Excellence in Anesthesia Service

Best in Class

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Optimize your Anesthesia Service

MedStream provides anesthesia solutions for hospital partners seeking improved patient care and responsible financial performance. Our best-in-class capabilities meet every clinical, operational and financial challenge to ensure excellence.

MedStream services include:

  • Practice management icon Practice management icon Practice management

    Foster an efficient, collaborative workplace to deliver quality patient care and achieve optimal financial results

  • O.R. performance<br />optimization icon O.R. performance<br />optimization icon O.R. performance

    Implement operational best practices and quality metrics to ensure maximized through-put and regulatory compliance

  • Professional recruitment<br />and staffing icon Professional recruitment<br />and staffing icon Professional recruitment
    and staffing

    Draw from our accomplished network of providers to ensure best in class clinicians are caring for your patients

  • Financial oversight icon Financial oversight icon Financial oversight

    Management of program expenses and identification of growth opportunities in support of the facility’s financial goals

  • Specialized anesthesia<br />services icon Specialized anesthesia<br />services icon Specialized anesthesia

    Boost patient satisfaction and drive new revenue through partner programs, including pain management and surgical services consulting

  • One-call leadership accountability icon One-call leadership accountability icon One-call leadership accountability

    Provide our partners in administration and in the OR with consistent, responsible management and ownership of department performance

“MedStream is a valued partner in providing perioperative services.  From our first contact with leadership to the daily clinical care being provided, we have found them to be professional, responsive and competent.  MedStream has met or exceeded all expectations."

CEO, North Carolina

"MedStream committed to transforming our anesthesia department and they have followed through.  They implemented an effective, sustainable improvement in service while prioritizing cost-containment.  MedStream continues to communicate and look for ways to improve."

CEO, Tennessee

“The transition from our previous anesthesia group to MedStream was as seamless as possible.  Our administrators and surgeons enjoy a strong and durable relationship with Dr. Ellington.  We’ve seen consistent improvements in our service since partnering with MedStream.”

CMO, North Carolina
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Founder Ken Ellington, M.D. established MedStream in 2006 as an extension of his own successful anesthesia consulting practice. With his brother, Doug, Dr. Ellington has built a team of seasoned anesthesia management professionals and business directors.

  • Kenneth R. Ellington, MD head

    Kenneth R. Ellington, MD




    • Medical Director of Perioperative Service at Mission Hospitals in Asheville, 1998-2007
    • Chairman, Asheville Anesthesia Associates, 2001-2005
    • Board Certified, Diplomat American Board of Anesthesiology, 1991
    • M.D. with honors: University of North Carolina School of Medicine
    • Surgical Internship: University of Florida
    • Residency: University of Virginia
    • Member of AMA, North Carolina Medical Society, ASA and ASRA

    Dr. Ken Ellington is the founder and President of MedStream, channeling 30 years of experience as a board-certified anesthesiologist to hospitals seeking his experience, innovation and partnership. Early on, he gravitated toward leadership positions, possessing a natural ability to build teams and resolve problems in a collaborative process.

    "I experienced operating rooms in chaos, where surgeons couldn't get their cases done, and there were issues with everything from training to schedules. The clinical concerns sparked in me an interest to make things better. So I helped form a committee of the whole OR staff who worked to take the program from inefficient to efficient. It was a key experience, one that was very satisfying."

    As a partner at Asheville Anesthesia Associates, Ken helped build the 15th largest anesthesia organization in the United States. During this time, he assumed the firm's chairmanship as well as being appointed Director of Perioperative Services at Mission Hospitals, a key hospital client of the firm. Under his leadership, the perioperative services team transformed the hospital's surgical program from one of the poorest performing to one of the highest-ranking programs in the United States.

    Ken's leadership accomplishments led to an active consulting practice, with numerous engagements in anesthesia and OR management throughout the Southeast. He established Medstream in 2006 as a natural extension of his expertise, creating a company dedicated to improving efficiencies in healthcare with a focus on anesthesia services and perioperative management.

