Geri Eaves. At the Bone and Joint Institute Surgery Center in Franklin, Tennessee, growth has remained steady despite post-COVID staffing hurdles and ongoing financial pressures.
Geri Eaves, the center’s CEO and administrator, recently spoke with Ambulatory Surgery Center News about the shift toward higher-acuity orthopedic and spine cases, how her team navigated labor shortages without stipends, and why technology is at the center of her 2025 investment strategy.
The conversation – edited for style, length and clarity – helps paint a picture of the challenges that ASC leaders continue to navigate.
ASC News: Tell me a little about your center.
Eaves: We are a six-OR orthopedic spine surgery center. We’re actually a really large surgery center, so most of the issues that a lot of places have are as far as space and not having enough room. Well, we have a lot because we’re very large.
We opened five years ago, and we actually opened during COVID. We have been very successful since.
In terms of orthopedics, where do you see the most opportunity for growth?
As of right now, a lot of the growth is going to the total joints cases from the spine cases. Most of the procedures that CMS is approving, if we can move them to the outpatient setting, that’s where we’re moving them.
Could you talk more about total joints and the technology that’s enabled those procedures in the outpatient setting?
Years ago, total joints meant being in the hospital for at least a week. Now we have advanced technology with new innovation. We have robotics. We have the ability to bring a patient in at our facility for maybe four to five hours tops. They come in, check in, and are in pre-op for approximately an hour. The procedure takes one and a half to two hours, and then they’re in recovery for one and a half to two hours.
A lot of the advancements with nerve blocks have made it a lot easier for patients to get up, ambulate and go home sooner. They can get home, they’re comfortable, and they can actually rehab and recover a lot faster.
Has the anesthesiologist shortage impacted your center at all? Are there any workarounds?
We are very lucky. We have a privately owned anesthesia group that works with us that is amazing. We are not at the point where we have to pay what they’re calling stipends, so we do not have that issue right now. But we’re also in a very prominent area of Tennessee that has a very specific population. We don’t have a huge amount of Medicare patients, which actually helps with the anesthesia issues.
Anesthesia, for the most part, depending on your facility, the stipends can be very impactful to your revenue. It’s really hard. It’s hard to find enough anesthesiologists and CRNAs. The facilities that have really high Medicare rates, especially ophthalmology and GI centers, are really impacted because of the amount that anesthesia is paid.
Have you seen any recent changes in payer contracting, tighter reimbursements, or prior authorization challenges?
I have not seen that issue in my facility. Other people I know, other centers, have had issues, but not mine.
Can you talk about staffing and recruitment at your center?
Staffing has been a nightmare since COVID. COVID really hit us hard. We lost a lot of staff, nurses, surgical techs and other positions. Some went home and didn’t come back. A lot of our nurses decided it was time to retire. So we were already short on nurses and then became shorter.
Salaries increased a lot because we needed people to work, and we were willing to pay whatever we needed. But those increased rates were really hard to sustain. We ended up without enough staff and paying a lot of agency fees.
Now, we’re starting to see that come down a little. For the last two years, I had a really hard time filling a lot of my surgical tech positions. Nursing wasn’t quite as hard because a lot of people want to work in an ambulatory surgery center. They’re not working nights, weekends, or holidays. But surgical techs were still really hard to fill.
I’ve just now gotten to the point where I’m able to fill all of my positions. If I had wood, I’d knock on it. I’m actually in a really good place with staff. It’s taken us the last three years to really build back up on staffing and get people back in the workforce.
Have you seen interest from private equity or hospital systems in partnering with your center?
There’s a lot of private equity buying up different companies and facilities. You’re seeing a lot of that nowadays. As for where I’m at, I’m not. We’re actually partially owned by a community hospital and partially owned by physicians. We do have a management group, but we’re just not seeing that where I’m at.
How are payers responding to higher acuity procedures moving to the outpatient setting?
The payers are actually very supportive of moving cases into the outpatient setting. The patients are able to get in and out quicker. They’re not staying in the hospital. You don’t have the higher rates payers are responsible for, so a lot of them are very willing to push more cases into the outpatient setting.
Do you think that will continue?
Yes, we are going to see more and more cases, more procedures pushed to the outpatient setting.
Are there any particular procedures you’re preparing for?
We’re going to see more and more extensive spine procedures come to the ASC, and we’re also going to see more cardiology.
If you could wave a magic wand and fix one operational bottleneck, what would it be?
If I had a magic wand, one of my biggest issues is staffing costs and labor costs. It’s really the only thing I can truly somewhat control, and it’s very impactful to your bottom line.
What areas are you investing in most right now?
Probably for us, one of the areas we’re trying to invest in more is technology. Everything we do requires more and more technology. We want to be more efficient. We want to be more value-based, but we also want to provide the best care to our patients possible. The best way to do that is to bring in more technology.
You’re seeing a lot of different people talk about AI, about EHRs. More and more facilities in the ambulatory setting are starting to bring in EHRs and also robotics.
Are you looking at robotics or EHRs?
We’re looking at both. We already have a micro robot for our total joint replacements, but we’re also looking at EHRs and AI and how it can make us more efficient and provide better patient care.
