Fourth Annual
Who’s Who in the Ambulatory Surgery Industry
By Jennifer Schraag and Kathy Dix
Welcome to our fourth annual Who’s Who in the Ambulatory Surgery Industry issue. We asked our readers and members of the industry to nominate outstanding individuals, facilities, and organizations that serve the outpatient healthcare community, and were impressed by the caliber of these candidates who give the industry its good name. In a year of tough challenges to the livelihood of the ASC industry, it’s appropriate to celebrate our victories, acknowledge our contributions, and ponder the future of this dynamic healthcare delivery model.
The People
Gordon J. Bruinsma
Bruinsma serves as a direct consultant serving physicians, hospitals and medical companies. When a decision is initially made to begin exploring the feasibility of a new project, Bruinsma is usually brought in early to be the client’s advocate as they walk through the process.
With his background of more than 20 years of experience in banking and financial real estate, Bruinsma brings the utmost professionalism and expertise to the table. He advises, as the owner’s representative, all aspects of the potential project including assistance in land evaluation, recommendations of various management companies, architects, real estate developers, and equipment planners; and he aids in securing all the financing for the project.
“I love it,” he boasts. “It’s really about helping physicians reach their goal of having their own centers or facilities to take more control of their lives from a time standpoint. Being able to help them do that is probably what drives most of us. I like to work on projects, but more important I like the interaction with the physicians. It’s really quite enjoyable.”
Bruinsma graduated from the University of Michigan, Ann Arbor, with a bachelor’s degree in business administration, and is a registered CPA and licensed realtor in Michigan.
Rob Carrera
Carrera has been active legislatively at the state level regarding issues affecting ASCs in Colorado, Minnesota, and Utah. He formerly served as the Colorado Ambulatory Surgery Center Association’s vice president and was one of its founding members; he is also a clinical faculty member of the University of Colorado Health Sciences Center, and is a board member of United Cerebral Palsy of Colorado.
Carrera says the ASC industry is unique in its business practices because the success of each center is of personal matter. “I like the fact that you have the people who use the business as investors in the business,” he shares. “The physicians have such a vested interest in making sure that the product and the service is excellent for all the stake holders.”
Pat Churchwell, RN, BA, is vice president of development at Surgery Consultants of America. “Pat Churchwell taught me the business,” says Mike Pankey, administrator of the ASC of Spartanburg, S.C. “As far as ASC management and development, Pat is as well rounded as anybody I’ve met in the industry. She has an answer to everything,” he adds.
Churchwell anticipates several turbulent years ahead, as the Centers for Medicare and Medicaid Services (CMS) revise the reimbursement rules for ambulatory surgery. “It’s difficult to analyze what will happen in the next couple of years,” she says. “You have to be even more cost-conscious and make sure you are both customer-oriented and cost-efficient.
The positive part of the CMS changes is we will be able to do more procedures in a surgery center than we are currently able to do now. On the one hand, you’re going to see growth, but because of these changes in reimbursement, there will be challenges, especially in single-specialty centers. That’s an area that hasn’t been figured out — including how the other payors that currently reimburse based on Medicare groupers are going to handle that, and how the new contracts are going to work.”
Joseph Clark, president of the ambulatory surgery division at Health- South Corporation, has worked within the ASC industry for seven years — and in healthcare for 25 years. “I got into healthcare because I wanted to have some kind of sense of contribution to society, and the ASC environment provides me a great chance to do that,” he explains. Clark says the mix of bringing clinical experts, management and capital together to provide a strong healthcare model makes the ASC industry one of the great success stories of the American business and healthcare landscapes.
Prior to coming to HealthSouth, Clark served as president and chief executive officer of HealthMark Partners Inc. as well as other senior management roles, including chief executive officer of Response Oncology, a provider of cancer services. Clark also served with Humana and American Medical International.
He currently is dedicated to working closely with industry players to help shape the CMS proposed final rule; is working hard to get Health- South back on its feet after the 2003 scandal the company endured, and is in the end stages of executing the plan to separate the HealthSouth surgery division to make it a freestanding company — of which he will continue with in his current role. “I think we will be a much more focused participant in the ASC industry once that gets done,” he says.
Clark holds a bachelor’s degree in economics from Dartmouth College and a master’s degree in management from Troy State University. He is a board member of the American Association of Ambulatory Surgery Centers (AAASC).
