Western Bariatric Institute, Reno, Nevada

TELL US ABOUT THE ROLES AND RESPONSIBILITIES OF THE LEAD STAFF AT YOUR FACILITY.

Western Bariatric Institute is an established, highly experienced, multidisciplinary, surgical weight loss center located in Reno, Nevada. With a long track record of professional care, compassionate service, and outstanding outcomes, we are dedicated to providing our patients with the highest level of care available. Our practice houses four board-certified surgeons, three advanced practice nurses, a registered nurse, two medical assistants, a dietitian, and a whole line of support staff to care for our bariatric patients through every step of the process towards weight loss surgery. In total, we currently have 24 employees who specialize in providing outstanding patient care and service.

John Ganser, MD, Mark Kozar, MD, Kent Sasse, MD, and Robert Watson, MD, are our four surgeons who perform the surgical procedures and supervise the care of all patients. Western Bariatric Institute was established in 2000 as a division of Western Surgical Group, the largest surgery group in Northern Nevada. Since its inception, more than 1,600 bariatric procedures have been performed by our surgeons.
The Medical Director for Western Bariatric Institute is Dr. Kent Sasse. Dr. Sasse received both his medical degree and completed a residency in general surgery from the University of California, San Francisco, and completed a fellowship with the Lahey Clinic in colon and rectal surgery. He is fluent in English and Spanish; is a Major in the US Air Force Reserves; a board certified surgeon; fellow of the American College of Surgeons; and member of SAGES, ASBS, Society for Surgery of the Alimentary Tract, and the American Society of Colon and Rectal Surgeons. He is also a clinical instructor at the University of Nevada School of Medicine and clinical instructor for the Uniformed Health Services, MGMC. Since 2003, Dr. Sasse has performed over 550 bariatric surgical procedures.

WHAT IS THE SIZE OF YOUR FACILITY? WHAT DOES IT PHYSICALLY ENCOMPASS?

Western Bariatric Institute moved into a new practice suite in March, 2006, after constructing an office built specifically focused on the needs of bariatric patients. Our clinic houses five exam rooms, a private classroom for teaching preoperative and postoperative classes, a private office for our dietitian, and numerous other offices for our support staff. We are located directly across the street from one of the three hospitals in the Reno area, allowing for easy access to facilities for many of our patients. In addition, our office suite is housed in a building with a state-of-the-art fitness center located on the first floor.

Our facility also provides a comfortable patient and reception area with seating that is appropriate for bariatric patients and exam rooms that were specifically designed to make our patients as comfortable as possible. Although only in our office space since the spring of 2006, we are already in the process of expanding our clinic with a new training room, more exam rooms, and further office space being built out for a tentative completion date of mid-2007.

What is the number of patients treated on an annual basis at your facility? What are the patient demographics?

In 2006, over 530 primary weight loss surgical procedures (gastric banding, Roux-en-Y gastric bypass, and revisions) were performed at Western Bariatric Institute. For the three years prior, following are the numbers: 2005 – 468 patients; 2004 – 249 patients; 2003 – 286 patients. The average age of our patient population is 46.26 years, with our youngest patient ever being 15 and our oldest being 77. Eighty-two percent of our patients are female and 18 percent are male, although we seem to be seeing more men lately. Eighty-seven percent of our patient population has been Caucasian, five percent Hispanic, and two percent African American.

Was it difficult attaining the SRC Center of Excellence designation?

Attaining the SRC Center of Excellence designation was not an easy process, but we believe it to be valuable for our community to ensure that patients are receiving the highest level of care available. The process of pulling together information to substantiate that each of the guidelines are being met is probably the most time-consuming piece, but definitely acts as a means for verifying that the systems put in place are working. We continually review the SRC guidelines to monitor that our program is staying on track and also use them as a tool for improving processes for our practice. Three of our four surgeons have been appointed with the Center of Excellence accreditation, and our newest surgeon is completing the application now.

Does your center have one particular area of expertise?

