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find the conference website. That's the beckershospitalreview.com
events page. See you in Chicago.
This is Alan Connan back at the Becker's
podcast. I'm delighted to have back on the
podcast
Tammy Smittle, who is the CEO
of Stonegate Surgery Center and chief nursing officer
of Northwest Hills Surgical Hospital, both of which
are located in Austin, Texas.
Tammy, delighted to have you back on the
podcast with us today. Before we dive into
some questions, I'd love to hand it over
to you just to hear a little bit
more about your background and your dual role
as CEO and CNO of those two facilities.
It's it's an interesting role.
So I'm happy to be back, first off.
So thank you guys for inviting me. I've
been a nurse for 28 years. My entire
career has been in the perioperative world, so
surgery has been my life for the last
28 years. And so if you put me
on the floor somewhere, I probably wouldn't know
how to behave. Do love myself the the
anything in the surgery related. So currently,
I'm CEO of a surgical of a surgery
ambulatory surgery center in South Austin, and then
I'm interim CEO and then chief nursing officer
of a surgical hospital,
in North Austin. Both are owned by SCA
Health, so it makes it pretty easy. But
I spend about half my
time, I've I've moved throughout the day. So
I'm half of the day at Sungate and
half of the day at North West Hills.
Like I said, I've been a nurse for
28 years. I've this is not my first
time of being CEO of a hospital. I've
done that two other times in my career,
and I've also ran surgery centers.
I took up my first surgery center in,
2008,
So that's where it started.
So I've got extensive history in this and
and feel like I've kinda got a grasp
on all the comings and goings in the
ASC world and the surgical hospital world.
Yeah. Absolutely.
And, you know, such a unique position you're
in as well wearing many different hats, I
imagine, on any given day, especially in that
dual CEO and CNO role of those two
facilities.
Mhmm. Tammy, I'd love to dive right in.
I think,
specifically, when you're thinking about the ASC
sector today,
can you give us a little bit of
insight into what are 2 or 3 trends
that you're paying really close attention to,
and why?
Okay. And it I don't know if it's
much changed over the last year, but I'm
happy to share.
Obviously,
I'm watching for increased case volume and complexity
of cases within the ASC market. Obviously, starting
January 1 this year, we're able to do
total shoulder
replacements and and total reverse shoulder arthroplasty. So
that's been a big win for ASCs, and
it's been a really big win for Stonegate
Surgery Center. I picked up a bunch of
surgeons actually that are performing these cases with
us. So
complexity of cases,
is definitely the one thing that I'm watching.
The second thing that is kind of I'm
watching and interesting to me is kind of
the expansion on the value based health care
and kind of the incentives that insurance companies
are creating for high quality cost effective care.
And it's interesting because
this is something I see in my dual
role is, like, Medicare has the comprehensive joint
replacement program within
the hospitals and the surgical hospitals, and that's
been in place
for years. I I think it started maybe
in 2010,
but it still hasn't picked up in the
ASC market, which it incentivizes
the facility to keep costs cheap. And no
one does that better than us in the
ASC market. So it's really been surprising to
me that that hasn't
gone across to the ASC market yet, but
I'm anxious to see where that goes. And
then working with in with, employers directly to
see,
like,
big systems in this town, like, with our
HEB grocery stores. Can we work with them
directly to take care of those patients and,
you know, those that have that that pay
for their work comp directly or their insurance
directly, so the self funded care. So it's
been interesting to to watch that and see
how that's grown over the last year or
2. And and the third thing, I don't
completely think it's a positive thing, but I'm
watching the consolidation and mergers amongst
ASC markets and the hospital systems that see
the need to own an ASCs.
So it's been interesting to watch
independent centers
learn that they it's hard to stay independent
these days. You just have to
partner up with a big hospital system for
insurance contracts. And we did it at Stonegate,
and it was a game changer.
We partnered with Ascension Health. So it it
was a game changer as far as our
payer contracts go. So that's the third thing
that I'm really trying to keep my eye
on.
