Two Jefferson City health care providers will complete construction of multi-million-dollar outpatient surgery centers around spring 2022, as skyrocketing demand for outpatient surgeries pushes changes in the way they deliver services.
Jefferson City Medical Group announced in December its plan to spend $17 million on a new 28,000-square-foot outpatient surgery center on Edgewood Drive, about 2 miles west of the JCMG main campus on Stadium Boulevard.
JCMG President Jeffrey Patrick said during a groundbreaking ceremony last week the new building, located next to Ria's Restaurant, would more than triple the size of the provider's existing outpatient facility.
Capital Region Medical Center announced its plans for a 24,000-square-foot outpatient surgery center, in a space that was being used for parking, a month earlier. The space, located beneath the hospital's existing outpatient wing, is to include operating suites, endoscopy suites, advanced imaging capabilities and room for more growth.
It's no coincidence both health care providers are moving aggressively to meet a demand that began growing a few years back.
Both organizations have juggled options surrounding calls for more outpatient procedures.
During a typical year, CRMC, which has seven operating rooms, conducts between 5,000-6,000 surgeries, CRMC President Gaspare Calvaruso said.
Last year, with the COVID-19 pandemic causing cancellation of many elective surgeries, procedures were down for all health care facilities.
JCMG physicians conducted 8,135 surgeries in 2019, Patrick told the News Tribune last week. He expects that number to climb after the new facility opens.
Regardless, he said, "It's good for the community to have outpatient services expanding in both places."
While SSM Health's St. Mary's Hospital in Jefferson City offers outpatient procedures, including surgeries, it has no plans to create any outpatient surgery center, said Jessica Royston, SSM Health regional manager of marketing and communication.
But many of its procedures are same-day surgeries, meaning patients are able to return home the same day as their procedure.
"At St. Mary's Hospital, patient safety is our top priority," Royston said. "In fact, we recently earned the Joint Commission's Gold Seal of Approval for total hip, knee and shoulder replacement surgery. This certification means the hospital offers coordinated care for the patient and consistently delivers excellent outcomes, has outstanding safety ratings and a patient-first approach."
Nationwide demand for expansion of outpatient surgeries grows and the reasons are numerous, according to the Advisory Board. The Advisory Board spun off from a company that former "Atlantic" owner David Bradley founded in 1979 to discover the best ideas in health care. He created the company "because great ideas have the power to transform industries," according to the Advisory Board website.
Within the organization's 2019 report on outpatient surgery centers, which it refers to as ambulatory surgery centers (ASC), the board refers to three drivers in their growth.
In "ASCs are growing even faster than you think. How can hospitals respond?" the board finds that chief among the push for outpatient procedures is government efforts to reduce costs in programs, such as Medicare.
That's a significant reason JCMG is building a new facility.
"How did the country get to where it's pushing the outpatient setting? They're doing it mostly because of costs," Patrick said. "In an effort to save taxpayer money - and I'm sure to control costs - they are pushing. That is a national trend. It's not going to stop. I'm sure it's just going to accelerate."
An outpatient center and a hospital can have the exact same procedure with the exact same patient with the exact same physician, he said, but if that procedure is at a hospital-based facility as opposed to an outpatient, the cost is significantly higher.
The report says Medicare reimburses an outpatient center $3,721 for an average pacemaker implant, compared to $7,731 for the same facility done at a hospital-based outpatient department (HOPD) setting. Medicare reimburses $14,540 for the procedure done in a hospital inpatient setting.
The report says there has been a shift of outpatient surgeries from HOPDs to centers. So, where once HOPDs were responsible for about 59 percent of the procedures, they are now responsible for about 40 percent, with centers responsible for about 60 percent.
The flip is reflected in the growth of outpatient surgery centers. Volume in the centers increased by 22.9 percent in 2017, the report says.
One of the most important things driving the change is that the Centers for Medicare and Medicaid Services expands its list of procedures that are approved for outpatient services, Patrick said.
"They are actually encouraging and pushing you to do more cases in the outpatient setting," he said.
Most recently, CMS added outpatient total hip replacement. Total knee replacements have been on there for a long while, Patrick said.
"Those are two big areas that we don't have the capabilities to do in our existing area. You do have to have the ability to have a 23-hour stay, so we will have a couple of rooms for patients where they can stay 23 hours," he said.
Another driver for outpatient surgery center growth, the report says, is what consumers want - convenience and lower cost.
Like anything else, consumers want the best value for their bucks when choosing to have surgery done.
If people can get the procedures done locally, at lower cost, it's better for the community, Calvaruso said.
"A lot of surgeries have become laparoscopic - one-day type of surgeries," Calvaruso said. "In that kind of environment, an outpatient surgery center can really be fantastic for a patient. They can come in, have a really great experience, and an easy experience and a fast experience."
CRMC has consistently been expanding surgeries, he said, and built its outpatient wing about five years ago to keep up with demand.
"There's been a focused effort here at Capital Region to provide things in an outpatient setting. That was the reason we did the outpatient expansion," he said.
The setting for the new center, beneath the outpatient expansion, will be convenient for patients and physicians.
CRMC generally serves eight counties - Cole, Callaway, Gasconade, Maries, Miller, Moniteau, Morgan and Osage.
The hospital serves that area's population of between 150,000-200,000 people.
"There are people making choices to go elsewhere," Calvaruso said. "We believe that our quality and metrics demonstrate we can do just as good as - or better than - Columbia or St. Louis."
Both facilities need room to grow.
CRMC is out of room.
The hospital's board has regularly discussed the need to expand surgical capacity within the organization, Calvaruso said. There is pressure for growth within the hospital's existing operating space.
Despite having an opportunity to expand on inpatient services, it realized a greater benefit to the community would be expanding outpatient services.
JCMG has also regularly responded to needs for growth, Patrick said, whether that was with creation of an MRI Center, a Women's and Children's Center or the group's freestanding Orthopaedic Center.
The new facility will allow JCMG to offer new procedures, Patrick and Surgery Center President Jonathan Craighead said at the facility's groundbreaking.
"When you look at our ability to be able to offer new procedures - whether it be outpatient joint replacements, minimally invasive spine procedure, advanced general surgery, laparoscopic procedures - basically every sub-specialty is requiring new techniques, new facilities, new technology to continue to keep up with trends," Craighead said. "This is going to allow us to continue to be able to do that."