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News & Events

Thu, April 16, - 11:11am 2020


Colonoscopy: Early detection that can be life-altering
Two women. Two mothers. Two families. Two cancer diagnoses. Two lives saved due to early detection.

Carla and Linda both walked into Mississippi Valley Surgery Center and Endoscopy Center, for routine screenings – expecting to walk away with the “all clear.” But what they received were two shocking cancer diagnoses. Their journeys of treatment were very different, but early detection helped save both their lives.

March marked National Colorectal Cancer Awareness Month, and it’s why these brave, local women are sharing their stories and encouraging everyone to get a colonoscopy.

Carla’s story: Listening to her doctor

Carla, a 51-year-old Davenport resident and church choir director, was referred to Dr. Bettaiah Gowda for a screening colonoscopy after her primary caregiver couldn’t determine why her iron levels were so low. Dr. Gowda with Gastrointestinal Clinic of the Quad Cities chooses to perform his outpatient procedures at Mississippi Valley Endoscopy Center. 

A colonoscopy is an outpatient procedure that allows the physician to examine the large intestine (colon) for changes and abnormalities, typically polyps or colon cancer. The procedure takes about 30 minutes and the patient is under sedation.

When Carla’s colonoscopy revealed a large, cancerous mass, she was shocked. Even months later, she can’t retell the story without tearing up.

“I really never thought there would be an issue,” Carla said. “It was the most devastating time of my life. When I heard that it was cancerous, I was shocked. I felt numb, and I just blanked out. I wasn’t receiving the information well.”

Carla, who described her state as an “emotional wreck,” continued feeling upset. After she reached out with questions, Dr. Gowda immediately called to reassure her.

“He told me everything was going to be ok, and this wave of peace came over me,” Carla said. “He was so compassionate and sincere. He has a compassion for people, knows his job, and is really good.”

For Dr. Gowda, reassuring patients is part of his job. With nearly 25 years of experience, Dr. Gowda has helped many patients facing unexpected results.

“As doctors, we’re here for patients,” said Dr. Gowda. “We know that some results can be scary, but that doesn’t mean patients should avoid a screening. The earlier it’s detected, the better the treatment can be. According to the CDC, more than 30 percent of adults ages 50-75 are not up to date with colorectal cancer screenings, which is why we emphasize its importance. Colon cancer is the most preventable type of cancer and early staged colon cancers are typically curable. The most common symptoms of colon cancer are “no symptoms”, hence the importance of getting screened.”  

Less than a month after her colonoscopy, Carla underwent a surgery to remove the mass, which thankfully had not spread to any other areas. She’s thankful she had the colonoscopy when she did, and she’s having her four children get tested.

“Early detection definitely saves lives,” Carla said. “It has changed my outlook to see how precious life can be. That was so unexpected.”

“You have every reason to find it early,” said Dr. Sreenivas Chintalapani (Chin), of Gastrointestinal Clinic of the Quad Cities. “You don’t want to wait for it to show up because there is little that can be done at that point. It grows silently. The prevention potential is really great. As a whole, wouldn’t we better off preventing cancer rather than treating it?”

Mississippi Valley Endoscopy Center physicians recommend both men and women get routine screenings starting at the age of 50. Those with a family history of polyps or colon cancer may be advised to have colonoscopies sooner.

Linda’s story: Proactive health for her children

For 73-year-old Linda, a Bettendorf resident who enjoys her job as a school bus driver, the decision to have a colonoscopy was all about reassuring her kids she was healthy and well.

“After losing my husband, I wanted to prove to my kids I was taking care of myself and I was healthy,” said Linda. “I felt completely fine – no pain at all and no complaints.”

Part of Linda’s health check-up was a colonoscopy with Dr. Chin at Mississippi Valley Endoscopy Center. To her surprise, the test revealed colon cancer. And the cancer had already spread to her lungs.

“Initially, I thought, ‘Oh no,’” Linda said of hearing she had cancer. “But I told my kids I was going to fight it, and I did. You just have to keep positive, hit it head on, and hit it hard.”

Linda had the cancerous mass in her colon and the bottom of her right lung removed. She began going through cancer treatments including rounds of radiation and chemotherapy.

