Leading Change in Ambulatory Surgery with Tammy Smittle of Stonegate Surgery Center

Summary

Becker’s Healthcare Podcast: Leading Change in Ambulatory Surgery with Tammy Smittel of Stonegate Surgery Center

Release Date: July 29, 2025
Host: Francesca Matthews
Guest: Tammy Smittel, CEO of Stonegate Surgery Center

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Introduction

In this engaging episode of the Becker’s Healthcare Podcast, host Francesca Matthews sits down with Tammy Smittel, the CEO of Stonegate Surgery Center based in Austin, Texas. With nearly three decades of experience as a surgical nurse and a deep-rooted passion for healthcare, Tammy provides valuable insights into the evolving landscape of Ambulatory Surgery Centers (ASCs).

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Tammy Smittel’s Background

Tammy Smittel brings a wealth of experience to her role as CEO. "I've been a nurse for almost 30 years. I am now a group CEO of a surgical hospital here in Austin and then a surgery center also in Austin," she shares (01:08). Her extensive background as a surgical nurse shapes her effective leadership and commitment to enhancing patient care within her centers.

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Top Three Trends in Healthcare and ASCs

When discussing the current trends in healthcare and ASCs, Tammy highlights three primary areas:

1. Migration of High-Acuity Procedures to ASCs
   Tammy observes, "We started with total knees and then adding total hips and now total shoulders. It's exciting to see those patients migrate over to the ASC world" (01:44). This shift indicates that ASCs are increasingly capable of handling complex surgical procedures traditionally performed in hospitals, enhancing efficiency and patient outcomes.

2. Partnerships Between Employers and ASCs
   Employers are increasingly partnering with ASCs to move procedures out of hospitals. Tammy explains, "It's often waiving out of pocket cost to the patients and it's increasing quality and reducing cost to the employer because a lot of these employers have self-funded plans" (01:44). This strategic alliance benefits both employers and patients by lowering costs and improving the quality of care.

3. Hospital Investments and Mergers with ASCs
   The third trend involves significant hospital investments in ASCs. Tammy notes, "Over 70% of health systems plan to expand or acquire ASC capacity in Austin" (01:44). These mergers facilitate operational efficiencies, allowing hospitals to focus on more critical cases while ASCs handle a broader range of surgical procedures, meeting patient demand for more streamlined and less crowded care environments.

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Exciting Developments in Ambulatory Surgery

Tammy expresses her enthusiasm for two major developments:

1. CMS’s Phase-Out of the Inpatient Only List
   "It's going to be 285 musculoskeletal procedures scheduled for 2026 going to be released off of the inpatient only list," Tammy explains (03:28). This move by CMS validates the safety and efficacy of performing these procedures in ASCs, aligning with Stonegate’s existing practices and paving the way for broader acceptance and implementation.

2. Changes to Non-Compete Agreements in Texas
   In Texas, there is a forthcoming change to non-compete agreements that will adjust the five-mile radius requirement to one year (04:28). Tammy sees this as a significant opportunity, allowing independent ASCs like Stonegate to recruit talented doctors from hospitals more effectively and in a timely manner. "They'll be able to join my ASC at a timelier basis," she adds, highlighting the potential for enhanced staffing and expertise at her centers.

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Growth Strategies for the Next 12 Months

Tammy outlines a dual-focused growth strategy for Stonegate Surgery Center:

1. Recruiting New Doctors While Maintaining Existing Relationships
   "I'm always recruiting, I'm always looking for new doctors... we can pick the right doctors with the right procedures, with the right attitude and the right patient care" (05:25). This selective recruitment ensures that new additions align with Stonegate’s standards and enhance the center’s capabilities.

2. Leveraging Happy Surgeons as Marketers
   Tammy emphasizes the power of word-of-mouth marketing: "The best marketer I've ever had is a happy surgeon" (08:01). By maintaining high levels of surgeon satisfaction through competitive distributions and a supportive work environment, Stonegate benefits from organic promotion as satisfied surgeons advocate for the center within their professional networks.

