.). Surgery Center at Tanasbourne, which was opened in March 2009 by Providence Health and Services, is a free-standing, multi-specialty facility with four ORs and two procedure rooms. The center is managed through a joint venture with Blue Chip Surgical Partners and stands at around 17,000 square feet. The center features state-of-the-art medical technology and performs, in addition to GI, general surgery, orthopedics, gynecology, plastic surgery, pain management, spine and ear, nose and throat procedures.
Center administrator Cindy Givens said the center drives GI referrals by following up with physicians about the patient's experience — an aspect of the relationship that ASCs might sometimes overlook. "I make sure the loop is closed," she says. "When they send a referral over, we follow up with them to let them know the patient was scheduled on this date, or that we were not able to contact the patient, or that the patient was referred on to another provider."
Surgery Center of Joliet (Joliet, Ill.). The Surgery Center of Joliet opened in 2008 and specializes in colonoscopy, EGD and upper and lower GI diagnostics and screenings. The center houses two procedure rooms, two endoscopy rooms and three operations rooms and contains a portable endoscopy machine that allows patients to undergo endoscopic procedures in one of its ORs. According to Marge Schillaci, administrator of the Surgery Center of Joliet, the ASC keeps costs low by decreasing inventory of high-cost items.
"We looked at what we were keeping on the shelf and also specifically how long it took us to get the item," she said in an interview with Becker's ASC Review. "Based on what our volumes were and actually looking at our usage, we no longer kept more on the shelf than we actually needed." She said this strategy improved cash flow to the center and decreased holding costs. In addition to GI procedures, Surgery Center of Joliet also performs ENT, general surgery, pain management, plastics, podiatry and orthopedic procedures.
West Metro Endoscopy Center (Douglasville, Ga.). West Metro Endoscopy Center in Douglasville opened in 2008 and staff four physicians. The physician-owned center has three operating rooms and performs strictly gastroenterology procedures — approximately 3,350 every year. The surgery center is accredited by the AAAHC. According to Dr. Morris and Ms. Baker, Atlanta Gastroenterology Associates' centers are successful in part because they provide "patient convenience with eight locations [and] offer special procedures often only provided in hospitals." The center expanded its list of services by adding hemorrhoid banding in 2008.
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Advanced Endoscopy Center (Bronx, N.Y.). Advanced Endoscopy Center opened in April 2007 as a joint venture between a group of physicians, Physicians Endoscopy and a local hospital in the Bronx. Twenty-two physicians use the facility, with 10 physicians owning interest in the center. Advanced Endoscopy Center is an AAAHC-accredited center and an ASGE Center of Excellence and performed over 10,000 procedures in 2011.
"We have a great team of physicians and staff, and they work really hard to make sure patients are processed efficiently and quickly," says administrator Steve Housberg. "Our average wait time is an hour and a half from start to finish, and we have state-of-the-art equipment." He says the surgery center just "put money back into the facility" by purchasing a million dollars worth of endoscopes and reprocessors.
Alabama Digestive Health Endoscopy Center (Birmingham, Ala.). Alabama Digestive Health Endoscopy Center, a three-way joint venture between Tenet Healthcare's Brookwood Hospital, local physicians and Practice Partners in Healthcare, performs colonoscopies, EGDs and flexible sigmoidoscopies. The facility administrator, Jackie Harrison, RN, has been with Practice Partners since the opening of the center and has led the facility in what Practice Partners president and CEO Larry Taylor calls "incredible clinical and non-clinical work on a daily basis to provide the physicians and patients the highest care."
The center opened in March 2008 and currently employs 35 staff members, 26 of which are RNs or LPNs. In 2011, the center achieved an excellent average turnover time of 10 minutes per case and updated its equipment with the latest scopes. The center has also continued same-store growth on an annual basis since it opened. In 2012, Mr. Taylor says the center will "continue to add physicians to our center, utilizing the combined resources of the center and the hospital to provide the finest clinical care."
