Our president, Dr. Ken Moore, asked me to write on my practice here in Springfield, Missouri. Springfield is unique in having two very strong hospital systems with their own capitated insurance programs, which include the enrolled majority of residents in the metropolitan area.
These two hospitals have exclusive contracts with many major insurance companies and have their own employed orthopedic staffs. Out of the 56 orthopedic surgeons here, there are only a few independent of the hospitals.
I have practiced in Springfield for 33 years, and actively covered the hospitals including trauma. My independent clinic has been in existence for the last 16 years; and in the past two years, an outpatient surgical clinic has been developed allowing complete independence of the local hospitals.
Startup costs for an outpatient surgical center can be significant, and the accreditation process can be intimidating. Undergoing the accreditation process by the Joint Commission on Hospital Accreditation was a real learning experience. I hired a firm from New York state called Somnia, Inc., which charged about $11,000 (well worth it) to guide us through the process. The Joint Commission (JCAHO) charged approximately $4,500.
The biggest expense, however, was acquisition of equipment and changes in our physical facilities. Fortunately, we had ample space which adapted well to a single operating room with proper lighting, air conditioning, electrical outlets, drainage, etc. The day of the accrediting inspection was anxious, but we passed easily. An article about our experiences was written for Outpatient Surgery Magazine Journal, February 2006 edition.
A local anesthesiology group provides anesthesia services every Thursday. They bill separately. However, some patients have their procedures under block anesthesia given by me. For example, wrist fractures which often arrive at odd hours are treated open, closed or pinned percutaneously under IV block or axillary block with mild sedation. Carpal tunnel releases are performed under local with mild sedation. Knee arthroscopy is performed with femoral block and local to the portals. Shoulder surgery is performed with a scalene block and local quite successfully.
Most important to the success of the surgery center are the three C's: coding, collections and control of overhead. We have enlisted a billing service for the surgical facility's fees, which are important and require perseverance. Our clinic's staff handles the usual office charges and surgical fees. Reasonably priced online supplies can be found. Screws, plates, K-wires, drills, saw blades, suture anchors, disposable sterile drapes, etc. are frequently overpriced so one needs to shop around. We were able to obtain our workhorse reasonably priced C-arm image intensifier on the secondary market. Running an outpatient surgical center is demanding and challenging. However, I am convinced better, safer, less expensive and much more convenient services can be provided to patients.
No problem has arisen with referrals. However, that is a potential problem area. Another possible downside is that relations with the local hospitals will deteriorate. Hospital associations are dead set against outpatient surgical centers, and have even tried to pass blocking legislation in Missouri. I have weathered some extremely devious tactics by our local hospitals. They have actually been successful in forcing some other outpatient facilities out of town. Another downside is that some major cases cannot be performed outpatient and require referral.
On the positive side, a great deal of self-satisfaction comes from having appreciative patients. I find the practice a good deal more gratifying than hospital work, and my life style is much improved.
Michael S. Clarke, MD, FACS
Clarke Orthopedic Clinic
3150 South National Ave.
Springfield, MO 65807