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Hello. This is Francesca Matthews with the Becker's
ASC review podcast.
I am thrilled to be joined today by
Tammy Smittle, CEO of Stonegate Surgery Center. Tammy,
Tammy, thank you so much for being here
today. Thanks for having me.
Great. Well, just to start off, could you
please introduce yourself and tell us a little
bit about your background?
Yeah. So I'm Tammy Smittle. I've been a
nurse for almost thirty years.
I am now a group CEO of a
surgical hospital here in Austin and then a
surgery center also in Austin. So I have
ASD and then, a surgical hospital that's about
15 miles apart from each other. So
been in health care for a long time,
been a surgical nurse my entire career.
Can't imagine doing anything else except what I
do.
Excellent. Well, we'll just, jump right into it
then. As an ASC leader, what are the
top three trends you're following in health care
and ASCs today?
Yeah. So the top three are obviously the
same as everybody else's. Watching the higher acuity
patients and procedures being performed within the ASC
safely.
We you know, it started last year with
or several years ago, we started with the
total knees and then adding total hips and
now total shoulders. And there's a lot of
things that we can do
better than the hospital systems can, so it's
exciting to see those patients,
migrate over
to the ASC world.
Second thing would be the employers,
entering partnerships with ASCs
to shift procedures out of hospitals
and,
and into the ASCs entirely.
It's often waiving out of pocket cost,
to the patients, and it's increasing quality and
and reducing cost to the employer because a
lot of these employers have set have self
funded plans.
So it's been fun to watch the ASCs
work directly
with these self funded plan employers
to get take care of the patients.
The third thing kind of follows into
cases moving over to ASD is the the
amount of hospital investments. And in Austin, it's
pretty impressive right now.
Currently, over 70% of health systems plan to
expand or acquire ASC capacity.
In Austin, it's it's happening now on a
daily basis. So it's interesting to see these
hospital mergers with ASCs.
It's you know, because it's it it's
better for patients. Like, it's they can have
the sicker patients in the hospital and do
all their surgical cases in the ASC.
And it's operational efficiencies, and and I think
the surge the patients are demanding it. Market's
demanding that these cases move
to the ASC.
They don't wanna be around sick patients. So
those are the trends that I'm currently watching.
Mhmm. Absolutely. And what are you most excited
about right now in this space? So last
week was we all got the email or
the
the note from Becker saying that, that CMS
has proposed this three year phase out of
the of the inpatient only list.
Super excited about that.
It's gonna be 285
musculoskeletal
procedures scheduled for 2026
gonna be released off of the inpatient only
list.
We've been performing cases and we can perform
these cases,
for commercial plans and we've been doing, you
know, lumbar fusions and we've been doing the
reverse total shoulders and,
even some hip and knee revisions. We've been
doing these safely
for a while. It's really great that CMS
is recognizing it,
so I'm excited to see that. Another big
thing that we're excited about is,
and then Texas is this noncompete
issue.
We're being told it's gonna change the five
mile radius for one year. So that's gonna
be huge
in order for
as an independent a runner a c CEO
of an independent surgery center, it's interesting to
get these doctors that are leaving hospital employment.
They'll be able to join my
my ASC at a timelier basis in five
mile Nanga Peak. That's not bad. So excited
about that.
Absolutely. Yeah. Definitely. I've been speaking to a
lot of leaders about that inpatient only list
announcement, and I think a lot of folks
are are looking forward to see how that
changes things.
We can do it. I mean, we've been
doing taking care of it's a fine line.
You know, it's a tight group of making
sure that the doctors and anesthesiologists
work well together as far as getting the
patient selection right. Because you don't wanna take
patients that aren't gonna do well in the
ASC because if something goes wrong, it's we
have to transfer the patient. Right?
So I think that that's gonna be a
learning curve. It's just for surgeons to work
with anesthesia
to make sure that our patient selection's
spot on.
Absolutely.
And how are you thinking about growth over
the next twelve months? So So I think
that's two phases. And like I said, I've
been doing this for almost thirty years, and
I I like to think as the the
team mom for orthopedic surgeons here in Austin.
So it's crucial to to manage it
bringing a new business while maintaining healthy relationships
with the business you already have. So
I think that
I'm always recruiting. I'm always looking for new
doctors, but I'm at a lucky spot
with my current surgery center at Stonegate that
we can kinda pick and choose who comes
to Stonegate.
You know, when you're hungry, you pick where
you work with everybody. But now you can
you pick the doctors that fit
what's going on in your surgery center so
I can I can pick the right doctors
with the right procedures with the right attitude
and the right patient care?
And so we're that we're getting that so
we can recruit,
smartly,
this in the orthopedic world.
Another thing is, like, with your current doctors,
there's not a better marketer for you than
a happy surgeon that's getting distributions.
So if you just keep your current business
happy,
then they're gonna be out there hitting the
streets telling everybody that this is the center
to go to because they've had they get
taken care of. They're getting distributions.
You know?
It's a happy place to work,
and and that's that's huge, and I want
my surgeons happy. And so we work really
hard on that.
Another aspect that I focus on with my
current doctors and even with new doctors is
bringing new procedures
that they may not know about. And my
surgery center was the first surgery center in
Texas for an orthopedic surgeon to
to do a peripheral nerve stem, and now
I have six orthopedic surgeons that are doing
peripheral nerve stems. So they're excellent for for
patients.
It's a well reimbursed procedure. It reimburses kinda
similar to a spinal cord stimulator.
My orthopedist are doing it for rotator cuff,
pain after rotator cuff, residual pain after total
joints, or even ankle or wrist pain. So
this gives the surgeons a new avenue to
take care of their patients that before they
would look for pain prescription to to
to take care of them with. So
growth is it's on my mind on a
daily basis, but it's a you have to
do you have to keep the what you
got happy and and recruit new over at
the same time.
Mhmm.
Absolutely. And I I like what you said
there about that that kind of word-of-mouth factor,
I think, especially just
given, you know, the way technology is today.
It's almost like the old fashioned way. It
can kinda cut through the noise a little
bit when you've got people just in the
community talking about their experience.
You can't really trust you can't Google like
you used to. Right? You can't really trust
that as as
as factual. So I'm telling you, like, the
the best marketer I've ever had is a
happy surgeon.
Even even doctors that are not invested, they'll
go and say, hey, man. I can I
I'm efficient? They have quick turnovers.
I can do eight cases before noon. There's
there's nothing better than hearing that from another
surgeon to get a phone call. So we're
we're really blessed.
I have a great team that works their
buns off to make sure everything goes great
and patient care is good. So,
I know they work hard, but we feel
lucky at the same time.
Absolutely.
And that sounds like a a good place
to end things here. It's all I have
for you today, Tammy.
And thank you so much for joining us.
It's been a pleasure speaking with you, and
I look forward to connecting with you again
in the future.
You as well. Thank you so much.