Ambulatory Endoscopy Clinic of Dallas (Dallas, Texas). The Ambulatory Endoscopy Clinic of Dallas opened in April 1993 as the first licensed free-standing surgery center exclusively for GI procedures in North Texas. According to the center's site, the facility was opened by a group of physicians who wanted to create a facility that provided efficient, easily accessible care for patients and featured a staff dedicated exclusively to GI health.
In Jan. 1995, Healthcare Corporation of America joined the center as its general partner, and the facility is currently operated under Ambulatory Surgery Division of HCA. AECD has been accredited by AAAHC since 1995 and named a "substantially compliant" facility every year since its initial accreditation. Featuring one OR and two procedure rooms as well as nine practicing physicians, the center states its mission is "[providing] economical, high-quality ambulatory care in a manner consistent with the needs of the community we serve."
Arkansas Surgery & Endoscopy Center (Pine Bluff, Ark.). Arkansas Surgery & Endoscopy Center opened in 1995, the project of sole physician owner Syed A. Samad, MD, FACP, FACG, AGAF. The single-specialty surgery center has two operating rooms and performs approximately 1,500 cases per year. According to Ahmed Samad, MD, "Dr. Samad is a very well-educated physician who saw the great benefit to providing outpatient care in the form of an ASC." He has achieved the CASC credential as well as his board certification in internal medicine, gastroenterology and managed care medicine and serves as a full adjunct clinical professor of medicine with University of Arkansas for Medical Sciences.
In 2005, 10 years after opening his first surgery center in Pine Bluff, Dr. Samad opened a second ASC in Little Rock. The Pine Bluff location was the first GI ASC to serve southeast Arkansas, and its owner has "always strived to provide the highest level of quality care to its patients while running an efficient ASC," according to Dr. Samad. "ASEC has been in the forefront when it comes to successful GI-driven ASCs in the state of Arkansas," he says. "With the decreasing amount of single physician owner ASCs, ASEC continues to strive."
Amarillo Endoscopy Center (Amarillo, Texas). Amarillo Endoscopy Center is a Medicare-approved, GI-driven center that performs a variety of procedures, including colonoscopy, upper endoscopy, capsule endoscopy and remicade treatments. The ASC features two GI physicians —Amit K. Trehan, MD, and Srinivas Pathapati, MD. According to Freida Toler, administrator of Amarillo Endoscopy Center, physicians have input about every staff member hired at the center, effectively building cohesion between physicians, nurses and other staff members.
She says she also cross-trains employees and moves them through different departments in order to encourage collaboration and break down walls between physicians and employees. "Periodically staff members move through different areas of the ASC they haven't been in for a while to maintain competency in all areas, as well as to ensure they aren't working with the same people all the time," she says. "Surgical teams tend to form cliques, so we try to make sure everyone gets a chance to work with different people."
Barkley Surgicenter (Fort Meyers, Fla.). Barkley Surgicenter opened in 1993 as the project of a group of gastroenterologists. The center is currently owned by seven physician-owners — Nick Sharma, MD, Brian Feiock, MD, Brian Longendyke, DO, Michael Weiss, MD, Michael Bays, DO, Ramesh Koka, MD, and Srinivas Raju, MD. The center contains one operating room and three procedure rooms and is utilized by nine physicians, all in the field of gastroenterology.
According to administrator Keri Gantt, the center leaders recently performed an entire crosswalk of the ASC's policies and procedures and made sure everything fit with Joint Commission standards and Medicare regulations. She says the success of the center can be attributed to "great communication between management, physicians and staff."
Berks Center for Digestive Health (Wyomissing, Pa.). Berks Center for Digestive Health opened in 2001 and is currently owned by 11 physicians and Physicians Endoscopy. The center includes three procedures and 13 practicing GI physicians. According to administrator John Gleason, a strong relationship between the physicians' offices and the ASC leadership has enabled BCDH to drive strong volume to the center.