“A colonoscopy as a procedure is a team effort even though the physician is doing it,” said Dr. Chin. “The nursing around the procedure, the care that is involved around it – there is a science and expertise that is acquired over many years. And that knowledge base, expertise and experience is unmatched at Mississippi Valley.”

Dr. Chin was also on-call when Linda had a bleeding ulcer. Throughout all the many trials Linda faced, she was determined to fight it and show her kids that she would “whip it.”

Recent tests proved promising for Linda, who continues to work and spend time with her family. She now advocates for people not to be hesitant when it comes to early and regular colonoscopies.

“Get something done. Don’t ignore it. Don’t postpone it,” said Dr. Shashinath Chandrahasegowda (Shashi), of Gastrointestinal Clinic of the Quad Cities. “No one should die from colon cancer in the modern world. Our goal is to eliminate colon cancer because it is preventable.”

FAST FACTS of Colon Cancer

  • 1 in 20 will be diagnosed with colon cancer in their lifetime.
  • 60% of all colon cancer deaths could be prevented with regular screenings.
  • Cancerous polyps and colorectal cancer don’t always reveal symptoms, especially not right away. You could be at risk and not know it – that’s why having a screening test is so important.
  • Over 90% of colon cancer appears in men and women ages 50+.
  • 1 in 3 adults ages 50 to 70 are not up to date with recommended colon cancer screenings.
  • There are currently more than 1 million colon cancer survivors in the U.S. thanks to early detection.
  • Screening colonoscopies are considered a preventative benefit with most insurance companies at no out of pocket cost to the patient.

If you’re interested in learning if a colonoscopy would be a good fit for you, contact us or work with your primary care doctor to get a referral.

This column originally appeared in Healthy Cells Magazine.

Thu, April 9, 2020

Spinal Cord Stimulation

Nearly one in five people worldwide suffer from moderate to severe chronic pain. It strikes individuals differently and sometimes builds gradually.

Before you know it, weeks turn to months, and you’re forced miss out on the things that brought you joy – shutting out friends and family, missing time with your kids, struggling with day-to-day activities – all because of chronic pain.

Dr. Maruti Kari, with UnityPoint Pain Center, is getting individuals back to the lives they love at Mississippi Valley Surgery Center (MVSC) located at 3400 Dexter Court, Suite 200 in Davenport, IA.

“A lot of people don’t realize the stigma towards patients with chronic pain,” said Dr. Kari. “Most of these people are just trying to live a normal life, but the world is closing down on them. I’ve seen families falling apart when they walk through our door, but I’ve also seen lives changed with this technique that can decrease pain by more than 50 percent.”

As an expert in the latest advancements in chronic pain management, Dr. Kari often recommends spinal cord stimulation when nonsurgical pain treatment options have failed to provide enough relief.

Spinal cord stimulation: a leading-edge technology option

Everyone experiences some aches and pains, but chronic pain is different than typical pain. Nerve signals in the body are constantly sending messages to the brain – when a nerve is injured, it can continue to send pain signals to your brain even after an injury is healed. This is when chronic pain persists. Spinal cord stimulators can be used to disrupt and mask the pain signals that are traveling to the brain.

Most of Dr. Kari’s spinal cord stimulation procedures are completed at Mississippi Valley Surgery Center. Since opening its doors in 1996 as the first outpatient center in the area, MVSC has set the standard for excellence. With a medical staff focused on individualized patient care, they’re experts in the latest, proven techniques that lead to better outcomes and faster recovery.  

“Spinal cord stimulation can be a truly effective way to curb chronic pain,” Dr. Kari said. “While it doesn’t rid the body of what’s causing the pain, it changes the way the brain perceives it.”

Spinal cord stimulation technology has advanced within the last four years so that it can stimulate more specific areas of the body. For example, instead of stimulating the entire leg, the stimulators can now be pinpointed to stimulate only the foot.

Not only does a spinal cord stimulation rid the body of pain in a relatively short amount of time, but it does so in a way that reduces the need for pain medications.

“With so many opioid deaths and overdoses, medication is not something many physicians want to employ,” Dr. Kari said. “And if a patient who has been taking narcotic pain medication comes into my office, it’s clear that the medication isn’t working. Spinal cord stimulation is a good alternative.”

