Hi everyone. This is Erica Spicer Mason with
Becker's Healthcare. Thank you so much for tuning
into the Becker's Healthcare podcast series.
So today we're going to talk about clinical
excellence, economic value, and operational support in the
ASC.
And joining me for this conversation is Patrick
Magellanis,
the president and CEO of Steinler Orthopedics.
Patrick, so glad to have you with us
for the podcast. Thank you again for being
here today. I'm delighted to, participate. Thank you
for having me.
Yeah. We're we're really happy to have you
and to learn a bit more about your
center.
But before we get into that, would you
mind sharing just a little bit more about
yourself and your work in healthcare?
Sure. So I've been with Steiner Orthopedics for
seven years, now.
I worked in community oncology for five years
before I joined Steiner.
I think that when I joined Steiner, what
we were really looking toward was the future
of what Steiner would look like. Steiner started
in 1950
and really was a group practice through all
those years, never owning an ASC or a
percentage owner in an ASC.
And what's really changed for us is trying
to get on the path of orthopedic self
determination.
And for us that meant moving into an
ASC environment. So we opened our first ASC
ASC in March. We have a six room
ASC that we think is,
the future for our own self determination. I'm
excited now to expand my responsibilities in ASC
management.
Patrick, great to learn a little bit more
about you, and congrats on opening,
Steindler opening the first ASC in March. That's
really exciting.
And I wanna go back just to for
a moment and talk a little bit more
about Steindler.
Can you share a little bit more about
the organization's
inception and really the vision and goals for
it as well?
Well, Arthur Steinler started the University of Iowa's
orthopedic department in the nineteen twenties. He retired
from the University
of Iowa in the late forties and started
Steinler Orthopedic
Clinic in conjunction with the Sisters of Mercy
at Mercy
Hospital in downtown Iowa City.
So, our beginnings really started with one of
the founders of orthopedic medicine in The United
States.
Just yesterday, I ran across a stat that
I wasn't aware of that the first orthopedic
female surgeon in The United States
trained under Doctor. Steinler. So we have a
rich tradition. I have a number of the
textbooks that Doctor. Steinler authored in the thirties
and forties.
So we have this rich tradition. Steinler Orthopedic
Clinic, when he started it, it was you
know, was a swan swan to his career.
And we've been in Iowa City and serving
Eastern Iowa since 1950.
Currently,
we have 18
physicians,
numerous,
mid level extenders and a fantastic clinical care
team.
We're extremely well known for orthopedic excellence going
back to Arthur Steinler.
And, you know, our our footprint now is
is expanded to include
a ambulatory surgery center. And we are, I
think, putting the finishing touches on putting a
community hospital right next door to us.
Really exciting. And it sounds like such a
growth period for Steinleer. So, Patrick, thank you
again for sharing a bit more.
And as it stands now, what procedures is
your center currently specializing in? I know you
talked about ortho excellence here.
So can you touch on some of those
specialization areas and what you foresee adding in
the future for the center?
Well, our ASC
is orthopedic only.
I don't foresee in the near future that
our facility will do anything other than orthopedics.
So the subspecialties that you would expect, including
pain management, so hand and upper extremity, foot
and ankle,
total joints.
We have a very strong total joint practice.
We're about to enter our busy quarter, you
know, Iowa's farmland,
people have met their deductibles, which is common
for most
orthopedic practices.
But we're also farmers are about to take
in the fields and so our fourth quarter
tends to be super busy doing all the
orthopedic practices that a farming type community needs
for the upcoming year.
Oh, that's great to learn. Thank you, Patrick.
And I know the the center is relatively
new having just been established in March.
Can you walk us through what the RFP
and the bidding process looked like as you
developed the center?
And as part of that, how did you
factor in future needs like potential expansions or
even new tools and technologies during the decision
making?
Yeah. So when we when we really conceived
the idea of building an ASC,
really the genesis for that or the cornerstone
was
having the ability to have self determination,
not having an ASC
where that's clearly,
you know, five years ago, we identified as
most people five years ago would have identified
That is the trend, lower cost outpatient environment.
You know, from our perspective, COVID accelerated that
many patients. We started doing some procedures that
would work historically,
inpatient procedures or hospital procedures, hospital based procedures.
We we I remember very clearly one day
we put on Facebook and social media that
we had done our first ASC,
knee replacement,
and the community feedback was was strong and
folks wondering why we were doing that. And
I remember I was at a ortho conference
and our social media person said, I took
the post down because we had so much
feedback. And I remember
saying, no, please post it again. We've been
doing outpatient procedures for quite some time. We've
just done them in a hospital setting. And
then COVID occurred
and then patients were like, anything to keep
me out of the hospital. And the demand
for ASCs, as you know, on the listeners
note, has increased. From our perspective, what was
really important is we knew that our community
hospital was in dire financial straits. And I
had projected when I arrived at Steinler that
bankruptcy was most likely on the horizon. And
that's in fact what actually happened.
Our community hospital closed,
was acquired by the University of Iowa and
incorporated in the University of Iowa and the
academic medical center footprint that they have. And
so our ASC, I think, at the time
it was conceived, was rightly conceived as an
opportunity for us to have self determination where
we have our own facility.
As far as what went into planning, initially,
I was Iowa is a CON state. And
so we had to go in front of
the Health Facilities Council in the state of
Iowa and get permission
to build an ASC.
And as most listeners who are in orthopedics
would know, if you're in a CON state,
that's a very difficult thing to do. Most
likely,
unless you have a hospital partner and you
work with a hospital partner to pave the
way, there's usually opposition.
And in more cases than not, any type
of sole application is denied.
In our
situation,
we knew that there were certain
elements in place that made our application likely.
So we did apply and we did receive
unanimous approval.