"We had a slow start to the year and were off-budget in terms of volume and revenue," he says. "Thanks to some innovative scheduling through open endoscopy and a sense of urgency to fill the schedule, we were able to make up all the lost volume and revenues in the final three months of the year."
Burlington County Endoscopy Center (Lumberton, N.J.). Burlington County Endoscopy Center opened in Nov. 2008, a partnership between a Gastroenterology Consultants of South Jersey and Physicians Endoscopy. Physicians Endoscopy had previously worked with the practice starting in 2006 and was involved with the physician group through the development process.
There are currently seven physicians with financial ownership in Burlington County Endoscopy Center, with an additional two physicians using the center for cases. In 2011, the physician GI practice added an eighth fellowship-trained GI specialist, which administrator Elaine Lang says was a significant advantage for the practice as well as the center.
Bux Mont Endoscopy Center (Sellersville, Pa.). Bux Mont Endoscopy Center was founded by Bux Mont Gastroenterology Associates and is currently owned by four physicians — Jerome Burke, MD, William O'Toole, MD, Michael Cassidy, MD, and Ira Kelberman, MD. The center averages 350 procedures a month, with colonoscopies being the most frequent procedure. The center is run by administrator Penny Jacobs, RN, BSN and medical director Dr. Burke. Since opening in April 2008, the center has opened a second room, with the possible expansion of a third room in the future. Due to the center's quality improvement program, the ASC has also been granted an exception from the state to perform procedures on ASA III patients.
The center has also added BRAVO pH monitoring and is considering adding hemorrhoid banding in the near future. The center is staffed by 16 nurses and techs, six GI physicians, one colorectal surgeon and 10 anesthesiologists. "Our physicians are very involved in the day-to-day operations of the center," says Wendy Freed, RN, DON. "Their commitment to the center is evident in their weekly meetings with the administrator. There is a true presence and concern for all aspects of the operation of the facility."
Digestive Health Center (Madison, Wis.). Digestive Health Center is a 50/50 joint venture between SSM Healthcare of Wisconsin and Dean Health System, the latter of which is 95 percent owned by physician shareholders. The Digestive Health Center opened in 2004 — initially performing only GI procedures but expanding to include pulmonology procedures in 2010. The center's primary procedures at this time include colonoscopies, upper endoscopies and bronchoscopies.
According to Jonathan Lewis, RN, MBA, vice president of ambulatory surgery centers for St. Mary's Dean Ventures (the center's corporate name), the center implemented an endoscopic bronchial ultrasound program in 2011 and converted its colonoscopy prep protocol to the split prep for patients. The center has also fully implemented an Epic electronic medical record that includes nursing and physician documentation, computerized physician order entry and billing.
Eastside Endoscopy Center (Bellevue, Wash.). Eastside Endoscopy Center opened in 1995 and specializes in upper endoscopies and colonoscopies, which are performed in three procedure rooms. The center, which is managed by Physicians Endoscopy, has been accredited by the AAAHC since 1996 and was the first endoscopy center in Washington to achieve AAAHC accreditation. According to Michelle Steele, administrator of Eastside Endoscopy, the ASC recently implement an electronic medical record, allowing staff to track times and easily identify areas of delays and target them for improvement.
She said the center also successfully implemented anesthesia services, contracting with a local anesthesia group to administer propofol in the facility. "One of the reasons I believe patient satisfaction is high is because our patients are now awake and alert after the procedure and are able to remember discussing their procedure results with the gastroenterologist," she says. She calls the center "a family" and credits its success to the combination of great physicians, RNs, medical assistants, techs and its corporate partner, Physicians Endoscopy.
