University of Kentucky's UK HealthCare is the state's largest academic medical referral center, serving patients from all over the commonwealth.
Even though the organization's Lexington, Kentucky flagship facility boasts nearly 1,000 beds, operating rooms are chronically booked at maximum capacity, a situation that limits access to surgical care and creates significant backlogs in surgical areas. Physical expansion, while in development, is capital-intensive and takes time.
UK needed a cost-effective strategy to quickly expand surgical capacity and outpatient access while ensuring that inpatient surgery volume did not go down.
UK partnered with Surgical Care Affiliates, which operates more than 200 ambulatory surgery centers across the country, to enter into a joint venture at Lexington Surgery Center. UK invested $1.2 million to purchase a 51% stake in the ambulatory facility, which hosts eight operating rooms and four procedure rooms.
The partnership agreement allows UK physicians to work and operate there alongside current community physicians, with with community staff employed by SCA
Taking into account factors like the complexity of procedures and medical comorbidities, UK identified four specialties with high-volume, low-acuity surgeries to be relocated to the Lexington Surgery Center: gastroenterology, ophthalmology, pediatric ENT, and plastic surgery.
The selected surgeries are typically routine, shorter, lower risk, don't need overnight care, and have a quicker recovery period, making them ideal for an ambulatory setting, says Mark Newman, M.D., executive vice president for health affairs at UK.
The benefits to patients at the ambulatory surgical center include improved access, shorter wait times, and for some, the lower out-of-pocket costs associated with ambulatory rather than inpatient procedures. Even seemingly small advantages like easy parking and the ability to walk right into the facility make for a better operative experience, Newman says. Physicians who have worked there have been very happy as well, he adds.
UK doctors began performing outpatient surgeries at the surgical center in mid-November 2018 in just one room. It soon expanded to two, and now a total of 250 cases have been completed at the Lexington facility.
The first month saw a slight decline in inpatient surgeries as procedures were being relocated, but thanks to a strong backfill plan, volume increased by the end of three months. “We've been able to essentially maintain our main OR and ambulatory surgery while we continue to grow the number of cases that we're doing outside," Newman says.
The goal is to handle an additional 3,000 UK cases at the ambulatory facility over the next couple of years, with a five-year goal of 11,000 surgeries combined from UK doctors and the community clinical providers. Next up is to optimize the four procedure rooms at the center by expanding endoscopy services and increasing the number of smaller procedures that don't need full operating rooms.
It's still early days, so UK can't yet quantify cost savings per case, but the partnership so far has been a success in terms of providing more care in an ambulatory, lower-cost setting and freeing up beds for people who are in greater need of complex, inpatient care, according to Newman. The partnership — and additional ones envisioned across the state — are key parts of UK's strategy for growth and increased brand awareness.
“Access is one of the number one reasons patients come to you," Newman says. “We have to make it easier for those people who want to get to us, to get to us… We're bringing that advanced medicine closer to them. That's what we want to be able to do."
Christy Colburn is a frequent contributor to athenaInsight