SUCCESS IN THE ASC

PART 3 IN A SERIES

Jeffrey Whitman, MD, was fresh out of medical school back in 1985 when he joined Charles Key, MD, in his private practice in Dallas. The practice consisted of just one clinic and its adjoining ophthalmic ASC. In addition to the two physician-surgeons, the staff consisted of just 20 employees, including four certified registered nurse anesthetists who did double-duty as clinic staff. The surgery center operated just one day a week.

Today, the Key-Whitman Eye Center comprises seven (soon to be eight) clinics and manages the business operations of three other ophthalmology practices throughout the Dallas/Fort Worth metropolitan area. It still hosts just one ASC; however, the new headquarters surgery center with four ORs now operates five days a week and handles thousands of cases each year (see sidebar).

How did Key-Whitman grow into one of the largest ophthalmology and eye surgery practices in Texas? What can other practices learn from its experience to help them achieve the same growth and success in their own markets?

“I think some of it is serendipity, and I’m not jokingly saying that,” says Dr. Whitman, president and chief surgeon of the practice. “Sometimes an opportunity comes up and you just take it. Not every opportunity that we’ve taken has worked out, but enough of them have to help get us here.”

Serendipity only goes so far, though, and Dr. Whitman is quick to add that much of Key-Whitman’s success comes down to a mix of five ingredients: openness to innovation, cutting-edge technology, aggressive marketing, strong leadership, and relationship building.

Innovation, Not Complacency

“My mentor was Dr. Charles Key, and he really got into my head [the idea] to never become complacent about your clinical and surgical treatment,” Dr. Whitman says. “‘Always be willing to try something new,’ he’d say, and ‘you’re not doing something right if you’re not changing your technique.’ He was the one always trying new lenses, new implant techniques, new technology, and it all rubbed off on me.”

Indeed, as is the case with other surgical specialties, such as neurosurgery and cardiac surgery, technology is arguably the engine that drives any surgery center. Key-Whitman participates in FDA studies to evaluate the efficacy of new surgical techniques and technology not just for the specialty as a whole, but also for its own ASC.

“When you’re actively engaged in research, the companies give you the latest and greatest instruments, lenses, and machines to work with, so you have those to use on regular patients, too—not just those who meet the study criteria,” Dr. Whitman says. “We get to use new technology first, which is great for getting us more patients.”

“We’re known for having the latest technology and offering everything that’s out there,” says Nikki Hurley, RN, MBA, COE, director of surgical services at Key-Whitman. “We are always early to adopt new products and new technology.”

That’s not to say that the practice buys everything it tests. Some technologies represent great leaps forward, while others represent only incremental steps. Purchasing decisions regarding phaco machines, femtosecond lasers, and other costly technologies are always discussed and voted upon by the Key-Whitman board of directors and partner-level surgeons.

“We try to be democratic about it,” Dr. Whitman explains. “If you want other surgeons to continue using your facility, you have to [involve them] in those decisions.”

Giving Employees a Say

Key-Whitman takes a similar approach when it proposes procedural changes to its clinic and ASC operations that affect its staff.

“If we’re going to implement something that’s going to change the flow or routine of our practice, we sit down with staff and discuss all aspects of implementation, including possible pitfalls and ways to prevent them,” Hurley says. “If implementation goes really well, then we pat ourselves on the back. If it doesn’t, we go back to the drawing board and figure it out.”

Staff are also involved in the hiring process, interviewing candidates with whom they will be working closely.

Finally, teambuilding is an important component. The practice regularly hosts offsite activities that require staff to cooperate with each other to achieve goals. They also celebrate birthdays, host catered lunches, and do other things to foster a sense of belonging and appreciation among the staff.

Marketing: A Major Player for Growth

Unlike some other ophthalmic practices and ASCs, Key-Whitman invests heavily in messaging through television, radio, and, of course, social media platforms like Twitter and Facebook. Dr. Whitman and his fellow physicians also appear weekly on a local television show, “Good Morning Texas,” to discuss eyecare-related topics.

“It may be the latest, greatest lens implant. It may be seasonal allergies. It may even be something like explaining why your eyes burn in the swimming pool. But we generally gear those segments toward things we do surgically,” he says.

“In ophthalmology today, for the larger practices, growth comes in one of two ways: Either you’re optometrically driven and you do a lot of comanagement with optometrists, or you’re marketing driven. We have chosen to be marketing driven,” says Dr. Whitman.

Key-Whitman recently took its marketing to an even more personal level by leveraging digital technology to custom record and push videos to patients about their upcoming procedures, post-op instructions, and even happy birthday wishes. The video messaging system can also be used to promote procedures and implants to prospective patients who are referred by their physicians, friends, or family members.

“It’s a big step forward in what we’re doing, and it gives us a direct digital connection with each patient,” Dr. Whitman says. “We market ourselves in just about every way you can.”

Overcoming Challenges With Strong Leadership

No practice escapes adversity—major or minor. In recent years, Key-Whitman has weathered a tornado that put its flagship clinic and the ASC down for a week; ransomware that attacked its IT provider and hobbled the practice’s computer-based operations; a snowstorm that shut down the practice for several days; and, of course, the COVID-19 pandemic, which led to the cessation of all elective procedures for several months.

“We were more than nervous about COVID,” Hurley says. “If it had not been for the Paycheck Protection Program, we would have had to let go so many of our staff. As it turned out, we were able to keep everyone except for a few who decided to go on unemployment. We wanted to keep everybody feeling as safe and secure as possible professionally.”

The key to overcoming all these challenges, Dr. Whitman says, was—and continues to be—strong leadership.

“We have Nikki in the surgery center, and if she doesn’t get rattled, we know the surgery center will be fine, no matter what,” says Dr. Whitman. “When things like these happen, [CEO] Dan Chambers is the one directing the different offices, pushing out emails or texts to all the physicians, administrators, and staff.”

During the pandemic, Dr. Whitman explains, he invited all the staff to talk to him about their concerns regarding the disease, vaccinations, masking, and other measures. “There’s a lot of misunderstanding out there. We, as leaders, have the capability and knowledge to answer a lot of those questions, and we need to make ourselves available.”

Benchmarking for Growth

The adage says, “you can’t improve what you don’t measure,” and Dr. Whitman says benchmarking is another important key to growth of the practice. He and Hurley continually monitor and measure costs per case, patient outcomes and volume, and other criteria.

“We look at things like what we spend on labor on a monthly, quarterly, and annual basis, and we compare that on a year-over-year basis,” Hurley says. “But we don’t just compare ourselves to ourselves. We also compare ourselves to other ASCs.”

“There are a lot of practices in Texas, and that’s why benchmarking is so important,” Dr. Whitman agrees. “You shouldn’t hide in your own tent because you’re satisfied that you did better than last year. There’s always room for improvement, and, to me, if you’re not benchmarking against other ASCs, you have totally missed the economic boat in terms of being as profitable as you can be.”

Doing the Right Thing

Ultimately, whether it is attracting new patients and surgeons, helping other independent eye clinics manage their business, participating in studies of and investing in new technology, or building a strong team, Dr. Whitman believes his ASC’s success ultimately stem from strong relationships.

“If you do something that’s helpful for someone, eventually they want to become part of your practice,” he says. “It’s doing the right thing. You have to give people a reason to stay with your surgery center.” ■