Our center focuses on two types of minimally invasive weight loss surgery, the Roux-en-Y gastric bypass and gastric banding. Our multidisciplinary approach is built around providing as many tools as we can for our patients under one roof. We provide preoperative classes for all patients on what to expect before, during, and after surgery and provide nutritional counseling prior to surgery. We have strong partnerships with many local practitioners for conducting psychological evaluations as well, with one practitioner even being housed in our building. Our registered dietitian is available to patients for preoperative assessments and nutritional guidance before or after surgery, and also teaches various classes on healthy eating that are open to anyone in our community. The trek to long-term success for bariatric patients requires being focused not only on the surgical aspect, but also on the extended follow-up with the patient, and our program is dedicated to providing tools to make our patients as successful as possible.

Our surgeons are also experienced in achieving excellent outcomes with complex revision procedures.

GIVE A GENERAL SYNOPSIS OF HOW YOUR PATIENTS ARE TREATED WHILE UNDER THE CARE OF YOUR CENTER.

As any provider of care for obese patients can tell you, the first priority is to make the patient feel as comfortable as possible. The first step toward weight loss surgery with our program is to attend one of our free informational seminars to learn more about the procedures that we perform. These seminars are presented by one of our four surgeons and are held two or three times per month. Starting with this presentation and for every step moving forward, we make every attempt to make our patients feel knowledgeable about the surgical procedure that they are undergoing and that they are receiving the personalized attentive care that they expect.

We strive to make every patient feel important and comfortable, and customer service is a number one priority in our practice. We have implemented patient surveys that are completed by every patient at their first postoperative visit to gauge our success for providing high levels of patient care. In addition, our lobby has patient feedback forms and a drop box so that patients can share their feedback anytime with our staff. We take their feedback into quarterly training programs required for all staff.

By having these programs in place, we hope that our patients realize how much we value them entrusting us with their care. For weight loss surgery, our past patients are our best spokespeople and models for the outside world. Their experience with our practice will be what they share with their family and friends, and it is our hope that those experiences have been positive ones.

WHAT ARE SOME OF THE NEW EQUIPMENT, DEVICES, AND PRODUCTS INTRODUCED AT YOUR FACILITY LATELY?

Western Bariatric Institute has instituted a “paperless” office, with the utilization of electronic medical records (EMR). This program allows information about our patients to be entered directly into our database with the patient right in front of us, which helps with more accurate and timely data entry.
We also use the EMMI patient education program, which provides our patients with an interactive program specifically designed for the weight loss surgery procedure that they have chosen. The EMMI program was designed as a presentation tool for patients and their family members to gain a complete understanding of the surgical treatment that they are to undergo and offers education and guidance on what to expect before, during, and after surgery.

WHO HANDLES THE PROCEDURE SCHEDULING? DO YOU USE A PARTICULAR SOFTWARE PACKAGE?

We have a dedicated employee to handle all of our surgical scheduling who has built strong relationships with all of the schedulers at the local hospitals and surgery outpatient centers. The program that we utilize within our office for scheduling is the Greenway/PrimeSuite system, which is utilized as an electronic medical record program and scheduling program. Our scheduler has worked with our surgeons for many years and knows the approximate time it takes each surgeon to complete each surgery; she therefore schedules procedures accordingly to try to keep the surgeons as on time as possible.

HOW IS INVENTORY MANAGED IN YOUR FACILITY? WHO HANDLES THE PURCHASING OF EQUIPMENT?

Currently, we do not carry any products in our office that need to be inventoried. We work with an online company where our patients can order supplies and have them shipped directly to their homes. We are in the process of expanding our clinic, however, and part of that expansion might include a small retail area for our patients to purchase products that are helpful preoperatively and postoperatively. We are still working through the logistics of adding this service to our clinic, but feel that it would be beneficial for our patients.

Regarding the purchasing of equipment and supplies, all ordering is handled through two employees out of our parent company, Western Surgical Group. If new equipment or supplies are needed, a request is submitted to one of the designated employees stating what is needed and why, and then the requested items are ordered (if approved). By utilizing this method, it ensures that duplicate orders are not made and that the products requested are truly needed to effectively and efficiently run our practice.

HAS YOUR FACILITY RECENTLY EXPANDED IN SIZE AND PATIENT VOLUME?

