Sun Sentinel Palm Beach Edition
State’s first same-day surgical center to close
It’s hard to imagine now, but 40 years ago, the concept of having surgery without spending a night in a hospital was unsettling to many in the medical community.
Hospitals were judged by how many beds they could fill.
Most insurance companies wouldn’t reimburse patients for procedures unless they were admitted to a hospital.
And some physicians were wary of operating without hospital backup.
But in the early 1970s, a group of 26 physicians — all staff members at Memorial Hospital in Hollywood — joined together and built Ambulatory Surgical Facility at Sheridan Street and North 46th Avenue.
It was the state’s first free-standing same-day surgical center, built four years after the nation’s first ambulatory surgery center opened in Phoenix, Ariz., in 1970.
The Hollywood facility, now called Memorial Same Day Surgery Center but owned independently of Memorial Healthcare System, is today one of 445 such centers in Florida. But its days are coming to an end.
The partnership that owns the facility, comprising 40 local surgeons and a financial investor, is closing it at the end of August and transferring “a large portion of the surgical cases and employees” to a newer facility the partnership owns on the campus of Memorial Hospital West in Pembroke Pines, spokeswoman Kim Wrath said.
Area surgeons are opting to use newer centers, including facilities owned by hospitals and insurance companies, reducing the number of surgeries at the Sheridan Street center, said James Seymour, the center’s administrator.
The opposite problem existed in the early 1970s.
A shortage of operating room space to perform elective surgeries prompted the founding group of physicians to open the center in 1974. According to a 1983 report in the Fort Lauderdale News, a need for the center was recognized after some doctors found their patients
had to wait as long as six weeks to get elective surgery in area hospitals, and in some cases, found surgeries canceled because the space they booked was needed for emergencies.
The same-day center provided flexibility while saving patients up to half the cost of overnight hospital stays for simple procedures such as tonsillectomies, cataract surgeries and some plastic surgeries.
Hospitals, however, didn’t share that enthusiasm for saving patients money, and didn’t appreciate the competition.
“If you’re a hospital CEO and find out a doctor intends to do surgery in a place that’s not your hospital, you’re going to freak out,” said Peter Lohrengel, executive director of the Florida Association of Ambulatory Care Centers. “Back then it was unheard of. Everything was done at hospitals. If you needed an EKG, you were admitted to a hospital.”
Two years after the Hollywood facility opened, Good Samaritan Hospital in West Palm Beach joined the State Hospital Advisory Committee in opposing an application by a local physician group there to open an ambulatory surgical facility, arguing it would duplicate services. The physicians prevailed.
The number of ambulatory care centers in the U.S. increased sharply after 1980, when Medicare began reimbursing 80 percent of the costs of approved procedures. Hospital systems embraced the idea, creating same-day centers on their campuses.
Outpatient surgeries increased by 77 percent between 1979 and 1983, while the number of free-standing [unaffiliated with a hospital] ambulatory care centers grew from 80 in 1978 to about 3,000 in 1986.
Also boosting viability of same-day surgery were advances in anesthetics. “With the drugs that were used before, like ether, it took longer to go to sleep and it took them longer to wake up,” Dr. Barry Silverman said in a 1983 Fort Lauderdale News story about the Sheridan Street center. “The advent of muscle relaxants and other anesthetics allows the patient to be kept in a lighter state.”
Those developments, combined with other surgical advances in medical technology, widened the number of procedures possible within a single day.
Early news coverage of the Sheridan Street center noted procedures by ears, nose and throat doctors, Seymour said. “Adenoids, tonsils, and putting tubes in children’s ears,” he said, adding, “We’re still doing those.”
According to Becker’s Hospital Review, the four most common specialties in sameday surgical centers today are gastroenterology, urology, ophthalmology and orthopedics.
Arthroscopic and endoscopic procedures, not envisioned in 1974, are among the most commonly performed today. Physicians make tiny incisions, or sometimes no incision, to examine and treat. Procedures include colonoscopies, examinations of the esophagus, stomach and intestines, as well as arthroscopic repairs of knees and shoulders.
“I had knee surgery in the 1980s and had to stay in a hospital overnight,” Seymour said.
Also popular are gastric band surgeries, a weight-control procedure for the morbidly obese involving placement of a band across the top portion of the stomach below the esophagus.
Advancements in surgical technology and pain management will further expand procedures offered by same-day centers, Lohrengel said.
Memorial Same Day Surgical Center is starting a spine surgery program and plans to offer procedures such as cervical spine fusions and anterior cervical disc fusions currently found in specialized spine surgery centers, Seymour said.
Robotics, until recently priced only in reach of large hospitals, are starting to show up in outpatient settings and will fuel further innovation, Lohrengel said.
Seymour said the Sheridan Street facility isn’t being torn down and will continue to be used as medical offices. Some of its 30 staff members will transfer to the Pembroke Pines center, he said.
So will area surgeons, many of whom have been serving patients at the original center for 20 to 30 years and are realizing how strange it will feel to work somewhere else, Seymour said.
Staff and surgeons alike appreciate the historical significance of the center, he said. Vintage photographs hang on the center’s “wall of history,” including a 1975 Miami Herald story calling it the first freestanding ambulatory surgical center east of the Mississippi River, Seymour said.
“There’s a sense of sadness, but also a realization that it had a good run,” he said. “It’s time to move to a newer location.”