The Endoscopy Center at Bainbridge (Chagrin Falls, Ohio). The Endoscopy Center at Bainbridge opened in Oct. 2007 and currently partners with University Hospitals, which owns a minority interest in the center, and management partner Physicians Endoscopy. The surgery center has six physician-owners who are currently the only providers to use the facility and perform colonoscopies and upper endoscopies. The center, which is an ASGE-recognized unit, received its AAAHC accreditation renewal in September and will be up for ASGE renewal this spring. Speaking on the success of the center, administrator Jean Neading says, "The nurses [at our center] have worked with these physicians for 20-25 years prior to opening our facility. When the center opened in October, the physicians brought these nurses with them, so they're all very seasoned and experienced and know their physicians very well."
Fleming Island Surgery Center (Orange Park, Fla.). Fleming Island Surgery Center was founded in Jan. 2007 and currently performs approximately 8,000 cases per year, 65 percent of which are GI. The center features five GI specialists who routinely use the ASC and between four and five general surgeons who perform GI cases at the center. The center is accredited by the AAAHC and is affiliated with Borland-Groover Clinic, the largest gastroenterology clinic in the Southeastern United States.
According to Lindsay Allen, special services coordinator for Borland-Groover Clinic, the center added an additional GI physician in 2011 and was able to decrease its expenses by 5 percent over the last year. "[This] was a huge accomplishment for us," she says.
Gateway Surgery Center (Edwardsville, Pa.). Gateway Surgery Center, which was purchased by Covenant Surgical Partners in July 2010, opened in 2007 and performs approximately 5,800 cases every year. The center is open from 6:30 a.m. until 3:00 p.m. and performs colonoscopies, endoscopies, peg tubes, bandings and dilations. The center is licensed by the Department of Health, accredited by AAAHC and recognized by ASGE for promoting quality in endoscopy.
According to Kathryn M. Hummel, "The patients and families who come to the center daily tell us how warm, friendly, efficient and professional the entire staff is. We use CRNAs for our sedation, and again, the patients think this is 'wonderful.'" The center is at street-level and is handicap-accessible, with plenty of available parking. "We do think we are the best!" Ms. Hummel says.
Hackensack Endoscopy Center (Hackensack, N.J.). The ownership at two-OR Hackensack Endoscopy Center has stayed relatively similar for the last 10 years, according to administrator Aaron Shechter. The center opened in 2001 and has stayed 100 percent physician-owned since then, performing an average of 7,000 procedures a year.
"The center is very focused on providing high quality patient care, but also a very high level of service to the patients," Mr. Shechter says. "We offer valet parking for patients and we provide a nice, pleasant place for patients and families to come when patients require a procedure." He says the center tries to keep up with recent technological developments by purchasing new Olympus high-definition instruments and scopes.
Jacksonville Center for Endoscopy (Jacksonville, Fla.). The Jacksonville Center for Endoscopy was established in 1998 and is currently a state-licensed, Joint Commission-accredited, AHCA-certified ASC owned and operated by the physicians of Borland-Groover clinic. The center, which has two locations in Jacksonville, performs colonoscopies, upper endoscopy and sigmoidoscopy and staffs only nurses trained specifically in endoscopy. The center performs more than 32,000 procedures annually.
Since its inception, JCE has been determined to implement health information technology to improve quality and safety, as well as streamline workflow, increase patient throughput and maximize revenues. JCE administrator Cindy Hall says the center aimed to "ensure that our physicians had access to patient information that was up-to-date to the minute." Since the implementation of an EMR, JCE has saved more than $26,000 and is now completely paperless, according to Ms. Hall.
Lincoln Endoscopy Center (Lincoln, Neb.). Lincoln Endoscopy Center opened in July 1998 to house the cases of physicians from Gastroenterology Specialties, P.C. The surgery center has three suites equipped with state-of-the-art Olympus equipment, and patients have individual restrooms and lockers in the pre-op and post-op bays. Lincoln Endoscopy Center was also the first free-standing endoscopy center in the state of Nebraska.