Western Bariatric Institute is currently in the process of expanding our clinic location to better accommodate the growing demand for our services. We are building a larger training/conference room that will help with our preoperative and nutritional classes, and are adding on exam rooms and office space. We have recently added another patient advocate to our team to continue to provide a personal guide through the process, and expect in the coming months to add an insurance authorization/scheduling specialist and medical assistant to the mix.

We are also beginning a partnership with a medical weight loss center called the International Metabolic Institute, which focuses on the patient’s metabolism for preoperative weight loss, long-term weight loss maintenance, and a non-surgical approach to weight loss.

HOW HAS MANAGED CARE AFFECTED YOUR FACILITY AND THE CARE THAT IT PROVIDES TO PATIENTS?

We believe that managed care has affected everyone in the healthcare industry and feel that the best way to handle it is to just work through the requirements to the best of our abilities. Managed care determines the facilities that we utilize for our surgical procedures, and in our area, our surgeons currently do operations at five local institutions. All of the facilities that we use meet our high levels of standards for patient safety and care. Managed care requires us to do ongoing trainings with all five local facilities to ensure that their staff is up to date and trained to handle bariatric patients. Since insurance determines the surgical locations for us, it is imperative that all of the locations understand our expectations for how our patients are to be treated, both physically and emotionally.

What measures has your facility implemented in order to cut or contain costs and improve efficiency?

To help contain costs for our patients, we have been able to work with many of the local surgical centers to offer our cash pay gastric banding patients a significantly reduced price for the procedure. By partnering with these locations, the out of pocket expense for our patients has been significantly reduced, and allows us to assist many additional patients with their long-term weight loss goals. In addition, the local institutions that we partner with have worked to create bariatric teams to handle our patients with the highest level of care and respect available. By having teams who are accustomed to working with bariatric patients, the efficiency and level of care provided to patients has dramatically improved.

One of our hospital partners has even created a shadowing program for new clinical team members that improves patient satisfaction and safety, along with efficiency. Through this program, a team member is assigned to a bariatric patient prior to surgery and stays with the patient throughout the entire process. The clinical person is there holding the patient’s hand when he or she goes in to surgery, is present during the surgical procedure itself, is the first person to be seen by the patient when he or she wakes up, and then follows the patient to the recovery area postoperatively. In addition to being an obvious patient satisfaction and quality improvement measure, this program engulfs the clinical team into the life of the patient and allows them to experience what the patient experiences firsthand; it also allows the team to see the entire process and allows a unique approach to improving the efficiency of the program through a bird’s eye view of the entire process.

DOES YOUR FACILITY HAVE AN OUTPATIENT PROGRAM?

Gastric banding is considered an outpatient procedure for most of our patients. Along with our local surgical centers, we are able to work with their staff to assist the patient to undergo surgery and go home the same day, assuming that everything has gone smoothly. Our physicians, advanced practice nurses (APNs), and staff also see many patients on an outpatient basis as they progress before and after surgery. We also look forward to working with a new metabolic medical weight loss center in Reno called the International Metabolic Institute (iMetabolic) for assistance with our patients’ non-surgical care and health.

HOW DOES YOUR FACILITY DEAL WITH THE ISSUE OF PATIENT SAFETY AND STAFF SAFETY?

When our office suite was designed, the comfort and safety needs of our bariatric patient population were taken into account to ensure that our facility would meet the needs of not only our staff, but our patients. From our waiting room seating to our exam room tables, the equipment in our office is suitable for our patients.

For our surgical partners, all facilities do have protocol and safety measures in place to ensure that patients are moved safely and efficiently when and if needed. All of the facilities are equipped with the appropriate equipment for bariatric patients, including bariatric gurneys, wheelchairs, hospital beds, and lift bars. Employees of the local surgical centers and hospitals are all required to undergo annual safety training, which includes lift and transfer protocols.

HOW ARE EMPLOYEES ORIENTED AND TRAINED AT YOUR FACILITY?

Employees go through an intensive two-week training program with their immediate supervisor upon hire and have access to additional training with other team members as deemed necessary. All new employees also receive an employee handbook upon starting, along with written protocols for office procedures. Employees are always encouraged to ask questions as they arise; we have an open door policy for employees to discuss questions or concerns with supervisors at any time.

