Surgical procedures continue to shift away from hospitals to outpatient facilities.1 As technologies and anesthesia techniques evolve, more complex patient cases can be performed successfully in ambulatory surgery centers. Now is the time for physicians to consider how they can further their practices by entering the ASC market.
To learn more about the process of successfully building an ASC, Becker’s Healthcare recently spoke with two leaders from Arrowhead Surgery Center (Duluth, Minn.) — neurosurgeon Jared Broadway, MD and administrator Ben Fagerlie.
Arrowhead Surgery Center, which has its state licensure and is currently awaiting The Joint Commission survey, will soon open its doors to the community. Dr. Broadway and Mr. Fagerlie discussed the multi-year planning processes and the partnerships Arrowhead Surgery Center has leveraged to create a truly patient-centered ASC for spine surgery.
Design principle 1: Keep patients top of mind
Patient demand is one of the major contributors to ASC growth.2 Rather than spending days in a hospital, people prefer outpatient surgery and being able to recover in the comfort of their homes. To deliver the highest level of care and meet patient expectations, every detail of the ASC must be designed with the patient in mind.
One of the first considerations for Dr. Broadway and the Arrowhead Surgery Center team was selecting the right building location. Duluth, Minn. is located on a rocky hill on the shores of Lake Superior. The downtown area has many one-way streets, and parking can be difficult. In addition, winters are cold and snowy.
“The community in northeastern Minnesota is aging and we had heard about their challenges with the roads and parking in Duluth,” Mr. Fagerlie said. “We spent a lot of time thinking about the patient journey and recognized the importance of finding a place that would be easy for people to get to.”
The Arrowhead Surgery Center team evaluated both a former high school building, located on a hill, and new construction. Unfortunately, neither were ideal. Instead, the team decided to lease space as an anchor tenant in the largest, privately owned building in Duluth. The building owners shared Dr. Broadway’s vision, and they agreed to renovate the lobby. The first floor of the 180,000-square-foot building has now been converted to Arrowpointe Medical Center.
“I think we’ve done something novel by creating a medical destination sub-specialty building,” Dr. Broadway said. “Arrowpointe Medical Center includes our neurological spine ASC, as well as dermatology, retinal surgery, physical therapy and plastic surgery practices. This is a new experience for our community where larger organizations deliver most healthcare.”
Arrowpointe Medical Center has 1,100 free parking spaces, a comfortable lobby and a covered discharge area adjacent to Arrowhead Surgery Center, so family, friends and caregivers can easily pick up patients after a procedure.
“We took a lot of time on the front end to think about the patient experience,” Mr. Fagerlie said. “We want it to be easy for people to get here, and we want them to feel comfortable once they arrive.”
Design principle 2: Plan with an eye toward scalability and expansion
Arrowhead Surgery Center’s 17,500-square-foot facility includes a clinic, two operating rooms and one procedure room. Dr. Broadway and the team worked closely with an architect to ensure that over time, two additional ORs can easily be added to the ASC without disrupting patient flow.
“If we decide to expand, it won’t impact operations,” Mr. Fagerlie said. “Medical gas lines have already been piped in for two additional operating rooms, and the sterile processing area is located adjacent to the two existing ORs. A big part of our planning process was making sure we were positioned for the future, not just for our current needs.”
Dr. Broadway concurred. “Many ASC operators fail to plan for the future, especially if they are using an existing structure,” he said. “We’ve planned everything so the conversion to a four-OR ASC will be relatively simple. The other thing to keep in mind is sterile processing capacity. You must be able to support your caseload.”
Design principle 3: Remember that you don’t have to go it alone
As Dr. Broadway and the Arrowhead Surgery Center team embarked on the ASC building process, they also met with several potential vendor partners and evaluated the pros and cons of each one.
“Until they get deep into the research, many surgeons aren’t aware there are partners like Stryker that can assist with an ASC build-out,” Dr. Broadway said. “One thing that stood out to us about Stryker was that they are just as excited about our project as we are. They really understand our vision.”
Arrowhead Surgery Center was also impressed by the breadth of Stryker’s product catalog, from OR lights to instrumentation, stretchers, wheelchairs, patient warming devices and more.
“Stryker brings so much to the table, which allows for capital placement in the ASC that can be paid down through utilization of their large product line,” Dr. Broadway said. “Stryker technology is truly state of the art, especially for spine surgery. We have the equipment that will allow us to perform a level of complex spine surgery equal to larger organizations.”
For example, Arrowhead Surgery Center is using Stryker Airo TruCT — the world’s first point-of-care CT scanner used for navigation in a surgery center.3 This provides the team with image quality that can be customized to each patient’s unique needs.
Developing this ASC has taken nearly five years, which included disruptions during the COVID-19 pandemic. Stryker worked closely with Arrowhead Surgery Center at every step of the construction process to ensure the organization had what it needed in terms of equipment.
“Despite supply chain challenges, Stryker always had a plan for getting us equipment,” Mr. Fagerlie said. “They continually updated us about shipment status and moved with us as our targets changed. We never panicked because they understood where we were at and found ways to get us what we needed.”
Stryker’s marketing programs were also valuable for the Arrowhead Surgery Center team. “We appreciated that Stryker was willing to go beyond the spreadsheets,” Mr. Fagerlie said. “We have marketing resources, but they are limited. It was great that we could take advantage of Stryker’s marketing materials for our audiences and messaging.”
“With this partnership, our hope is to become the place in the Upper Midwest where people come not only to see what we’ve been able to do from a partnership perspective, but to train, learn and expand their armamentarium based on the technologies we’ve put in place,” Dr. Broadway said.
Design principle 4: Create a great culture and let it drive patient care
To ensure a great patient experience, Arrowhead Surgery Center is building a strong organizational culture and hiring a strong team of employees.
“We want to provide fantastic care, and patients will feel that when they come through our doors,” Dr. Broadway said. “If you have a great culture, the staff will deliver on that promise.”
The organization is being very selective in its hiring. The goal is to form a special team of people who want to offer outstanding care to their family, friends and other members of the community.
A promising outlook for the ASC
The common thread through all of Arrowhead Surgery Center’s work is the patients. “Opening an ASC has been an intense process, but we’ve learned so much,” Mr. Fagerlie said. “All of our decisions have focused on providing the best patient experience. We never cut corners, whether it was the building, technologies, implants or finding the right employees.”
When Arrowhead Surgery Center opens its doors, it will be a sort of homecoming for Dr. Broadway. “After practicing in Duluth for several years, I spent four years in Fargo, North Dakota,” he said. “From a personal perspective, I have a lot of patients that I’ve treated in this area. I’m excited to return and to be their spine surgeon, if the need arises again.”
For fellow surgeons planning to open an ASC, Dr. Broadway has a key piece of advice given his positive experience working with Stryker: Engage with a strategic partner. “If you’re standing on the sidelines and are interested in the ambulatory setting, explore the possibilities and find a partner that can offer guidance and support along the way.”
1https://www.beckershospitalreview.com/finance/outpatient-volumes-to-increase-in-2023-vast-majority-of-health-leaders-say.html
2https://www.beckersasc.com/asc-news/asc-market-expected-to-reach-150-6b-by-2033-report-says.html
3https://www.stryker.com/us/en/spine/products/airo-truct/imaging.html