Richard Cartabuke, M.D., is a physician executive leading an ambulatory surgery center with some impressive numbers:
- Staff satisfaction rating, 90%
- Patient satisfaction rating, +99%
- Physician-satisfaction rating, 100%
- Net income-to-net revenue ratio, 42%
- Average operating room turnover time, nine minutes
- Marketing expense, $0
- Surgical procedures lost due to day-of-surgery cancellations, 0.062% (four of 6,489 in 2002)
"It's unexpected and wonderful," says Cartabuke, an anesthesiologist with a specialty in pediatric anesthesiology and a master's degree in business administration from Ohio State University.
AAASC board member and judge Jane Thilo, M.D., is a former owner of an ambulatory surgery center, or ASC, an entrepreneur and now a principal at Encompass Health, a leadership and organizational development consultancy in Mercer Island, Wash. She says she is impressed by Cartabuke's clear commitment to education, both his own and the education of his staff.
"Most of all," Thilo says, "I was impressed with Dr. Cartabuke's creative approach to leadership, which has manifested tangible results such as outstanding scores on patient-, staff- and surgeon-satisfaction surveys, lower complication rates, increased revenues and decreased expenses leading to significant improvement in center profits.
"Dr. Cartabuke is a leader who is not afraid to roll up his sleeves to work hard along with his staff. I think he is a model medical director and a model leader."
Cartabuke is scheduled to receive his award at the AAASC's 25th annual meeting March 4 in Orlando, Fla.
A reputation for clinical excellence, a solid understanding of business fundamentals, a strong work ethic and some keen interpersonal skills have made Cartabuke the superb leader that he is, according to his colleagues. "His ability to look at the big picture and break it down into little parts is overwhelming," says Kim Esteph, a registered nurse and the ASC's facility administrator. She has worked alongside Cartabuke since the facility opened. "His interpersonal skills with the surgeons are priceless," Esteph says. "Being in the shop every day, that consistency; if you can have the medical director visible, accessible, that makes a huge difference."
Cartabuke says he tries to get a sense of what is in the best interest of the organization, then presents the case to his colleagues to see if that's where they want to go. "What I've found is change is almost impossible without the buy-in of those who have to make the changes," he says.
For example, a utilization analysis at the facility showed a high number of surgeries were being scheduled on Tuesdays and Fridays, 40 to 45 cases compared with an average of 25 cases per day the rest of the week. The choices for growth were either spend a lot of money to build a sixth operating room, or spend nothing and even out the caseload.
"It took about three months of negotiation," Cartabuke says. "Several docs couldn't move, but others volunteered. Now, we're averaging about 32 cases a day."
According to Maureen Stubbs, M.D., a fellow anesthesiologist who nominated Cartabuke, "He has clinical brilliance (and) he is a soft-spoken, gentle person who is respected by everybody." Stubbs says the center's Cartabuke-inspired culture extends to crosstraining--of nurses who can fill in where needed, operating room personnel who can restock the preoperative holding area, surgical technicians who can help with billing, and scheduling personnel who can make beds and move equipment.
The physicians on staff join in, Stubbs says, recalling how her fellow anesthesiologists pass out premedications in the preoperative holding area and escort discharged patients to their cars if the nursing staff is tight.
Cartabuke helped develop Ohio Surgery Center's Perioperative Event Record, a survey tool to track atypical events and trends among patients to improve protocols and quality of care. Negotiating with payers, Cartabuke has bargained incentivized contracts in two directions, giving price breaks to payers that increase the center's patient volume and obtaining payment raises based on the facility's ability to meet quality criteria of the payer's choosing.
Cartabuke says he maintains a full clinical schedule, with his executive role taking a couple of additional hours a day and a few on weekends.
The center is owned by 23 otolaryngologists and Cartabuke's anesthesiology group, which combined control 92.5% of the enterprise. The remainder is owned by Nueterra Healthcare, an ASC investment and management firm based in Shawnee Mission, Kan.
Cartabuke also serves as president and treasurer of Premier Anesthesiologists, the eight-physician group associated with Ohio Surgery Center.
Richard Cartabuke, M.D.Age: 47
Education: State University of New York Health Science Center, Syracuse; MBA, Ohio State University
Residency: Anesthesiology, SUNY, Syracuse
Practice: Premier Anesthesiologists, Columbus, Ohio
Leadership: Chief Medical Officer, Ohio Surgery Center, Columbus