Michael Piver, the new vice president of orthopedics at Johnson City, Tenn.-based Ballad Health is keen on communication and collaboration.
He oversees orthopedics in the Appalachian Highlands, a region with 29 counties, and he has 25 years of experience in healthcare leadership. Mr. Piver spoke with Becker's to discuss health system strategies, uniting physicians and forming smart practice partnerships.
Note: This conversation was lightly edited for clarity and length.
Question: What are your top three goals going into 2025?
Michael Piver: The first one is growth, not only for orthopedics, but also for our health system. Two is working on more enhanced ways of working with our community and employed physician partners for orthopedics within our 29 county region. Third is continuing to provide great patient care and access for those that we serve.
Q: Can you talk about any key metrics that you plan to measure to ensure strong orthopedic clinical and financial success?
MP: We are just finishing up our fourth year of our orthopedic code management agreement in February, and that program was focused on patient outcomes and quality, along with collaboratively working with our surgeons to standardize processes and reduce cost. In those four years, HCAP scores have increased over 12% while our 30-day readmission rates have decreased more than 20%. Those are again two key metrics we will be collecting, and we have started collecting the patient reported outcomes for total hips and total knees, which is something that I've done in previous lives at other facilities. I'm very familiar with that, and I know that we will expand that, not only to the total hips and knees, but we'll look at other specialties within orthopedics that make sense. I think that's an important measure, and it helps us to see where we have opportunities.
Within that space, you always have cost initiatives in any sort of arrangement. So we will look at our current structure and figure out where there are opportunities in all of these, all of these measures will be in collaboration with our physicians. If they're not bought in, our health system is not bought in and if we're not in lockstep, then we're not going to get the success that we need.
Q: What's your approach to keeping all these physicians feeling united across the region?
MP: I think that the best way is by having regular communication with those physicians. I think one of the challenges that any health system has is making sure that all of your stakeholders are informed of all the things that are going on. Working with our service line directors, our hospital executives will help to make sure that we get that message out to our physicians. This is extremely important because typically when you have breakdowns, it is due to the fact that there's a lack of communication.
Q: What's the next big thing that orthopedic health system leaders should be paying attention to in 2025 or whether it's in a rural area or a city?
MP: It's not surprising that in orthopedics, the biggest trend is the migration of surgical cases to ambulatory surgery centers, and hospitals will be taking care of patients who are sicker or have more complex needs. The other thing that is a big trend right now is the increasing expenses associated with running independent orthopedic practices. Health systems that have or are partnering with their surgeons, both on joint venture ambulatory surgery centers as well as providing them with partnering options have a better opportunity to more closely align with the goals of growth for both groups, while providing great patient care and quality for the community.
Q: Are there any interesting orthopedic practice partnerships in the near future for Ballad?
MP: We're always looking at opportunities. In the short time that I've been here, I've learned that Ballad really keeps their options open and doors open to discussions with physicians. Health systems that provide options for physicians and physician groups as opposed to being very closed off to looking will be better suited than those that do not.
Q: What do you look for in potential independent practice partners? What's your pitch to them?
MP: I can't speak to Ballad's strategy on that since I'm newer, but in my past life the pitch that has resonated is the ability for the orthopedic group to continue to have some autonomy. Have an agreement which allows for autonomy and closely aligns with the goals and objectives, not only for the group, but also for the health system. Those seem to work really well and last longer as opposed to agreements where the physicians feel controlled by the health system.
Q: What are two pieces of advice that you would give for other orthopedic leaders like yourself to thrive in 2025?
MP: The two pieces of advice are to be creative in your strategy for collaborating with the issues. I think that there are ever-changing models out there, obviously working closely with your legal team to make sure that you're staying within the boundaries. But I think that there are an awful lot of new and exciting opportunities out there.
Second, to be successful is constant communication with your physicians and physician leaders and to you know, in my role, and in similar roles being that conduit between the health system and the physician group, and helping to translate the different wants and desires, and then begin to find a solution that works for both. I think that if you can find that win-win situation, then you have much more likely success for the future, as opposed to somebody who thinks that they've lost or been taken advantage of.