    Ken is only satisfied when he successfully transforms a dysfunctional environment into a successful workplace. "My driving motivator is to form happy, cordial practices within the hospitals we serve, where everybody enjoys going to work, patients are well-taken care of and hospitals are successful. Improvements within the surgical program can make a huge difference to a hospital, the difference between success and failure."

    With MedStream, "I've built a team with demonstrated leadership ability, people who put the emphasis on building relationships, conduct themselves in such a way to always provide value and who want to do something good first and foremost."

  • Douglas Ellington head

    Douglas Ellington




    • Vice President of Operations, Matthews Ford
    • Commodities Manager, Interstate Johnson Lane
    • Account Executive, Dean Whittier
    • Bachelors of Administration in Economics, University of North Carolina at Chapel Hill

    An expert in anesthesia billing, practice management and corporate finance, Doug Ellington brings over 20 years of senior executive experience to the leadership team at MedStream. Doug is responsible for identifying and implementing financial solutions for MedStream clients, complimenting the clinical team’s perioperative expertise with his financial and business acumen.

    Doug directs MedStream’s business matters, overseeing hospital contracts, payor agreements and billing process as well as partnering with CPAs, bankers and attorneys to support all aspects of starting up and sustaining service to MedStream partners. His strategies to address inefficient staffing, unstructured scheduling and sub-optimal billing operations improve financial performance while assuring corporate compliance. The all-important process of credentialing is performed under his watch to ensure a seamless transition, which he notes, “is a primary consideration for us, and a strong way to begin a new business partnership.”

    Doug established MedStream as a start-up enterprise in partnership with his brother, Ken, in 2006. “I love the personal challenge of turning a struggling operation into a high functioning business unit. For me, it’s the process of problem-solving and strategizing – both within our organization and for our hospitals – that is so satisfying. I enjoy building our business together with our team, in addition to the opportunity to work with my brother and a talented leadership toward a common goal.”

  • Ellen Boney, MD, MBA head

    Ellen Boney, MD, MBA




    • President, Anesthesia Division, Apollo MD
    • CMO, Anesthesia, Apollo MD
    • Regional Medical Director, Apollo MD
    • Owner and Broker, Harbor Light Securities and Harbor Light Investment Advisors
    • Regional Medical Director, Lighthouse Anesthesia
    • Assistant Professor, Emory University
    • Member, ACHE, AAPL, ASA, SCAA

    A hands-on knowledge of patient care and expertise in operations are critical in the delivery of high-quality patient-centered service.  Dr. Ellen Boney, Chief Operating Officer, possesses both the clinical background and business knowledge to effectively lead MedStream's practice management.  "It is fulfilling to apply my clinical and business experience to programs that improve both provider processes and patient outcomes."

    Ellen is focused on optimizing all aspects of our service delivery, including client-facing services and operational infrastructure.  She leads initiatives that ensure practice performance, staffing and recruiting are all operating at a level to sustain current commitments as well as accommodate MedStream's rapid growth.

    "It's a pleasure to take the foundation that Ken and Doug have created and scale it to a growing, national company.  While economics are important in today's healthcare environment, MedStream remains laser-focused on providing quality anesthesia care."

  • Richard L. Jacobs, MD head

    Richard L. Jacobs, MD




    • Associate Faculty, Department of Anesthesiology, Duke University Medical Center, 1998-2010
    • Medical Director Anesthesia Service, Upper Valley Medical Centers, 1993-1998
    • Chief of Anesthesia Service, David Grant USAF Medical Center, 1992-1993
    • Specialty training in Cardiovascular Anesthesia, Vanderbilt
    • Internship & Residency, Wilford Hall USAF Medical Center, 1985-1989
    • 1981-1985 Doctor of Medicine, University of Michigan Medical School
    • 1977-1981 Bachelor of Science, Chemistry, Bowling Green State University

    Rick Jacobs has been with MedStream since its early days.  In serving our partners as Chief Medical Officer, Rick oversees clinical services and works with onsite medical directors to implement changes and improve performance.

    “It can be a challenge to enhance services while operating from a competitive standpoint,” Rick said. “With MedStream, I encounter unique and challenging situations at each hospital. I like the process of transforming resistance and skepticism into a mutually beneficial partnership over time. It’s the kind of involvement you don’t see in most anesthesia careers.”

