Becker's ASC Review

40 ORTHOPEDICS 10 large orthopedic practices growing bigger in 2019 By Laura Dyrda H ere are 10 large orthopedic practices that have acquired new physicians, built new locations and expanded technological capabilities in the first quarter of the year: e Centers for Advanced Orthopaedics in Bethesda, Md., has grown practice revenue by 75 percent since opening in 2014 and re- ports a 40 percent increase in physician vol- ume. e practice has grown to nearly 180 physicians throughout Washington, D.C., Maryland and Northern Virginia, organi- cally and through acquisitions. e practice plans to add new groups and partners regionally and beyond, and sees population health as a huge opportunity in the future. e CORE Institute, based in Phoenix, opened a new clinic in Scottsdale, Ariz. e practice now includes 10 locations in Arizona and 19 locations overall. e new location expanded the facility's square foot- age by 50 percent. In September 2018, the practice added eight physicians and aims to continue growing in the future. Illinois Bone & Joint Institute, based in Morton Grove, opened a new physician and rehabilitation clinic in Crystal Lake, Ill., and a physical therapy clinic in Palatine, Ill., earlier this year. e practice now has more than 100 physicians and 20 locations, as well as five orthopedic urgent care locations in the Chicago area. Midwest Orthopaedics at Rush in Chicago opened its first freestanding physical therapy clinic in Orland Park, Ill. e practice also began construction on a 100,000-square- foot facility in Oak Brook, Ill., in January. Midwest Orthopaedics at Rush physicians provided care to 66,000 patients in 2018 and performed more than 16,000 surgical proce- dures across six locations in Chicago. OrthoCarolina, based in Charlotte, N.C., continues to add physicians to its 300-plus provider group, focused on orthopedics, sports medicine and spine. e practice has 32 orthopedic clinic locations across North Carolina as well as physical therapy, MRI and urgent care. In 2019, the practice has added two orthopedic surgeons. OrthoVirginia, based in Richmond, acquired Virginia Beach-based Virginia Institute for Sports Medicine and now includes more than 100 physicians and 22 office locations. e practice includes outpatient surgery centers and physical therapy clinics as well. Proliance Surgeons' Proliance Orthopedic Associates opened an orthopedic urgent care center in Tukwila, Wash. Proliance, based in Seattle, has clinics in Renton and Covington, Wash., as well that serve more than 50,000 patients each year. Rothman Orthopaedics, based in Philadel- phia, opened new offices in Doylestown Town- ship, Pa., and Monmouth Junction, N.J., earlier this year. e practice also partnered with Leawood, Kan.-based NueHealth and Denver- based MUVE Health to expand beyond the East Coast; it is exploring opportunities in Florida, Texas and several Midwestern states. e Steadman Clinic based in Vail, Colo., opened a new clinic in Frisco, Colo. e prac- tice plans to add sports medicine physician Armando Vidal, MD, in May. He will become the practice's 15th physician. Dr. Vidal previ- ously served as the executive vice chair in the department of orthopedics at the University of Colorado Denver School of Medicine. Resurgens, based in Atlanta, began in 1999 as a merger between seven independent physician groups and now has 24 offices in Georgia. e practice implemented an artificial intelligence platform in March to improve data accuracy and clinical work- flows for its 100-plus affiliated physicians. n Challenges, opportunities and bundled payments in orthopedics: Q&A with Dr. Michael Chmell By Alan Condon M ichael Chmell, MD, is the medical director of Rock- ford-based Ortho Illinois Surgery Center. Here, he shares his thoughts on modern challenges fac- ing orthopedic surgeons, bundled payments and opportunities to advance the field. Question: What are the one or two biggest challenges for you as an orthopedic surgeon today? What keeps you up at night? Dr. Michael Chmell: I think the big- gest challenge in orthopedic surgery is remaining independent, not work- ing at the behest of hospital systems. Part two of this is whether the ongoing trend of "super groups," with dozens or hundreds of members is the cor- rect path to compete with this system or doomed to follow the same path. My view is that independent practices of 10 to 25 surgeons is optimal in terms of providing economical quality care, optimizing the best surgeons performing the correct cases. Q: How do you see bundled pay- ments, value-based care and other new payment models affecting orthopedics? MC: Regarding bundled payments, I view this as optimal for providing eco- nomically correct care for our patients with the highest quality. No one knows the best way to treat a total hip or knee patient better than their surgeon, who under such a system will direct all care. That being said, an infrastruc- ture is needed to carry out bundled payments: risk assessment nursing pre-op, nurse managers to assist with the bundle post-op, dedicated anes- thesiology and physical therapy. Once the system is in place, however, private orthopedic practices and ASCs should hugely outperform any hospital sys- tem in terms of profitability. Q: Where is the best opportunity for orthopedic surgeons to ad- vance the field? MC: Orthopedic surgeons need to take on a greater role in patient care. We need to play a greater role in such things as BMI reduction, HbA1C reduction and the elimination of un- necessary testing, such as MRIs done for inappropriate patients. Taking such things out of the primary care or educating them more could save more money than bundled payments in my opinion. We should market ourselves as musculoskeletal primary care and take over all such testing, rather than have it originate at a medical primary care office. n

• Cover