Yeah. Yeah. Fascinating. I gotta get your perspective
on bird's eye view there in terms of,
like you said, the increased case volume, case
complexity,
specifically in relation to total shoulder and the
ASCs,
a little bit on body based care and
and direct to employer models.
And then I wanted to just follow-up on
your your 3rd point there in terms of
consolidation. It's, you know, something we've seen across
the board, across the country,
with hospitals, with health systems, with ASCs.
Can you give us a little bit of
insight into
how how consolidation is affecting,
competition in your market and kinda how you
see that evolving over the coming years?
So it's it's interesting.
And I don't know
I guess, obviously, with ASC,
the majority of us, if not all of
us, are physician owned. So the best thing
everybody wants to make
make more money for doing the same amount
of work or you where you wanna smart
work smarter and not harder. So, you know,
if you have just straight up Medicare based,
you know, contracts with insurance payers, you have
to do
one and a half times and twice amount
of work in order to get the same
reimbursement
that I'm getting with some of my commercial
contracts now partnering with the big system.
And, obviously, you get more business in the
door if you're doing distributions. Like, these doctors
talk. So if we're doing distributions,
then it's just much easier to get distributions
out the door with good payer contracts. Obviously,
that's a no brainer. So I I think
that
that that's the piece
that you just kinda have to have these
days. It's, I worked for an independent group
before
that we were negotiating our own contracts,
and it's it's tough. It is a tough
market. It's it's tough to even get a
response to an email sometimes with some of
the big commercial payers just because we're not
high on their food chain. So,
it's just a much easier to get their
attention, and it it doesn't always work fast.
And you guys, everyone that is in this
business understands that the insurance
it it works slow.
Getting them built into the system gets is
slow. But it's just hard to make make
it work independently
without having a big partner. I I'm not
saying you can't do it. You can. This
volume has to be higher.
Mhmm. Yeah. Totally makes sense. And, Tammy, I
wanted to follow-up with you. I know that
one key area that a lot of ASC
leaders are focusing on,
focusing
on, and I believe yourself as well in
a recent, article with backers, is leadership training.
When we think about the next the next
generation of leaders coming through, can you give
a little bit of insight into why you
think that's
so important and it's such a key investment
area for for for many ASCs right now?
Huge.
So a couple of things. I feel like
regardless of how
great patient care you do, if you have
that culture in your center, the doctors are
not gonna be happy. And I'm from a
strict belief that if the surgeons are happy
and the staff is happy, and if staff
is happy, patients are happy.
So you just have to have a good
culture. You have one bad and everyone has
heard the one bad apple.
It's so true in a small setting like
an ambulatory surgery center. Then the cost. This
is sheer cost of turnover, especially amongst leaders.
It it's 1,000 and 1,000 of dollars per
employee. So you put in you you put
in the effort. A, it starts at the
beginning. Right? Hiring the right people. You have
to have someone who has the right fit
with the right mentality for the culture.
And I just it's I can't
impress enough on how important culture is within
these centers.
So with SCA Health, they do a great
job. They call it fleet a facility leader,
onboarding. So it's,
it's called Flow.
They take this the new
the new manager out of the center for
a week. They they fly them to wherever
is closest for SCA. For us, it's in
Dallas, and they do nothing but 3 days
of just drinking the Kool Aid. Right? Like,
this is how SCA operates. This is why
your voice is important. This is why you
always get to have you know, you have
a say in how this facility runs. So
it's I think it's it's a it's cheaper
for us to invest in our new leaders
to teach them how to be a leader
than to just keep hiring new leaders and
the cost it is on onboarding them.
It is it is crucial.
And doctors hate change. They hate change. I
I I have not met one surgeon that
enjoys change. So if they have the same
people that they can trust and they know
they put their favorite scrub sack in the
room every time, Or if they're having a
bad day or we screwed up some, which
happens. Like, they feel comfortable enough to call
me or call the OR manager and be
like, hey, bro. What were you thinking? So
it's those relationships that if you have a
new person in there, those doctors are gonna
get up and move their cases somewhere else.
