Hospitals join to make outpatient surgery center in Nashua [The Telegraph, Nashua, N.H.]

Oct. 08--NASHUA -- The city's two hospitals and Dartmouth-Hitchcock Nashua have joined together to create a new outpatient surgery center that adds three operating rooms to 20 already in the city, hoping that more will be less: more ORs equaling less cost.

"There's a push to move as much outpatient surgery to outpatient settings as possible," said Craig Beck, president of the board of directors of the Surgery Center of Greater Nashua, which has scheduled its first operation (a knee arthroscopy) for Tuesday , with a grand opening ceremony Wednesday.

"Health plans are really looking to drive their patients to lower cost areas. ... Rather than having this service done in the hospital, if you go to (ambulatory surgery center) and have it done, have lower co-pay, lower deductible, even lower insurance premiums," Beck said.

The Surgery Center, which cost roughly $1.6 million to build, will operate in the former Lamprey Health Care facility alongside Southern New Hampshire Medical Center, 10 Prospect St.

It will specialize in surgeries that don't require an overnight stay before or after the medical procedure, mostly because of types of surgery -- such as work on joints, podiatry surgery, or ear, nose and throat surgery -- that doesn't require general anesthesia for longer than two hours or complicated pain management.

Patients also will be screened to reduce "co-morbidities," unrelated medical issues that could cause problems. Importantly, the center will not take emergencies, which not only makes it easier to schedule the operating rooms but has other benefits that lead to more straightforward surgeries.

"All of our patients will have empty bellies," said Suzanne Longshore, an operating room circulating nurse for the new facility, during a Monday tour of the facility. "That's huge."

Surgery here will be cheaper than hospital surgery because of less overhead -- fewer staff on site, less equipment because it does fewer procedures, no 24-hour coverage -- plus faster turnaround between surgeries keeping the operating rooms paying for themselves.

Ambulatory surgery centers, or ASCs, have been around for a long time -- the first facility with that title dates back to 1970 -- and a number exist around New Hampshire. Most are associated with a single hospital or medical practice.

The Surgery Center's creation by St. Joseph Hospital and Southern New Hampshire Medical Center, each of which has nine operating rooms of its own, and Dartmouth-Hitchcock, which has two ORs used for endoscopies in its Nashua facility, is a reflection of modern health care reality, Beck said.

"Each had an ability to build an ASC if they chose to. ... But having each build their own two-room ASC, is not, quite frankly, all that cost effective," he said.

"This collaborative effort keeps costs down," said Laura Hartmann, executive director of the center, who formerly worked as director of the surgery center at St. Joseph Hospital.

Beck said the nonprofit Surgery Center of Greater Nashua is equally owned by the three entities, each of which appoints two people to the six-person board of directors: "Each owns a third, that's an important dynamic in terms of discussions."

He pointed to the Radiation Center of Greater Nashua on Southwood Drive, near Exit 8. It was created by the three hospitals two decades ago, to provide radiation therapies that were too expensive to create separately.

"We've really used that as a model," he said.

The complication for St. Joseph Hospital and Southern New Hampshire Medical Center is that they will be, to an extent, competing with themselves.

Surgery centers in hospitals are expensive to build and run.

St. Joseph Hospital, for example, touted a $7 million upgrade to its center in 2011, and both hospitals have publicized their use of high-tech surgery "robots," with costs that run into six figures.

An empty OR brings no income to the hospital. If their usage falls because some patients are going to the ambulatory surgery center, it might make it harder for them to pay off those costs and justify future upgrades.

One of the reason patient and insurer costs are lower in ambulatory surgery centers are fast turnaround times -- a function of lack of emergencies and certain types of intensive surgery.

The operating rooms also lack some equipment found in full-service ORs.

Still, they bristle with electronic equipment, much of it held by huge articulated arms coming down from the system -- including systems that can send laprascopic photos from inside your colon directly to your medical record during surgery.

There's plenty of important non-electronic equipment, too, including "puddle guppies," which can be thought of as the liquid-consuming cousins of the Roomba vacuum cleaner, coping with many fluids associated with surgery.

"Surgeons are happy when their feet are dry," Longshore said.

The Surgery Center of Greater Nashua has about 20 full-time equivalents for staff, including nurses. It licenses surgeons and anesthesiologists to use the facilities.

It has three operating rooms, although only two will be used at first while it continues ramping up. It has 14 pre- and post-operative rooms and a Phase I post-op area with a 2-1 nurse-to-patient ratio just in case, plus nursing stations, check-in desk and a waiting room, in about 10,000 square feet.

It occupies the first floor of the building, which also holds medical offices and practices specializing in oncology, urology and women's care.

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David Brooks can be reached at 594-6531 or dbrooks@nashua telegraph.com. Also, follow Brooks on Twitter (@GraniteGeek).

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