Phase one: a psychological assessment

When a patient is considered a good candidate for a spinal cord stimulator, they begin a three-phase process with Dr. Kari. If the patient is using insurance to pay for the surgery, their process requires an evaluation by a board-certified psychologist to evaluate the likelihood of successful outcomes.

During the assessment, the psychologist evaluates the medical history, chronic pain struggles and coping skills of the patient. Understanding the full picture of the patient, including mental health, and even the patient’s support system, is an important part of procedure success.

“It is important for us to know the lifestyle of the patient, and the coping mechanisms they’ve used to mitigate pain up until this point,” Dr. Kari said. “If their lifestyle and how they manage the pain is unhealthy, no matter how well the device works, they could continue to have pain.”

Phase two: putting the device to the test

Once a patient is approved by a psychologist, phase two begins. Known as the spinal cord stimulator trial phase, phase two allows patients to test the device without getting it permanently implanted. In fact, the spinal cord stimulator is the only device that patients can try first without getting implanted.

When undergoing the trial procedure at MVSC, the patient receives a local anesthetic to numb the area. Insulated wires, called leads, are carefully placed through a needle and connected to a small stimulator that remains on the outside of the body. Daily phone calls are made to the patient from Dr. Kari and his team to monitor the stimulation over a seven-day period, and the leads are easily removed at the end of the trial.

While some physicians recommend taking time off work during the trial period, Dr. Kari recommends that they remain in their usual routines.  

“This device is supposed to help you in your normal, everyday life,” he said. “If the patient sits in a chair all day, their pain may decrease. To me, that defeats the purpose. I want to make sure the patient can return back to their everyday life.”

Once the seven-day trial period is over, Dr. Kari meets with the patient to discuss how they’re feeling.

“If a patient comes back after the trial period and tells me it was pure magic, that’s when we put the device in permanently. If the patient comes back and tells me, ‘Hmm, I think it helped some, but I’m not sure,’ then we don’t put it in. I don’t want my patients to have a permanent device if they’re not 100 percent convinced that it’s something that’s good for them.”

Phase three: permanent implant, permanent results

For nearly 90 percent of patients who do find success during the trial period, it’s then time to move to phase three – permanent implantation. During this time, the leads are placed underneath the skin through a small incision in the back and the spinal cord stimulator is implanted in the abdominal or buttocks area. The patient can increase and decrease the level of stimulation using a remote or Bluetooth app, reducing their pain by 50 to 70 percent.

While this is considered a minor surgical procedure, it can safely be done in an outpatient setting – like MVSC – allowing many patients to recover at home within hours of surgery and return to light levels of activity within days.

“I encourage everyone to think about their quality of life and consider if pain has made a negative impact,” Dr. Kari said. “If you’re not able to do the things you used to enjoy, that’s when you should definitely consider taking action.”

If you’re interested in learning if spinal cord stimulation would be a good fit for you, contact us or work with your primary care doctor to get a referral to Dr. Kari with UnityPoint Pain Center.

This column originally appeared in Healthy Cells Magazine.

Tue, January 7, 2020

From: Michael J. Patterson, FACHE
President and CEO

Subj: Mississippi Valley Surgery Center Achieves AAAHC Advanced Orthopaedic Certification

We are pleased to announce that Mississippi Valley Surgery Center (MVSC), located in Davenport, Iowa, has recently attained the AAAHC Advanced Orthopaedic Certification. MVSC is the first and only ASC in the state of Iowa to achieve this highly regarded advanced certification. MVSC’s Total Joint and Spine program is a nationally recognized leader in outpatient advanced orthopaedic surgeries.

MVSC has performed over 4000 Total Joint and Spine Procedures. The team at MVSC has been instrumental in assisting other programs across the country to develop and implement their own Total Joint and Spine programs. Dr John Hoffman, Medical Director of the Total Joint Program, and Dr Michael Dolphin, Medical Director of the Spine program at MVSC have been instrumental in developing clinical pathways and protocols to ensure optimal patient outcomes.

Dr Tuvi Mendel, Board Chairman states “MVSC and our physician partners implemented advanced techniques in outpatient orthopaedic care over a decade ago and we are very proud of the outcomes we have achieved and the cost savings to the healthcare system we have recognized during that time. Now with our ability to provide total joint replacement to the Medicare community, we expect to see continued development of patient focused care and additional savings for our patients.”

