At 25, No Growing Pains at Southwoods

BOARDMAN, Ohio – An idea hatched during a drive to Cleveland is in its 25th year with an eye on future growth.

In the space of that hour-long drive, Ed Muransky and Dr. Louis Lyras seized upon a goal to develop an outpatient surgical hospital in Boardman, the cornerstone of what today is Southwoods Health.

A quarter-century later, the venture has expanded from a 15,000-square-foot outpatient operation with roughly nine cases per day to a medical network that includes an acute-care hospital, a pain and spine clinic, regional physician offices, imaging, express care and a sleep center.

And, it’s not finished yet. This fall, Southwoods plans to break ground on a new orthopedic center at its Boardman campus, says its CEO, Muransky.  “The whole drive in orthopedics is to open your eyes and take a look at what’s in the Valley,” he says. “I hope that Southwoods is a leader in this area.”

Muransky says the center will be dedicated specifically to orthopedic care and patient education. “We’re now up to 11 doctors in orthopedics on this campus and that’s growing,” he says. “We have four more orthopods coming on in the next 12 months. This is, over the next 10 years, one of our growth areas. As we’re reinvesting in the community, we’re reinvesting in more doctors.”

Dr. Louis Lyras and Ed Muransky co-founded Southwoods Health in 1996 with the idea to give doctors a bigger say in how patient care is delivered. 

The idea is to consolidate Southwoods’ orthopedic care into one location instead of the seven sites it manages today. Making it easier for patients and physicians through better, more attentive, and efficient care is key to a successful medical operation, Muransky says.

It’s also key to understanding the values behind Southwoods’ remarkable growth over the last 25 years, adds Lyras, chairman of surgery.

Indeed, he says the drive to build Southwoods was prompted by the need to provide a better, more efficient means to accommodate physicians, staff and most important, patients.

“We were on our way up to Cleveland to talk about starting an imaging center,” Lyras recalls. Initially, he and Muransky explored the concept of establishing an MRI service for the region. But Lyras had just finished up a particularly frustrating day at the hospital and that drive to Cleveland changed the entire plan.

“I said, ‘Forget about the imaging center. Let’s open up an outpatient surgery center,’ ” Lyras says.

He thought patient care could be transformed, Lyras says, if physicians could move unencumbered without the bureaucracy of a large health care system. “I wanted to bring more efficiency to patient care,” he says. The answer was to establish a place where physicians had their own say and could make decisions quickly, he says.

None of it was easy, Muransky says.

“It was good back then what we didn’t know,” he says, noting had the pair understood beforehand just what was involved in beginning a new surgical center, things might have turned out differently.  

Establishing a new outpatient center wasn’t a popular move, Muransky says, alluding to resistance from existing institutions and the red tape involved with obtaining a certificate of need.  Still, the Surgical Hospital at Southwoods opened in 1996 as a health system campus on Market Street in Boardman.

During the first year of operation, Lyras says, all of Southwoods’ employees could fit into a single conference room. Back then, the surgical hospital consisted of four operating rooms and two endoscopy suites, he says.

Today, Southwoods employs more than 1,000 people across its network.

“It was baby steps,” Muransky says.

Once the outpatient center was established, in 2002 Southwoods added pain and spine management services to its portfolio, which also included an expansion of its outpatient surgical center.

Throughout this period, however, patients and physicians began to inquire about the potential of Southwoods developing an acute-care hospital at the campus as its outpatient census continued to rise.

“Patients were writing in their questionnaires about staying overnight,” Muransky says. Such demand convinced the company that the addition of a full-service hospital at Southwoods made sense.

By 2008, however, the country’s political winds were shifting and there was concern as to whether regulators would place a moratorium on physician-owned hospitals. If Southwoods was going to build a new hospital, the company had better move quickly, Muransky and Lyras were advised.

“We broke ground in 2008 and were accredited in 2009,” Muransky says. Months later, the Obama administration placed a moratorium on physician-owned and operated hospitals. Expansions followed the next decade with Southwoods Imaging and Southwoods Express Care.

