Industry experts discuss seven key elements that must be in place to form a comprehensive orthopedic care center with either a hospital partner or as a surgery center.
1. Surgeons representing all subspecialties. To earn their name, comprehensive orthopedic centers must include subspecialists from across the board, including trauma and pediatric orthopedic surgeons. If you have a need for a particular specialist who isn't in the community, you may need to directly recruit that physician. "We had one pediatric orthopedic surgeon here by himself for many years, and there was a need for a second surgeon," says Larry Parker, MD, a spine surgeon with The Orthopaedic Center in Huntsville, Ala. "We went out as a group and advertised for that surgeon." Groups can place listings on professional websites to recruit these physicians or look within their own network of physicians to find someone who would fit with the center.
However, there are several regulatory issues group leaders must consider when recruiting new physicians or specialists. "You need to have a fair market community needs assessment so that you can recruit a surgeon in according to regulatory guidelines," says Kim Pensenstadler, director of business development at Chapman Medical Center in Orange, Calif. She spearheaded the opening of Chapman Neurological Spine Institute. "If there isn't necessarily a need for additional surgeons in the community, identify strong surgeons who are already there and see if you can build a relationship together."
One option for partnering with other surgeons in the community is through a merger. Merging is often tough on both groups, and the physicians should make sure they are a good fit before becoming partners. "When mergers happen between two groups, they should have the same philosophy," says Dr. Parker. "The group physicians should get along, share business costs and work together."
2. Strong ancillary services. A comprehensive orthopedic center brings together several types of physician specialists, including orthopedic surgeons and pain management physicians, with orthopedic ancillary providers such as physical trainers, rehabilitation specialists, radiologists and sometimes athletic trainers. All of these providers should have a focus on working with orthopedic patients if you want to compete with the services provided by surrounding healthcare providers. Hospitals often employ ancillary service professionals who usually have general experience instead of strictly orthopedic training, as the specialists at your facility should have to gain the competitive edge.
"You really need to recruit and attract specialists who are experts at what they do across the board," says Craig Levitz, MD, an orthopedic surgeon and partner at Orlin & Cohen Orthopedic Associates in Rockville Centre, N.Y. "When you are talking about comprehensive care, you have to be able to offer ancillary services with an equal expertise to that of the surgeons. You can be the best physician in the world, but if the radiologist misses a tear, that's a problem. It's really important to surround yourself with top notch people."
3. Investment in technology that won't cripple cash flow. A truly comprehensive orthopedic center must include all subspecialties as well as ancillary services, and the appropriate equipment to go along with them. Acquiring the new equipment and instrumentation for additional procedures is a costly but necessary endeavor. If the center is hospital-based, administrators have to make sure you have the right operating room sizes and table for hand surgery, joint replacement and spine surgery, says Ms. Pensenstadler. In office-based centers, leaders will need to sure the hospitals the group performs surgeries at offers needed equipment.
For office-based centers, technology may include an MRI or other radiology equipment to support comprehensive services. A small group of three or four physicians won't be able to make the investment without seeing a huge negative impact to their bottom line, but a group of several physicians and specialists shouldn't have a problem breaking even and then making a profit, says Dr. Levitz. It's illegal in some states for physician practices to own an MRI, and physician-owned providers that do supply MRI services must give patients the option of having their radiological services performed elsewhere. These regulations are meant to curtail profiteering from self-referrals, but receiving imaging services on different days or at different facilities can slow the care process if the radiologists and physicians aren't coordinating the patient's care together.
"We have no trouble spending a few million dollars on an MRI because it will help us give better care and we stand to gain from the investment in the MRI," says Dr. Levitz. "When you are able to control the different elements of care in a comprehensive model, it gives the patients better care more quickly and has a lot more respect for the patients' time and money."
4. A sturdy administration. It's important for a comprehensive orthopedic center to have a strong administration to preserve the integrity of the whole group. "Each of the subspecialty groups has their own pull and interests they focus on, and a strong administration allows us to make sure each of the other groups and individual physicians have their needs met with the overall goals of the whole group in mind," says Dr. Parker. "It's key to have a neutral administration so that personalities and political influxes that may occur on a day-to-day basis don't overcome the group as a whole. Our group is very strong politically and internally because of the administration."
His center includes an executive committee of five physicians elected from each subspecialty group, and the members are rotated out every two years. The executive committee meets bimonthly to discuss the issues and serve the group as a whole. "Any year there is a representative from every subdivision so everyone has a voice at the table from the executive side," he says. "In large groups, there are usually one or two strong personalities that make decisions for the group, but in a changing executive committee, we let everyone have a chance to serve."
A strong administration is transparent, he says. Every physician should have access to the discussions and understand the issues. People on both sides of an issue should understand that the final decision was made as the best decision for the group as a whole.
