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Surgery Center up and running

Paul Raymore
Paul RaymoreNurse and Truckee Surgery Center director, Andi Johnson, and Dr. John Foley have performed dozens of procedures since the Truckee Surgery Center opened last month.
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Patients in need of non-emergency orthopedic surgery have a new option in town.

Previously, the only facility in the Truckee/North Tahoe region equipped to perform orthopedic surgeries was Tahoe Forest Hospital. However, last month, five orthopedic surgeons, who used to conduct almost all of their surgeries at the hospital, opened the Truckee Surgery Center in the recently completed Gateway East building B.

Citing their desire for more control over patient care and their own schedules, as well as the possibility of providing a friendlier, more efficient atmosphere, doctors James Fischer, John Foley, William Krissoff, Deane Stites and Anthony Zissimos opened the center in mid-September.

The Truckee Surgery Center contains two fully-equipped operating rooms, space for two patients to undergo pre-operation care and room for three in their recovery room. Six orthopedic surgeons practice there, along with four anesthesiologists, three full-time pre- and post-op nurses and three full-time operating nurses.

It was established to meet the needs of patients needing orthopedic surgery on an out-patient basis (those patients who don’t require an overnight stay), and TSC Director Andi Johnson expects to perform approximately 80 surgeries per month.

Open Monday through Thursday, the Truckee Surgery Center has performed almost 20 surgeries since accepting it’s first patient on Sept. 18.

In general, outpatient centers have less overhead than hospitals, which leads to lower cost procedures, said Robert Schapper, CEO of Tahoe Forest Hospital. However, sometimes private medical clinics accept a smaller set of insurance carriers than major hospitals. Since the Truckee Surgery Center is relatively new, it is still working on establishing contracts with all of the major insurance carriers of Truckee and North Lake Tahoe residents, a process it expects to complete soon.

According to Johnson, the differences between the surgery center and the hospital include the friendlier setting at the surgery center as well as a more efficient schedule. With no emergencies diverting personnel and resources away from regularly scheduled surgeries, patients at the surgery center can expect less waiting time both before and after their surgeries.

The choice is not so clear-cut though if one considers the excellent reputation the Tahoe Forest Hospital has in providing care for orthopedic patients. Tahoe Forest Hospital continues to be rated as one of the highest performing hospitals in the state in terms of patient satisfaction according to the Patients Evaluation of Performance in California or PEP-C survey which is released by the California Institute for Health Systems Performance and the California Healthcare Foundation.

The hospital contains four operating rooms, two of which were built last year and feature completely state-of-the-art equipment, and another which is being converted into a specialty room for shorter, outpatient-type surgeries. In addition, the new wing of the hospital that is currently under construction will include a modern outpatient surgery center with more space for both pre- and post-op care.

Surgeons who are members of the medical staff at the hospital are required to be credentialed and undergo rigorous background checks before they are given privileges to practice within the hospital. Even then, they are proctored to make sure they conduct procedures correctly and with the patient’s best interest in mind.

Because the same six orthopedic surgeons who practice at the hospital are the ones who practice at Truckee Surgery Center, patients can expect the same high level of care at either facility.

Outpatient surgery in general is becoming more and more common, and according to Schapper, approximately 80 percent of orthopedic procedures are now done on an outpatient basis.

In the past, approximately 1,000 orthopedic procedures were conducted at Tahoe Forest Hospital each year. Because all of the orthopedic surgeons in the Truckee community now practice at the surgery center as well as at the hospital, Schapper expects to see a 50 percent drop in the number of orthopedic surgeries done in the hospital – a loss that will cost the hospital millions of dollars.

That loss in revenue will force the hospital to cut costs through a reduction of staff hours and layoffs if the hospital cannot reassign staff to other areas for which they have the necessary skills. “The decline is not good for the hospital because it impacts our staffing,” Schapper said. “So some people will be losing hours and some people will lose jobs.”

Although the decline in orthopedic procedures conducted at the hospital will have some negative effects, Schapper expects that giving patients more choices will be a good thing for the community overall.

“Competition is not bad, but it comes at a price… I think it provides choice for the patient and I think it’s an opportunity for our staff and the hospital to work together in different ways,” Schapper said. “Just having the choice creates the need for us to service our customers better.”

The outlook for collaboration between the surgery center and the hospital looks good. The hospital has been in talks with the surgery center about buying in to the business, and orthopedic surgeon Dr. John Foley will serve as the Chief of Staff at the hospital in 2004.

Meanwhile, the staff at the surgery center is happy to be there. Pete Seagoe, a Registered Nurse First Assistant at the surgery center, spent 18 years working full-time at Tahoe Forest Hospital. He cites the lack of on-call duties, which results in much more personal freedom and a more predictable schedule, as one of the major advantages of working at an outpatient-only center.

According to Seagoe, the doctors at the surgery center don’t have the distractions that they have at the hospital, and “because there isn’t the bureaucracy, you’re able to spend more time with the patient. We still get them out of here quicker, but they get more personalized attention.”

Part of the reason for that may be the luxury the staff has of specializing in only orthopedic procedures.

In addition to the more predictable schedules and greater control over policies and procedures the surgeons enjoy at the Truckee Surgery Center, the doctors say financial considerations also played some role in their decision to open the center.

Because insurance companies sometimes pay facilities fees (those fees billed by a clinic or hospital) at a different rate than they pay doctors for their professional services, the doctors at the surgery center have more flexibility in their medical billing practices and in contract negotiations with insurance companies.

Dr. Foley downplayed the financial incentives of opening the surgery center, instead emphasizing the surgeons’ desire to provide a better service to their patients.

“The whole idea of the surgery center didn’t really have to do with putting money in our pockets,” Foley said. “Really we’re doing it for efficiency reasons.”

Noting that the center is a smaller, more personal facility, Foley said he enjoys working there because patient confidentiality is greater, there is less risk of hospital born infections, and patients have more flexibility in financing their surgeries.

That being said, Foley mentioned that all of the surgeons at the surgery center will still be covering all of their normal schedules at the hospital, and all trauma and inpatient surgeries will still be done at the hospital.

Because this area sees so many sports-related injuries, the medical staff at both facilities are some of the best in the country, and perhaps the only poor choice a patient could make would be leaving this area to have their orthopedic procedure performed elsewhere.


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