Michael Patterson, MVSC President and CEO states “This Advanced certification from AAAHC is a validation, from a nationally recognized accrediting body, that the entire Team at MVSC is meeting its mission of Excellence in Care and Service. I am so proud of the clinical and support teams that play a vital role in caring for our patients and their families. We are fortunate to have the talent and experience on our team that allows us to care for these advanced orthopaedic patients.”

MVSC is located in Davenport, Iowa and has 7 OR’s and 14 overnight recovery care suites. MVSC was first developed in 1996, completed a significant modernization and expansion in 2019 and serves patients from all over the Midwest.

Mon, July 24, 2017

There was a time when virtually all surgical procedures were performed in hospitals. It was not uncommon to wait weeks for an appointment, and patients often spent several days in recovery.

Thanks to medical advancements, today’s procedures, ranging from tonsillectomies and ear tubes to hip and knee replacements, are taking place in ambulatory surgery centers (ASCs), such as the Mississippi Valley Surgery Center at 3400 Dexter Court in Davenport.

ASCs provide same-day surgical procedures and have positively transformed the surgical experience for patients. That's because most people feel physically and emotionally more comfortable in an outpatient environment.

Why choose a surgery center?
Surgery centers provide a high-quality, cost-effective alternative to hospitals.

Since its inception in 1996, Mississippi Valley Surgery Center has been dedicated to providing a convenient and patient-centered facility for outpatient surgical services. The team at the Surgery Center performs approximately 9,000 procedures each year and employs close to 100 clinical and non-clinical personnel.

According to Michael Patterson, President and CEO of Mississippi Valley Surgery Center, the facility’s healthcare experts are focused on personalized care so that you can recover faster in the comfort of your home.

“We specialize in minimally invasive surgical techniques that allow our patients to recover faster,” said Patterson. “Our entire staff is focused on creating the best outpatient experience.”

The surgery center is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC), demonstrating its commitment to high-quality health care and high standards. The surgery center is also Medicare certified.
According to Patterson, the surgery center goes above and beyond for its patients.

“As the Quad-Cities largest multi-specialty outpatient surgery center, we have experts in the most up-to-date and proven techniques that lead to better outcomes and faster recovery times,” he said. “Patients from around the Quad Cities and beyond choose our surgery center for outpatient procedures because we offer a comfortable, relaxed atmosphere.”

Sylvia, a patient who has had a total of three procedures at the surgery center, echoed this sentiment in a comment card she recently submitted to the surgery center.

“All of the doctors, nurses and staff, from the check-in to check-out, were so caring to me,” she said. “This is a top-notch center and we are so blessed to have them in Davenport.”

What to consider when deciding where to have surgery
If you are planning a surgery and feel that recovering at home may be right for you, here is more information you should know about the benefits of an ambulatory surgery center:

  • Scheduling: Because a surgery center does not manage an emergency room environment and all procedures are planned, it is less likely that a procedure will be delayed or rescheduled.
  • Comfort: With a team that cares and specializes both in the emotional and physical comfort of patients, surgery centers experience a very high patient satisfaction rate. In December 2016, patient feedback at the Mississippi Valley Surgery Center indicated that 95 percent of all patients would recommend the facility to family and friends.
  • Infection rate: Accredited surgery centers like the Mississippi Valley Surgery Center meet or exceed an extensive set of infection prevention standards. That means surgery centers have an excellent track record of providing safe patient care, and as a result, surgery centers experience a very low infection rate.

Talk to your doctor
Quad-City physicians from a variety of practices choose to perform their outpatient procedures at the surgery center.

If you’re considering surgery, talk to your doctor about your choices. Do your own research, and be prepared with a list of questions. Ultimately, knowing your options will lead you to an experience you’ll feel good about.

To learn more about the Mississippi Valley Surgery Center, go to and visit Facebook at

Mon, June 6, - 9:09am 2016

By Harris Meyer  | June 4, 2016 | Modern Healthcare

Before Stacey Cook received the first of two hip replacements last year at an outpatient surgery center in Davenport, Iowa, his surgeon, Dr. John Hoffman, told him he would be standing and walking within a few hours and would go home the next morning.

