Becker's ASC Review

70 ORTHOPEDICS The 'sweet spot' for orthopedic supergroups: 3 practice leaders weigh in By Alan Condon T hree orthopedic surgeons leading supergroups of 100 physicians or more in Florida, North Carolina and Maryland discuss the advantages of larger physician practices and how they see consolidation evolving in the specialty. Note: Responses were lightly edited for length and clarity. Michael Doyle. CEO of Florida Orthopaedic Institute (Tampa): ere is definitely a sweet spot between leveraging scale and remaining nimble in your decision-making process. Ultimately this is dependent upon having the right people, processes and procedures in place. Even in a consolidated world, healthcare remains local. Certain models work in certain markets. Our model was designed to promote local independence to ensure specific needs and market drivers are met. I do not think there is such a thing as too big. Most groups experience difficulties when they fail to build the base infrastructure that provides the solid foundation for growth or diverge from the business where they experienced their initial success. While orthopedics is still largely fragmented, I do believe you will see practices continuing to consolidate in the years to come. Ultimately, physicians still control their own destiny. Yes, there are several outside pressures making it extremely difficult for the sole practitioner to survive in today's world, but those that are willing to roll up their sleeves are still able to be successful. at said, I don't believe you will see many physicians going out and starting their own practices in the current environment. Orthopedic surgeons coming out of fellowship today seek stability. Stability in the form of a pipeline of patients as well as clinical and administrative support. Staying independent can be the right plan, but having a plan is the most important initiative that a lot of practices lack. Bruce Cohen, MD. CEO of OrthoCarolina (Charlotte, N.C.): Scale is very important. Whether it is through affiliated networks, [management services organization] structures or group aggregation, it will be critical for independent orthopedists to align. We must be the leaders in musculoskeletal value-based care and population health. e only way to do this is through large groups or networks. So, at present, I do not believe "too big" is a barrier. It will become more challenging to compete and survive as a smaller entity. e future for medicine to be successful during these challenging healthcare times is to embrace value-based care and evidence-based approaches to care. is transition is going to be difficult and consume resources, which will be very challenging for smaller groups. One additional challenge for smaller organizations will be access to proper IT platforms and cybersecurity over time. Nicholas Grosso, MD. President of e Centers for Advanced Orthopaedics (Bethesda, Md.): ere is no limit for how big an independent orthopedic group should be, so long as it is structured in a way that maintains efficiencies amidst growth. With 160 physicians and 60 office locations, my practice is considered a supergroup. When structured appropriately, the benefits of a supergroup of our size empowers physicians with the resources needed to navigate the rapidly changing healthcare landscape while retaining the independence to practice medicine the way they see fit. n The 1 issue that affects all businesses and Americans By Mariah Muhammad Thomas Scully, MD, serves as a neurosurgeon at Tucson, Ariz.-based Northwest NeuroSpecialists. Dr. Scully spoke to Becker's about the biggest challenges facing his practice today and what excites him for the future. Question: What issues are you spending most of your time on today? Dr. Thomas Scully: I am wearing a few hats currently. Besides an active, thriving private practice, I am chairman of surgery at my hospital and medical director for our ASC. Thus, the issues I deal with daily are varied. In my practice, we continually strive to provide timely, quality care in an environment made more difficult each day by prior authorizations, many of which interfere with the services patients need. In addition, inflation affects our practice as it impacts all businesses and Americans. Unfortunately, we exist in an income-fixed environment, or income declining as the case may be. We are at the mercy of Medicare and a few large insurance companies regarding our reimbursement. As chair of surgery, our hospital faces the 2022 post-COVID-19 world, which is quite different from 2019. The overarching issue is the lack of staff. This impacts our ability to do surgery, recover the patient and take care of them when hospitalized. As a corollary, we are attempting to upgrade big- ticket surgical adjunctive equipment, which is a major capital expense. These are tough juggling acts for hospitals. As medical director of our ASC, I have very few headaches! However, our center is blessed with an incredible nurse that is our administrator. She stamps out many fires and saves me on a weekly basis. Q: What are you most excited about right now? TS: I am excited to see the future. Many are seeing a bleak time ahead. But, we have a daughter as an ICU nurse, and our son is in medical school. Knowing their dedication and work ethic allows me to see the future in their generation's hands in a better light! n

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