Musculoskeletal management services organizations and private equity firms continue to make inroads into the orthopedic field as small to midsize independent groups look for strategic partnerships to allow them to grow and maintain their autonomy.
Two spine surgeons discuss the ups and downs of these consolidation models and how they see them playing out in the orthopedic field.
Question: How do you anticipate management service organizations and private equity groups affecting consolidation among orthopedic practices in the coming years?
Dr. Brian Gantwerker: Of all the things that result in the curtailing of physician independence, MSOs offer the best hybrid model. When it comes to offloading overhead while letting the surgeon or group be "themselves," it allows for growth, cost containment and very likely the most job satisfaction compromise. Private equity, as we have seen entering this space, is not good for patient care. The corporate practice of medicine is not the solution to what ails our system. Patients over profits should always be the physician's mantra. While it is tantalizing to partner up, go to expensive lunches, and sign lucrative deals, it is not worth the sacrifice of autonomy and very likely, selling the soul of your business. By the time one realizes patients are not getting the same quality of care one would customarily give, it will be too late to change. This, I fear, will be the endgame of our system.
Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): In recent years, high-acuity surgeries, including both spine and orthopedic cases such as total joint replacement and shoulder reconstruction, have migrated from the inpatient to the outpatient environment. This trend is progressing quite rapidly. Private equity groups have taken the opportunity to help control this migration by investing as financial supporters and capitalizing on the opportunity. To do so, they are instituting significant business input and quality control as this transition takes place. The goal is to develop a more cost-effective outpatient world that can handle the shifting insurance market and position it for managed care in its ultimate version. You can look to the MSOs integrating multiple centers together via either purchase or management to accomplish this goal.