WHAT ARE YOUR STRATEGIES FOR RETAINING AND MOTIVATING STAFF?

As anyone trying to run a busy physician practice can tell you, employee retention and motivation are keys to the success of the practice. The cost of recruiting and training a new employee is tremendous, so keeping the talent that you already have in place is vital. Western Bariatric Institute offers employees an attractive benefits package, including medical, dental, and vision coverage, and all employees receive 10 paid holiday days per year, in addition to 10 paid days off per year. In addition, a holiday party is held every year for employees and their spouses, and the evening includes dinner, dancing, and door prizes, including one additional week of vacation time per year.

Employees are also encouraged to further their career within the organization via continuing education courses and job transfer opportunities. Once an employee has been with our organization for more than three months, the employee is eligible to apply for another internal position. Job openings are always posted to internal team members prior to looking outside of the organization to fill the position. Concerning continuing education, employees are encouraged to discuss with their supervisor any educational seminars that they are interested in attending and review how it would be beneficial to the employee and the organization. Western Bariatric Institute believes in fostering the professional needs of our employees to assist with overall retention and satisfaction with the job.

Another unique strategy for our organization is our dedication to the personal care of our patients. We want our staff to get to know our patients and build personal relationships with them, which helps patients to have a strong feeling about our organization, but is also good for employees as it enhances their day-to-day job functions.

HOW IS STAFF COMPETENCY EVALUATED?

All employees in our organization have performance evaluations annually to determine if they are meeting the objectives of their positions. This review is conducted by the employee’s supervisor after receiving feedback from other office staff and the surgeons. Annual reviews are an opportunity to discuss with employees their strengths and areas of growth potential, and also provide them with an opportunity to provide feedback back to management.

PLEASE DESCRIBE YOUR PATIENT EDUCATION PROGRAM.

We believe that we provide our patients with extensive tools and guides for success both preoperatively and postoperatively. The patient education program begins for many of our patients prior to even meeting staff or attending one of our seminars. We have created a user-friendly and information-laden website to help our potential patients through the process toward weight loss surgery. Prior to seeing a patient interested in bariatric surgery, we require that they attend one of our free seminars that are held at least twice per month. We typically see anywhere from 70 to 75 patients at each of these seminars and use this forum to educate them about the two surgical procedures that we perform. During our seminar, we discuss with attendees the pros and cons of each surgery and provide time for patient questions and answers. From there, our patient advocates personally call every attendee within three days of the seminar to see if they are interested in setting up a personal consultation or if they are not interested at this time.

The next educational tool we provide to patients comes in the form of preoperative surgical classes held about 1 to 2 weeks prior to the patient’s surgery date. These classes are taught by one of our APNs and our nutritionist, and provide last minute guidance for patients as they prepare for surgery. During this class, patients are advised on such things as what to take to the hospital, what to expect during preoperative preparation, what to expect when they wake up, and how to handle the first few weeks after surgery. This class is also an opportunity to remind patients one last time prior to surgery that weight loss surgery is a tool, and is not an end-all fix for obesity. It is stressed throughout the class that the patients themselves hold the key to success according to how compliant they are with the guidelines provided for after surgery. Our nutritionist also is an integral piece of this training, and she discusses with patients how to handle food after weight loss surgery. For many, there is fear about what they can or cannot eat after surgery, and our nutritionist provides insight on what to expect and how to establish positive eating habits. These classes are also a great opportunity for our patients to receive some personal guidance from our team prior to surgery. As the surgery date nears, many questions and concerns arise and, by offering these classes for our patients and their support persons, we believe that we are providing the extra level of care and service that our patients expect from our program.

Beyond these classes, Western Bariatric Institute also offers monthly classes on the nutritional and dietary needs of the bariatric patient. For many patients, they feel extremely successful immediately after surgery when the weight often “drops” off. Once they hit a plateau though, or are not being aware of what they are eating, they can feel frustrated or defeated. Because of that, our dietitian teaches classes on how to eat. We also brought bariatric chef Dave Fouts to our center for two cooking demonstrations in September, 2006, to provide extra support to our patients. This visit was a great way to show our patients that we are committed to not only their surgical success, but their long-term success as well.

