Panoramic Health, an integrated provider group in kidney care, recently announced the opening of a new 10,000-square-foot ambulatory surgery center (ASC) in Tampa, Florida. The facility, developed in partnership with Florida Kidney Physicians (FKP), features five operating rooms and aims to offer advanced vascular treatments in an outpatient setting.
Dr. Shyam Uttamchandani, FKP chief financial officer and nephrologist, said that the center is trying to transform kidney care from “reactive” to “proactive.” The main thing that sets the center apart, Uttamchandani added, is its focus on specifically serving the end-stage kidney disease population.
“Right now, the majority of the patients coming through are in-center hemodialysis patients that have either an AV fistula, an AV graft, or surgical creations, or dialysis catheters, which are bridges until they get their surgical access,” he told ASC News. “The main procedures right now are being done in the center to ensure that those surgical accesses stay viable and healthy so that patients don’t get hospitalized.”
With over 750 aligned providers across 19 states, the company plans to continue expanding its ASC presence nationwide.
“We saw a need in the Tampa area to develop a joint venture ambulatory surgery center alongside our physician partners so that they had a better resource to coordinate interventional procedures for their late-stage chronic kidney disease patients and their dialysis patients,” Nick Carlucci, chief growth operations officer at Panoramic Health, told ASC News.
ASC News connected with Uttamchandani and Carlucci to get the full story.
This interview has been edited for length and clarity.
ASC News: Could you give me some basic details, like the number of operating rooms, staff and some of the procedures that will be performed in the new space?
Uttamchandani: We opened it toward the end of February of this year. It’s actually a pretty big footprint. We’ve got 10,000 square feet, six fully built-out operating rooms. We’re still in the ramp phase right now, so we’re using one, sometimes two operating rooms per day. Right now, we’re just doing all procedures related to dialysis. It’s just east of Tampa, along the main thoroughfares for the interstate, where all the different interstates kind of center around Tampa. So, we’ll be able to get patients easy access from the Greater Tampa area as far east as Lakeland.
Patients have loved it. My dialysis unit that I round out is relatively close to it, and patients love the convenience and the easy access to get in and out. Staffing-wise, we have one full-time interventional nephrologist and a couple of circulating scrub techs, as well as nurses, that are running there.
The patient experience has been quite positive so far.
Could you provide some more background on FKP?
Uttamchandani: We’re a fairly young practice, but the physicians have been practicing for a while. FKP was born in 2017. We actually came together as a merger of three practices and three individual physicians. We started with 20, and today we’re close to 100 nephrologists with another 40 physician extenders across the state, from Jacksonville to the Tampa area, Miami, St. Pete, Fort Lauderdale, as well as the southwest coast of Florida.
It’s been growing rapidly, and I think the physicians have significant buy-in as to what we’re trying to accomplish.
What are some of the benefits to a joint venture?
Uttamchandani: From a physician’s standpoint, it’s nice to have this network of partners across the country where we can say, “Look, this is what’s working or not working in our market. Are there similar hurdles elsewhere across the country, either from an operational standpoint or from a clinical standpoint?”
And I think Panoramic has been that backbone, that glue, so to speak, that helps all the providers in different ASCs work together to ensure that we get the best outcomes for our patients.
How common is it for these types of procedures to be performed in an ASC setting? Do you see that growing?
Uttamchandani: We hope it does. Unfortunately, far too many procedures get done in an inpatient setting. In our region, and I think even national data, shows that 70% to 80% of these patients, unfortunately, get treated in an inpatient setting. In the dialysis centers, where you’re seeing these patients on a weekly basis, you can do some diagnostics to get a heads-up when things are going to go down so you can try to get these procedures done.
The problem is, when you don’t have a center like this available for patients, the only option then ends up being a hospital setting. What should take three to four hours to get in and out sometimes takes three to four days.
Carlucci: Today, 75% to 80% of these procedures, nationally and in Florida, are being performed in higher-cost hospital settings where nephrology groups have limited input into the care their patients are receiving.
With Panoramic Health, our commitment to improving patient care alongside our nephrologists and reducing costs as a value-based care organization, having an ASC as a care delivery option for those patients outside the hospital setting in a lower-cost, higher-quality center is key.
Our goal is to flip that percentage so that 75% to 80% or more of those procedures are performed in an outpatient ambulatory surgery center.
And what are the strategic factors and timeline that you think you would need to achieve that growth?
Carlucci: Locally in Tampa, I believe that with our physician partners’ commitment, this will happen quite quickly. When we expand outward and thinking about how Panoramic Health will accomplish this goal statewide in Florida or nationally, that’s where you see the project we’ve just completed in Tampa as a model.
[The question is:] How do we scale that across the state of Florida and in other areas where Panoramic Health is present? This will be a rapid scale growth both in Florida and nationally to replicate what we’re doing in Tampa.
What else is important to know about the Tampa ASC or about kidney care-related procedures in an outpatient setting?
Uttamchandani: I think it’s made a big difference so far in preventing hospitalization. I work in all three different realms of providing care for patients with kidney disease: the office-based, the dialysis centers and the hospital.
Too often, what happens is, before the center opened, we would find out on a Monday that a patient’s access wasn’t working in the dialysis unit. Whereas they’re getting dialysis normally, Monday, Wednesday, Friday, they go to the hospital on Monday. By the time they get on the schedule for the procedure, it’s Wednesday. Now they need to stay an extra day to make up for the dialysis they already missed.
So, what should have been an outpatient procedure has turned into a four to five-day hospitalization. When patients go into the hospital, they’re out of their routine. They’re not getting the exact medications they should. Even though the physician is there, the protocol in the hospital setting is different from the outpatient setting.
We found that continuity of care has been much better since the center opened, and the number of hospitalizations over the last 90 days due to access-related complications has dropped significantly, which is a very good thing.
You mentioned the relationship between preventative care and reducing hospitalizations; do you have numbers that speak to that specifically?
Uttamchandani: So, our group in the Tampa Bay area has about 4000 end-stage kidney disease patients. I don’t have the exact data on hospitalizations in front of me, but anecdotally, and from what we’ve seen in our group, I’d say that about 70% of the hospitalizations are access-related.
We are seeing a downward trend in the number of hospitalizations since we opened the center. This means that patients are staying healthier, they’re staying out of the hospital, and we are preventing some of these crises from happening. So, from a numbers standpoint, I’d say a 10% to 20% reduction is what we’re seeing so far.