    Rick’s perspective comes from 30 years of clinical experience and executive leadership gained while directing anesthesia services and serving on multiple hospital committees. He’s had an integral part in helping multiple facilities find success in the marketplace by chairing peer review and quality assessment initiatives, as well as SCIP and surgical committees.

    “I enjoy problem solving and getting others to think outside of the box,” Rick said. Working with MedStream, “I get the chance to help a facility that might have been struggling for years.”

  • Lance Player, MBA head

    Lance Player, MBA

    VP, Finance & Operations



    • Director, New Markets Tax Credit Program, TD Bank
    • Vice President, Senior Middle Market Banker, TD Bank
    • Credit Portfolio Manager and Commercial Banker, SunTrust Bank
    • M.B.A., Georgia Institute of Technology
    • Bachelor of Arts, Finance, Wofford College

    In leading the company's non-clinical day-to-day business operations and business services for client sites, Lance manages all operational departments, finance and accounting, and human resources.  In addition to process and performance management, Lance is also responsible for developing and implementing operational strategies and processes, financial and data analytics, and developing short- and long-term strategic financial plans for MedStream.

    In fact, Lance’s appointment to MedStream underscores the company’s vision for its future and respective growth goals, which are particularly aligned with his experience.  “I was attracted to MedStream because of the people behind its success, the company’s growth to date and the tremendous opportunity for continued growth.  The healthcare industry is changing and I want to help MedStream capitalize on the opportunities in the market.”

    Lance will monitor efficiency and operational excellence to ensure that MedStream’s business model is scalable to handle its expected future growth. “Operational efficiency to me does not simply mean number crunching, rather achieving best in class performance standards which allows us to deliver for our clients and be a leader among our peers.”

  • Terry Cline, CRNA head

    Terry Cline, CRNA




    • Bachelor of Science Degree in Nursing, University of Southwestern Louisiana
    • St. Joseph’s School of Nurse Anesthesia, Fort Worth, TX

    Terry Cline provides active oversight and management of the anesthesia departments within each of MedStream’s client hospitals. As Chief Clinical Officer since 2009, Terry has 35 years of experience and a proven ability to identify, stabilize, and correct issues impacting clinical and operational functions.

    Terry embodies MedStream’s leadership capability, bridging both clinical and administrative needs to accommodate financial goals and deliver superior clinical services. “We work for three sets of people: patients, surgeons, and administration. Our process includes extensive relationship-building, from OR technicians to surgeons to CEO.” While implementing procedural, staffing, and management changes, Terry still practices clinically, maintaining an active presence in the OR to observe direct patient care first-hand.  

    “I’m motivated by the satisfaction that comes from fixing problems and getting people working together to create a smooth-running department. Enhanced performance – and higher patient satisfaction scores – have a direct correlation to an environment where people feel valued.”

  • Lindsey A. Nelson, MD head

    Lindsey A. Nelson, MD




    • Anesthesiologist, Vail Valley Medical Center, 2011-2017
    • Anesthesiology Internship and Residency: University of Cincinnati College of Medicine
    • MD: University of Minnesota School of Medicine

    The ability to consistently evaluate the quality of our providers via patient-centered outcomes in real time is critical to navigating the current medical environment.   At MedStream, Our Chief Quality Officer oversees the implementation of our quality initiatives, reporting the constantly changing requirements placed on our providers and leading the process of clinical outcome reporting.   With over 20 years of experience in NIH and industry-sponsored research, Dr. Lindsey A. Nelson is well-skilled to perform this important role. 

    Prior to joining MedStream, Lindsey was the assistant director at the world-renowned Steadman-Philippon Clinic in Vail, CO.   While there, he was instrumental in developing new methodologies of patient outcome data collection and perioperative processes.   Joining MedStream provided an ideal opportunity to apply his expertise and implement new strategies to evaluate outcome data as a function of quality and cost throughout our provider network.   