Rebecca Craig, RN, administrator of Harmony Ambulatory Surgery Center in Fort Collins, Colo., has always enjoyed the efficiency and value of the ambulatory setting. Her current surgery center is a joint venture with a local hospital and local physicians, so, she says, “It’s the best of both worlds, because we’re allowed to be very efficient. They let us do our thing and they’re a good partner.” The hospital has a phenomenal reputation, and a focus on quality and excellence of care. “Having them as a partner is wonderful for our reputation,” stresses Craig. “I think joint venturing with hospitals secures the longevity of the facility.” She believes a joint venture is good for the industry, because it keeps the hospital from accusing the ASC of taking cases away. “And we are a very positive line on their financial statement,” she quips. Craig has involved herself in politics related to ASCs for several years, and is a former president of the state ASC association. “I feel I’ve made a positive impact on the industry because I truly believe in the ambulatory care setting,” she says.
Bonnie Denholm, RN, MS, CNOR, is a perioperative nursing consultant for the Center for Nursing Practice at the Association of periOperative Registered Nurses (AORN). Denholm is involved with the organization’s specialty assembly for ambulatory surgery, and works with other departments on coordinating ambulatory products and services. Because ASCs are not necessarily regulated in every state, AORN is becoming increasingly involved with having that happen — placing RN circulators in every OR whether it is outpatient or inpatient. “Ambulatory surgery will become even more consumer-driven as consumers continue to pay higher deductibles and more out of pocket, so they will be looking more closely at the quality they’re getting in the centers,” she predicts. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is advocating consumer awareness, and AORN will have a similar philosophy, she says, promoting good awareness of three core products — the recommended practices, Periop 101, and the PNDS, which is a patient-focused model for nursing care.
Jeffery S. Eckert, AIA, senior principal and co-founder of Eckert Wordell and co-founder of Esphera3, has worked in the medical market for 23 years and evolved the firms around the niche of specialty medical facilities.
“We pride ourselves of being on the leading edge to provide physicians with more than just doing a building. We try to plan and design a facility that meets the staff and physician needs, while radiating care and concern for the patients,” Eckert explains. Expanding on that thought, his latest venture, Esphera3, is the culmination of a joint project with a construction management firm that ultimately creates a business organization that provides development, financing, planning, design and construction services; including medical equipment planning, interior design and client facility start up and operations; in short from inception to completion — all under one contract. “Our belief is that we design and build to a budget — not budget to a design, which leads to financial problems.”
Eckert shares his knowledge with others through not only his designs, but also through his regular speaking engagements at national and regional conferences and through his numerous published articles that appear in industry publications. He is a member of the National Council of Architectural Registration Boards (NCARB), the American Institute of Architects (AIA), the Outpatient Ophthalmic Surgery Society (OOSS), the American Academy of Ophthalmic Executives (AAOE), and the American Society of Ophthalmic Administrators (ASOA).
“There is a challenge that comes with working within a market that is so complex and as regulated as these ASCs are and it is being able to orchestrate that complexity to make it simple and to make it real that excites me,” Eckert says.
George Eckland, PharmD, president and CEO of Med Pro, Inc., initially began his career in sales of lasers and ophthalmic equipment. In 1984, a group of ophthalmologists asked for his help in developing a surgery center. Eckland met with a state fire marshal and the department of health services to determine how to create a Medicare-approvable surgery center, and six months later, the first center was built. “The department of health services came in and said, ‘This is nice — why don’t you do more of these?’” he recalls.
Eckland helps ASCs find a space, design the center, select an architect, hire a general contractor, equip the facility, recruit nurses, and then get it accredited, state-licensed, or Medicare-certified. “I think we’ve done close to 50 percent of all the centers. At last count, there were between 525 and 535 centers in Calif, and we had done 250,” he says.
Eckland develops the preliminary plans for each center, then provides them to the architect with construction specifics. He has made standards his watchword; in fact, his company was the first in California to sit down with state health services and ask if it was possible to develop standards for the industry. “That had never happened before. Even today, there is nothing official in the law in California that refers to the standards required for Medicare certified surgery centers, so the department of health services tells the consumer, architect, or contractor to call George Eckland, for what have become the standards in the state,” he points out.
The standards are now being proposed as law, and Eckland hopes that by spring 2007 they will become law.
Alan Gold, MD, FACS, has been practicing aesthetic plastic surgery through his own private practice since 1978; many years of which he has practiced out of his own ASC, Gold Ambulatory Surgery Center, located in Great Neck, N.Y. Gold graduated from Colgate University in three years, with honors, and then attended New York’s Downstate Medical Center College of Medicine. He served his general surgery residency at North Shore University Hospital, and completed his plastic surgery residency at the New York Kings County Hospital - Downstate Medical Center. Gold also serves as clinical associate professor of surgery at the Weill Medical College of Cornell University.
