The Outpatient Outlook

A St. Cloud Surgical Center Blog


If any doctor at St. Cloud Surgical Center knows a thing or two about sports injuries, it’s Podiatrist Dr. Ashton Nelsen.

As a former Division II track star at Minnesota State University Mankato, Dr. Nelsen has had her fair share of time on the sideline due to injuries. Her experiences as a student-athlete and love for sports medicine are what led her to a career in Podiatry. As a podiatrist, Dr. Nelsen focuses on everything related to foot and ankle health, including hammertoe corrections, bunion removal, and major ankle surgeries like lateral ligament reconstruction due to ankle sprains.

Ankle Sprains are the most common type of athletic injury, with research suggesting they account for 15-30% of all sports injuries. And while it is common among athletes, ankle sprains can happen during everyday activities too! With those stats, it’s probably safe to say you’ve experienced an ankle sprain or know someone who has, but what exactly happens when you sprain your ankle?

While it may not look like much, the inner workings of your foot and ankle are very complex. Each foot comprises 26 bones, 33 joints, and more than 100 muscles, tendons, and ligaments that work together to provide support, balance, and mobility. When talking about ankle sprains, we focus on the ligaments that help stabilize joints and prevent excessive movement. An ankle sprain can occur when this stabilization is disrupted through an unusual amount of force caused by the twist of your foot, roll of the ankle, or any other movement beyond typical motions.

You may have had a Sprained Ankle if you’ve experienced any of the following:

  • Inability to weight bear on your ankle
  • Ankle pain, which can be mild to severe
  • Decreased range of motion at the ankle joint
  • Swelling and inflammation
  • Bruising
  • A popping sound during a suspected ankle injury
  • Instability of your ankle in any way (most common with severe sprains)

For many of Doctor Nelsen’s patients, traditional recovery methods like physical therapy, bracing, or something as simple as the R.I.C.E technique will help resolve an ankle sprain. However, one out of every five patients that walk through her door has a severe sprain that can’t be relieved by rest and ice. These types of severe ankle sprains typically result in chronic ankle instability, leading to your ankle going out from under you at any moment, thus causing more damage to the ligaments.

If you find yourself reading this and think you may have chronic instability, all hope is not lost! While rest and relaxation won’t help, a simple surgery using bracing internally may be the ticket to a pain-free way of living. This bracing is a surgical procedure used to reconstruct and augment the body’s own ankle ligament. This procedure was designed to speed up recovery, allow for an immediate range of motion, and result in an ankle that is 3x stronger than your body’s own ligament!

“I always tell patients after this procedure you are more likely to break your ankle than damage the repair site because it is that much stronger!” – Ashton Nelsen, DPM

If you suffer from chronic ankle instability, bracing internally might be the best recommendation for you, especially if you are an athlete. With an average 13-week recovery time compared to 17 weeks from the traditional lateral ankle ligament repair, internally bracing can have you back on the track, mat, rink, or court faster!

Learn more about chronic ankle instability and ligament bracing from Dr. Nelsen in the video below.

For more information on Dr. Ashton Nelsen and her current practice, visit St. Cloud Foot and Ankle.


Laredo Sports Medicine Clinic

SportsMed Inc.

Ambulatory Surgical Center or Hospital: Where Should You Go?

For many patients, their first experience at a freestanding surgery center is at our facility. In these cases, it is our job is to provide them with the knowledge to confidently choose a surgical center over a traditional hospital-based outpatient department. If you are thinking about coming to St. Cloud Surgical Center for your next procedure, continue reading. We think you’ll find this information very helpful!  

What is an Ambulatory Surgical Center? 

By definition, Ambulatory Surgical Centers are modern-day healthcare facilities that have a primary focus on providing same-day surgical care. In the last 30 years, the roles and overall number of ASCs in the nation have increased dramatically. Ambulatory Surgical Centers have genuinely transformed the outpatient experience by providing a convenient alternative to traditional hospital-based outpatient practices. Not to mention, they have done so with a strong track record of quality care and positive patient outcomes! 

What is the difference between an Ambulatory Surgical Center and Hospital? 

Many of the workflows and procedures performed at both institutions will be the same. There will, of course, be some differences, but we both share a common goal of providing the highest quality of care. Many of the differences between the two are seen in the background operations. 