5. Broad marketing efforts. Once the center is formed, marketing of the services is important for increasing patient volume and enhancing physician reputation. There are some marketing opportunities that work well for sports medicine while others that are more beneficial for spine. Working with local high schools as team physicians might be good for sports medicine physicians, while spine surgeons might be more likely to hold informational seminars for patients with back pain.
"Within a large group, you have to have sub groups of marketing entities," says Dr. Parker. "Sports medicine can market directly to their patients while a spine center is able to market their services to a different audience."
Physicians within each subspecialty should meet to discuss the best marketing methods for their service. Because there are such different marketing practices to reach the different audiences, it may be beneficial to hire separate marketing personnel to work with different subspecialties.
6. A central location. One of the biggest challenges of constructing a comprehensive orthopedic center is finding the best location to serve the community and the physicians. The location should be in a spot that is easily accessible for patients in the community and convenient for the physicians who will practice at the center.
"Our concept for a comprehensive orthopedic center really became a reality once we found a location that was truly perfect," says David Ott, MD, founder of Gateway Surgery Center in Phoenix, Ariz. "It didn't favor any one group of physicians. That was the key because you've got to have a community of orthopedic surgeons who can get along because you are often bringing competitors together to do this in a collaborative pattern."
The location should also be convenient for patients in a community that expresses a need for comprehensive orthopedic care.
7. Specific orthopedic surgery facility design. The facility needs to have enough space to meet the unique needs of orthopedic surgeons and patients alike. Orthopedic patients will want private rooms with bathrooms that are wide enough to enter and exit with wheelchairs as well as zero threshold showers. The facility will also need to support state-of-the-art operating tables and C-arms.
"Economically, you have to be able to drive a fairly big machine," says Dr. Ott. "There are also a lot of conveniences you can have with a specific orthopedic center. There can be short distances from the door to registration, shorter lines and less staff to deal with during the admissions process than in standard hospitals. You're able to bring in the advantages of a large multispecialty hospital with a developed service line, but the intimacy of a small facility."
Protocols and procedures should be put in place to handle these patients, and some facilities even include intensive care units. "To be successful, you've got to be able to treat all patients," he says. "You can't just have a center that only takes the most healthy patients. You have to deal with the complex patients too."
Related Articles on Orthopedic Care Facilities:
6 Ancillary Services to Increase Your Orthopedic Practice Revenue
6 Ways Orthopedic Practices Can Boost Word of Mouth Marketing
5 Revenue Cycle Mistakes Orthopedic Practices Make
1. Surgeons representing all subspecialties. To earn their name, comprehensive orthopedic centers must include subspecialists from across the board, including trauma and pediatric orthopedic surgeons. If you have a need for a particular specialist who isn't in the community, you may need to directly recruit that physician. "We had one pediatric orthopedic surgeon here by himself for many years, and there was a need for a second surgeon," says Larry Parker, MD, a spine surgeon with The Orthopaedic Center in Huntsville, Ala. "We went out as a group and advertised for that surgeon." Groups can place listings on professional websites to recruit these physicians or look within their own network of physicians to find someone who would fit with the center.
However, there are several regulatory issues group leaders must consider when recruiting new physicians or specialists. "You need to have a fair market community needs assessment so that you can recruit a surgeon in according to regulatory guidelines," says Kim Pensenstadler, director of business development at Chapman Medical Center in Orange, Calif. She spearheaded the opening of Chapman Neurological Spine Institute. "If there isn't necessarily a need for additional surgeons in the community, identify strong surgeons who are already there and see if you can build a relationship together."
One option for partnering with other surgeons in the community is through a merger. Merging is often tough on both groups, and the physicians should make sure they are a good fit before becoming partners. "When mergers happen between two groups, they should have the same philosophy," says Dr. Parker. "The group physicians should get along, share business costs and work together."
2. Strong ancillary services. A comprehensive orthopedic center brings together several types of physician specialists, including orthopedic surgeons and pain management physicians, with orthopedic ancillary providers such as physical trainers, rehabilitation specialists, radiologists and sometimes athletic trainers. All of these providers should have a focus on working with orthopedic patients if you want to compete with the services provided by surrounding healthcare providers. Hospitals often employ ancillary service professionals who usually have general experience instead of strictly orthopedic training, as the specialists at your facility should have to gain the competitive edge.
"You really need to recruit and attract specialists who are experts at what they do across the board," says Craig Levitz, MD, an orthopedic surgeon and partner at Orlin & Cohen Orthopedic Associates in Rockville Centre, N.Y. "When you are talking about comprehensive care, you have to be able to offer ancillary services with an equal expertise to that of the surgeons. You can be the best physician in the world, but if the radiologist misses a tear, that's a problem. It's really important to surround yourself with top notch people."
