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Orthopedic center's proven track record in Bath Township facing another test with Akron facility
By Cheryl Powell
Beacon Journal medical writer
Published on Sunday, Aug 17, 2008
Twenty years ago, Dr. T.J. Reilly took out a loan against his house to help pay for a new type of medical building in the suburbs with three outpatient operating rooms.
Skeptics — and, truth be told, even some of the partners — wondered whether patients would follow the Akron doctors to Bath Township for outpatient procedures to repair bones, joints, muscles, tendons and related problems.
In those days, banks were reluctant to loan millions of dollars to a group of doctors for an unproved concept in the region, Reilly recalled.
About 1,000 outpatient surgery centers existed nationwide in the late 1980s, compared with more than 4,000 today, according to the Ambulatory Surgery Center Association.
So the physicians secured personal loans and took out second mortgages to finance the $8.5 million project.
''When we moved out here in 1989, even some of our physicians were concerned, 'Are my patients going to follow me?' '' Reilly recalled.
The investment unquestionably paid off for Reilly and the dozen or so other orthopedic doctors who fused their practices in 1988 to form the Crystal Clinic.
Today, the Crystal Clinic includes 30 specialists who provide more than 6,000 outpatient surgeries annually in the Bath Township flagship location and another 116,000 patient visits in 11 offices in Northeast Ohio.
By the end of the year, the respected orthopedic regional powerhouse is expected to merge with Summa Health System's orthopedic department, currently based at St. Thomas Hospital in Akron.
As part of the deal, the doctors are getting a 50 percent stake in Summa's inpatient programs, as well as half ownership of a $100 million, 96-bed orthopedic hospital that is being constructed on Summa's Akron City Hospital campus.
In exchange, Summa is getting a 50 percent stake in the Crystal Clinic's outpatient surgery business, which opened in 1989 and has been making money every year since early 2000.
The combined entity is expected to post first-year gross revenues of about $80 million, according to Crystal Clinic Chief Executive Ronald Suntken.
The Crystal Clinic had been exploring options for building its own orthopedic hospital, possibly in Montrose or Hudson, when the doctors instead opted to partner with Summa and keep inpatient services in Akron.
When the new hospital is completed in fall 2010, it will bear the name, ''Crystal Clinic Orthopaedic Center.'' (The doctors will keep a separate practice with separate billing for their physician fees.)
New clout
This time around, there's no need for personal loans, Reilly said.
The Crystal Clinic's doctors now have equity, clout and a reputation for success from their outpatient surgery center.
''The next logical step is the inpatient side of things,'' said Reilly, a hand surgeon and the Crystal Clinic's president.
The Crystal Clinic has ties to St. Thomas Hospital that date to its formation.
When the doctors proposed the outpatient surgery center in 1988, the state had a ''certificate of need'' system requiring health-care providers to prove the need for new hospital beds, operating rooms and other services.
To get approval for the new outpatient ORs in Bath Township, the Crystal Clinic agreed to pay St. Thomas Hospital a minimum of $50,000 annually to close two of its underused operating rooms.
At that time, St. Thomas was in the process of merging with Akron City Hospital to form Summa Health System.
The state's certificate of need program subsequently was abolished and the Crystal Clinic no longer was required to make payments to St. Thomas.
But the Crystal Clinic's link to St. Thomas and Summa has remained strong, with Summa relying heavily on the Crystal Clinic doctors to keep its hospital beds filled and its operating rooms busy.
About 71 percent of the 3,800 inpatient surgeries and 57 percent of the 2,800 outpatient procedures in Summa's orthopedic program last year were performed by Crystal Clinic doctors, said Dr. Scott Weiner, head of Summa's orthopedic department.
''It's a very important group,'' Weiner said. ''Fortunately, they're a quality group. The Crystal Clinic surgeons have been a very strong, supportive group. Akron City Hospital probably missed the ball several years ago by not partnering. But then, the concept was very foreign.''
