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Becker’s Healthcare Podcast
Building Orthopedic Excellence at Steindler Orthopedics with Patrick Magallenes
00:13:47
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- [00:00]
A
Hi, everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series. So today we're going to talk about clinical excellence, economic value and operational support in the asc. And joining me for this conversation is Patrick Magellanus, the president and CEO of Steinler Orthopaedics. Patrick, so glad to have you with us for the podcast. Thank you again for being here today.
- [00:25]
B
I'm delighted to participate. Thank you for having me.
- [00:29]
A
Yeah, we're really happy to have you and to learn a bit more about your center. But before we get into that, would you mind sharing just a little bit more about yourself and your work in healthcare?
- [00:39]
B
Sure. So I've been with Steinler Orthopaedics for seven years now. I worked in community oncology for five years before I joined Steinler. I think that when I joined Steinler, what we were really looking toward was the future of what Steinler would look like. Steinler started in 1950 and really was a group practice through all those years with never owning an ASC or a percentage owner in an asc. And what's really changed for us is trying to get on the path of orthopedic self determination. And for us that meant moving into an ASC environment. So we opened our first ASC in March. We have a six room ASC that we think is the future for our own self determination. And I'm excited now to expand my responsibilities in ASC management.
- [01:25]
A
Patrick, great to learn a little bit more about you. And congrats on opening Steinler. Opening the first ASC in March. That's really exciting. And I want to go back just for a moment and talk a little bit more about Steinler. Can you share a little bit more about the organization's inception and really the vision and goals for it as well?
- [01:45]
B
Well, Arthur Steinler started the University of Iowa's orthopedic department in the 1920s. He retired from the University of Iowa in the late 40s and started Steinler Orthopedic Clinic in conjunction with the Sisters of Mercy at Mercy Hospital in downtown Iowa City. So our beginnings really started with one the founders of orthopedic medicine in the United States. Just yesterday I ran across a stat that I wasn't aware of, that the first orthopedic female surgeon in the United states trained under Dr. Steinler. We have a rich tradition. I have a number of the textbooks that Dr. Steinler authored in the 30s and 40s. We have this rich tradition. Steinler Orthopedic clinic. When he started, it was a swan swan to his career. And we've been in Iowa City and serving eastern Iowa since 1950. Currently we have 18 physicians, numerous mid level extenders and a fantastic clinical care team. We're extremely well known for orthopedic excellence going back to Arthur Steinler. And you know, our footprint now is expanded to include a ambulatory surgery center. And we are I think putting the finishing touches on putting a community hospital right next door to us.
- [03:03]
A
Really exciting and it sounds like such a growth period for Steinler. So Patrick, thank you again for sharing a bit more. And as it stands now, what procedures is your center currently specializing in? I know you talked about ortho excellence here, so can you touch on some of those specialization areas and what you foresee adding in the future for the center?
- [03:25]
B
Well, our ASC is orthopedic only. I don't foresee in the near future that our facility will do anything other than orthopedic. So the subspecialties that you would expect, including pain management, so hand and upper extremity, foot and ankle total joints, we have a very strong total joint practice. We're about to enter our busy quarter. Iowa's farmland people have met their deductibles, which is common for most orthopedic practices. But we're also farmers are about to take in the fields. So our fourth quarter tends to be super busy doing all the orthopedic practices that a farming type community needs for the upcoming year.
- [04:04]
A
That's great to learn. Thank you. Patrick And I know the center is relatively new, having just been established in March of this year. Can you walk us through what the RFP and the bidding process looked like as you developed the center? And as part of that, how did you factor in future needs like potential expansions or even new tools and technologies during the decision making?
- [04:28]
B
Yeah, so when we really conceived the idea of building an asc, really the genesis for that or the cornerstone was having the ability to have self determination, not having an asc where that's clearly five years ago we identified as most people five years ago would have identified. That is the trend lower cost outpatient environment. From our perspective, Covid accelerated that many patients. We started doing some procedures that were historically inpatient procedures or hospital procedures, hospital based procedures. I remember very clearly one day we put on Facebook and social media that we had done our first ASC knee replacement and the community feedback was strong and folks wondering why we were doing that. And I remember I was at a ortho conference and our social media person said, I took the post down because we had so much feedback. And I remember saying, no, please post it again. We've been doing outpatient procedures for quite some time. We've just done them in a hospital setting. And then Covid occurred and then patients were like, you know, anything to keep me out of the hospital. And the demand for ASCs, as you know and the listeners know has increased. From our perspective, what was really important is we knew that our community hospital was in dire financial straits. And I had projected when I arrived, Steinler, that bankruptcy was most likely on the horizon. And that's in fact what actually happened. Our community hospital closed, was acquired by the University of Iowa and incorporated the University of Iowa and the academic medical center footprint that they have. And so rasc, I think at the time it was conceived, was rightly conceived as an opportunity for us to have self determination where we'd have our own facility. As far as what went into planning initially, I was a con state and so we had to go in front of the health Facilities Council in the state of Iowa and get permission to build an asc. And as most listeners who are in orthopaedics would know, if you're in a CN state, that's a very difficult thing to do. Most likely, unless you have a hospital partner and you work with a hospital partner to pave the way, there's usually opposition. And in more cases than not, any type of sole application is denied. In our situation, we knew that there were certain elements in place that made our application likely. So we did apply and we did receive unanimous approval. Steinler had actually applied for one some 15 years earlier and was denied and