WHAT TYPE OF PATIENT SUPPORT PROGRAMS ARE OFFERED AT YOUR FACILITY?

In the Reno/Sparks area (the metropolitan area surrounding our practice), we have four monthly support groups—some falling on weeknights and some on weekends to accommodate all of our patients’ schedules. We provide quarterly trainings for our support group leader facilitators and are ready and able to assist them should any questions or concerns arise. We try to have a guest speaker present at all support group meetings to help promote conversation, but also sometimes allow for basic patient question and answer time. There are many outlying areas that feed into our clinic and because of that, we also have six other support groups that are held in some of the smaller communities to allow for our patients not in our direct area to have a support network as well. The facilitators of these groups are also required to attend our quarterly trainings, and we are available for those groups as well for any questions or concerns.

One of the biggest and most rewarding patient support programs that we offer for our patients and the community is our annual fashion show. April 21st, 2007 was the date for our 5th annual “Miracles Happen” fashion show and we had approximately 850 people in attendance. The fashion show is an amazing opportunity for our patients to showcase their success to not only their families and friends, but to the community and others who may be considering weight loss surgery. In 2007, we had approximately 30 models in the show and local boutiques donated clothes for our models to wear. This growing event truly leaves a lasting and heartwarming impression on all of our guests as they learn more about how weight loss surgery has changed the lives of many of our patients.

We also send quarterly to semi-annual newsletters to our preoperative and postoperative patients to keep them up to date on what is going on within our clinic and provide ongoing support. These newsletters are an opportunity to learn about new staff members in our clinic, and one of our surgeons always writes on a topic of interest for weight loss patients. In addition, we have recently started adding recipes to this newsletter as a resource for our patients.

The last support program that we offer for our patients is a project currently in process to put together a bariatric cookbook. Recipes will come from our patients, bariatric chef Dave Fouts, and our own dietitian. We hope to have this cookbook available by the fall of 2007.

WHAT LONG-TERM FOLLOW-UP MEASURES ARE PRACTICED AT YOUR FACILITY?

Part of the designation of being a Center of Excellence is to have 75-percent follow-up on patients for at least five years postoperatively. This requirement has proven to be somewhat of a challenge for us as many patients visit their primary care physician for follow-up care, especially once they pass their six-month or one-year postoperative date. To combat this, we have put in place a recall tool that allows us to set a follow-up date for all patients, reminds us to contact them for follow-up, and keeps the patient on the follow-up list until an appointment is made. In some instances, a patient does not feel that it is necessary to come in to our clinic for follow-up visits, and for those patients, we have created a short phone survey to discuss the patients’ health to at least gather some follow-up information. It is important to the surgeons and staff at Western Bariatric Institute that we provide long-term care to our patients and provide ongoing support as they move forward in attaining or maintaining their weight loss goals. Follow-up is also vital for our organization as we strive to have quality outcomes documented in our medical management system to allow for research follow-up.

WHAT QUALITY CONTROL ASSURANCE MEASURES ARE PRACTICED IN YOUR FACILITY?

Our clinical staff meets monthly to discuss concerns with how the facility is running and to also share any clinical updates appropriate for our patient population. During these meetings, the surgeons and nurses have an open forum to discuss cases and brainstorm ideas on how our clinic may run more smoothly. In addition, Western Bariatric Institute has an open door policy for all employees to share thoughts and ideas on how our program could be improved. Not only are employees encouraged to share their thoughts in person, but a suggestion box is located in our kitchen area if an employee has a thought or idea, but would rather share it anonymously.

Clinical staff members are also highly encouraged to pursue educational opportunities and conferences as they arise. Our surgeons and nurses attend quarterly trainings or conferences to increase their knowledge base, and then are encouraged to share new information with the rest of the team during the monthly meetings.