New trends prevail
In recent years, hospitals nationwide have been partnering with doctors for joint ventures to boost patient volume and to prevent doctors from creating competing facilities.
Critics of the trend contend that doctors with ownership interests in hospitals are more likely to refer to those facilities, leaving nonprofit hospitals stuck with the money-losing cases.
Akron General Medical Center, Summa's cross-town rival, has no plans to enter joint ownership ventures with doctors for services on its main campus, President and Chief Executive Alan Bleyer said.
''One can't depend on safety-net institutions that are seeing an erosion of patient population and expect them to continue to be viable,'' Bleyer said. '' . . . If a group of physicians is able to go off on their own and strip patients, the public good will not be served.''
The merger between the for-profit Crystal Clinic and the nonprofit Summa orthopedic program will require a review by the Ohio Attorney General.
Unlike many doctor-owned specialty hospitals nationwide, Reilly said, the Crystal Clinic Orthopaedic Center will be located ''in the center of the urban population,'' with nonprofit Summa sharing in the revenues and maintaining the same charity-care policies.
New taxpayer
The new orthopedic hospital will be a for-profit business and is expected to generate $2.3 million annually in property taxes.
Declining reimbursement from the government and insurers, coupled with rising costs and other challenges, make it difficult to attract and keep doctors in Northeast Ohio, Reilly said.
The new facility will help, he said.
''The way I see it, '' he said, ''doctors are either going to work for a hospital or become a hospital.''
In the meantime, the Crystal Clinic is continuing to build on the success at its Montrose outpatient facility with a major renovation and expansion.
In 1990, there were 2,300 outpatient surgeries at the Crystal Clinic. By last year, there were 6,175 outpatient procedures.
To accommodate the growth, the Crystal Clinic Surgery Center in Bath Township expanded from five to 10 operating rooms in the past year.
Construction and equipment costs totaled $5.5 million, Suntken said. In addition, another $2.5 million worth of renovations are under way in the physician office portion of the facility.
Administrative offices and the Crystal Clinic's Summit Hand Center relocated to a neighboring building to make room for the surgery center expansion.
Dr. Rob Bell, a founding partner in the Crystal Clinic and shoulder surgery specialist, credits much of the practice's success over the years to its retention and recruitment of doctors who are ''fellowship trained,'' meaning they complete extra training in a ''subspecialty'' after their five-year orthopedic residency.
All are involved in teaching orthopedic residents at Akron Children's Hospital, Akron General and Summa. Every Crystal Clinic doctor also is a member of the faculty at the Northeast Ohio Universities College of Medicine (NEOUCOM).
''You have to have people who are active academically — not only locally but regionally and nationally,'' Bell said. ''What it does is it gives name recognition to the entity.''
The Crystal Clinic's subspecialists routinely get patient referrals from a 17-county region in eastern Ohio, Reilly said.
A patient's tale
Lisa McCrary of Orrville opted to take her 14-year-old daughter, Ciera, to see Reilly at the recommendation of the girl's pediatrician at the Cleveland Clinic Wooster Family Health Center.
On a recent morning, Reilly chatted with the girl while performing an outpatient surgical procedure under local anesthetic to remove scar tissue and loosen tendons in her pinky finger, which she couldn't straighten because of previous sports injuries.
Ciera got a close-up view of the pinky finger repair via a monitor by her bedside in the expanded Crystal Clinic surgery center.
''See how straight I can get your finger now?'' he asked her midway through the procedure after he removed scar tissue.
''Dang!'' she replied in amazement.
''It's pretty important that the patient sees what's possible so when she's working in therapy, she knows it's possible,'' Reilly explained.
Less than 30 minutes after the procedure began, Ciera was in recovery with her relieved mother.
''I think we're in good hands,'' her mother said. ''As a matter of fact, I know we are.''
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
Twenty years ago, Dr. T.J. Reilly took out a loan against his house to help pay for a new type of medical building in the suburbs with three outpatient operating rooms.
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