Santa Rosa Memorial Hospital opened its Ambulatory Surgery Center (ASC) near the hospital in 2003 to expand access to care, adapt to consumers’ changing needs, maximize convenience for patients and families, and ensure clinical quality and patient safety in a setting conducive to outpatient care. The center’s development followed a nationwide trend toward same-day surgeries. The rise of minimally invasive techniques during the 1980s and 90s transformed surgeries that once required an overnight hospital stay into procedures suitable for outpatients. In the 1980s, about 15% of surgeries in the United States were performed on an outpatient basis. By the 1990s, when planning for Memorial’s ASC began, that proportion had reached 70%.

At the ASC, Memorial maintains 100% ownership of the facility, while I and fellow physician investors in a limited liability company that contracts with the hospital are paid for running the surgery center. Our company (Santa Rosa Surgical Management Company, LLC) pays an on-site director to supervise services at the center, but Memorial employs the remainder of the ASC’s 22 staff members. This agreement between the hospital and the LLC allows physicians more direct control and input in meeting quality standards, while reducing significantly the monetary outlay and financial risk associated with establishing our own facility.

The combination of physician oversight with the medical and financial resources of Memorial Hospital has yielded a stable resource that’s well positioned to meet community needs for years to come. National health care reform is driving greater reliance on an integrated, broad spectrum of care that stresses lower-cost alternatives to acute hospital-based treatment, and the ASC plays a much-needed role in that continuum.

At the same time, the proportion of Sonoma County residents age 65 and older has increased at about three times the rate of the rest of our local population. As patients in this age bracket require health care services, we will be challenged to deliver surgical treatment more efficiently--an advantage offered by ambulatory surgery centers.

Located on the second floor of a 17,000-square-foot, two-story building on Doyle Park Drive, in close proximity to Memorial and other medical offices, the ASC features six operating rooms, six pre-op beds, 12 recovery beds, a spacious waiting area, a covered drive-up entrance and adjacent parking. We provide a wide variety of specialty care and procedures, including urology, gynecology, orthopedics, general surgery, plastic surgery, pain management, ophthalmology (oculoplastics), and otolaryngology.

On-time surgeries are one of four key metrics on which our performance as an ASC clinical team is judged, and for which we as a management company are held accountable. These primary performance objectives are:

Patient satisfaction. Our benchmark calls for patient satisfaction scores ranking in the top 92.4% of comparable centers in the country, or better. Postoperative surveys tell us how favorably our patients view the caliber of their care, as well as their comfort and the environment at the ASC.

Process improvement. To minimize wait times for patients, staff and fellow physicians, the attending physician is required to be in the operating room suite within 10 minutes of the start of the first scheduled procedure of the day. This sets the pace for the remainder of the day, ensuring subsequent surgeries do not get backlogged.

Quality. We strive to achieve 100% compliance with universal protocols for “time outs” immediately prior to any procedure. We have demonstrated 100% compliance with that standard during the first three quarters of 2011.

Patient safety. We commit to reducing the risks of postoperative infection through adherence to strict protocols and thorough postoperative evaluation of each case. Throughout 2011, we have kept the infection rate below 0.01%.

One advantage to physicians who invest in or practice at a hospital-owned ASC can sometimes prove an obstacle--namely, the hospital’s responsibility for purchasing and maintaining equipment. When hospital resources allow for new equipment to be purchased, physicians and patients benefit from upgraded instrumentation and technology that helps advance the scope and quality of care. But, particularly during tight budget years, the ASC competes with the hospital’s other capital investment needs, including maintenance or new ventures at the main hospital. Ultimately, Memorial administrators must decide which projects to fund.

This occasional obstacle is offset by opportunities the management company model presents to local physicians and our patients. These include:

• Governance structure that physicians determine.

• Financial incentives--including rewards for improving performance--that are consistent with patient satisfaction and safety goals the hospital shares.

• Ensuring compliance with laws, regulations and clinical best practices.

• Influence in recruiting and retaining fellow physicians and employees.

• Freedom to direct and coordinate procedure scheduling.

• Stability and expertise of staff, with low turnover.

• Ancillary services provided by the hospital, including lab, pathology, imaging, physical therapy, housekeeping and dietary.

• As an affiliate of a not-for-profit health system, we treat all patients regardless of their insurance status or ability to pay.

• Better coordination and integration of care for patients.

• Staff productivity and efficiency that place us in the top 10% nationally.

• Ability to deliver cost-effective care.

• Back-up emergency medical resources, should a patient’s condition require it.

• The flexibility to share electronic medical records systems, equipment and services with the hospital next door.

Even with a payor mix as diverse as the hospital’s, the ASC has continued to be a sound business model financially. It is based on a commendable and sustainable philosophy: the more physicians, nurses and other medical professionals directly influence decisions affecting patient care, the better the outcomes for patients.

Dr. Lazar, a Santa Rosa urologist, is managing physician director of the Santa Rosa Memorial Hospital Ambulatory Surgery Center.

Email: jene.layton@stjoe.org