Gold recently was elected the new board president of the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF). Prior to this two-year appointment, Gold served as vice president for the board of directors and chaired several committees for the organization including the strategic planning committee and the standards committee.
Gold says he looks forward to working with AAAASF in implementing international public safety initiatives and other “ambitious goals” he and the organization share. He notes that one of the most significant achievements of his career is the acknowledgement of his AAAASF peers of the work that he has done by allowing him to serve as president of the association.
Gold’s greatest passion encircling the ASC industry is the ability to make a difference with respect to patient safety. “I think that as physicians we are granted a level of trust by our patients that is unique among other professionals; they literally put their lives in our hands. Among our other responsibilities, it is incumbent upon us to assure them that their treatment is being rendered in the safest possible environment,” he concludes.
Molly Gutierrez
Thomas S. Hall, president and chief executive officer of NovaMed, was recruited to his position in 2004. Hall had previously been an executive at a healthcare corporation that provided disease management programs to health plans and employers. NovaMed is an ASC management company with 27 surgery centers in 14 states. Hall is attracted to the ASC industry because it is so dynamic, he says. “There are a lot of exciting opportunities — the fundamentals of the business are wonderful — everything works. ASCs are a lower cost alternative, and when you add to that the aging of America and the shift from inpatient procedures to outpatient, this industry is a good place to be.” Acquisitions may be a large part of the future industry, he says — there are approximately 5,000 ASCs in the United States, and only a small percent fall under the umbrella of a management company. “There’s a real potential to grow through partnerships,” he reports.
Jeff Love realized the need to better position ASCs in the state of Utah so he and several colleagues acted upon it. Love spearheaded the Utah Ambulatory Surgery Center Association (UASCA) in September 2004 and has since rallied a plethora of state legislative support; including center visits by the state’s governor, a strong alliance with the Utah Healthcare Task Force, and an impressive reputation.
“ASCs need to voice their stand in the Utah legislation to help to gain fair ground in Utah’s healthcare market,” Love emphasizes. “There is not a level playing field, and that is what we want. We’ve come a long way in a short period of time; we have become a force, and we are a household name within the healthcare industry in the state.”
Love says UASCA is sponsoring legislation this January in the state legislative session in an attempt to increase patient access. The kick-off for this legislation occurred at UASCA’s second annual meeting held in October when national players such as FASA’s Kathy Bryant, Tod Anderson, associate regional administrator of the division of Medicare operations with CMS, and key state senators and representatives addressed the 20 center-member organization.
Love’s other role in life is serving as administrator of Mt. Ogden Surgical Center, a three-operating room, two-procedure room multi-specialty, physician-owned ASC that recently celebrated its ninth anniversary.
“There’s never a dull moment,” Love emphasizes of the ASC industry. “I have more than 20 years of ASC experience and there has never been a dull moment. There is always something changing. I love the fast-paced nature.”
William R. Massingill, AIA, NCARB, chief operating officer of Polkinghorn Group Architects, Inc. is a well-respected and highly skilled professional in the ASC industry. A graduate of the University of Texas at Austin, where he earned a bachelor of architecture degree, Massingill has more than 20 years experience in healthcare architecture and has participated as principal in charge and project manager on a variety of healthcare, commercial, educational, and interior projects.
He is certified in Texas and New Mexico, and is an active member of the American Institute of Architects (AIA), the Texas Society of Architects (TSA), and the National Council of Architectural Registration Boards (NCARB). He has served as chairperson of the TSA Committee on Architecture for Health and has served as president, TSA director, and practice commissioner for the Austin chapter of the AIA. A very active member in his church, Massingill is an ordained deacon and elder who teaches Sunday school and remains highly involved in the church youth program.
Massingill says he enjoys working within the ASC industry because of its highly patient-focused facet. “Ultimately, it is about the patient being as comfortable as they can be on the day that they are going to have that procedure done,” he says.
Scott Palmer, president and chief operating officer for the ambulatory surgery center division of Source Medical, has spent more than 25 years in the ambulatory industry. He has founded and presided over many companies within the industry, and through a series of mergers, has transitioned to his current position at Source Medical. Most recently, Palmer helped launch CTQ Solutions, a company providing ambulatory surgery facilities with patient satisfaction measurement and benchmarking services. He is a frequent speaker and author within the industry, and serves as a consultant for independent facilities and corporate development companies. Palmer has been involved in the ambulatory industry since a part-time job in college, and, he believes, the market will continue to advance as it has done for the past 30 years. “We see every surgery center needing to replace its information system in the next five to seven years,” he predicts. “They’re all becoming outdated or are the wrong tool for the job.”
