Only the strong survive. It’s the title of two albums, two books, two movies, and at least six songs. It could also be 2020’s motto for running a business. And especially when it comes to a business that relies completely on elective surgeries, like the Capital City Surgery Center. Its surgeries include orthopedics, spine, urology, ENT, pediatrics, ophthalmology, and other services.
With nearly 800 of those surgeries performed each month, the physician-owned surgery center in Raleigh had poised itself to grow. Then COVID-19 came along.
Know That Preparation Isn’t Everything
Laws require Medicare-certified surgery centers to have written, up-to-date emergency preparedness plans. But there’s a big difference between planning for a disaster and actually living it. At least, according to CCSC administrator Jamie Ridout (RN, MSN, MBA, NEA-BC, CNOR). “I don’t know that anyone could have truly been prepared for the pandemic and how quickly it came,” she says.
“I don’t know if it was as much a matter of preparation as it was of being able to respond. Looking back, the onset of the pandemic seems slower, but in the moment, everything moved so quickly.”
While Capital City fortunately didn’t have to shut down completely, the pandemic required urgently switching focus to non-elective cases. “It was a very dynamic, moment by moment shift in plans—a lot of ‘blocking and tackling’ and figuring out the best decisions given the information we had at the time,” Ridout explains. “Looking back, we made sound decisions, because we were committed to our highest priority of safety, as well as keeping our staff whole.”
Put Your Heads Together
Oftentimes, decisions made by a group—as opposed to unilaterally—come more easily because everyone shares interest in the outcome. Capital City is no different. “We have tremendous engagement from our physician-leaders, our hospital partner [WakeMed], and our staff,” Ridout says. “We have a governing board who met to determine how we would handle things and what direction the center would take once the public health emergency was established.”
Once the governing board decided to choose non-elective surgeries, it formed a physician-led committee to review all potential cases. All the center’s multiple specialties had physician representation on the committee, Ridout explains. “Before we scheduled a case, we would run it by the committee to determine if we could perform the surgery with minimal risk to patients and staff. If a patient couldn’t wait without experiencing some level of harm or adverse outcome, the committee would deem the surgery non-elective and acceptable to move forward.”
Stay True to Your Core Values, says Capital City Surgery Center
When loans and grants became available—including Payment Protection Program loans, the CARES Act Provider Relief fund, and others—Capital City very carefully didn’t rely on loan money just because it was available. “We did receive the Medicare stimulus payment for small businesses, but we have a strong enough cash position that we felt like we could ride out the shutdown without having to borrow money that we would need to pay back,” explains Ridout.
A strong financial position built over time is essential for a business to overcome market volatility, pandemic-induced or not. And building that kind of profitability starts with ensuring that all business operations relate to the organization’s mission and vision.
“If you start with the care and safety of your patients and employees—eventually the rest will fall into place,” shares Ridout. “That is the root of what drives us. Without delivering quality care, taking care of each other, and operating a safe, reliable organization for the patients who trust us, nothing else will work. If you have a shaky foundation, you are building a house of cards.”
Play the Long Game
When Capital City reopened for elective surgeries, it “recovered very quickly from a volume perspective,” says Ridout. “Surgery is the name of the game—getting cases scheduled is what we do,” she notes.
Even so, the center’s relaunch had a strategy. “We have always been proactive about getting cases scheduled, but we wanted to sustain ourselves in a long-game fashion,” explains Ridout. “We didn’t want to blow May out of the water and then suffer for the rest of the summer.”
In fact, the long game seems to center surgery centers in the healthcare market’s future.
A few patterns signal their growing importance. As complex procedures continue to migrate from hospitals to surgery centers—Capital City performs total joint replacements and spine surgeries—the case volume of existing ASCs is only growing. This trend occurs even though facility growth has slowed. Becker’s ASC expects outpatient procedures to grow by 11% between now and 2022. Meanwhile, inpatient procedures will decline by 4%. That data also expects this market to reach $40 billion by the end of 2020.
“There has been a national push to get elective surgeries out of hospitals and into surgery centers,” says Ridout. “How much of that growth is staying on course versus how much is due to the pandemic is hard to say,” she continues. “I think it’s a combination of both. In the near future and in the long run, surgery centers will play a very important role in communities.”
Along with orthopaedics—which has third-largest case volume in surgery centers, behind ophthalmology and GI—cardiology could become the next service marked for growth. At least, that’s what the KaufmanHall 2018 Industry Flash Report: Ambulatory Surgery Centers reports.
The Capital City Surgery Center is a multi-specialty, free-standing ambulatory surgery center with seven operating rooms, and four procedure rooms. The center began as (and remains) a joint venture between 48 physician-investors, WakeMed Health & Hospitals, and Compass Surgical Partners.
Stay tuned to our Business and Health sections for more North Carolina news and updates.