Gramercy Strives to be a Cost-Effective Alternative within Healthcare

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Gramercy Surgery Center, a freestanding, Article 28 facility, was founded in 2006 by Katy R. Chiang, chief executive officer and president. It is operated and managed by Jeffrey Flynn, chief operating officer and administrator, who joined the center when it was established. Located in New York City, Gramercy is one of Manhattan’s leading multispecialty centers.

Flynn said the organization’s development strategy over the last nine years has been rooted in his team’s cognizance of future trends.

“Gramercy’s success has been our ability to kind of look at what’s coming down the pike and being ahead of the curve because we’re always evolving.”

Gramercy was originally an out-of-network center from 2006 to 2009, but after the 2008 economic crash, some of the services it offered, such as podiatry, were no longer in demand.

“We looked for other things,” Flynn said. “We expanded to other specialties. The one good thing in ambulatory care is that everything always changes.”

Flynn said the team had to step back and reevaluate which services were needed, which weren’t, and which services needed to be added to their offerings.

Fostering a sense of teamwork

Another secret to Gramercy’s success is its team mentality, Flynn said. “One of our tenets is we want people to thrive and take ownership of their jobs.”

Everyone owns Gramercy, he added, because everybody on the team brings something different and unique to the table.

Having a unified team is especially important when it comes to listening, Flynn said. You can’t be divided on the inside and listening to what’s going on in the healthcare world outside, which trends are picking up steam, and what the needs of communities are. You have to be able to listen to doctors in order to know where they’re coming from and what challenges they’re facing.

Bringing 14 specialties to the community

When Gramercy began as an out-of-network center, it had only four specialties and severely limited resources. In 2006, a vascular surgeon told Gramercy that he could only perform 5 percent of what he needed to do at their center. As of 2013, a vascular surgeon can now do 75 percent of his work at the center.

Over the years, Gramercy has expanded to 14 specialties and is able to conclusively demonstrate that its costs are lower than a hospital’s costs in terms of basic complications, infection rate, return-to-surgery rate, and hospitalization rate. It was the first surgery center to do lap-band in New York, charging patients three times less than what the procedure would cost in a hospital.

“I challenge any outpatient surgery department at a hospital to meet my numbers,” Flynn said. “And through collaboration with local New York payers, the insurance companies are willing to pay us more because we have proven we can do it for cheaper and at a higher quality.”

Flynn said infection control at Gramercy is tighter and more easily controlled than in a hospital setting, where a variety of contaminants can enter a surgical suite.

He goes to great lengths to ensure his staff is thoroughly trained in all areas. For example, he requires his nurses and technicians to be ACLS-trained, since there aren’t 50 extra nurses in a surgery center. He even runs drills with expired dantrolene, so they understand how difficult it is to press into a bag.

“I can control who touches what in my center,” Flynn said. “I can show that I’ve gone after certain procedures that have notoriously high infection rates and show that those rates won’t happen in my center.”

Supporting hospitals and other clinics

Gramercy is not an adversary to hospitals, Flynn said. Rather, it is an alternative and an assist to hospitals.

Nevertheless, hospitals are resistant to the idea of ambulatory care, and Medicare is proposing cuts that will handicap single-specialty centers. With 14 specialties, Gramercy is well-equipped to convince hospitals of its worth to them while weathering the many storms of modern healthcare.

Flynn said there’s good camaraderie among all of the surgery centers in New York and with certain hospitals as well. If Gramercy doesn’t have something, then it can send a patient to the center that does.

This frees the organization to focus on doing the programs that are right for it.

“Again, it comes down to looking at costs and looking at where you can share,” Flynn said. “The original centers in New York, we all talk to each other. Because at the end of the day if I need to borrow something or if they need to borrow something, I want to know that they’re down the road and ready to do it. The same with the hospitals.”

If clinics get involved in subterfuge, where they’re stealing patients and doctors from other centers, then they won’t last long.

“We’re all facing a crisis in New York, not so much if you’re multispecialty, but I know the endoscopy centers have been hit, given the Joan Rivers situation,” he said. “And I have to tell you the one thing is: If you’re not following the rules, that’s just shame on you.”

This is something that the national companies who are coming into New York have yet to grasp, he said. They don’t understand the sharing culture among the centers or how to handle contracts with insurers or even how to deal with the department of health.

“Within the healthcare industry in general, we are really the alternative to the future that’s going to be helpful to hospitals,” Flynn said. “We should see ourselves as allies to hospitals. It’s time to really educate and collaborate with the insurance companies. At the end of the day, there is still going to be a certain aspect that’s going to be outside the hospital system. I really think you can survive and thrive outside the hospital system, but you don’t have to be an enemy of the hospital systems. You can work with them.”

-by Pete Fernbaugh

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