The facility performs three procedures — colonoscopies, upper endoscopy and flexible sigmoidoscopy — and all GI physicians are board-certified by the American Board of Gastroenterology. According to clinical director Becky Johnson, the center is careful to work with physicians on needed equipment and come to a reasonable conclusion about final purchases. She says she also visits at least one conference every year focusing on GI to keep up with technological advancements in the industry.
Manhattan Endoscopy Center (New York City). Manhattan Endoscopy Center was opened by a group of 17 physicians and Frontier Healthcare in January, one of New York state's largest ambulatory surgical centers. The facility expects to see more than 15,000 patients in its first year. The center provides services such as colonoscopy, upper endoscopy and endoscopic ultrasound and brings together 17 gastroenterologists from hospital systems such as Lenox Hill Hospital, New York University Hospital and New York Presbyterian Hospital.
"We are seeing the ASC setting as the future for outpatient procedures, particularly in specialties like GI," says Peter Kim, MD, board member of the center. "The center will provide a site of service that matches, if not exceeds, the stringent safety requirements and infection controls seen in a hospital setting and achieved through an efficient, cost-effective model, while providing for a thoroughly personalized patient experience."
Memorial Mission Surgery Center (Chattanooga, Tenn.). Though a multi-specialty center, Memorial Mission Surgery Center performs around 60 percent GI procedures — 6,600 out of 11,000 total cases in 2011. The center, which opened in 2003, is owned primarily by GI and orthopedic physicians, as well as two general surgeons and one ENT. The center is owned 70 percent by physicians and 30 percent by the local health system.
According to administrator Brent McLean, the center managed to cut costs in 2011 by streamlining GI supplies so they're not located in multiple areas. In the previous set-up, GI materials were kept in all three GI procedure rooms, and staff members tended to hoard the supplies to make sure they had enough for their cases. Now, the materials are stored in a central location in the GI lab, and staff members only stock their procedure rooms for the next day's cases.
Michigan Endoscopy Center (Farmington Hills, Mich.). Michigan Endoscopy Center opened in March 2003 as a joint venture between 16 physicians and corporate partner Physicians Endoscopy. The center includes three operating rooms and three procedure rooms and is used by 19 physicians — 15 GI physicians and 4 colorectal surgeons. According to administrator Brien Fausone, MEC is a very busy surgery center, with average daily procedures at 62 and high-demand days at more than 80.
"We were a low cost/high volume provider with an outdated and cramped waiting room," he says. "In 2010, we made the decision to acquire an additional 3,000 square feet of adjacent space to build out a new waiting room and business office. The patient response — and more importantly, the physician referral response has been overwhelmingly positive." The surgery center also created an environment with Wi-Fi, HD TV and quiet areas for escorts to wait or work in comfort.
Midtown Endoscopy Center (Atlanta, Ga.). Midtown Endoscopy Center, a center affiliated with Atlanta Gastroenterology Associates, was established in 2001 and currently performs approximately 10,620 cases a year. The physician-owned center staffs 18 physicians and recently added hemorrhoid banding (2008), liver biopsy (2009) and Bravo pH (2010). According to Steven Morris, MD, managing partner, and Jana Baker, practice administrator with AGA, the center's success can be attributed to "skilled, experienced physicians and staff" and "attention to individual patient needs." The surgery center contains four ORs and is accredited by the AAAHC.
Mirage Endoscopy Center (Rancho Mirage, Calif.). Mirage Endoscopy Center is a single-specialty endoscopy center managed by Health Inventures that opened in March 2003. The surgery center has two procedure rooms and is used by eight gastroenterologists. According to administrator Dana Folstrom, the center was recently successful with the help of Health Inventures' contracting department in renegotiating several of its key commercial contracts, ensuring increases in reimbursement for the next three years.