Additionally, Tammy highlights the introduction of innovative procedures, such as peripheral nerve stimulation for orthopedic issues, which provides surgeons with new avenues to treat patients effectively without relying solely on pain prescriptions. This not only improves patient outcomes but also positions Stonegate as a leader in adopting advanced medical techniques.

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Conclusion

Tammy Smittel’s insights reveal a dynamic and forward-thinking approach to managing and expanding an ASC. Her focus on strategic partnerships, selective recruitment, and leveraging internal satisfaction for organic growth underscores the multifaceted strategies necessary for success in the competitive healthcare landscape. As Medicare and CMS policies evolve, leaders like Tammy are well-positioned to navigate and influence the future of ambulatory surgery.

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Notable Quotes:

• "It's going to be 285 musculoskeletal procedures scheduled for 2026 going to be released off of the inpatient only list." — Tammy Smittel (03:28)
• "The best marketer I've ever had is a happy surgeon." — Tammy Smittel (08:01)

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For more insights and detailed discussions from healthcare decision-makers, tune into the Becker’s Healthcare Podcast series.

Transcript

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[Francesca Matthews]

Hello, this is Francesca Matthews with the Beckers ASC Review Podcast. I am thrilled to be joined today by Tammy Smittel, CEO of Stonegate Surgery Center. Tammy, thank you so much for being here today.

[Tammy Smittel]

Thanks for having me.

[Francesca Matthews]

Great. Well, just to start off, could you please introduce yourself and tell us a little bit about your background?

[Tammy Smittel]

Yeah. So I'm Tammy Smittel. I've been a nurse for almost 30 years. I am now a group CEO of a surgical hospital here in Austin and then a surgery center also in Austin. So I have an ASD and then a surgical hospital that's about 15 miles apart from each other. So been in healthcare for a long time. Been a surgical nurse my entire career. Can't imagine doing anything else except what I do.

[Francesca Matthews]

Excellent. Well, we'll just jump right into it then. As an ASC leader, what are the top three trends you're following in healthcare and ASCS today?

[Tammy Smittel]

Yeah, so the top three are obviously the same as everybody else is. Watching the higher acuity patients and procedures being performed within the ASC safely. We, you know, it started last year with or several years ago. We started with the total knees and then adding total hips and now total shoulders. And there's a lot of things that we can do better than the hospital systems can. So it's exciting to see those patients migrate over to the ASC world. Second thing would be the employers entering partnerships with ASCs to shift procedures out of hospitals and and into the ASCs entirely. It's often waiving out of pocket cost to the patients and it's increasing quality and reducing cost to the employer because a lot of these employers have self funded plans. So it's been fun to watch the ASCs work directly with these self funded plan employers to take care of the patients. The third thing kind of follows into cases moving over the AST is that the amount of hospital investments and in Austin, it's pretty impressive. Right now, currently over 70% of health systems plan to expand or acquire ASD capacity in Austin. It's happening on a daily basis. So it's interesting to see these hospital mergers with ASCs because it's better for patients. They can have the sicker patients in the hospital and do other surgical cases in the ASC and it's operational efficiencies and I think the patients are demanding it market's demanding that these cases move to the asc. They don't want to be around sick patients. So those are the trends that I'm currently watching.

[Francesca Matthews]

Absolutely. And what are you most excited about right now in this space?

[Tammy Smittel]

So last week was we all got the email or the note from Becker saying that CMS is propose this three year phase out of the inpatient only list. Super excited about that. It's going to be 285 musculoskeletal procedures scheduled for 2026 going to be released off of the inpatient only list. We've been performing cases and we can perform these cases for commercial plans and we've been doing lumbar fusions and we've been doing the reverse total shoulders and even some hip and knee revisions. We've been doing these safely for a while. It's really great that CMS is recognizing it. So I'm excited to see that. Another big thing that we're excited about is and in Texas is this non compete issue. We're being told this is going to change the five mile radius for one year. So that's going to be huge. In order for as an independent runner, CEO of an independent surgery center, it's interesting to get these doctors that are leaving hospital employment. They'll be able to join my my ASC at a timelier basis and 5 mile non compete. That's not bad. So excited about that.