Steiner had actually applied for one some fifteen
years earlier and was denied and had just
kinda ruled that out.
When our application was approved, we originally thought
that we were gonna build a multi specialty
ASC, and so we designed it to be
multi specialty. So our capacity,
it's six rooms currently, and we can expand
it relatively easy to eight total operating rooms.
But for a number of reasons, we're limiting
it for the next few years to orthopedic
only, and I think it'll be some time
before we open it up to multispecialty.
As far as our planning,
we toured a number of ASC facilities
around the country, and we saw many things
that we thought would be wonderfully,
incorporated into our facility, things that we just
really wanted to see,
larger operating rooms. We wanted to make sure
that each of our rooms was,
light so that, you know, if you walk
into Room 1 or Room 4, Room 6,
you know, if you're blindfolded and you walk
in and take the blindfold off, they all
look the same. They all feel the same.
So we wanted that type of consistency. But
we also, more importantly,
we saw a lot of things that didn't
make sense to us. I remember going to
one ambulatory surgery center and,
owned by a large company,
that has a footprint nationally. And,
they had a sister
ASC in the same city, and they had
a surprise inspection. And so in the facility
that we were touring as guests
on our site visit,
I remember they were putting boxes in into
cars that morning to try to prepare for
a potential inspection. And, you know, we said
that that's not something that we wanted to
do. Another facility said that
the central sterilization component,
was very small. And the and the feeling
was they were in the orthopedic
surgery center business, not the central sterilization business.
And so they went with the bare minimum.
And, you know, we looked at that and
we talked to folks who work there. And
we determined that for us, the best course
of action was to just make sure that
we built a facility that could handle all
of our needs and potential growth. And it
it also turns into opportunities for us because
if we put a community hospital next door,
we think there's an opportunity for us to
provide
sterilization
services to the community hospital, which will be
a savings for the hospital
and create an opportunity for us to have
a true partnership with a community hospital partner.
So there's a lot that we did that
went into our planning and our thinking. But,
you know, for the most part, I think
the most important thing is the patient experience
around ASC is exceptional. And I would invite
anyone who wanted to come take a tour
of what we've done to come take a
look at it. We're proud of it, but
it really works
well. In some cases, I might say that
we overbuild. We have probably more supply area
than we need, but we also have a
standard that nobody who walks through it will
ever see cardboard in a walkway, in a
hallway.
Oh, absolutely. And, Patrick, I really appreciate the
overview of kind of where the center started
and where it is now and this focus
on exceptional
patient experience in the ASC. I I think
that that's
such a great foundation for everything else that
you just described and what's possible in terms
of the center's growth and expansion.
And I know a big part of the
patient experience, of course, is having,
surgical
procedures and technology that make
those experiences for patients that much more streamlined
and easy. So I know that part of
that for Seimler is its partnership with J
and J MedTech. So I'd love to learn
a little bit more about that partnership and
maybe some of the nonnegotiables
that you established upfront as you were searching
for a partnership like this.
Well, as you can imagine, we had a
lot of interest. I mean, I think,
one of the things that we wanted to
do
was try to hone in on an opportunity
to create the most value within our facility.
And
one aspect of that was trying to get
to
one or two
partners
where we concentrated our spend to really drive
down our price.
With everything else,
labor, health insurance, materials
increasing year over year and really not seeing
much in the way of reimbursement increases,
being very thoughtful about efficiency and spend was
something that we honed in on. And so
that was a major aspect of the RFP
process.
But those ideas, of course, are are super
important, but they only work well if the
quality that you're gonna get from the partner
you choose is quality that you can live
with every day and that you're comfortable with.
And so,
you know, we had a lot of interest
and we really honed it down. And when
it when it's all said and done, I
think what we really we thought that the
partnership with J and J was gonna be
super comprehensive
and that we would work with folks who
were very much invested in our
success. And then, you know, partnership's often thrown
around as just a term, and it really
doesn't have the traction that really means that
it's a dual sided commitment. And with J
and J, we just felt like we were
gonna have that commitment from them.
And I can say that, you know, since
we made that decision and we built the
facility and we worked through all the different
equipment that came with the partnership and we
opened and they came to celebrate our opening
and things that we're doing now and a
continuation of that relationship, I think we made
the right call.
Yeah. That I love what you're saying here
about
kind of that bidirectional,
effort and investment in a partnership. I'm sure
that really,
solidified that decision for you all. And
it's been great, Patrick, learning more about
Steindler's history,
where the newest center is at and some
of these growth and expansion opportunities.
I know we covered a lot of ground,
but is there anything else you'd like to
add or or leave our listeners with today?
Yeah. I think that yeah. Yeah. I'd remind
everyone that for all of us, the challenges
continue
to increase and and the approaches that we
have to take to be successful in the
orthopedic space and running a surgery center,
our our challenges are increasing. And I think
one of the things that I really value,
and I and I commend Becker's for this
as well, is that we do have this
really unique community where we share information, we
share insights, we learn best practices from one
another, and I appreciate that. And so, you
know, from Steiner's perspective, if there's anything that
we've done and can share with anyone, we
welcome the opportunity to do so. I can
say for absolute certain that so much of
what makes us run well
has come through others who have helped us
along the way. And so that's one of
the things that really is to respect about
the orthopedic community.
Oh, great note to end our conversation on,
Patrick. Thank you so much again for making
time for our conversation today and for joining
Becker's for a podcast. It was great having
you. Well, thank you for having me, and
thank you for,
taking interest in Southern Orthopedics. Absolutely. And we'd,
of course, also like to thank our podcast
sponsor for today, J and J MedTech. Listeners,
be sure to tune into more podcasts from
Becker's Healthcare by visiting our podcast page at
beckershospitalreview.com.