Today, the Southwoods complex logs 600,000 patient visits annually.

“The quality of care we deliver to the Valley has really been a source of pride for all of us,” says Dr. Tom Gemma, medical director at the Surgical Hospital at Southwoods. “Growing up here in Youngstown, [it] means something very special to know that we can provide care here that isn’t provided at other locations.”

Gemma, an anesthesiologist, says Southwoods provides an opportunity for patients to receive excellent care without having to drive to Cleveland or Pittsburgh for treatment.

“Clinically, we’ve been able to provide a very efficient and clean level of care,” he says.  “Our infection rate is extremely low and quality of care is extremely high.”

Case volume in his department and across the network continues to climb, according to Gemma.

Technology has also emerged as a driving force to improve the quality of care at Southwoods, he says.

The health care system, for example, realized early that robotics would play a significant role in surgical procedures, Gemma says. “Watching that grow has been something that I’ve enjoyed. It’s provided a new level of surgical care.”

While investment in new technology is important to providing patients with some of the most sophisticated treatments, it’s also vital to recruit new talent to the health care system, Muransky says. “This is how these younger doctors are being trained,” he says. Today, 15 of Southwoods’ surgeons use robotics, Muransky says.

Angela Kerns, chief nursing officer, says it’s imperative that patients feel comfortable and be treated with compassion while at Southwoods.  Recently, the hospital earned a five-star rating from the Centers for Medicare & Medicaid Services. It regularly earns a high level of customer satisfaction, she adds.

“Historically, we’ve received a 99% customer satisfaction as it relates to other hospitals,” Kerns says. “We watch that very closely. We honor every patient request as much as we can.”

Feedback from patients is a critical part of maintaining excellence at Southwoods, she says. 

“We ask about their suggestions. We’re very actively engaged,” Kerns says, noting she often speaks with patients directly to determine how the company can improve. 

Patient satisfaction is a driving force for all Southwoods operations, say chief nursing officer Angela Kearns and medical director Dr. Tom Gemma 

A critical component to improving access to care was expanding Southwoods’ physician network, says Steve Davenport, chief operating officer. Initially, the system sought specialists in cardiology, urology and other disciplines to join the Southwoods group, he says. But that trend has now expanded to primary care practices in the region.

“We started going out in the family medicine market and putting our focus on developing our network of family practice, internal medicine and primary care doctors,” Davenport says. This enables patients who are evaluated by a Southwoods primary care physician to continue through the system should further treatment such as surgery be necessary.

Another effort to expand access has evolved through Southwoods’ Express Care model, Davenport says.“It allows us to bring comprehensive care closer to the communities we serve,” he says.

Southwoods operates Express Care sites in Boardman and Campbell, while another is under construction in Columbiana, Davenport says. A fourth Express Care is planned for Calcutta. “The whole idea is to make access more convenient for our patients,” especially those in their 20s and 30s who may not have a primary care doctor.

Part of Southwoods’ success, Lyras says, is that its ownership incorporates the clinical knowledge of physicians and the business acumen of executives such as Muransky. “It’s a great blend of business and medicine,” he says. Southwoods employs about 100 physicians and has 90 major shareholders.

Still, Muransky says he’s as surprised as anyone about the growth of Southwoods. “If we thought 25 years ago that we would be sitting here discussing today what we now own, we would have been liars,” he says. “It’s mind-boggling.”

Southwoods provides a vital service for the community, Muransky says – as do the other regional hospitals – particularly since the demographics in the Mahoning Valley point to a growing aging population. What’s important is that health care systems work together to provide the best care for patients so they remain in the Valley for treatment.  

“We see what is lacking in our community and what is outsourced,” he says. “We can do more things maybe in conjunction with a couple of the hospitals here.”

Ultimately, the entire Mahoning Valley benefits, Muransky says, reflecting on 25 years. “We set out doing the right thing for the right reasons,” he says. “What drove us then, drives us now – we want to make Youngstown better.”

Pictured at top: Southwood Health’s campus in Boardman will soon be expanding with the addition this fall of an orthopedic center that consolidates care from seven sites.