Consolidation in orthopedics is nothing new, but more independent practices are weighing strategic partnerships as overhead rises, reimbursements decline and the effects of staff shortages and the COVID-19 pandemic continue to plague the healthcare industry.
The leaders of seven orthopedic groups from across the U.S. spoke to Becker's Spine Review about the toughest challenges in their specialty and what to expect in 2022.
Editor's note: Responses were edited for style and clarity.
André Blom. CEO, Illinois Bone & Joint Institute (Des Plaines): To be successful in today's orthopedic landscape, you need a multidimensional physician leadership structure that can navigate all or most aspects of an extremely active and vibrant sector of healthcare. Therefore, I believe that successful practices should be heavily invested in governance design and appropriate organizational support. Investment in current and future state leadership tracts, along with authentic commitments from physicians to actively and consistently participate in strategy and execution of practice initiatives, are essential if you want to retain ongoing success in the marketplace. As such, I believe that practices will be successful to the degree they are committed and invested in physician leadership strategies and structure.
Alex Vaccaro, MD, PhD. President, Rothman Orthopaedic Institute (Philadelphia): The biggest threat that independent orthopedic practices face today is the exponential migration of graduates as hired employees into large healthcare systems. Over 70 percent of new orthopedic graduates are now forgoing private practice and signing up as full-time employees into health systems throughout the country. Outside stakeholders, including payers and the government, are concerned that this will dramatically increase the cost of care while at the same time minimize physician autonomy with regards to best patient care business practices and quality of life in the long run.
The question is: Will patients benefit from the loss of independent physician leadership on best practices and site of care when a nonphysician administrator is now in charge of directing resource utilization and location of care? It is imperative that physicians have the autonomy to determine what is in the best interest of patients while making sure that care is delivered in safe, low-cost facilities that may not be available or desirable to a large healthcare facility.
Independent physicians who are patient-facing are motivated to do things in the best interest of patients in terms of efficiencies, point-of-care access and advocating in a scarce resource environment. These liberties will most likely be curtailed in an employed model.
Alex Bateman. CEO, Resurgens Orthopaedics (Atlanta): We have to remain relevant. We feel that private medicine is still the best medicine and that orthopedic groups must continue to compete with the tremendous amount of consolidation that's out there among the health systems in Georgia. HCA has exited, Tenet has exited, and the hospital systems are continuing to grow in both numbers of assets and also their employed physicians and their primary care groups.
So it's very important for the orthopedic community to do the same: to aggregate, to invest in ourselves, to invest in our data. We have a tremendous amount of data and information that comes through our practices, and even a group of our size hasn't really invested in a way to turn that information into intelligence that will allow us to treat patients better, manage their health better, and create better economics for the provider and cheaper care.
There's so much to be done, but it takes a lot of expertise, time and capital. With all the energy needed to run the day-to-day operations of a busy practice, we have to be very intentional with these efforts. As we aggregate partnership groups together, we can leverage that energy and spend and we can invest in those critical areas that are going to take us to the next level.
I think that the most pressing thing in orthopedics is to solidify ourselves, to make sure we're well-positioned to continue to be successful and a meaningful part of the healthcare ecosystem in the state.
Bryan Williamson, MD. Medical Director, OrthoLoneStar (Houston): The most pressing issue for independent orthopedic practices is navigating the rapidly changing healthcare environment. Hospital employment, private equity consolidation, diminishing reimbursement and increased regulatory oversight are just a few of the issues challenging the ability of orthopedic practices to remain strong and independent. Fortunately, we believe independent orthopedists are in the best position to thrive in this dynamic healthcare market.
Nicholas Grosso, MD. President, Centers for Advanced Orthopaedics (Bethesda, Md.): There are a number of pressing issues facing independent orthopedic practices, all related to the transition from fee-for-service to value-based care. How organizations manage this pivotal moment in healthcare will ultimately determine their path forward.
Ed Hellman, MD. President and Interim CEO, OrthoIndy (Indianapolis): The biggest thing is how to stay independent. The last decade or two we've seen reductions in reimbursements for professional services while reimbursements have stayed high on the facility side. At the same time, overhead has gone up, such as malpractice insurance, information systems and compliance. These things are very costly, and that's decreased the margins that an independent orthopedic group operates under. The successful groups have found ways to develop ancillary income streams, whether it's ownership of therapy or imaging centers or surgery centers. In our case, we have a physician-owned hospital that's part of that as well, and that has allowed us to stay independent of the major health systems.
Kim Mikes, BSN, RN. CEO, Hoag Orthopedic Institute (Irvine, Calif.): As large numbers of orthopedic practices consolidate under national health organizations, independent orthopedic practices may lose access to patients who will be directed to affiliated surgeons. Practice overhead costs have also grown due to the COVID-19 pandemic. There is a shortage of healthcare workers, and those who are looking for employment are looking for a higher rate of pay.