Traditionally, a hospital-based outpatient department, or HOPD, is owned and attached to a hospital, whereas an ASC is a standalone practice with no hospital affiliation. This separation makes the regulations for ASCs and HOPDs different. Most of the time, patients see these differences reflected in the cost. 

What is the cost of going to an Ambulatory Surgical Center?

Choosing an Ambulatory Surgical Center for your procedure will be more cost-effective than visiting a traditional hospital setting. The same procedure performed at both is reported to cost Medicare 47% less at an ASC than an HOPD. That is a significant difference and will show in your pocketbook! 

NOTE: The cost of a procedure will vary from person to person, depending on current medical coverage.

What are the advantages of an Ambulatory Surgical Center? 

ASCs have been shown to have greater efficiency with no differences or higher complication rates when compared to the traditional hospital setting. At centers like ours, we have a narrow scope allowing for more specialized care. Additionally, since centers are not owned by a hospital but rather providers, there is a greater sense of autonomy and alignment in physicians and center goals. Patient above profit is the primary focus at an ASC.

What surgeries can I have done at St. Cloud Surgical Center? 

At St. Cloud Surgical Center, we offer a variety of outpatient procedures and specialties, including: 

Why do patients love the St. Cloud Surgical Center?

It is our experience that patients find the highly specialized care and advanced technology offered at our facility results in a higher satisfaction rate. Here are some other reasons patients choose the St. Cloud Surgical Center: 

  • Easy Parking
  • Friendly Faces
  • Newly Remodeled OR’s
  • Knowledgeable Physicians
  • Quality care is provided every step of the way!

At the end of the day, no matter where you go, the goal of your selected facility should be to provide quality care for patients, serve physicians, and improve healthcare in America. This is exactly what we strive to do at St. Cloud Surgical Center. If you are considering a procedure at our facility, please contact us for more information.


SEEING CLEARLY IN 2022: Talking Cataracts with Dr. Mitchell Gossman

Eye concerns that lead to surgery can be very intimidating to think about for most people. For a good reason too! The eye is your camera to the world. Through this lens, you can see the love in your spouse’s eyes, enjoy the gummy smile on your grandbabies’ faces, and bear witness to the most beautiful cotton candy sunsets. Without the sense of sight, your world would look a lot different. While most eye concerns come with age, it’s important for everyone, young and old, to take care of their vision to not miss out on these magical moments of life.

To have you seeing clearly in the new year, we sat down with Dr. Mitchell Gossman, an Ophthalmologist at St. Cloud Surgical Center, to talk more about the most common eye condition in the nation, Cataracts. Dr. Gossman sub-specializes in Cataract Surgery and has received specialized training in neuro-ophthalmology from Mayo Clinic in Rochester, Minnesota. Having worked at St. Cloud Surgical Center since early 2002, he is highly revered by his peers and patients as an expert in the field.


As unfortunate as it is to hear, age is the most common reason for vision loss. Over time, everything in your body begins to wear out, knees, hips, and yes, your eyes. They are not an exception to the rule! By far, one of the most common surgeries done in the nation is cataract surgery. We often hear patients who need cataract surgery say, “It runs in my family.” While this isn’t wrong, it’s also not strictly caused by genetics. It “runs in your family” because cataracts account for 51% of blindness worldwide. The truth of the matter is cataracts are completely age-related.


  • You are experiencing cloudier vision.
  • You have developed a glare when looking at headlights.
  • Streaks begin to come out of headlights and road signs.
  • You experience sudden trouble reading or looking at screens.
  • You have difficulty doing your job or basic tasks.
  • You are over the age of 60.

Cataracts can happen on a spectrum. You can have very aggressive-looking cataracts with minimal symptoms. Or, you can have mild cataracts that cause a lot of symptoms. However, there is no way to predict by looking at someone when the patient will want surgery.


