Stacy Danahy at the ASC Investment & Operations conference.When it comes to developing, launching and growing a successful ambulatory surgery center (ASC), the journey for operators can be both exciting and challenging.
Along the way, there are certain key factors that can determine whether an ASC will thrive.
Few understand this better than Stacy Danahy, who has spent more than 25 years opening and managing dozens of ASCs across the country.
Danahy currently serves as the vice president of orthopedic and spine growth and strategy at Compass Surgical Partners. Compass is an independent partner specializing in the development and management of ambulatory surgery centers through joint ventures with health systems and physicians, with over 250 ASCs developed in the past three decades.
Danahy first got her start in the ASC realm from an ad in the newspaper, after she had just relocated to Florida looking for her next role.
“I had worked the night shift for years, and I worked so many Christmases and New Years and missed out on all those things. When I relocated, I didn’t have family support,” she said during a conversation at the Ambulatory Surgery Center News Investment & Operations conference. “So for me, this was the dream job.”
Since then, she has participated in the creation of at least 30 ASCs, often building processes and teams from scratch.
“I have opened and been a part of at least 30 ASCs from the ground up,” Danahy said. “I’ve worked in every nook and cranny of the ASC space, except for billing and collecting.”
That hands-on experience is critical for effective leadership, especially in a surgery center, which doesn’t have the same support systems as a hospital, she said.
“It’s not like the hospital, where there’s a whole department to do things. It’s not siloed,” she said. “It’s very, ‘I wear a lot of different hats, and I need to know how to jump in, because there’s not another shift coming in to help me.’”
Converting hospital outpatient departments
Increasingly, hospital outpatient departments (HOPDs) are being converted into ASCs, which comes with advantages and hurdles for operators. One standout challenge in her career involved converting a hospital outpatient department into an ASC while trying to retain their workforce, Danahy said.
“My biggest challenge in opening an ASC was an HOPD conversion,” she said. “The surgeons only practiced at the HOPD or did inpatient cases. So to flip that switch, they said, ‘We want to keep all these staff members.’”
One of the most pressing issues was financial feasibility: The center simply could not support the salaries of the entire HOPD staff while still building its own volume. At the same time, the team did not want to lose experienced workers who had already cultivated relationships with the surgeons.
As a solution, Danahy and her colleagues pursued a creative dual-employment arrangement that allowed staff to split time and resources between the hospital and the emerging ASC.
“So the partnership with the hospital, they actually had some ORs, we were able to keep the staff dual employed,” she said. “So we leased them, shared equipment between the two, and kept the practice whole.”
Operators tackling similar transitions should prepare for complexities in licensing, accreditation, and financial bridging, she said.
“It was a challenge working through the nitty gritty,” she said.
Building a team and culture
Recruiting a solid team is often a top priority, but finding the right fit for the ASC environment can be tricky, Danahy said.
“Honestly, a lot of times it’s working with the physicians,” she said. “They’re your best recruiter. …They normally give you a list when you’re opening up. If they know the staff before you go, ‘Oh, I’d love them in an interview,’ they may go, ‘Oh, they’re horrible in the room.’”
Once hired, staff must embrace cross-functionality and a sense of ownership, she said.
“Not everybody wants to help you write that story,” she said, adding that the team you hire first should be willing to build policies, enter preference cards and tackle varied tasks without the backup of a large hospital department.
Retention, on the other hand, hinges on recognition and transparent communication around performance.
“Share the successes,” she said. “Have that moment. Have the shout-outs. I like sharing the KPIs. … Have surgeons call them out; make sure the surgeons are telling them that they’re doing a good job.”
As far as KPIs go, she outlined three key metrics she considers essential for new centers.
Tracking the exact moment a patient enters the operating room, and confirming that everyone is prepared and in place for the scheduled start, is a first step. Then, measuring the efficiency of the surgical team from the time the patient is in the room to the moment the first incision is made is an important follow-through.
“[We need to know] how long does it take us, from the time we enter the room to the time that the surgeon’s ready to make an incision,” she said.
And turnover time looks at how quickly the OR can be prepared for the next case.
“People get lost when they leave the case,” she said. “They disappear. “[So we need to] set those expectations up front.”
Strong partnerships
The success of an ASC also hinges on strong partnerships with both surgeons and anesthesia providers. While some centers might shop solely for the cheapest anesthesia stipend, it’s critical to look at clinical and operational factors as well, Danahy said.
“We’ve gone away from the efficiencies and the flow just to go, ‘Who’s going to charge us a stipend and who’s not,”” she said. “We forgot to look at, ‘How long do their blocks take? Do they show up on time? Are we going to have enough people there with us to support the surgeons?’”
For surgeons, providing a second OR just to mirror a hospital setup is seldom feasible unless the surgeon’s block usage justifies it.
“We have to be efficient,” Danahy said. “We have to fill our rooms up before we open the next.”
If they are able to build an efficient operation, an ASC’s first six to nine months often centers on securing payer enrollments, building case volume and stabilizing finances, Danahy said. After that, Danahy said she turns her attention to staffing expansions and surgeon block schedules.
“If you hire them too soon, then they’re sitting around,” she said. “You’re burning cash because the cash hasn’t come in yet. And the other part is creating that block-schedule consistency.”
Centers should also monitor when it’s time to add more rooms or services.
“Looking at block utilization and how we’re filling the block [is important],” she said. “I had to look at their block schedule and realign it. … If they’re not using it, we shouldn’t allow them to keep it.”
At the end of the day, Danahy’s overarching theme is partnership.
“If our attendees walk away remembering one thing, it’s, ‘Build a relationship with your physician partners.’ Engage them early,” she said. “I think a lot of times, we have superficial conversations, but we don’t dig in to find out what their dream is, what made them tick, right? That’s the culture we’re going to create.”