Mhmm. Yeah. Yeah. It's such a big challenge
across the health care spectrum. We're fascinated to
kinda hear your perspective there, and I'm sure
why many ASC leaders and listeners listen to
this will also find that so so important,
critical to the future as well.
I wanted to
get away from what we talked about, some
of the challenges, some of the trends that
you're focusing on at the moment.
Wanted to flip the script a little bit
in here about what what are you most
excited about when you think about the future
of health care?
So I try there's some cool things. And
and it also
it also I I'm excited about neuromodulation within
the orthopedic market, and let me explain why.
I don't know if you've ever tried to
recruit a surgeon, but it's not easy. It's
it's a lot of work. It's a lot
of work to get them in the door.
So then it's I try to build the
business of the the surgeons that are already
in my in my door.
So and it also creates stickiness, right, where
they come to you for other things. So
this is all just relationship enhancing.
So
one of my doctors and we were the
1st surgery center in the state of Texas
to do, peripheral nerve stems by an orthopedist,
and an ASC was done at Stonegate.
So,
and now I have 5 orthopedic surgeons that
are performing these cases, and it's for patients
that have painful knees after total knees.
It's 6 months post op total knees that
are still having chronic pain or patients that
BMI is too high or their a one
c is too high in order to have
a total joint replacement. This is stuff this
is a procedure that can be done. It's
a quick procedure that can be done and
give pain relief so then patients can lose
the weight or can get their, you know,
their diabetes under control.
So this has also created
an outlet for my orthopedic surgeons that did
not know what to do with their patients
that continued to have. They have good movement.
They have,
they have good results from their chronic for
their pay or for their total knee or
their total shoulder,
but they just still have pain. So this
is an outlet for my orthopedic surgeons to
to have another option for their for their
patients. And this procedure has worked great.
We've done a few cadaver labs, and I
do it as much as I can to
get my other orthopods in there. And anyone
that's new starts with me, I tell them
about this. It's a great procedure for the
for the surgery center, and it's an excellent
procedure for these patients. And it's creating pain
free results.
I also think that this could build the
total joint replacement for the alternative knee. So
if you're don't hurt after your first total
knee, what's the likelihood of that patient coming
back? If they're bone on bone on one
knee, there's pretty high likelihood they're bone on
bone on the other. So this has created
some great options to keep patients in the
yeah. Keep patients in the door, not have
to refer them out, not ghosting them because
they don't know what to do with them
anymore.
And then maybe even getting them back for
the the other side for their total joint.
Mhmm. Yeah. The neuromodulation
in the orthopedic market, certainly an area of
growth there. Earlier on in a conversation, you
mentioned about recruiting some surgeons who are also
performing outpatient total shoulder arthroplasty.
Yeah. Can you give me a sense of
when you're looking ahead, 12 to 24 months
out, what are the other key areas of
growth that you're focusing on?
So I feel like you pick one thing
and kinda do it better than anybody else.
And I really believe that we do the
orthopedic
market in Austin better than anybody else, but
it goes back to having great culture and
a great team that hustles. And I mop
floors and take out trash. Everyone mops floors
and takes out trash there.
So if you just put a hustle in
there and you become partners with that physician,
it's easy these guys talk,
and it's easy to get the word out
that your center is doing it better than
anybody else. And as far as the growth
has been, you know, volume brings volume. I
I don't know if you I don't know
what exactly what happens because you think some
of these doctors don't wanna go where it's
busy, but that's kind of the opposite. They
wanna go where these other guys are going
that because, you know, if these difficult guys
come into Stonegate and they're having a great
experience, then, man, my case, it'll be easy
there. So it's it's
word-of-mouth, and Austin is a competitive market. You
have to work hard.
I'm gonna say that the team at Stonegate
works harder than anybody else in town as
to
making sure our surgeons are happy and and
they're part of the team. Totally. Tammy, a
pleasure having you back on the podcast again
and hear about all the fantastic work you're
doing.
Really, really enjoyed this conversation. Really can't wait
to pick pick back up with you again
next next year, hopefully. Thank you, Tammy. Yeah.
Sounds great. Thank you.