  1. First, you need to determine if you’re a good candidate for cataract surgery. Start by making an appointment with your optometrist or get a referral to be seen by an ophthalmologist, like Dr. Gossman, who would perform your surgery.
  2. If your provider determines that surgery is the best course of action, you have two choices. Get the surgery or live with gradually increasing vision loss.
  3. If you move forward with surgery, you will need to take measurements to determine the lens implant power required to correct the issue.
  4. After measurements, you will schedule your surgery date at St. Cloud Surgical Center! Surgery is done one eye at a time, with a few weeks of check-ups in between.
  5. Surgery day! From pre-op to post-op, the whole process will take about two hours. We will begin with sedation (general anesthesia), so there is no pain whatsoever. The surgery itself takes 10 to 15 minutes. Your surgeon will remove the eye’s cloudy lens that sits right behind the pupil, and an artificial, clear lens will take its place.
  6. Once discharged, you will have a list of things you can and cannot do. You’ll come back the next day, and again one week after, for a check-up. If things look good, we’ll move on to the next eye.
  7. Once both eyes are corrected, you can begin to see clearly again!

For Dr. Gossman, this is the best part of his job. The WOW factor that occurs post-surgery is what makes his job worth doing. In 99% of his cases, patients only regret is not opting for surgery sooner. With the advancements of cataract surgery, it is a safe, comfortable, and painless experience. There is no reason to be part of the population struggling to see. Schedule your cataract surgery at St. Cloud Surgical Center today and start seeing 20/20 again!

Updated Look, Same Great St. Cloud Surgical Center

After a year of ongoing construction, the most recent expansion and remodel of the St. Cloud Surgical Center is complete. The remodel began in October 2020 and officially wrapped up in November of 2021. With a little over a year of work, we were able to add 7,500 additional square feet to our building, upgrade our sterile processing center, create updated spaces for our team, make exterior improvements, and much more. We recently sat down with St. Cloud Surgical Centers CEO Darci Nagorksi, and Facilities Director, Brad Kompelien, to hear more about the expansion and what that looked like on the front lines.

Q: First and foremost, what makes the St. Cloud Surgical Center so special?

D: We’re a very unique operation. From a square footage standpoint, there’s probably not another facility in the state that is a stand-alone surgery center of this size. We’re a multi-specialty, 80% surgeon owner, and just the sheer size of it all is pretty impressive. Also, all of our patients go home the same day. Many other centers, especially with total-joint, have overnight stay, but ours all go home the same day. This is a unique and challenging model in itself.

B: And I think just having an intuition of this caliber with a hospital across the road that’s an excellent facility for medical care is incredible. We have supported local doctors and the administration of these buildings, which isn’t easy to manage, for fifty years.

D: It’s like a mini-hospital!

Q: What was all done as part of the remodel and expansion?

D: The most significant, most noticeable part of the project was that we added about 7500 sq. ft. to the south side of the building. This expansion allowed us to triple the size of our sterile processing department, which cleans and sanitizes all the equipment we use for procedures. With the addition, we could enlarge the cafeteria about 3x the size of what it was. We have roughly 150 staff members who eat there, so we needed a decent size cafeteria! Additionally, we added a conference room and a new mechanical room to accommodate the sterile processing updates.

B: With the new space created for the sterile processing department, we converted their old work area into two larger, expanded ORs. These ORs are about 620 sq ft.

D: Which is standard in most places.

B: Correct. Standard at most places, but with our space, our ORs are generally 430 sq. ft., making this a big upgrade for us!

D: Yes, the surgery staff is really excited about this!

Q – Why was the expansion at St. Cloud Surgical Center needed?

D: In 2022, we’ll be celebrating our 50th anniversary, and in that time, the types of procedures we do here have changed dramatically. When the building was built in the 90s, we predominantly did small cases, like ENT, eyes, and colonoscopies. All of which require little equipment. Over the past ten years, though, we’ve started doing a lot more orthopedic and spine cases. When you start getting into procedures like those that need more equipment, big and small, things have to change. Our sterile processing department was getting overwhelmed, and we didn’t have the space to quickly turn cases over with clean equipment, which obviously didn’t work. We needed that extra space for the OR rooms to accommodate the new equipment for these larger procedures. Most cases will have a robot, multiple staff members, computers, etc., and 430 sq. ft. was getting to be tight. Overall, we were challenged on various fronts, and the expansion was absolutely necessary.

Q: What was done to the interior of the Surgical Center to improve the space?

D: We added a lot of new lighting, wall coverings, tile, and new carpet to the remodeled areas.

B: The color scheme for the expansion and remodeled areas has been updated, too. It’s now more of a gray color scheme vs. the browns and creams before. We still kept it neutral but switched to cool tones.