had just kind of ruled that out. When our application was approved, we originally thought that we were going to build a multi specialty asc and so we designed it to be multi specialty. So our capacity, it's six rooms currently and we can expand it relatively easy to eight total operating rooms, but for a number of reasons, we're limiting it for the next few years to orthopedic only. And I think it'll be some time before we open it up to multi specialty. As far as our planning, we toured a number of ASC facilities around the country and we saw many things that we thought would be wonderfully incorporated into our facility. Things that we just really wanted to see larger operating rooms. We wanted to make sure that each of our rooms was light so that if you walk into room one or room four, room six, you know, if you're blindfolded and you walk in and take the blindfold off, they all look the same, they all feel feel the same. So we wanted that type of consistency. But we also, more importantly, we saw a lot of things that didn't make sense to us. I remember going to one ambulatory surgery center and owned by a large company that has a footprint nationally, and they had a sister ASC in the same city, and they had a surprise inspection. And so in the facility that we were touring as guests on our site visit, I remember they were putting boxes into cars that morning to try to prepare for a potential inspection. And, you know, we said that that's not something that we wanted to do. Another facility said that the central sterilization component was very small. And the feeling was they were in the orthopedic surgery center business, not the central sterilization business. And so they went with the bare minimum. And, you know, we looked at that, and we talked to folks who work there, and we determined that for us, the best course of action was to just make sure that we built a facility that could handle all of our needs and potential growth. And it also turns into opportunities for us, because if we put a community hospital next door, we think there's an opportunity for us to provide sterilization services to the community hospital, which will be a savings for the hospital and create an opportunity for us to have a true partnership with a community hospital partner. So there's a lot that we did that went into our planning and our thinking. But for the most part, I think the most important thing is the patient experience around ASC is exceptional. And I would invite anyone who wanted to come take a tour of what we've done to come take a look at it. We're proud of it, but it really works well. In some cases. I might say that we overbuilt. We have probably more supply area than we need, but we also have a standard that nobody who walks through it will ever see. Cardboard in a walkway in a hallway.
- [09:39]
A
Oh, absolutely. And, Patrick, I really appreciate the overview of kind of where the center started and where it is now, and this focus on exceptional patient experience in the asc. I think that that's such a great foundation for everything else that you just described and what's possible in terms of the center's growth and expansion. And I know a big part of the patient experience, of course, is having surgical procedures and technology that make those experiences for patients that much more streamlined and easy. So I know that part of that for Steinler is its partnership with J and J Medtech. So I'd love to learn a little bit more about that partnership and maybe some of the non negotiables that you established up front as you searching for a partnership like this.
- [10:25]
B
Well, as you can imagine, we had a lot of interest. I mean, I think one of the things that we wanted to do was try to hone in on an opportunity to create the most value within our facility. And one aspect of that was trying to get to one or two partners where we concentrated our spend to really drive down our price. You know, with everything else, labor, health insurance, materials increasing year over year and really not seeing much in the way of reimbursement increases. Being very thoughtful about efficiency and spend was something that we honed in on. And so that was a major aspect of the RFP process. But those ideas of course are super important, but they only work well if the quality that you're going to get from the partner you choose is quality that you can live with every day and that you're comfortable with. And so, you know, we had a lot of interest and we really honed it down. And when it, when it was all said and done, I think what we really, we thought that the partnership with J and J was going to be super comprehensive and that we would work with folks who were very much invested in our success. And you know, partnerships often thrown around as just a term and it really doesn't have the traction that really means that it's a dual sided commitment. And with jj, we just felt like we were going to have that commitment from them. And I can say that since we made that decision and we built the facility and we worked through all the different equipment that came with the partnership and we opened and they came to celebrate our opening and things that we're doing now and a continuation of that relationship. I think we made the right call.
- [12:04]
A
Yeah, I love what you're saying here about kind of that bi directional effort and investment in a partnership. I'm sure that really solidified that decision for you all and, and it's been great. Patrick, learning more about Steinler's history, where the newest center is at and some of these growth and expansion opportunities. I know we covered a lot of ground, but is there anything else you'd like to add or leave our listeners with today?
- [12:30]
B
Yeah, I think that I'd remind everyone that for all of us, the challenges continue to increase and the approaches that we have to take to be successful in the orthopedic space and running a surgery center, our challenges are increasing. And I think one of the things that I really value, and I commend Beckers for this as well, is that we do have this really unique community where we share information, we share insights, we learn best practices from one another. And I appreciate that. And so, you know, from Steiner's perspective, if there's anything that we've done and can share with anyone, we welcome the opportunity to do so. I can say for absolute certain that so much of what makes us run well has come through others who have helped us along the way. And so that's one of the things I really respect about the orthopedic community.
- [13:17]
A
Great note. To end our conversation on Patrick, thank you so much again for making time for our conversation today and for joining Becker's for a podcast. It was great having you.
- [13:26]
B
Well, thank you for having me. And thank you for taking interest in starting orthopedics.
- [13:31]
A
Absolutely. And we'd of course also like to thank our podcast sponsor for today, JJ MedTech. Listeners, be sure to tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.