    “I emphatically believe that MedStream’s culture of innovation and collaboration has created an opportunity to build the strongest anesthesia provider service company in the country.   The data analytic systems that have been developed within the organization set them apart in their ability to evaluate provider quality and cost metrics and respond quickly and with agility to the current requirements of today’s payors. “   


  • Jack Neil, MD head

    Jack Neil, MD




    • Anesthesiologist, Pardee Hospital
    • Pediatric Anesthesiology, University of Michigan
    • Anesthesiology Residency, Medical College of Georgia
    • Medical School, South Carolina School of Medicine
    • BS, Computer Information Systems, University of South Carolina
    • Machine Learning Certification, Coursera, Stanford University

    As Chief Technology Officer, Dr. Jack Neil manages the information technology applications designed and implemented by MedStream.  Jack serves as a liaison to our sister company, BlueNine Systems, partnering with them during the development of our proprietary Anesthesia Information Management System and QCDR. He has led the implementation of a system-wide provider communication network which includes a chatbot for autonomous functions, has filed numerous patents and is published in the areas of artificial intelligence and distributed ledgers.

    "I applaud the vision of MedStream's founder Ken Ellington to utilize technological innovation to improve efficiencies rather than simply pushing providers to work harder" Jack states.  "The intersection of healthcare and technology is the solution to our nation's current high-cost, low-value model."

    In addition to leading technology initiatives, Jack is a practicing anesthesiologist at a MedStream practice in North Carolina and an active member of the American Society of Anesthesiology's Electronic Media and Information Technology Committee.  "I enjoy the duality of applying what I learn in the clinical arena onto a technological platform serving our client base and, conversely, implementing MedStream technological best practices into disparate clinical settings."

    His current areas of active research involve machine/artificial intelligence and blockchain applications to healthcare. Projects include natural language expert knowledge capture, acoustic deep learning, and medical device compliance systems (utilizing blockchain storage).

  • Katy Yarbrough head

    Katy Yarbrough

    VP, Business Development



    • Director, Business Development, American Museum of Natural History
    • Executive Director, Partnership Programs, The Princeton Review
    • Assistant Vice President, Marsh & McLennan Inc.
    • Bachelor of Arts, Communications, Wake Forest University

    Using her 20 years of marketing and account management experience, Katy Yarbrough identifies hospital systems facing the challenges MedStream specializes in solving and connects hospital leaders to the customized solutions MedStream provides.

    “Hospitals often experience common problems in their own unique way, whether the issues are expenses, quality, lack of leadership or compliance. So my job is to listen first,” she states. History, desires and goals are then synthesized with raw operational data in a process that identifies areas of opportunity and under-performance.

    Being the liaison between what hospitals need and what MedStream provides is a personal challenge Katy relishes. “I work with intelligent and compassionate people every day – people who could operate differently as their company grows. Yet they treat each opportunity and every new client with as much care and enthusiasm as their earliest ones. Knowing we deliver solutions that make a difference is very gratifying.”

  • Tighe Simons, RN, MBA head

    Tighe Simons, RN, MBA

    Simons Surgical Solutions



    • Vice President of Surgical Services, Mission Hospital System, 2006-2011
    • Director of Surgery, Mission Hospital System, 1995-2006
    • MBA, Montreat College, North Carolina
    • Bachelor of Business Administration, Montreat College, NC
    • Bachelor of Science, Nursing East Carolina University, Greenville, NC

    As a healthcare leader and consultant with more than 30 years of experience, Tighe Simons partners with MedStream to focus on perioperative efficiency modeling and leadership development, guiding ORs in their transition to becoming effective, professional workplaces providing quality patient care.

    Tighe’s collaboration with MedStream leadership is not new; her long partnership with CEO Ken Ellington began in the Mission Hospital system in Asheville, NC, where together they were part of the leadership team responsible for renovating the hospital’s surgical program, an effort so successful it received national recognition and numerous rewards.

    In providing turn-key solutions for dynamic surgical environments, Tighe says, “Anesthesia is only one piece of the picture. When I work with hospitals, I work in concert with surgeons, perioperative services, and hospital administration. It takes mentoring, relationship-building and leadership…something I learned from Ken Ellington.”  