There are three elements to that, he explains -- “technology advances; clinical automation; and leveraging the Internet to increase efficiency, reduce costs, improve service to physicians and patients, and provide timely information.”
Lorin E. Patterson, JD, is a partner in the health law section of the international law firm of Reed Smith LLP. Patterson practices business, corporate, commercial and securities law, with an emphasis on healthcare joint venture formation, planning, and development.
Patterson, who has been involved with outpatient surgery ventures since 1995, is an enthusiastic, dynamic and sought-after speaker at numerous national conferences, and addresses a variety of hot topics. He has also served as chair of the today’s surgicenter conference for three consecutive years. Further, Patterson regularly publishes articles concerning industry events and news, and recently presented today surgicenter magazine’s first live Webinar, “Understanding the Centers for Medicare and Medicaid Services (CMS) Proposed Rule.”
Patterson has witnessed many changes in the outpatient surgery industry since he first journeyed down this path over a decade ago. One he specifically notes is the willingness of management companies to sign on with ventures even with a minority ownership in centers.
Patterson says what enthuses him most about the ASC industry is watching a deal take shape from its inception through to the construction of a superior clinical environment. “I believe in this industry,” he says. “Outpatient care; that is where medicine is going and it is exciting to be riding the wave.”
John F. Schario
Schario anticipates continued de novo building, as well as expansion of new surgery centers, “but more so than in the past, I think you will see more resyndications, and continued consolidation of surgery centers. I think some of the larger players will continue acquiring some of the smaller players.” Hospital systems, he adds, will continue to see value in partnerships and be a new market for companies like Nueterra.
Rob Schwartz
Schwartz brings to the job numerous years in healthcare lobbying, as well as experience from his time serving as Sen. Joe Lieberman’s chief of staff. He worked as senior vice president of American Medical Response, and when that company collapsed, he took the opportunity to launch his own consulting practice: Strategic Resources, a consulting practice that focused on government relations, public policy, and marketing with a particular focus on healthcare. “We had the good fortune of getting a number of healthcare clients,” he recalls. Several years later the Colorado Ambulatory Surgery Center Association (CASCA) hired him to manage and lobby for the organization and its member ASCs.
Since, he has been instrumental in building the association’s educational and communication efforts, as well as effective legislative lobbying and successful physician recruitment.
Schwartz thrives in the ASC environment because it is a model he believes works positively for the American people. “It truly represents the best of what America is all about,” he shares. “By that I mean there are people who are innovative and entrepreneurial who have created this business and they created it not only to do something in a capitalistic way, but they did it to bring better services to their patients. It’s an honor -- and I truly mean that -- to work for this industry because they truly represent the best in healthcare and that is what makes me passionate about being a champion for it.”
Shannon Smith
E-learning offers education in every aspect of the business side — medical records, billing, collections, etc. “A lot of people work their way up in the business office, and you can do the tasks but don’t know how to manage them, so we offer a bridge from staff member to management,” she explains. “That’s what a lot of companies are realizing — that fulfilling the role of business office manager is difficult because you need operational and financial knowledge, and you usually get candidates with one or the other, so they need training to round out their experience.”
Lisa L. Spoden
She also is a regular speaker and writer on the topic of managed care and in fact has recently released her latest book titled Managed Care Contracting Survival Guide for Health Care Providers.
Her primary work revolves around her role of overseeing SHC’s Association Management and Managed Care Contracting branches. She holds a special place in her heart for state ASC associations and has been a longstanding advocate for launching these proactive models as well as helping them thrive. She shines in advocating for the ASC industry and bringing key players together to work with CMS, the GAO, and other governmental and legislative bodies to further the ASC industry.
Spoden says it is the “entrepreneurial spirit” of the physicians and the ASC companies that keeps her charged and always aspiring to do more. “I love the fact that there are so many bright people involved in the ASC industry,” she shares, “We are constantly challenging each other on how we can go about strengthening our position in the marketplace and how we can set the pace for technological changes, regulatory changes, heightening patient satisfaction and lowering cost. We are really going to stay on the cutting edge of healthcare delivery,” she asserts. “It’s a great field.”
Craig Veach
“It is such an interesting business,” he says. “When you have a surgical hospital call you up and say they are changing the way that they administer medication because the use of our module helped them discover ways to improve patient safety; to be able to introduce them to the benefits of IT is really a rewarding experience. IT is one of the only ways that they can really improve their bottom line under the current circumstances by helping them become more efficient, become more effective, and to help identify better ways of doing things.”
Eric Zimmerman