"Given the current economic environment and its impact on volumes, along with recent cuts in Medicare, we consider this a key accomplishment in maintaining center revenue and maintaining our high level of service and care to the community." Mr. Folstrom says the center's key to success is the employees' commitment to patient welfare and satisfaction. "As a single-specialty in a high Medicare environment, we have a particular need to operate very efficiently, and without the buy-in from the staff, this would be difficult, if not impossible," he says.
New York GI Center (Bronx, N.Y.). New York GI Center is a single-specialty GI ASC in Bronx, N.Y. The center opened in March 2007 and has since earned AAAHC accreditation, implemented electronic medical records and expanded to 18 gastroenterologists on staff. The center contains five ORs and performs approximately 10,800 cases a year, according to NYGI president James. C. DiLorenzo, MD. He says the center's initiatives for 2012 include an expansion, which will involve enhanced facilities for staff and patients and two additional ORs.
He also says the center plans to expand its charity care initiative and participate in GI QuIC. 2010. A joint venture between private practice physicians and a major academic medical center, NYGI contains "safety-based technology," such as 100 percent disposable endoscopic accessories, end tidal CO2 monitoring and a video laryngoscope for emergency intubations, according to Dr. DiLorenzo.
North Memorial Ambulatory Surgery Center (Maple Grove, Minn.). North Memorial Ambulatory Surgery Center is a multi-specialty surgery center with seven operating rooms. The center is a joint venture between physicians and the local hospital and is managed by Surgical Management Professionals. The center originally opened its doors in 2008, running four rooms with no endoscopy procedures. In Aug. 2011, the center integrated over 400 endoscopy cases per month from a center that closed within the same building. These 400 cases account for over 50 percent of total volume performed within the center today.
"This is the most efficient place I work," says Isaac Felemovicus, MD, a partner and practicing physician at the center. "It is not only elegant and visually attractive, but is a modern example of how a surgery/endoscopy center should work. There is nowhere else in the Twin Cities I can go where I can perform 17-18 colonoscopies from 7:30-3:00 on a routine basis."
Northwest Endoscopy Center (Marietta, Ga.). Northwest Endoscopy Center opened in Marietta in 2010 and has since received accreditation from the AAAHC. The physician-owned center staffs three physicians and contains three operating rooms, where the providers perform an average of 2,322 cases every year. According to Dr. Morris and Ms. Baker, the center is equipped with high-definition scopes and a fully functional electronic medical record, and propofol is always administered by anesthesia staff to improve patient care and quality. The surgery center expanded its list of services by adding hemorrhoid banding in 2010.
Northwest Michigan Surgery Center (Traverse City, Mich.). In 2004, 36 Northern Michigan physicians partnered with Munson Medical Center to create Northwest Michigan Surgery Center, an ASC that performs 17,400 multi-specialty cases per year aimed at addressing the expanding outpatient needs of the region. The center contains six ORs, three endoscopy suites and one minor procedure room, and eight GI specialists and nine general surgeons performed 9,500 GI procedures in the last year. The surgery center went live with EHR on Aug. 11, 2011, a feat that was accomplished during the center's busiest month to date without disrupting patient care.
Physicians Endoscopy Center (Houston, Texas). A joint venture with HCA Ambulatory Surgery Division, Physicians Endoscopy Center has 18 physician owners and eight procedure rooms and performs around 1,100 cases every month. The ASC was founded by several physicians who wanted "a centralized, convenient and patient-focused center to perform procedures at lower cost than hospitals," says PEC administrator Nancy Le Nikolovski. The AAAHC-accredited center opened in Dec. 2002 and performs GI procedures exclusively. Ms. Nikolovski says in 2011, the surgery center successfully added a hemorrhoid ligation clinic and propofol anesthesia. "This year marks our 10-year anniversary in serving the community and saving lives through colorectal cancer screenings, so we're planning a big celebration," she says.