3. Investment in technology that won't cripple cash flow. A truly comprehensive orthopedic center must include all subspecialties as well as ancillary services, and the appropriate equipment to go along with them. Acquiring the new equipment and instrumentation for additional procedures is a costly but necessary endeavor. If the center is hospital-based, administrators have to make sure you have the right operating room sizes and table for hand surgery, joint replacement and spine surgery, says Ms. Pensenstadler. In office-based centers, leaders will need to sure the hospitals the group performs surgeries at offers needed equipment.
For office-based centers, technology may include an MRI or other radiology equipment to support comprehensive services. A small group of three or four physicians won't be able to make the investment without seeing a huge negative impact to their bottom line, but a group of several physicians and specialists shouldn't have a problem breaking even and then making a profit, says Dr. Levitz. It's illegal in some states for physician practices to own an MRI, and physician-owned providers that do supply MRI services must give patients the option of having their radiological services performed elsewhere. These regulations are meant to curtail profiteering from self-referrals, but receiving imaging services on different days or at different facilities can slow the care process if the radiologists and physicians aren't coordinating the patient's care together.
"We have no trouble spending a few million dollars on an MRI because it will help us give better care and we stand to gain from the investment in the MRI," says Dr. Levitz. "When you are able to control the different elements of care in a comprehensive model, it gives the patients better care more quickly and has a lot more respect for the patients' time and money."
4. A sturdy administration. It's important for a comprehensive orthopedic center to have a strong administration to preserve the integrity of the whole group. "Each of the subspecialty groups has their own pull and interests they focus on, and a strong administration allows us to make sure each of the other groups and individual physicians have their needs met with the overall goals of the whole group in mind," says Dr. Parker. "It's key to have a neutral administration so that personalities and political influxes that may occur on a day-to-day basis don't overcome the group as a whole. Our group is very strong politically and internally because of the administration."
His center includes an executive committee of five physicians elected from each subspecialty group, and the members are rotated out every two years. The executive committee meets bimonthly to discuss the issues and serve the group as a whole. "Any year there is a representative from every subdivision so everyone has a voice at the table from the executive side," he says. "In large groups, there are usually one or two strong personalities that make decisions for the group, but in a changing executive committee, we let everyone have a chance to serve."
A strong administration is transparent, he says. Every physician should have access to the discussions and understand the issues. People on both sides of an issue should understand that the final decision was made as the best decision for the group as a whole.
5. Broad marketing efforts. Once the center is formed, marketing of the services is important for increasing patient volume and enhancing physician reputation. There are some marketing opportunities that work well for sports medicine while others that are more beneficial for spine. Working with local high schools as team physicians might be good for sports medicine physicians, while spine surgeons might be more likely to hold informational seminars for patients with back pain.
"Within a large group, you have to have sub groups of marketing entities," says Dr. Parker. "Sports medicine can market directly to their patients while a spine center is able to market their services to a different audience."
Physicians within each subspecialty should meet to discuss the best marketing methods for their service. Because there are such different marketing practices to reach the different audiences, it may be beneficial to hire separate marketing personnel to work with different subspecialties.
6. A central location. One of the biggest challenges of constructing a comprehensive orthopedic center is finding the best location to serve the community and the physicians. The location should be in a spot that is easily accessible for patients in the community and convenient for the physicians who will practice at the center.
"Our concept for a comprehensive orthopedic center really became a reality once we found a location that was truly perfect," says David Ott, MD, founder of Gateway Surgery Center in Phoenix, Ariz. "It didn't favor any one group of physicians. That was the key because you've got to have a community of orthopedic surgeons who can get along because you are often bringing competitors together to do this in a collaborative pattern."
The location should also be convenient for patients in a community that expresses a need for comprehensive orthopedic care.
7. Specific orthopedic surgery facility design. The facility needs to have enough space to meet the unique needs of orthopedic surgeons and patients alike. Orthopedic patients will want private rooms with bathrooms that are wide enough to enter and exit with wheelchairs as well as zero threshold showers. The facility will also need to support state-of-the-art operating tables and C-arms.
"Economically, you have to be able to drive a fairly big machine," says Dr. Ott. "There are also a lot of conveniences you can have with a specific orthopedic center. There can be short distances from the door to registration, shorter lines and less staff to deal with during the admissions process than in standard hospitals. You're able to bring in the advantages of a large multispecialty hospital with a developed service line, but the intimacy of a small facility."
Protocols and procedures should be put in place to handle these patients, and some facilities even include intensive care units. "To be successful, you've got to be able to treat all patients," he says. "You can't just have a center that only takes the most healthy patients. You have to deal with the complex patients too."
Related Articles on Orthopedic Care Facilities:
6 Ancillary Services to Increase Your Orthopedic Practice Revenue
6 Ways Orthopedic Practices Can Boost Word of Mouth Marketing
5 Revenue Cycle Mistakes Orthopedic Practices Make