Interview with Ann Roberts, Administrator, Surgery Center of Reno Q: In 2006, Saint Mary’s Regional Medical Center in Reno, Nev., handed over majority ownership of the Surgery Center of Reno to physicians. Why did it do that? Anne Roberts: The center was poorly managed and had a hospital mentality. That is to say, it was a very nice facility but it had a high volume of unprofitable cases, and payor contracts were not optimum. The center had a lot of plastic surgery and gynecology cases, which are typically not the most profitable activities for an ASC. To improve the situation, Saint Mary’s, a Catholic Healthcare West facility, decided to change the ownership model and hand over control to the physician partners. The deal brought in a management company, Regent Surgical Health. The center’s 31 physician-partners own 75 percent of the facility, while Catholic Healthcare West owns 13 percent and Regent owns 12 percent. The surgery center is now in the black with a much different case mix. Q: What do you attribute your success to? AR: We’ve had strong physician leadership and a management team that focuses on excellent clinical care for the patient. We provide an efficient, effective OR experience for the physicians and make this a great place to work. We also place great emphasis on compassionate, high-quality care with special attention to quality outcomes and infection control. We have made a number of specific changes in operations, starting in 2006. We have developed a special focus on orthopedics, spine, ENT, pain management, urology, bariatrics and general surgery. The center introduced spine and bariatric surgery in 2006. Spine was a good fit because we are a 24-hour stay facility and can provide extended recovery for our patients. ENT, spine, orthopedic surgery and general surgery have been designated centers of excellence in the ASC. That means we invest in state-of-the-art equipment and staff education and focus on things that really make a difference. We try to make our non-partners happy, which has really paid off. Fifty percent of our cases are performed by non-partners, which is an unusually high percentage for an ASC. Q: Nevada has been particularly hard-hit by the economy. Has that affected your volume? AR: The center went through a decline in volume in 2010, but we bounced back this year. I’m not sure exactly why. Nevada still has high unemployment and a high foreclosure rate. We’ve worked hard on our clinical initiatives and pay close attention to the business side of operations. I think it helps that we ensure accurate, appropriate payor source information and educate our patients prior to surgery about their financial responsibility. We want to make sure that there are no surprises for our patients. Our business office is a well-oiled machine and [we] focus on a positive experience for patients. The goal is that co-payments are collected at the time of service with efficient billing after the procedure. Q: What is your relationship with the hospital now? AR: Even though the ASC no longer is owned by the hospital, having Saint Mary’s as a partner is a positive for patients and physicians. The center is right across the street from the hospital, which makes it easy for physicians to go back and forth for surgery. It is also close to many physicians’ offices. If a patient needs to be transferred, it is a seamless event. Along with Regent Surgical Health, the hospital has a seat on the board of directors and assists the partners with strategic planning, recognizing healthcare trends in the community and nationwide. Q: What do you see coming in the future? AR: I wish I had a crystal ball so that I could see the next 5-10 years. National trends like the movement to accountable care organizations could conceivably alter our relationship with the hospital. To make ACOs work, hospitals may want tighter relationships with surgery centers and seek a majority share or even 100 percent share. ASCs will continue to be expected to provide transparent quality reporting, meet infection control standards and follow regulatory changes. This could affect the ownership arrangement.