Cook, a safety facilitator at Monsanto Co. in his mid-40s, didn't believe it. “I said, 'Yeah, right,'” he recalled. “But I was surprised that was exactly what happened. Six hours later I was walking.”

After each surgery, he went home the next morning, receiving assistance from family and friends for the first week. A year later, he's walking the golf course and even shooting basketball.

Cook's experience with Hoffman and the Mississippi Valley Surgery Center differed sharply from that of most U.S. patients who receive total hip or knee replacements, known as arthroplasties. They typically are operated on in an inpatient surgical unit, spend several days in a hospital bed, then move to a skilled-nursing or rehabilitation facility or receive home healthcare.

But that's starting to change, and tensions are rising between hospitals and orthopedic surgeons as a result. Building on advances in surgical technique, anesthesia and pain control, a small but growing number of surgeons around the country are moving more of their total joint replacement procedures out of the hospital, performing these lucrative operations in outpatient facilities. Some are sending their patients home within a few hours, while others have their patients recover overnight in the surgery center or hospital during 23-hour stays. These surgeons say very few of their patients require skilled nursing, rehab or home healthcare.

The Ambulatory Surgery Center Association says close to 40 centers around the country are performing outpatient joint replacements, and outpatient surgery companies such as Surgical Care Affiliates are aiming to increase them.

Moving these procedures to outpatient settings poses a major threat to hospital finances, since total joint replacements are one of the largest and most profitable service lines at many hospitals. In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement, costing the government more than $7 billion for the hospitalizations alone—over $50,000 per case. The financial threat will be even greater if the CMS changes its rules and allows Medicare and Medicaid payment for these outpatient procedures, which observers expect will happen in the next few years.

The migration of total joint replacements to outpatient settings also raises questions about the future of Medicare's mandatory bundled-payment initiative for inpatient procedures in 67 markets around the country, called the Comprehensive Care for Joint Replacement program, which began in April. If the CMS decides to pay for ambulatory procedures, that could undercut the hospital bundling initiative.

MH Takeaways The migration of lucrative joint-replacement surgeries to outpatient settings will cause friction between surgeons and hospitals and raises questions about the premise of Medicare's new bundled-payment initiative for hospital-based procedures.

Critics ask, so what? “Why would we not encourage the migration to outpatient if the outcome is the same and the cost is lower?” said Jeff Goldsmith, a national adviser to Navigant Healthcare. Goldsmith, a Medicare beneficiary, recently underwent a hip replacement and recovered so quickly he thinks it could have been done on an outpatient basis. “Why preserve the (inpatient bundling) program if the whole point is to save money for Medicare?” he said.

Until recently, outpatient total joint replacements were rare. Most providers and patients thought a several-day hospital stay was needed because of the pain, mobility and infection risks associated with these major surgeries. Now, when patients' health plans allow it, leading surgeons in this field say they are doing many or most of their joint replacements on an outpatient basis—except for patients who are extremely obese or have unstable chronic conditions. They say even healthy patients in their 70s or 80s can be candidates for outpatient surgery, but careful patient selection is essential.

Many more surgeons are eager to learn these improved clinical processes and start doing joint replacements outside the hospital. “Dr. Hoffman has surgeons and administrators from all over the country come tour and watch our processes two or three times a month,” said Michael Patterson, CEO of the Mississippi Valley Surgery Center, who recommends slow, careful adoption of outpatient procedures. “We advise surgeons that first they need to be able to get patients in and out of the hospital within 24 hours. They can't go straight from three- to five-day stays to 23 hours.”

The emerging outpatient delivery model is driven by both patients' and payers' desire to reduce their costs, increase convenience and satisfaction and diminish the risk of hospital-acquired infections. Orthopedic surgeons say doing joint replacements on an outpatient basis cuts costs nearly in half, although reimbursement is also lower. “People want quality at a reduced cost,” said Dr. Patrick Toy, who has done nearly 250 hip and knee replacements at the outpatient Campbell Clinic in Memphis, Tenn., which he partially owns. “This hits the nail on the head.”

