In the past few years, Sullivan Digestive Center, an endoscopy center in Kingsport, Tenn., shrank from five partners to just one, Michael Sullivan, MD. But even though the center lost some volume, it still logs 4,500 procedures a year and has emerged with a strong bottom line, says Administrator Penny Vaughn. The lesson? "Bigger is not always better," Ms. Vaughn says.
Here Ms. Vaughn identifies six ways the center manages to maintain high volume and quality.
1. Strong name recognition. The physicians who left the center also left the affiliated practice, with two of them taking over part of a network of satellites the practice shut down. But Dr. Sullivan has prospered on his own because he is a fixture in the community. He has been practicing there for 27 years and the center has been open for 20 years. "His name continues to draw a lot of patients," Ms. Vaughn says. Even when the other physicians were using the center, Dr. Sullivan was the high performer, accounting for 65 percent of volume, she says. The last partner, who left last year, was performing only 20 procedures a week at the center.
2. High daily volume. Dr. Sullivan performs 30-35 procedures per day, compared with a rate of 18-20 for some gastroenterologists. He works straight through, not even stopping for lunch. "We figure the patients are unable to eat, so why should we be?" Ms. Vaughn says. During the three days he is in the center each week, Dr. Sullivan starts around 6:30 in the morning and works for eight hours until about 2:30 p.m.
3. Quick procedures. Dr. Sullivan's scoping takes 10-12 minutes per patient. The center performs several enemas on each colonoscopy patient, which allows for faster insertion of the scope and makes it easier to detect polyps because the bowels are cleaner. The enemas are important because the success of a colonoscopy depends on complete visualization of the mucosal surface of the colon. The colonoscopy may take a little longer depending on findings, for instance if a mass or multiple polyps are found and require multiple biopsies or removal, she says.
4. Short turnaround time. The center has also shortened the turnaround time by using two procedure rooms. When Dr. Sullivan is done in one room, the second room is ready for him. "He just bounces back and forth," Ms. Vaughn says. When he is finishing up in one room, the RN uses the intercom to alert the other room that he is on his way so that they can start final preparations.
5. High quality. In May, the American Society for Gastrointestinal Endoscopy recognized Sullivan Digestive Center as one of 30 endoscopy units in the nation for their commitment to quality and safety. Ms. Vaughn says the center puts strong emphasis on infection control. For more than 10 years, it has been taking cultures on every endoscope on a quarterly basis. Even though endoscopy culturing is a useful method to assess the effectiveness of standard reprocessing procedures, only 17 percent of endoscopy units in the Northeast performed endoscope surveillance cultures, according to a 2004 survey in Digestive Diseases and Sciences.
6. No surprises before surgery. Clinical staff members do not want to be forced to cancel a procedure at the last minute because information gathered on the day of the procedure showed the patient was not a good candidate. "We don't want any surprises," Ms. Vaughn says. "We don't want to have complications." To guard against surprises, patients come in for an office visit prior to the procedure and see a nurse practitioner. In a face-to-face encounter, it's easier to ensure the patient is an appropriate candidate for an outpatient procedure, she says.
However, Ms. Vaughn says there is one downside to having only one physician. "All your eggs are in one basket," she says. "If anything happens to him, we're all jobless." But at age 57, Dr. Sullivan still has many years to go before retirement, she says.
Related Articles on Endoscopy Centers:
Gastroenterologist on the Move: Dr. Tamir Ben-Menachem Joins Summit Medical Group in New Jersey
ASGE Recognizes 30 Endoscopy Units for Commitment to Quality and Safety
New Endoscopy Surgery Center Planned for Honolulu