D: Overall, there wasn’t a ton done on the interior. That’s the someday project!

Q: What was done on the exterior and outside of the building?

B: We did a lot of work on the outside of the building, but the look is the same. As far as public perception goes, we put new signs on the building, but that’s it. The new lit neon signs show off a lot better than our previous ones!

Q: How does the remodel improve the experience at the center for your patients?

D: You know, the unfortunate thing about all the work is the patients don’t really know. It was really done from the operational side of things. We needed a better workflow for our teammates and have achieved that with all the updates to the sterile processing center and shared spaces like the OR and cafeteria. So, although they might not see it, ultimately, on the patient side the operational process is a lot safer and efficient for them. We’re very happy to be able to say that!

Q: What was the response like to the new cafeteria?

B: Oh, I think our teammates really like it!

D – I would say pretty positive. Before the expansion, we had a cramped area. As we grew, that space remained the same, and it wasn’t working anymore. Even though lunch runs from 10:30 AM to 1:30 PM, we were continuously challenged with getting enough seating for people. There’s always a good hour when it gets really packed. We also cook lunch on-site in the kitchen connected to the cafeteria, giving our cook more space and control in the kitchen has been nice.

B – We also added some outside seating. There’s only a limited number of staff who can use it, mainly non-clinical staff, but they really enjoy that.

Q: Can you see more patients at a time now?

D: Yes, and no. When it comes to these larger procedures, like total joint, we can perform better, and in theory, since we have the new sterile processing department, we could do more. However, we still run into issues because we don’t have additional admitting or recovery rooms. It all depends on the day; we did see a lot of growth this year, though! We had about 400 more total joints this year than last year. More people are choosing ambulatory surgery centers, which is great to see!

Q: Are you bringing on more surgeons and support staff to accommodate the growth?

D: At this time, no. It has pretty much been status quo on the number of surgeons we have here. Of course, we can welcome more, and there have been a couple added in the last year, but not necessarily in the areas that are growing the most.

Q: What is your favorite space that was remodeled?

D: There’s a lot of things, so that’s a hard one for me! From an operational standpoint, I would have to say the sterile processing center. That was a huge move for us because we so badly needed it. The previous space was not adequate at all. If I had to choose just one thing, though, I would pick the cafeteria because it’s where everyone comes together. Our staff, surgeons, and even supporting staff, I mean everyone, eat in the same area. There’s no separate physician room or a separate staff room. This is a unique feature, even to other ambulatory surgery centers.

B: For myself, it’s the operating room because of the technology. We made a big leap with the equipment we have. Before, we didn’t have what are called booms, and now we do. We have a new Stryker, cutting-edge boom technology, with a video matrix system where we can push video all over the room. That is the cool part because it’s the technology you’d have at big facilities, and we have them here in our little center.

Q: 2022 marks 50 years as St. Cloud Surgical Center; how do you envision the next 50 years in this newly renovated space?

D: We still have our eye on the front part of the building and are working on making better accommodations for when patients are awake. That’s definitely down the road, though! In my dream world, we would like to make our admitting rooms bigger and, for sure, our recovery rooms because it’s just on the backside of the ORs. Again, these rooms are small because we weren’t doing the type of cases back then as we are now. This is a hard task though because we have to work within our walls. So, ultimately, even if we can just cosmetically update, that would be huge. Right now, it looks tired. Is it functional? Sure. But some things would help it have better patient flow and an overall more positive experience. We definitely have more work to do to come full circle, but in good time!

B: In healthcare, it’s pretty hard to look ahead 50 years. I mean, we started as the second surgical center in the country, and look where we are now. To look ahead that far? I’m kind of a visionary, but I couldn’t get to that point. I’ve been here 20 years; I can’t imagine the changes in ten, even another five years.

Q: Do you have any final thoughts about the project and what could come down the road for St. Cloud Surgical Center?

D: We came a long way in what we did. It was hard. People were working through it the whole time.

B: There was very little space that wasn’t occupied by people working other than chunks that were getting worked on.

D: It took a lot of coordination. Brad and his group did a lot of work with our contractors and their subs. Kind of glad it’s done.

B: Mortenson Construction did a great job. Great to work with. Very knowledgeable. They were a huge asset to us and what we did here. I don’t know if there are a lot of companies who would have been able to survive it like we did.