Despite the looming financial threat, many hospitals have not settled on a strategy to address the outpatient migration, particularly where local surgeons have not yet adopted this new practice pattern. In some markets, hospitals and surgeons are starting to collaborate, while in others there may be conflict over who will capture the big dollars from joint replacements, which are surging as the baby boomers move into their creakier years.

“This is coming whether we like it or not, and we have to figure out how to better partner with physician practices to deliver the best care for patients and hopefully protect patient volume for the hospital,” said Kyle Armstrong, CEO of Baptist Memorial Hospital-Collierville, a suburb of Memphis served by Toy's free-standing surgery center. “I can imagine there will be some areas where it is contentious.” His system has considered buying or partnering in a Memphis outpatient surgery center.

In 2014, 23% of 354 hospitals surveyed by the Advisory Board Co. performed at least some outpatient knee replacements, while 7% performed at least some outpatient hip replacements. Experts say those numbers likely have increased in the past two years as more surgeons and their teams gain confidence with new and improved clinical protocols, making it possible to release patients more quickly.

“More hospitals are starting to move joint replacement into outpatient settings to compete with (free-standing) ambulatory surgery centers,” said Shruti Tiwari, a senior consultant at the Advisory Board. “Patients are warming up to the idea, particularly younger and healthier patients who don't have time for a three-day hospital stay and a protracted recovery process.”

“The smart, strategic hospital management teams understand they need to get ahead of this, so that when volume shifts out of their buildings they won't lose patients,” said Brian Tanquilut, a senior healthcare analyst at Jefferies & Co. “That's why the investor-owned hospital companies are making a big push on surgery centers.”

Even at hospitals that are already collaborating with their surgeons on outpatient joint replacements, executives caution that there are problems making outpatient joint replacements financially viable.

“The current ambulatory reimbursement system isn't really sufficient to cover the overall cost of care,” said Michael Dandorph, chief operating officer at Rush University Medical Center in Chicago. He projects that up to 25% of joint replacements may be done on an outpatient basis within five years if Medicare starts paying for them. “On a single-case basis, we're taking a revenue hit. But if it produces better outcomes and lowers the cost, that should attract more patients,” he said.

Orthopedic surgeons say that while they would like to collaborate with hospitals on outpatient joint replacements, institutional inertia makes it hard to implement innovative practices that better serve patients.

Dr. Richard Berger performs nearly 800 outpatient total joint replacement procedures a year, split between Rush University Medical Center's ambulatory surgery unit and the Munster (Ind.) Specialty Surgery Center, a free-standing facility he partially owns. “Even at Rush, which is a great hospital, it's hard to make changes and try new things,” he said. “At the surgery center, I make one phone call and anything I want to do, I can do.”

“You can control costs so much better in the ambulatory surgery center setting,” said Dr. Alexandra Page, who chairs the American Academy of Orthopaedic Surgeons' Health Care Systems Committee and whose practice partner has started doing joint replacements in a free-standing outpatient center in San Diego. “That works for everyone but the hospital.”

Some hospitals, such as Rush and CentraCare Health's St. Cloud (Minn.) Hospital, are responding by working with surgeons to do same-day or

23-hour joint replacement procedures either in hospital-run surgical units or outpatient centers, depending on each patient's needs. Dr. Joseph Nessler and his colleagues at St. Cloud Orthopedics, a 21-physician independent practice group, are doing more than 300 total joint replacements a year on an outpatient basis, divided between the physician-owned St. Cloud Surgical Center and the hospital. The chosen surgical setting is based on each patient's medical condition and whether an overnight stay is needed.

St. Cloud Hospital staff have honed their clinical processes to reduce the percentage of patients who need blood transfusions from 25% to zero, get patients up and moving within hours after surgery, and ensure they see a physical therapist that same day, said Naomi Schneider, the hospital's orthopedics director. They have also launched an intensive pre-surgical education program for patients, using videos and online resources, so they are ready for the rapid return home.

Even though about 25% of the total joint replacements Nessler and his colleagues performed last year were at their free-standing surgery center, the hospital still saw nearly a 10% jump in volume for joint replacements, Schneider said. That's because the combined program is drawing patients from all over the region who want a high-quality, in-and-out experience. Currently, there are no other providers in the area offering a well-established outpatient joint replacement program.