    Tighe's operational initiatives span the full spectrum of issues from supply-chain management to scheduling and expense reduction. Her client hospitals regularly experience a superior level of financial and operational efficiency, results that also present surgeons and staff with a more optimal work environment.

  • Tonya K. Powers, MD head

    Tonya K. Powers, MD

    MedStream Pain Services



    • Board Certified, American Board of Anesthesiology - Pain Management
    • Staff Anesthesiologist - Pain Management, Gaston Anesthesia Associates and Piedmont Medical Center 2000-2013
    • Fellowship in Interventional Pain Management, University of North Carolina - Chapel Hill
    • Anesthesiology Residency, University of North Carolina - Chapel Hill
    • Anesthesiology Residency – Combined Internship, University of Texas - Medical Branch
    • Doctor of Medicine, University of South Carolina - School of Medicine

    Dr. Tonya Powers worked with Ken Ellington to form MedStream Pain Services in 2013,  after Ken recognized pain management as an underserved area of specialization. As  MedStream's newest offering, Pain Services functions as a shared provider helping its  small community hospitals provide pain management services to their patients.

    Tonya specializes in diagnosis and treatment of painful conditions, from chronic headaches  to chronic neck and back pain to cancer pain and pain from orthopaedic injuries. "I'm an  interventionalist. As an extension of my anesthesia practice, I intervene between pain and  perception, helping patients with chronic pain to regain function and some semblance of  normal life," says Tonya.

    "I've known Ken for a lot of years, and MedStream has experienced a fascinating evolution  – like pieces of a puzzle falling into place. In creating a pain management service for his  clients, I credit Ken's professionalism, responsiveness and willingness to think outside the  box to make something happen. It's very gratifying to make my service successful, to help  people in this way."

  • Rodney V. Pugh, MD head

    Rodney V. Pugh, MD

    Regional Medical Director



    • Anesthesiologist, AllCare Clinical Associates, P.A. 1990-2017
    • Anesthesiology Internship and Residency: University of Texas Medical Branch
    • MD: University of North Carolina School of Medicine
    • Member of AMA, North Carolina Society of Anesthesiologists, AS and Buncombe County Medical Society

    Our Regional Medical Directors provide administrative and clinical leadership across the MedStream service footprint.  Dr. Rodney Pugh integrates the MedStream model into new client hospitals, ensuring the consistent application of best practices while monitoring departmental performance.  

    Prior to joining MedStream, Rodney served as the Chairman and President of AllCare Clinical Associates and as the Chairman of Mission Hospital Department of Anesthesia.  He has also been active in multiple medical society boards.  These engagements demanded of Rodney two levels of accountability to the community: both in a broad capacity leading improvement-based programs, and in a more focused application, treating one patient at a time.

    Serving as a liaison between our local providers and our corporate headquarters, Rodney provides important guidance and feedback in both directions. “The opportunity to work clinically and problem-solve with colleagues on the ground is naturally rewarding.  However the chance to scale that success beyond a single location is immensely gratifying.  Knowing we are serving a larger community through MedStream makes the collaboration that much more meaningful.”

  • Mary Ellen Gibbons, MSN, CRNA head

    Mary Ellen Gibbons, MSN, CRNA

    Regional Director for Clinical Services



    • BSN Nursing, University of Texas, Austin
    • Masters of Nursing, Duke School of Anesthesia

    Each Regional Director for Clinical Services provides clinical and administrative leadership at multiple facilities across the MedStream footprint.  In this role, Mary Ellen Gibbons identifies and shares proven best practices, creating a consistent service model that can be scaled across numerous facilities.  Mary Ellen enjoys the duality of this role, stating, “This position combines the best aspects of clinical and administrative roles.  I am able to bridge the gap between remote sites while also serving as a liaison back to MedStream’s corporate office.”

    In working clinically with our providers and the medical staff at each hospital, Mary Ellen has developed a network of teammates united in delivering quality service.  “When I travel, I can establish personal relationships and essentially develop an expanded family of providers.  I enjoy the one-on-one communication at each site, learning and collaborating for shared success.”


