Medarva Stony Point Surgery Center has evolved over six decades, from its beginnings as a specialty eye and ear hospital for the needy to become one of the busiest ambulatory surgery centers in the state.
Doctors at the center at 8700 Stony Point Parkway in South Richmond did 19,626 surgical procedures in 2014, more than any other surgery center in the state that year, according to Virginia Health Information, a private, nonprofit agency under state contract to collect and report health data.
The surgery center took a bold step in early 2014. It started posting online its estimated prices of some common procedures before insurance coverage — $1,651 for repair of a deviated septum and $929 for an upper gastrointestinal endoscopy with biopsy, for instance — to give price-minded consumers something to work with.
The figures don’t include doctor fees and implant costs and some other things, but provide some price transparency in a health system that generally blindsides consumers with hard-to-understand medical bills.
“Some people think that some surgery centers cut corners, and there’s the accusation that we just take the cream (of the crop),” said Bruce Kupper, president and CEO of Medarva Healthcare.
“This group does not cut corners. If there is a quality issue, whether it’s a physician or facility or an employee, they see us as an extension of their practice. They only want to be associated with things that are of quality. They let us know if there is an issue very, very quickly.”
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Medarva Stony Point Surgery Center was founded in 1952 as the Richmond Eye and Ear Hospital. The name changed in 2012 to Medarva, referring to medicine as an art in Virginia.
Over the years, it has maintained its independence in a marketplace where hospital systems have gobbled up physician practices and built freestanding surgery centers to capture market share.
Many of the affiliated doctors also have ties with the region’s major hospital systems.
They choose to do surgeries at Stony Point because the location is sometimes more convenient for patients and scheduling a block of time once a week — for instance, to do surgeries — is more convenient than going from hospital to hospital, Kupper said.
“They know we are going to be reasonably priced so patients with high deductibles or who have significant co-pays or who even want to pay cash, are going to get a reasonable price from us,” Kupper said. “We can turn the rooms faster than any hospital can so, in the same amount of time, they can do more cases.”
On a recent Thursday, the waiting room was filling up by 8:30 a.m. Thursdays are heavy on eye surgery. There are a lot of cataract cases. In the early 1980s, replacing the lens of the eye, clouded by age, with a clear artificial lens, used to require a hospital stay of three or more days. Nowadays patients are in and out within hours.
“It’s a very efficient environment so that patients can have a much more streamlined and good experience, so patients like it better,” said Dr. Andrew Michael, an ophthalmologist with Commonwealth Eye Care Associates, an independent practice with three locations in the Richmond area. Michael also is board chairman of managers of Medarva Stony Point Surgery Center and one of the physician owners.
Fridays are ear tubes and tonsils days, said Eddie Edwards, the surgery center’s marketing director. Children can get the procedures on Friday, and be well enough to go back to school the following Monday.
The surgery center has 115 employees. In addition, 140 doctors are credentialed to do surgeries there. About 78 are active, Edwards said.
“We’re independent, but we want to partner with people,” Kupper said. “We want to work with people so we don’t duplicate … a lot of other resources. We’re very nimble,” he said.
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Kupper came to Medarva in 2005. Before that, he was vice president for ambulatory and surgical services for Chesapeake General Hospital and prior to that worked for a health care consulting group in New Jersey.
He worked from 1989 to 1996 as vice president of operations for Children’s Hospital of the King’s Daughter in Norfolk. He has a master’s degree in health administration from Xavier University in Cincinnati and a bachelor of science degree in labor and human resources from Ohio State University in Columbus.
“We have had several different directors, and I will say Bruce Kupper has done just an excellent job” in moving Medarva Healthcare forward, said Cheryl Jarvis, chairwoman for 20 years of its philanthropic arm, now called the Medarva Foundation. “He is very devoted to the foundation and has been a huge help. We are reaching out into other areas.”
Other philanthropic efforts include a program that does vision and hearing screenings in school children in central Virginia. There also is a focus on research — most notably donations to researchers at Virginia Commonwealth University, the University of Virginia and Eastern Virginia Medical School.
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Medarva Healthcare, the nonprofit parent company, owns 50.3 percent of the surgery center, while the physicians own the rest.
Doctors apply for privileges at the surgery center just like they do at hospitals, Kupper said. Doctors who operate at the surgery center also are required to have admitting privileges at a local hospital in case the need arises to admit a patient.