D: We had quite a challenge just trying to remodel in a building like this. The amount of additional square footage we added and trying to then combine elements of a building to another part with proper airflow, HVAC, etc., is not manageable. Then we add working in sterile areas where you have to be very careful and not to mention a global pandemic; the odds were not great. We had to work really hard to make this happen. With that being said, we would be excited to do something to patient recovery and admitting side; it will be a challenge. We have to continue working just like we did here and add patients to the mix this time. We’ll definitely get there, but it’s going to take a lot of planning.

B: It’s quite a feat when you look back over the history of the surgical center and this building.

D: Right? And the growth we’ve had. St. Cloud Surgical Center started downtown in this little building in 1972 and moved to this space in the early 90s. To walk the halls now and see this is incredible. Fifty years is really special, especially in healthcare, and not being bought out. We’ve always been locally operated and partially surgeon-owned. It feels good to say that. I’m excited to see what’s next for us!

VELYS™ Robotic-Assisted Solution, Your New Best Friend In Total Knee Replacements

The team of joint specialists at St. Cloud Surgical Center is thrilled to announce the arrival of the latest knee replacement technology to hit the market, the VELYS™ Robotic-Assisted Solution. As one of the first surgical centers in the nation to be using this start-of-the-art tool, we have the unique ability to simplify surgery and optimize outcomes for our knee replacement candidates.

Recently, we sat down with our very own Dr. Eric Green, St. Cloud Surgical Center’s resident expert on all things VELYS™. Not only is Dr. Green an experienced orthopedic surgeon, but he was also one of six doctors selected by Johnson and Johnson to help develop this technology four years ago. With his extensive insight into VELYS™, every patient who walks through the doors at St. Cloud Surgical Center is undoubtedly in the best hands with Dr. Green at their bedside.

Designed for digital precision total knee replacements, the VELYS™ Robotic-Assisted Solution takes personalization to the next level. The advanced technology offered with the VELYS™ gives Dr. Green the ability to effectively predict your results and joint stability post-surgery to help you start moving again! Every knee is different, as is every patient who needs a replacement. We take your personal experience seriously, and it’s only going to get better now that the VELYS™ has arrived!

We asked Dr. Green what THREE things patients should know about the VELYS™ Robotic-Assisted Solution:

  1. When we say custom solution, we mean CUSTOM. The technology within the VELYS™ will fit your EXACT bone anatomy, including ligaments.
  2. The camera located in the VELYS™ can take 300 images per second compared to the prior systems that take 50-60 images per second. This faster, more efficient system allows us to keep up with every micro-motion inside the patient’s knee.
  3. In the early phases, it appears patients have less pain, quicker recovery time, and greater satisfaction overall with the VELYS™.

WEBINAR: Learn About Inspire and it’s Sleep Apnea Innovation

Struggling to get a good night’s sleep with your CPAP? Learn how Inspire might be able to help during an educational webinar presented by Dr. Ron Hanson on Thursday, October 2nd at 6:00 p.m. Inspire is the only FDA-approved obstructive sleep apnea treatment that works inside your body to treat the root cause of sleep apnea with just the click of a button. No mask, no hose, just sleep.

Learn more at our educational webinar

Presented by:
Dr. Ron Hanson of St. Cloud Ear, Nose and Throat Clinic
St. Cloud Surgical Center

View Important Safety Information & Register at:

WEBINAR: Inspire, the Leading Alternative to CPAP – FREE

Struggling to get a good night’s sleep with your CPAP? Learn how Inspire might be able to help during an educational webinar presented by Dr. Ron Hanson on Thursday, October 14th at 6:30 p.m. Inspire is the only FDA-approved obstructive sleep apnea treatment that works inside your body to treat the root cause of sleep apnea with just the click of a button. No mask, no hose, just sleep.

Learn more at our educational webinar

Presented by:
Dr. Ron Hanson of St. Cloud Ear, Nose and Throat Clinic
St. Cloud Surgical Center

View Important Safety Information & Register at:

Hip & Knee Pain Seminar June 22nd – Big Lake, MN

Free Hip & Knee Pain Seminar in Big Lake, MN at The Buff

Have you been looking for information about hip or knee surgery? We invite you to join us for a free seminar on Tuesday June 22nd at The Buff in Big Lake, MN to learn more about Mako SmartRobotics™. This medical breakthrough is a robotic-assisted technology that helps surgeons provide patients with a personalized surgical experience. A 3D model of your knee will be used to pre-plan and assist your surgeon in performing your knee replacement surgery. Learn more and get your questions answered!