[Francesca Matthews]

Absolutely. Yeah, definitely. I've been speaking to a lot of leaders about that only list announcement and I think a lot of folks are looking forward to see how that changes things.

[Tammy Smittel]

We can do it. I mean we've been doing taken care of. It's a fine line. You know, it's a tightrope and making sure that the doctors and anesthesiologists work well together as far as getting the patient selection right because you don't want to take patients that aren't going to do well in the ASD because if something goes wrong we have to transfer the patient. Right. So I think that that's going to be a learning curve is just for surgeons to work with anesthesia to make sure that our patient selection is spot on.

[Francesca Matthews]

Absolutely. And how Are you thinking about growth over the next 12 months?

[Tammy Smittel]

So I think that's two phases. And like I said, I've been doing this for almost 30 years and I like to think as the team mom for orthopedic surgeons here in Austin. So it's crucial to manage bringing a new business while maintaining healthy relationships with the business you already have. So I think that I'm always recruiting, I'm always looking for new doctors. But I'm at a lucky spot with my current surgery center at Stonegate that we can kind of pick and choose who comes to Stonegate. You know, when you're hungry, you pick where you work with everybody. But now you can, you pick the doctors that fit what's going on in your surgery center. So I can, I can pick the right doctors with the right procedures, with the right attitude and the right patient care. And so we're that we're getting that so we can recruit smartly in the orthopedic world. Another thing is like with your current doctors, there's not a better marketer for you than a happy surgeon that's getting distributions. So if you just keep your current business happy, then they're going to be out there hitting the streets, telling everybody that this is a center to go to because they get taken care of, they're getting distributions. It's a happy place to work, and that's huge. I want my surgeons happy. And so we work really hard on that. Another aspect that I focus on with my current doctors and even with new doctors is bringing new procedures that they may not know about. And my surgery center was the first surgery center in Texas for an orthopedic surgeon to do a peripheral nerve stem. And now I have six orthopedic surgeons that are doing peripheral nerve stems. So they're excellent for patients. It's a well reimbursed procedure. It reimburses kind of similar to a spinal cord stimulator. My orthopedists are doing it for rotator cuff pain after rotator cuff, residual pain after total joints or even ankle wrist pain. This gives the surgeons a new avenue to take care of their patients that before they would look for pain prescription to take care of them with. So growth is, it's on my mind on a daily basis. But it's a, you have to do, you have to keep the, what you got happy and, and recruit new over at the same time.

[Francesca Matthews]

Absolutely. And I, I like what you said there about that, that kind of word of mouth factor. I think especially just given, you know, the way technology is today. It's almost like the old fashioned way can kind of cut through the noise a little bit when you've got people just in the community talking about their experience.

[Tammy Smittel]

You can't really trust, you can't Google like you used to. Right. You can't really trust that as, as, as factual. So I'm telling you like the, the best marketer I've ever had is a happy surgeon. Even, even doctors that are not invested, they'll go and say, hey, man, I can, I'm efficient. They have quick turnovers. I can do eight cases before noon. There's, there's nothing better than hearing that from another surgeon to get a phone call. So we're, we're really blessed. I have a great team that works their buns off to make sure everything goes great and patient care is good. So I know they work hard, but we feel lucky at the same time.

[Francesca Matthews]

Absolutely. That sounds like a good place to end things here. It's all I have for you today, Tammy. And thank you so much for joining us. It's been a pleasure speaking with you and I look forward to connecting with you again in the future.

[Tammy Smittel]

You as well. Thank you so much.