Freestanding centers promote their advantages

Responsiveness to physicians, patient satisfaction

Hospital-based same-day surgery programs are doing a better job with operating room turnaround, moving patients through the surgery day faster, and listening to physician concerns, but freestanding centers still have the edge in a number of areas, say experts interviewed by Same-Day Surgery.

"There’s an esprit de corps, a positive staff attitude, and a motivation to do a good job in a freestanding program that isn’t always found in a hospital-based program," explains Susan R. Hollander, MBA, CHE, regional vice president of Aspen Healthcare, a Boulder, CO-based consulting firm that specializes in ambulatory surgery center joint-venture development, management, and ownership. "I’m not saying that you can’t find the attitude in a hospital-based program, just that freestanding center managers have been better at inspiring the attitude," she adds.

A positive staff translates into satisfied patients, and that means happy physicians, Hollander says. Physicians want to know that their patients are treated well and that they remember the surgical experience as a positive experience, she says.

Add patient satisfaction to efficiency and no lost time for the surgeon, and those factors add up to happy surgeons, Hollander says.

While hospital-based programs have been improving turnaround times, freestanding centers still have the advantage for keeping a surgeon on time, says Luke M. Lambert, chief financial officer for Ambulatory Surgical Centers of America, an ambulatory surgery center development and management company based in Norwell, MA. "Many hospital-based programs still bump outpatient procedures when emergency cases come into the hospital," he says. "This means that the ophthalmologist who planned on completing all of his cases by noon won’t be finished then, and may even have some procedures moved to another day."

Although many hospitals set up same-day surgery centers that are separate from the inpatient surgical department to address issues such as emergency cases interfering with the schedule, Lambert and Hollander say that there is one area in which freestanding centers still excel.

Even when a hospital sets up a freestanding center, it is still run with a "hospital mentality," Lambert says. "This means that the same bureaucracy exists in many areas such as purchasing, staffing, and addition of services."

Hollander has been associated with surgery centers owned by hospitals and with independent freestanding centers, and the hospital-affiliated centers have more layers to the decision-making process, she adds. "This means that the freestanding centers can respond to physician requests more quickly." The responsiveness of administration to any physician request, question, or concern truly sets a freestanding center apart, she adds.

The ability to be more creative in partnering with local businesses is another aspect of a freestanding center’s ability to make quick decisions and go outside restrictions that may be placed on hospital-based programs by organizational policies, Hollander says. "I’ve seen surgery centers work with local banks to develop a financial package for patients undergoing elective cosmetic or oral surgery," she says.

Hollander also has heard of a surgery center that attracted patients from a great distance, so the same-day surgery manager partnered with a local hotel to offer reduced rates and room service to the patient and family members. "Although patients might not need overnight care, they might want to rest a night before starting a long drive back home," she says. This is a good service that any freestanding center with patients driving a great distance can use to increase patient and physician satisfaction, she suggests.

It also is important for freestanding centers to focus on their payer relationships, Lambert says. "A freestanding surgery center saves the payer money because the fees are generally lower than a hospital-based program’s fees, and their customers are happy with the services," he says.

Freestanding surgery centers need a solid relationship with payers to ensure they are included in the payers’ panels, Hollander says. "Years ago, a surgery center manager needed to make sure the center was listed with the hospitals rather than the physicians in the payer’s approved provider list so that patients could find them," she says. That problem doesn’t exist as much today, but surgery center managers still need to work closely with their payers to make sure listings are accurate and appropriate, she adds.

There also are freestanding surgery centers that are going directly to self-insured major employers, says Hollander. The center managers can show that they offer cost-effective care, have qualified surgeons on staff, and score high in the patient satisfaction category, she adds.

Perhaps, the key to freestanding surgery centers’ success is the development of strong physician relationships, Hollander says. "Physicians have choices of surgery programs to which they can send their patients, but freestanding centers have the reputation of being a nice place to work," she says.

While surgery centers do offer benefits to physicians in terms of efficiency and responsiveness, it is usually the atmosphere that surgeons notice the most, she says. "My husband is an ophthalmologist, and he looks forward to his day of surgery at a freestanding center because it is such a pleasant environment," she says.


For more information about freestanding surgery centers, contact:

Susan R. Hollander, MBA, CHE, Regional Vice President, Aspen Healthcare, 606 Gantwood Lane, Whitsett, NC 27377. E-mail:

Luke M. Lambert, Chief Financial Officer, Ambulatory Surgical Centers of America, 15 Farrar Farm Road, Suite 2, Norwell, MA 02061. Telephone: (866) 982-7262 or (781) 659-0422. Fax: (781) 659-0434. Web: