The Center for Specialized Surgery at Ft. Myers (TCSSFM) opened its doors six years ago with a focus on orthopedic surgical care, and the primary goal of providing excellent, personalized outpatient care in a safe and comfortable environment. Working with Regent as management partner, TCSSFM’s 12 physicians specialize in orthopedics, spine, and pain management procedures. For the past two years, the ambulatory surgery center (ASC) has offered outpatient total joint replacement (TJR) surgery as well, with two surgeons specializing in that growing field.

A full-service musculoskeletal out-patient surgery center serving the greater Ft. Myers/Lee County, Florida area, TCSSFM is led by Administrator Kathy Horowitz, who was recognized in 2017 for her leadership of the center’s stellar performance in the key areas of profitability, growth and patient, physician, and employee satisfaction.

“Under Kathy’s leadership, all metrics point to continued success for TCSSFM,” says David Moody, vice president of operations at Regent. “Ft. Myers was among the first Regent centers to offer total joint replacement procedures, and they’ve been setting the pace and helping other centers succeed as TJR emerges as a profitable new practice area that improves the quality of care for patients.”


Moody attributes the ongoing success of the addition of TJR to TCSSFM’s service offering as a collaborative effort between Horowitz and her staff, the center’s surgeons, and Regent’s clinical team. Together, they have developed and honed effective protocols, patient selection and educational procedures, and clinical best practices.

But the initial hurdle they faced was working with payers to negotiate reimbursement for outpatient TJR. “Most of TCSSSFM’s payer contracts didn’t include TJR, so it was a challenge to get the carve outs, and restructure the contracts to support TJR,” Moody says.

“When it comes to reimbursement challenges, we’ve been very fortunate,” says Horowitz. “Regent’s Andrea Woodell has really helped us work with payer contracts, and our two TJR surgeons are very proactive in working with both Andrea and Regent’s clinical team to show how it’s better for patients to do TJR procedures here on an outpatient basis rather than in the hospital.”


With reimbursement challenges addressed, TCSSFM focused on patient selection and creating the optimal clinical environment for TJR procedures.

“You may think of this part of Florida as having a high concentration of Medicare patients that don’t currently qualify for outpatient TJR, but we actually have a significant population in that 50-65 age group that is using private payers,” says Horowitz. “The Medicare population is only about 33% of our center.” She explains that because TCSSFM’s TJR surgeons come from a large orthopedic physicians’ group and practice sports medicine, they’ve been able to identify strong candidates for outpatient TJR.

Dr. Fletcher Reynolds, a partner at TCSSFM and one of two surgeons conducting TJR procedures, has been instrumental in developing patient protocols for the center. “Healthy, active patients who are motivated by the fact that they really don’t want to spend time in a hospital with sick patients, and who have a good support system at home, are the best candidates for out-patient TJR,” he says. “They have a positive attitude to begin with, but to relieve their anxiety, we’ve standardized an approach to make each patient comfortable as they’re going home, including written materials that help them understand what’s going to happen each step of the way.”

“Once you have identified the right prospective patients,” Moody explains, “these cases require more instrumentation, and more experience on the clinical side both in the OR and during the immediate post-op phase as the patients prepare to go home. TCSSFM has done a great job of developing clinical best practices in these areas as well.”

Dr. Reynolds also points out the importance of having a strong relationship with an excellent home health agency, to ensure patients are visited in-person early the morning after surgery to make sure they get started doing their therapy, and that they’re getting all care they need.

Horowitz says advancements in surgical techniques and technologies that have enabled smoother procedures: “The way we do the TJR today, incisions are smaller, and anesthesia is so much better for TJR,” she says, citing new anesthesia abductor canal blocks that work on pain sensors but do not alter motor function, so patients can be up and moving faster.

“Our next goal is to set up a total joint class for patients who are scheduled for TJR or have potential to be scheduled. Through the class, they’ll tour the facility and talk about what to expect that day and after surgery, they’ll talk to a physical therapy specialist, and learn about things like gate training, walking with a walker, going up stairs. We’re always striving to offer a comforting, quality experience,” Horowitz says.


TCSSFM began doing TJR procedures in 2016, starting with partial knee replacements, and completed 11 patient procedures that year. In 2017, the number of procedures completed more than tripled to 36, and the center expects to double that number in 2018 with two expert surgeons.  In addition, surgeon satisfaction surveys came back at 100%, and the center’s patient satisfaction scores, their confidence in the care provided, exceed the national average at 98%.

“We measure our success on whether we have provided a positive experience for the patients and their families,” says Dr. Reynolds. “That means the surgery is on schedule and goes smoothly, their pain is managed well, and they can go home and feel ready to begin their recovery. And at the same time, it has to be a profitable venture for the surgery center. To make that happen, the whole team has a role to play, from anesthesia to nurses, techs to surgeons, to administrators.”

Horowitz attributes much of TCSSFM’s success to the skill and caring of all who work there. “We hire the very best,” she explains. “Our nurses are critical care nurses and know critical thinking, patient care, and how to comfort patients when they’re stressed and worried. Our surgeons are both talented, and supportive of the team around them.”

Looking forward, Horowitz believes TJR procedures will continue to drive growth at TCSSFM.

“Regent’s Chris Bishop, Dave Moody and Chris Stine are working with us and with payers on next frontier management strategies, on things like payment bundling,” she says. “They’ve been a very big support system for us, and the Regent clinical team is always available if we have questions. And, if Medicare approves outpatient TJR, our volume will probably triple just among those patients healthy enough to qualify for outpatient surgery. I’ll need more space and more surgeons!”

For more information on Regent’s management services and support for outpatient TJR, contact Thomas Crossen.