Medarva Healthcare has expanded to a second location with a medical office building in the fast-growing West Creek area of eastern Goochland County, just across the Henrico County line and a mile or so from Short Pump Town Center.
“It comes back to servicing the community,” said Peter Pastore, chairman of Medarva Healthcare. His father was a physician who started the eye, ear and nose department at the Medical College of Virginia.
“We feel that location will help service a group that either doesn’t get to our location in Stony Point or it’s more convenient for them. We are just trying to satisfy the need.”
One recent setback: The state turned down Medarva’s request to develop a surgery center at the location.
“We have filed an appeal and are preparing other strategies,” said Kupper, who is critical of the state certificate of public need program, which regulates private medical commerce.
Medarva also filed a new letter of intent for the project with the state in December.
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At a time when consumers are urged to shop around for health care, ambulatory surgery centers are touted as an affordable option for surgery and procedures that don’t require an overnight stay in the hospital.
Nationally, there are about 5,400 Medicare-certified ambulatory surgery centers, and that number has remained relatively stable over the past several years, according to the Ambulatory Surgery Center Association, a national trade group.
In Virginia, more than 50 ambulatory surgery centers operate.
Hospital outpatient departments are the key competition for ambulatory surgery centers, and some hospital systems have outpatient departments and operate ambulatory surgery centers.
“The distinguishing factor is, by and large, the care in the ambulatory surgery center is less expensive than being performed in the hospital outpatient department,” said William Prentice, CEO of the Ambulatory Surgery Center Association, based in Alexandria.
“When first developed, the whole idea for the surgery center was to be a place where you could take those less risky patients and do them more efficiently at a savings to the patient and the health care system,” Prentice said.
“But on that point, as technology has advanced, as anesthesia and pain control advanced, we are doing more complicated procedures and seeing more complicated patients. We are not taking just the easy patients,” he said.
Some research supports the notion that ambulatory surgery centers are a bargain — offering services at lower cost and similar quality to hospital outpatient departments.
Writing in the journal Health Affairs, professor Kathleen Carey of the Boston University School of Public Health compared price increases in ambulatory surgery centers versus hospital outpatients departments from 2007-12.
One conclusion: for six common outpatient surgical procedures, Medicare prices paid to ambulatory surgery centers grew at about the same rate as medical care prices overall, while prices paid to hospital outpatient departments climbed sharply.
In a different study, a researcher in the July 2014 issue of the journal Urology looked at what happened in 195 markets when surgery centers opened in communities that did not have one.
The study showed that quality, as measured by postsurgical death and hospital admissions, was not different. The research was financially supported by the federal Agency for Healthcare Research and Quality.
Concerns about quality and safety at ambulatory surgery centers is an issue, particularly with the death of comedian Joan Rivers in 2014 a week after she went into cardiac arrest while undergoing a procedure at one in New York.
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One of the challenges facing surgery centers is reimbursements.
Medicare pays hospital outpatient departments more than it pays ambulatory surgery centers for the exact same procedure. The surgery centers are paid a percentage of the hospital outpatient reimbursements, explained Prentice from the Ambulatory Surgery Center Association.
On top of that, the federal Medicare agency uses different inflation factors to adjust payments to hospitals and surgery centers.
Surgery centers get paid a fraction of what Medicare pays hospitals for doing the same procedure, Prentice noted. That affects the bottom line, but many surgery centers in Virginia make healthy margins.
Medarva Stony Point Surgery Center had one — about 12 percent for 2014. St. Mary’s Ambulatory Surgery Center, which did 3,371 surgical procedures in 2014, had a margin of about 23 percent, while the margin at Virginia Eye Institute, which did 12,160 surgical procedures, was 26 percent.
Kupper, who talks about venture philanthropic endeavors that Medarva Healthcare is pursuing, gives credit to the board of directors for its vision.
“They are the ones who stuck with this organization through thick and thin. When the hospital was losing money, they stood by it. When we made the decision to buy out here (at Stony Point), they stood by it. They have stood by the physician community,” Kupper said.
“The reason I get to do what I do is because of that board. They are creative. They’re imaginative. They are well-attuned to what the community wants and needs. Their egos are not satisfied by how big they can build their dynasty. Their egos are satisfied by what impact they’ve had on the community.”
By: Tammie Smith
Source: http://www.richmond.com
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