ASCs, regional expansion are key growth opportunities for large orthopedic groups: 7 practice leaders weigh in

Orthopedic

More large orthopedic groups are snapping up smaller practices and considering regional expansions to increase their economies of scale and grow their presence in new markets. New paths into value-based care and risk-sharing models are also top of mind for orthopedic leaders in addition to recruiting more physicians and adding new sites of service.

Seven orthopedic practice leaders shared how they are looking at growth:

Note: Responses were lightly edited for length and clarity.

Aaron Johnson. CEO of Twin City Orthopedics (Golden Valley, Minn.): We're always in growth mode, and that speaks to the culture and personality of our physicians. We have several projects that are about to begin or are already underway. We'll be opening a new facility in Plymouth, Minn., that will include a five-OR surgery center — that will be our newest addition from an ASC standpoint. Construction is just getting started, and that is anticipated to open in the fourth quarter of 2023. We are evaluating several other markets as well. With that expansion, we also need to recruit more physicians.

We're looking outside of Minnesota. You're seeing other orthopedic groups looking at growing regionally and even nationally. We expect to be the local orthopedic provider of choice, and that will evolve into a regional play for us as well. Never take your eyes off the core goal, which is patient care, but we plan to continue to grow TCO and the brand so we can take the excellent care we're providing to our current patients and bring that to new patients in other markets.

Alex Vaccaro, MD, PhD. President of Rothman Orthopaedic Institute (Philadelphia): We're expanding pretty rapidly. When we think about expansion, we examine a particular geographic location and what the orthopedic landscape is like. Some areas have a great orthopedic landscape; the communities are being serviced well, they've got great value-based programs and surgeons that buy into that philosophy. If that's the case, we feel that we may not provide further value. We go into places that may be a little bit behind when it comes to innovative value-based bundled payment programs, outpatient ambulatory care services, or there is fragmented care delivery. Those are prime markets we think are appropriate to expand into.

Nicholas Grosso, MD. President of the Centers for Advanced Orthopaedics (Bethesda, Md.): The biggest opportunity for growth lies in the shift to the outpatient setting. Here in Maryland, there are a significant number of one-room outpatient centers. We can increase efficiencies while remaining accessible for patients and providers alike by consolidating some of these existing surgery centers into multiroom facilities.

Michael Doyle, CEO of Florida Orthopaedic Institute (Tampa): FOI was built around the foundation of clinical excellence through education and research and is home to some of the highest regarded orthopedic surgeons in the world. Our focus will continue to be on partnering with like-minded best-in-class surgeons across the country who share a common desire to advance the practice of orthopedics and build a multigenerational business that is the destination of choice for highly skilled orthopedic surgeons.

Bruce Cohen, MD. CEO of OrthoCarolina (Charlotte, N.C.): We are strategically planning to grow our footprint regionally. We continue to look for opportunities that complement our current structure and coverage. A significant focus is on the ability to deliver value-based care and manage musculoskeletal population health. This requires regional growth and coordination. We also continue to grow our current practices to meet the needs of the communities that we currently serve. Finally, we are focusing on increasing our ambulatory surgery access and capacity and optimizing this critical service line.

Frank Aluisio, MD. Physician president of EmergeOrtho (Durham, N.C.): I don't think we'll add any other large groups because we want to maintain a flexible and nimble leadership. If we add too many other groups, you can have too large of a leadership and succumb to paralysis by overanalysis. We want to be able to stay ahead of the curve and be able to make quick decisions. I see us potentially adding small groups into the fold without diluting leadership and also managing small groups either alone or in conjunction with other large groups. 

North Carolina is a certificate-of-need state, so you can't open ASCs easily. There have been attempts over the past decade to get rid of CON legislation, so hopefully something will change soon. If that happens, we'll certainly expand into more ASCs. But right now we plan on doing a lot of our expansion through orthopedic urgent care and physical therapy facilities.

J. Bryan Williamson, MD. Medical Director of OrthoLoneStar (Houston): We are planning to grow and expand access to our services through opening additional sites of service, bringing on new providers, expanding into adjacent geographies and adding integrated treatment options. We will launch orthopedic bundles and institute value-based pathways. We plan to create a workplace environment for our employees and orthopedic partners that puts the patients' interests first.

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