Becker's Spine Review

21 PRACTICE MANAGEMENT The Future of Private Practice: Key Thoughts From OrthoCarolina CEO Dr. Daniel Murrey By Laura Dyrda S uccessful private practices are focused on the forces driving healthcare today: collaboration and integration, transparency on quality and cost, systems thinking and innovation. At the Becker's ASC 22nd Annual Meeting — e Business and Operations of ASCs in Chicago, Daniel Murrey, MD, CEO of OrthoCarolina, gave a presentation titled "e Future of Private Practice — Is it Supergroup, Employment or Neither? oughts from the Leader of the Country's Largest Orthopedic Group." "A lot of the change is driven by the increasing volume of data. Big data is real and we are being asked to contribute," said Dr. Murrey. "Groups that aren't on EMR or digital radiology now have to worry about data collection. If you are in a solo practice, the idea of spending nights and weekends understanding regulatory changes and learning government updates is difficult." As a result, many solo practitioners and small groups are joining larger groups or merging as larger physician organizations. Across the country, only 17 percent of physicians reported being in solo practice in 2014, down 8 percent from 2012, according to a report form e Physicians Foundation titled "2014 Survey of America's Physicians: Practice Patterns and Perspectives." ere were 35 percent of physicians who were physician practice owners in 2014, down from 49 percent in 2012. But independence is still alluring and many specialists feel is the best route forward. Physicians have a fiduciary responsibility for their patients; they're obliged to work for the patient's benefit, not their own. "In those terms, the more independent a fiduciary is, the easier it is for them to live up to their fiduciary responsibility," said Dr. Murrey. "We know there is a difference between internal auditors and external auditors. Physicians can be increasingly dependent in employed situations and asking someone to risk their employment can be difficult." As the CEO of OrthoCarolina, Dr. Murrey champions physician independence and spends time discussing independent physician opportunities with medical students across the country. Physicians, he argued, have unique perspectives as leaders in the healthcare space and should take on more active leadership roles. "Physicians are trained to look at the world in a certain way and that creates an affinity among them," he said. "Physicians even in competing health systems are still brethren and they have great affinity and respect for one another. at's a culture you can build on. Health systems have a culture defined by their leadership, who could be physicians, but might not be. ey are more likely to have cultural complexity." Many private practice physicians choose to stay independent for the autonomy; however, Dr. Murrey argued that only autonomy for better clinical judgments is acceptable. Autonomy gives physicians control over the practice setting; the autonomy to use any implant, even if it doesn't have the data to back it up, won't make private practice successful. e autonomy to arrive at the operating room late isn't the autonomy surgeons need. "Physicians need to have autonomy to serve the patient's interest, but if it's to serve someone who isn't the patient, that's not the best situation," he said. Becoming a systems thinker holds autonomous physicians accountable, and is one of the biggest transitions in healthcare today. Instead of focusing just on the surgery and radiographic outcomes, surgeons are now challenged to take responsibility for Dr. Daniel Murrey "If you have physicians emboldened for higher quality at a lower cost, the market should reward you with value-based contracting, ACOs and bundled payments." — Daniel Murrey, MD, of OrthoCarolina in Charlotte, N.C.

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