Skyline Endoscopy Center for Health (Loveland, Colo.). Skyline Endoscopy Center for Health opened in Dec. 2004, a joint venture between McKee Medical Holdings, a hospital that owns 25 percent, and Loveland Endoscopy Enterprises, a physician group that owns 75 percent. The center was developed by Pinnacle III and has been managed by the company since its inception. Skyline is a single-specialty GI/endoscopy center that performs colonoscopies and EGDs and performed 4,163 procedures in 2011.
According the center's administrator, the center continues to increase case load incrementally by negotiating and improving payor contracts, as well as purchasing all new endoscopes and an HD video system to improve polyp detection. The center has also upgraded its electronic procedure documentation system to improve physician satisfaction and efficiency and implemented the use of CO2 to reduce patient discomfort post-procedure.
Stateline Surgery Center (Galena, Kan.). Stateline Surgery Center started as a primarily orthopedic surgery center, until administrator Jenny Morris pursued a GI physician in the Joplin, Mo., area. "This practitioner was interested in using our center one day a week to perform GI procedures at our center," she says. "The managed care situation in the Joplin, Missouri area is restrictive due to exclusivity arrangements with the local hospitals and large payors, which prompted the discussions as the physician was interested in performing cases at an in-network facility." She says the center conducted a feasibility analysis to determine whether GI would be a good fit for the center, and the board voted to add the specialty.
In May 2011, a tornado hit Joplin and severely damaged Four States Surgery Center, in which the new GI physician was an owner. The physician needed another three days a week to perform procedures at Stateline, which ramped up GI volume, and a few months later, the center added another GI physician to perform cases three afternoons per week. At this time, the center averages 60-70 GI procedures weekly.
Surgery Center at Tanasbourne (Hillsboro, Ore.). Surgery Center at Tanasbourne, which was opened in March 2009 by Providence Health and Services, is a free-standing, multi-specialty facility with four ORs and two procedure rooms. The center is managed through a joint venture with Blue Chip Surgical Partners and stands at around 17,000 square feet. The center features state-of-the-art medical technology and performs, in addition to GI, general surgery, orthopedics, gynecology, plastic surgery, pain management, spine and ear, nose and throat procedures.
Center administrator Cindy Givens said the center drives GI referrals by following up with physicians about the patient's experience — an aspect of the relationship that ASCs might sometimes overlook. "I make sure the loop is closed," she says. "When they send a referral over, we follow up with them to let them know the patient was scheduled on this date, or that we were not able to contact the patient, or that the patient was referred on to another provider."
Surgery Center of Joliet (Joliet, Ill.). The Surgery Center of Joliet opened in 2008 and specializes in colonoscopy, EGD and upper and lower GI diagnostics and screenings. The center houses two procedure rooms, two endoscopy rooms and three operations rooms and contains a portable endoscopy machine that allows patients to undergo endoscopic procedures in one of its ORs. According to Marge Schillaci, administrator of the Surgery Center of Joliet, the ASC keeps costs low by decreasing inventory of high-cost items.
"We looked at what we were keeping on the shelf and also specifically how long it took us to get the item," she said in an interview with Becker's ASC Review. "Based on what our volumes were and actually looking at our usage, we no longer kept more on the shelf than we actually needed." She said this strategy improved cash flow to the center and decreased holding costs. In addition to GI procedures, Surgery Center of Joliet also performs ENT, general surgery, pain management, plastics, podiatry and orthopedic procedures.
West Metro Endoscopy Center (Douglasville, Ga.). West Metro Endoscopy Center in Douglasville opened in 2008 and staff four physicians. The physician-owned center has three operating rooms and performs strictly gastroenterology procedures — approximately 3,350 every year. The surgery center is accredited by the AAAHC. According to Dr. Morris and Ms. Baker, Atlanta Gastroenterology Associates' centers are successful in part because they provide "patient convenience with eight locations [and] offer special procedures often only provided in hospitals." The center expanded its list of services by adding hemorrhoid banding in 2008.
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