  • Tony Chipas, PhD, CRNA head

    Tony Chipas, PhD, CRNA

    Regional Director for Clinical Services



    • PhD Foundations of Adult and Continuing Education, Kansas State University
    • Masters of Health Science/Education, Wichita State University
    • Diploma in Nurse Anesthesia, Wesley Medical Center School of Nurse Anesthesia
    • BA Psychology, University of Kansas

    Tony Chipas has over 40 years’ experience as both a clinician and an educator.  This combination is particularly valuable in his role as Regional Director for Clinical Services.  Each Regional Director works clinically at many of our locations, modeling the behaviors we expect of our providers while also monitoring the departmental performance.  Tony leverages his educational background to communicate best practices and problem-solve with the medical staff and administration.

    “I have enjoyed speaking on a wide range of clinical topics at national and state meetings during my career.  My role with MedStream permits me to narrow that focus and address specific opportunities for optimization at each facility.”

    Tony is a long-time member of the AANA, including serving as a past Board Director, and a published author.  “I find it both challenging and satisfying to apply the experience I gained from presenting best practices in anesthesia management in a hands-on clinical capacity.”

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Performance Success

MedStream possesses the knowledge and experience to improve performance metrics while collaborating with administration, surgeons and OR staff.  Our team implements sustainable change and strives for a smooth transition.  What solution does your OR need?

MedStream consistently improves operating room performance for demonstrable and measurable success.
  • Increase on-time starts

    Example: Raised on-time starts from 60% to consistently over 95% by changing protocol and holding providers accountable.

  • Manage schedule to reduce down time

    Example: Reduced overtime hours by half in the first three months while continuing to complete the same number of surgeries.

  • Optimize resources to accommodate needs

    Example: Implemented block schedule and adjusted staffing model to complete same or greater number of surgeries.

MedStream specializes in making significant improvements to surgical services by harnessing the power of collaboration and relationship-building.
  • Establish a presence in the hospital

    Example: Anesthesia team regularly participated in leadership committees to foster cross-department communication.

  • Demonstrate flexibility

    Example: Worked collaboratively with OR team to manage the daily schedules to ensure staffing efficiency while still serving surgeons’ needs. Developed a flexible schedule that avoided excess cost.

MedStream helps hospitals enhance value with cost-cutting solutions that still uphold service quality.
  • Reduce supply costs

    Example: Partnered with the pharmacy to drastically cut anesthesia drug costs.

  • Optimize flexed staff

    Example: Established a block schedule for a multi-hospital system and moved anesthesia staff between facilities, reducing the CRNA FTE count by 4.

  • Leverage market awareness

    Example: Saved our client $1M by aligning provider salaries with the current market rate.

  • Increase collections

    Example: Applied our payor agreements to the billing process to collect higher reimbursements.

From pinpointing strategic partners to defining key opportunities, MedStream enhances hospital business and the service you provide to your community.
  • Identify opportunities to expand customer care

    Example: Recognized community need and offered a rotating pain clinic to reduce costs associated with a full-time provider.

  • Recruit for other physician specialties

    Example: Understood hospital need for specialists and tapped our broader physician network for candidates to fill the vacancy.

  • Anticipate needs for process enhancement

    Example: Developed a software data capture program to offer paper-free anesthesia record management.

MedStream helps hospitals navigate bureaucracy to remove obstacles that impact patient care and hinder growth.
  • Offer quicker response time, leading to faster resolution of issues

    Example: Replaced a multi-layered managed model with our hands-on model, facilitating direct communication between administration and our decision makers.

  • Develop solutions in response to unique circumstances

    Example: Customized a call model to reduce on-site requirements while accommodating OB’s need for continuous presence of anesthesia providers.

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Job Opportunities

MedStream is always looking for clinicians who share our commitment to providing the highest level of patient care. We currently have select openings for both anesthesiologists and CRNAs and invite you to direct your CV to recruitment@medstream.biz.


MedStream ensures excellence through anesthesia management to improve patient care and optimize financial performance. We deliver the clinical, operational and financial capability few anesthesia practice management firms can offer.

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