Rush also anticipates benefits from working with a renowned outpatient surgery provider like Berger. “If 15% of cases move to the ambulatory setting but we're able to attract more patients overall, that's good for us and it's good for the industry because we're producing better outcomes and lowering the cost of care,” said Dandorph, whose hospital performed 3,200 total joint replacements last year. “We're trying to figure out how to do that in partnership rather than being competitive.”

Other hospital systems, such as UnityPoint Health in Iowa and Illinois, are buying an ownership interest in outpatient surgery centers where orthopedists are performing same-day joint replacement procedures. Last year, UnityPoint acquired an interest in the Mississippi Valley Surgery Center; Hoffman and his colleagues performed more than 200 total joint replacements there in 2015.

The other new partner in Hoffman's surgery center is Surgical Care Affiliates, a publicly traded operator of ambulatory surgery clinics across the country. The company, which just announced an investment in a clinical platform to expand its network of surgeons performing outpatient joint replacements, says it now has 18 centers doing these procedures.

“There will always be a large population that will need the hospital,” said Amanda Olderog, director of strategic business development at UnityPoint Health-Trinity Hospital in Rock Island, Ill., whose system does about 1,000 total joint replacements a year. “But for patients who are healthier and often younger that can be done outpatient, our goal is to work with our surgeons to serve patients in the best way we can, in the best location.”

A major factor delaying the migration of joint replacements out of the hospital setting, however, is that the CMS has limited Medicare and Medicaid payments to inpatient procedures only. It withdrew its 2012 proposed rule to allow payment for outpatient total knee replacements in the face of negative industry comments.

The American Hospital Association opposed the rule change, arguing that outpatient joint replacements hadn't been proven safe. An AHA spokeswoman says the association has not reconsidered its position. Nevertheless, many experts say the outpatient procedures are now considered safe if done by well-prepared surgical teams on properly selected patients.

Some orthopedic surgeons and the Ambulatory Surgery Center Association have lobbied the CMS to change its payment rule, which would greatly increase the number of potential patients for outpatient joint replacements since the majority of people who need hip and knee implants are age 65 or older. A CMS spokesman would not say whether the agency is considering lobbyists' request.

Private payers also are sometimes balky about paying for outpatient joint replacements, surgeons and administrators say. Some orthopedic groups, such as the Orthopedic & Sports Institute of the Fox Valley in Appleton, Wis., and Monterey (Calif.) Peninsula Surgery Center, have signed bundled-payment contracts with insurers for outpatient joint replacements, according to the Ambulatory Surgery Center Association. Blue Shield of California is one insurer paying for these outpatient procedures under a bundled-fee arrangement.

But experts expect payers to embrace the trend as more patients opt for having these procedures done in the cheaper outpatient setting, reducing their out-of-pocket costs under high-deductible health plans.

“Think about the value equation,” Toy said. “We are doing the same thing we can do in the hospital, but arguably better.”

Thu, March 12, 2015


Wyatt Brashears will be three in July. He loves Mickey Mouse, dancing and hugging his sister Mayci the moment she comes home from school. 

“He’s a busy little guy, “said his mother, Elizabeth Brashears. “If there’s a mess, he’s in it. He’s rambunctious and fun. He’s growing so fast. I guess he’s your typical boy!” 

Another reason Wyatt is “typical” is because he’s struggled from the time he was born with fluid in the ear. According to the American Academy of Pediatrics, there are nearly 2.2 million cases of fluid in the ear in the U.S. each year.  The good news is Wyatt’s ear troubles disappeared once he had ear tubes inserted in an outpatient setting at the Mississippi Valley Surgery Center.


Fluid in the ear, also called serous otitis media (SOM) or otitis media with effusion (OME), happens when the auditory tube (Eustachian tube) is impaired. The auditory tube is connected to the back of the back of the throat and equalizes pressure behind the eardrum.  If the tube becomes clogged, fluid will become trapped in the middle ear space.

Anyone can get fluid in their ears, but it is much more likely to occur in young children. According to the American Academy of Pediatrics, the vast majority of children diagnosed with fluid in the ear are under five years old.


Fluid in the ears may or may not cause noticeable symptoms. Symptoms can include ear pain, hearing loss, and delayed development in speech and language.

