Partnering with a management and development company like Physicians Endoscopy (PE) can afford a long list of benefits, from leveraging rich expertise in building and acquiring ambulatory surgery centers (ASCs) to accessing a comprehensive team that works exclusively on the business and operational components of ASCs. But it’s natural for a center to initially come to the table with concerns about the partnership and the future of the center and its staff.
Two PE partnered center administrators-Darlene Buddendorf of Endoscopy Center at St. Mary and Penny Nicarry of Endoscopy Center at Robinwood-spoke with PE Senior Vice President of Business Development and Marketing Carol Stopa about their initial concerns and how those concerns were quickly alleviated.
Carol Stopa (CS): Tell me a little about your centers and when they partnered with PE.
Darlene Buddendorf (DB): We have served the south-eastern Pennsylvania, central New Jersey and greater Philadelphia communities since 2006. Our center was affiliated with a hospital, with staff employed by the hospital. Our partnership with PE began in 2016. The hospital remains an owner, but staff transitioned to become employees of the center.
Penny Nicarry (PN): We opened in 2002 and serve a tri-state area that includes Maryland, Pennsylvania and West Virginia. We were part of a health system for 10 years, with our staff employed by the system. We exited that relationship and partnered with PE in 2012.
CS: What were your concerns about entering into a partnership with a company like PE?
DB: The biggest concern was probably preservation-preservation of my staff and even myself. In the early planning stages, we didn’t know what to tell the staff as we lacked information about PE and their approach to partnerships. What would happen to our benefits? Will they still need me, the administrator, or our clinical director? Would they tell us we weren’t completing enough cases and needed to downsize? Are they going to advise us of the need to change staffing structure to reduce costs? I was stressing so much that I practically had a resignation letter drafted in my inbox.
PN: My apprehensions were similar. What changes were forthcoming? A lot of our employees had been with the center for 10 years, and turnover was minimal. Would there be staff retention? Would our benefits change? Would seniority carry over?
CS: Those concerns were justified. After all, Penny, you were a part of the center before it even opened. You brought the staff over and developed it from scratch. Now there’s this big change coming, and it’s daunting. How did PE help alleviate your concerns?
PN: The first question we asked was whether staff would keep their jobs. It was imperative to get that uncertainty out of the way. We learned everyone would keep their jobs, which relieved some apprehension. Then our minds shifted toward how our center would operate going forward. It felt like we were starting essentially at ground zero, knowing nothing except that our jobs were safe. But would we even want to stay in our positions?
To further alleviate our concerns, we held multiple meetings where we sat down with PE representatives and got answers. PE stepped up, with their representatives listening to us and treating us very well. They maintained our seniority and initially carried over the same benefits. We did have to get used to some changes.
For example, as part of the health system, we had a mail machine downstairs from the center that we used to send out mail. We no longer had use of the machine following the ownership change. It seems small, but we had to figure a new way to get mail out. Little issues like this popped up for a while, and we just had to be prepared to come up with solutions.
DB: The biggest factor in alleviating my concerns about the new partnership was being able to meet PE staff in person. It really helps to get to know your new partner and teammates.
Early in the process, I was able to tour PE headquarters in Jamison, Pennsylvania, and meet the PE team face-to-face. We were able to see how they work together and gain a better sense of the kind of partner we were getting. This provided some insight into how they would likely respond to us. It also helped to get to know individual team members. When we picked up the phone to call PE, we could then put a face to a name and know to whom we were speaking. We were happy to discover that PE has the same family-oriented camaraderie as our staff.
CS: It’s great when a partner can visit us in our office. It certainly helped that Endoscopy Center at St. Mary is close to us. When the distance grows, it can be a bit more difficult for physicians and center leadership to make the trip, but we always encourage and welcome it.
DB: The transition also was made easier through my ongoing communication with you and PE’s human resources department. When the time came for us to loop in our staff, PE’s team didn’t work from afar; they were hands-on right away. They visited our center several times and sat down with every member of my staff, answering all questions and providing comfort when necessary. They even brought pizza.
The entire experience was a bit overwhelming for my staff. After all, lots of them were long-term hospital employees and hesitant to embrace the change. PE gave them the time to vent, listened to their concerns and alleviated fears of the unknown.
CS: How has the partnership with PE helped you and your center?
DB: PE has helped us improve quality analysis and benchmarking by continuously updating us on new developments. They’ve helped us achieve significant cost savings through securing reduced pricing on equipment purchases. PE takes care of our billing, which helps ensure accounts receivable and payable turn around in a timely manner.
As an administrator, this support allows me to focus on other critical matters, such as maintaining better communication with staff and physicians, reviewing and filling operating room schedules and marketing the center for continued growth. It has allowed me to tackle projects I didn’t have time to do before.
The ongoing collaboration with PE is wonderful. I regularly work with Rob Puglisi, Vice President of Operations. He is like my own PE partner. I can pick up the phone and speak with him anytime to discuss matters involving the center.
PN: For us, PE’s negotiating power with payor contracting and supplies may be the most beneficial. They’re also great at helping us keep up with regulatory developments and updates. Running the day-to-day operations is a fulltime job itself. It’s great to have PE’s assistance in keeping us up-to-date on changing regulations.
I may have been skeptical of the partnership at the start, but it really has been a blessing in disguise. It seems like at least once a day someone on my team tells me they’re glad not to be with the health system anymore. When we were with the system, there were regular layoffs and tremendous uncertainty about professional futures. Now we have stability, a level of job security and a thriving center to boot.
CS: What steps would you recommend a center considering a partnership take to improve the process?
DB: I believe the process should include a means of communicating key elements of the partnership transition to the administrator early on so that they can better comprehend what will be expected of them and help alleviate misconceptions for the future. The physicians may know this partnership will be successful because they have dealt with the anticipated partners behind the scenes, so this communication can help the administrator have a better feel for the expected relationship.
I think there would be great value in scheduling regular communications, perhaps weekly calls between the administrator, physicians and partner. These calls could serve to provide updates on the transition and give an opportunity to address questions or concerns, including those from staff, sooner than later.
CS: We encourage physicians to inform their administrators about what is going on. They don’t need to share all the details, such as purchase price, but the more about the potential partnership that is a mystery, the more undue fears will build up.
DB: Once the staff feels like they know changes are coming, they will want to know the who, what, when, where and why of the potential change.
Management can help calm these fears by offering some direction sooner than later. Having physicians and the new partner address staff questions and clarify that a partnership is not a takeover may relieve many of the pressures and fears. I would also recommend an ASC visit its partner to see their headquarters and meet their staff. An administrator can gain a better understanding of how the partner is ready to assist and ultimately help make the center even better than it already is. Embrace the change.
CAROL STOPA is Senior Vice President of Business Development and Marketing for Physicians Endoscopy. She has more than 15 years’ experience in acquisitions, de novo and hospital/system joint ventures. She can be reached at email@example.com.
DARLENE BUDDENDORF is Administrator of Endoscopy Center at St. Mary in Langhorne, Pennsylvania. The center is about 7,500 square feet with four procedure rooms, three of which are licensed for operation. Physicians perform about 5,600 procedures annually.
PENNY NICARRY is Administrator of Endoscopy Center at Robinwood in Hagerstown, Maryland. The center is about 6,000 square feet with four procedure rooms, three of which are presently operational. Physicians perform about 9,500 procedures annually.