The Buff
16722 198th Ave
Big Lake, MN 55309

Quest For Affordable Surgery

Dr. Joseph Belshe worked as an anesthesiologist in rural Minnesota before founding St. Cloud Surgical Center in 1972 – the 2nd outpatient surgical center in the US and 1st in Minnesota.

“The surgeons I worked with were searching for a less expensive and better way to do simple surgeries outside of the hospital. With modern anesthesia, I knew it was possible,” said Dr. Belshe. From finding a facility and acquiring licensure from the State to convincing insurance companies to come on board, Dr. Belshe diligently followed his calling. As he celebrated his 100th birthday this year, Belshe continued to credit the “good people around him” for his

We hired and worked with only the best – excellent surgeons, exceptional nurses, and top-notch administrators,” recalls Belshe. One of those exceptional nurses was his wife, Mary. The Belshes hope to travel from their home in Florida to celebrate St. Cloud’s Surgical Center’s 50th Anniversary next year. Known for exceptional customer service and quality assurance, St. Cloud Surgical Center is AAAHC (Accreditation Association
for Ambulatory Health Care) accredited and serves approximately 10,000 patients every year.

Medicare Now Covers Same-Day Total Hip Replacement Surgery at St. Cloud Surgical Center

Beginning this year, Medicare will cover total hip replacement performed at Ambulatory Surgical Centers (ASCs), such as St. Cloud Surgical Center.

In the past, total hip replacement surgeries have required extended stays in the hospital or a rehab facility while the patient recovers. Now, better anesthesia techniques, surgical techniques, and improvements in prosthetic implants have significantly reduced the recovery time after a joint replacement. This means that extensive hospital stays are no longer required for post-operative rehabilitation.

Factors Influencing Decision
The number of total hip and total knee replacement cases is projected to increase from 1.1 million to approximately 1.9 million by 2026, and 51% of primary hip and knee replacements are expected to be performed in the outpatient setting.

Many factors have contributed to the migration of joint replacement cases out of the hospital setting:

Both Medicare and commercial payers have historically pushed for the use of ASCs as an alternative, lower-cost site of care.

Adding total hip replacements to approved procedures creates an opportunity for more efficient use of healthcare resources and infrastructure—which has been accelerated by the COVID-19 pandemic. It is expected that patients who can safely be treated in ASC settings will be diverted away from hospitals in increasing numbers, and hospital capacity will be reserved to treat more acute patients.

Improved patient selection protocols have been developed.

Younger patients are undergoing total hip and total knee replacement procedures.

Surgical techniques and pain control measures have advanced.

Growing research shows the safety and efficacy of same-day discharge joint replacement.

Find out what this new rule means for you, and if you are a candidate for outpatient joint replacement.

What does this new Medicare rule mean?

  • The new Medicare rule represents a recognition that patients often recover from surgery better in their own homes and that extensive hospital stays are no longer required for post-operative rehabilitation.
  • This gives patients more options in choosing the location, quality of care, and the ability to save in the cost of their care.

 What are the benefits of outpatient joint replacement?

  • Outpatient surgery has a lower infection rate.
  • Patients can rest easier at home in a comfortable setting as opposed to staying overnight in a hospital.
  • Outpatient surgery is more affordable for patients.

Does St. Cloud Surgical Center offer total joint replacement?

  • St. Cloud Surgical Center partners with physicians from St. Cloud Orthopedics to bring the most innovative joint replacement procedures to our patients.
  • We currently offer robotic-assisted total hip, total knee, and partial knee replacement.
  • Learn more about our same-day joint replacement program here.

Am I a candidate for outpatient joint replacement?

  • Patient safety is the primary driver as to where surgery can be done. There are many contributing factors if a person can qualify as an outpatient joint patient.
  • Single health factor concerns such as having diabetes or being overweight are not an automatic disqualifier.
  • Contact us at (320) 251-8385 to see if you are a candidate.

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