Elizabeth and her husband, Brett, noticed Wyatt touching his ears a lot. Since their daughter Mayci had struggled with ear infections just a few years before, they immediately visited their pediatrician to report the concern.

“Wyatt would just mess with his ears a lot. He’d put his fingers in them and poke at them,” said Elizabeth. “We picked up on the issue right away because we had been through chronic ear infections with Mayci just a few years earlier,” said Elizabeth.

To help both Mayci and Wyatt, the pediatrician referred the Brashear family to Dr. Douglas Dvorak, an ear, nose and throat (ENT) surgeon with Davenport-based ENT Professional Services, located in the Mississippi Valley Surgery Center complex. 

“While Mayci had chronic ear infections that required ear tubes, Dr. Dvorak told us that Wyatt had fluid in his ears. The fluid impacted his hearing, almost like he was listening from underwater – sounds were muffled and distorted. The good news was he hadn’t suffered any real or permanent hearing loss. Much like he had with Mayci, Dr. Dvorak recommended ear tubes as an effective solution,” said Elizabeth. “He took his time talking with us and describing everything both times we consulted him on ear tubes. He put us at ease.”


Ear tubes are tiny – they are smaller than the head of a match – but they do a big job. Placing tubes in the ears drains the fluid and ventilates the middle ear. Tubes may keep ear infections from recurring while the tubes are in place, which is why they are often used to help children who have repetitive ear infections. Because they also keep fluid from building up behind the eardrum, they are also used to help alleviate fluid in the ear.

Dr. Dvorak reassures families by letting them know that most ear tube procedures can be done at an outpatient facility, such as the Mississippi Valley Surgery Center.

“We find most people feel more relaxed in an outpatient setting,” said Dr. Dvorak. “Our small patients get a coloring book, crayons and a stuffed animal to keep them busy and happy. The staff we work with is very caring and focused on making the whole family feel at ease.”


Elizabeth and her husband were amazed by how quickly both Mayci and Wyatt recovered.

“Both of the kids were home within hours of the procedure, tearing around the house,” said Elizabeth. “It was back to playing, laughing and talking almost immediately. The best part was how well the tubes worked for both of them. We’re no longer battling ear infections and fluid in the ear at our house.”

Dr. Dvorak is located at 3385 Dexter Court in Davenport, Iowa. For more information about Dr. Dvorak and the other physicians at ENT Professional Services, visit or call 563-359-1646.

For more information about the Mississippi Valley Surgery Center, visit

Wed, December 3, - 1:01pm 2014

For Kurtis Manderscheid from Maquoketa, Iowa, motocross is more than a recreational activity — it’s a passion. So when a broken wrist resulted in painful pressure in his forearm that made it unbearable to ride, he knew he had to take action.  Click here to read more about Kurtis' experience.

Wed, December 3, - 1:01pm 2014

Imagine finding out tomorrow that you or a loved one needs surgery.  If you had an opportunity to design the perfect surgery experience, what would that look like for you? An experienced team of doctors and nurses? A comfortable environment where your safety and wellbeing are the priority? The choice to heal and recover in the comfort of your own home?  At the Mississippi Valley Surgery Center & Endoscopy Center, we’ve designed the patient care experience around you. From the nurses preparing you for surgery to the doctors and postoperative team — each and every person at the Mississippi Valley Surgery Center & Endoscopy Center is focused on providing you with a surgery experience you’ll feel good about.  Click here to read more.

Fri, December 27, 2013

Just the idea of surgery can be scary and intimidating, and there are always lots of questions. What are the risks? How long will the surgery last? How quickly will I recover?  If you or a loved one is considering surgery, use the tips developed by the talented and experienced staff at the Mississippi Valley Surgery Center to ease your concerns. Click here to learn more.

Fri, December 27, 2013

Forty-three-year-old AJ Perisho, a self-described “exercise
nut” and certified strength coach, was suffering from debilitating
pain in his left knee caused by the wear and tear of
his active lifestyle.
AJ sought medical advice to determine what could be done for his
knee. He had a knee scope done to repair minor damage in 2008, but
in 2012 the pain became a daily problem that led him to seek a better
solution. The first doctor he saw recommended he simply mask the
pain with ibuprofen for a few more years and then have a total knee
replacement when he was older. Read AJ's Story.


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