In addition, Western Bariatric Institute has put in place a customer service program called the “Exceptional Club.” Through this program, trainings are held quarterly for all employees to talk about ways to improve the level of care and service that we provide for our patients. This is an open forum meeting where everyone from our front desk check-in staff to our clinical staff comes together to talk about what is working in our office and what areas could use improvement. This meeting is also an opportunity to highlight the positive things going on in the office and share the positive comments that our patients have about us. By having such a program in place, it reminds our entire staff that our patients have a choice in where they receive their healthcare, and that we want all of our patients walking away from our program with a positive experience.

WHAT TRENDS DO YOU SEE EMERGING?

The field of bariatrics is ever evolving and changing, as any of us in this industry can attest. One trend that we have seen in our area is the flip from the majority of our surgeries shifting from gastric bypass to gastric banding. Over the last year, we have seen a significant shift between these two surgical procedures. Related to this, we also have seen the age of our patient population increasing lately, which we believe is due to the availability of the less invasive gastric banding procedure. It has been our experience that older patients are doing very well with the banding procedure, often even better than their younger counterparts due to their dedication to sticking with the long-term lifestyle changes necessary for success. Another trend that we see emerging involves shorter lengths of stay for patients after surgery. This seems to be typical across the healthcare spectrum, but is definitely apparent in the field of bariatric surgery as well.

Another evolving trend involves physician-supervised weight loss programs. More and more insurance companies are requiring a weight loss program prior to authorizing surgery, which can place a strain on not only the patient, but physician offices as well due to documentation requirements of these programs. Therefore, we are excited to be in the process of partnering with the International Metabolic Institute, which will provide our patients with the highest standard of care for medically sponsored weight loss and maintenance programs. We believe that the requirement for a medically supervised weight loss program will increase and hope to be ahead by already having a program in place to provide excellent care for our patients.

Are there new technologies or equipment you would like to see utilized in your facility?

As in any medical field, there are always new technologies coming out that would be nice to have available. A few things that would be on our wish list include a bariatric scale that could accommodate wheelchairs. We have multiple patients confined to wheelchairs or motorized scooters, and our current scale cannot accommodate them. In addition, a body composition analyzer would be nice to have available in our facility to determine our patients’ body fat levels.

What efforts do you make to maintain HIPAA compliance?

Patient confidentiality is always stressed in our office with all staff. Our office houses a private registration area for new patients to provide their demographic information in a secure and quiet location. We also have a HIPAA form that must be filled out by all patients at their initial visit that states whether they would like any medical information to be released to anyone other than themselves while under our care. If they wish this information to be available to a family member or friend, they must note that person’s name and then sign and date the form. This form is updated annually (unless requested sooner by the patient).

Our office also follows all normal HIPAA compliance requirements. Patient information is not shared with anyone other than the patient (unless requested as stated above) and staff is instructed to use caution when talking about cases or patients within the office to ensure that their conversations cannot be overheard. Our office was designed with patient privacy in mind. Our front office/reception area is separated from the waiting room via a glass divider to allow staff and patients privacy when discussing information.

What makes your facility unique?

From the beginning, our patients are treated with the utmost respect. Our staff consists of two patient advocates, whose roles are to walk our patients through the entire process from beginning to end. As anyone in this industry knows, the steps necessary to get to surgery can be complicated and cumbersome, and we believe that by providing patients with a person that they can call with any questions or concerns helps to alleviate some of their concerns about surgery. Our patient advocates are available to speak to prospective patients from the very beginning and even present to the attendees at our free seminars. From then on, they are ready and available to assist patients every step of the way.

A recent addition to our team is a clinical dietitian who not only sees patients for preoperative nutritional evaluations, but has also implemented monthly educational courses available to our entire population of pre- and postoperative patients. Topics for these classes include: “Getting Back on Track,” “Healthy Holiday Eating,” “Dealing With Hunger,” “Achieving Your Goals,” etc. These classes draw in not only recent patients, but also those who are two, three, four, or more years out from surgery.

We are doing what we do because we know it changes people’s lives, and that everyone needs support every now and then. We believe that by providing programs and events for the community and patients many years out, we are building a unique, truly patient-driven program.

Tags: Bariatric Center Spotlight

Category: Bariatric Center Spotlight, Past Articles