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47 PRACTICE MANAGEMENT What Will it Take for Independent Practice to Survive & Thrive Today? By Anuja Vaidya Five spine surgeons weigh in on the future of independent practice in America. Alden Milam, MD. Spine Surgeon at OrthoCarolina (Charlotte, N.C.): It's hard to imagine independent solo practice existing in the future because of constant change in healthcare financing and regulation. Howev- er, large independent practice will have several distinct advantages that will help that employment model thrive. Plas T. James, MD. Spine Surgeon at Atlanta Spine Institute: I'm an individual physician and I'm surviving well. However, I think it really depends on when you start out. If I had to start out today from scratch, I think it would be very dif- ficult but still viable. I think I have advantages in that I've been around long enough in the same market, in the same part of the town and city. ere's always room for individual healthcare, provided you can offer great service. No matter what it is, people want service. ey don't want a robo-phone. ey want to speak with a real person. If you give them individual attention, I think they'll come see you. It's important to make sure you answer their questions, and not get so busy trying to input data as opposed to listening to the patient. Independent physicians can survive if they remember to take care of their pa- tients' needs and address them individually. Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I think it is challenging, but doable. Independent physicians have to regularly educate themselves regarding trends in their specialty. ey have to have the ability to learn and apply new ideas to their practices in an efficient manner. In individ- ual practice, there is also the opportunity to implement new ideas more rapidly than a larger bureaucratic model can do. Our practice has been diving ever deeper into the bundled payment model with some early success. Having the degree of con- trol we do in creating an "all in, all one" price model gives the independent sur- geons, especially those with a facility, an advantage when competing on value. Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): With ever-increasing difficulty (thanks to the ever-increasing burden of new regulations and declining reimbursements), but yes! An independent physician must be willing to adapt to the changing environment and stay on the cutting edge of new science and technologies in his/her field to stay competitive. Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): We are seeing independent physicians on the decline in today's healthcare landscape. Dealing with regulatory pressures, growing insurance compa- nies, EHRs and other hurdles is troublesome to say the least. Still, there are a few ways physicians can maintain their independence. One way is to consolidate practic- es. Physicians can band together and create much larg- er private practices. is allows for more negotiating power with insurance companies and less financial strain on individuals. n Why Rothman Institute Partnered With Northwell Health, and Where They Will Expand in the Future By Laura Dyrda I n April, Philadelphia-based Rothman Institute announced a strategic affiliation with New Hyde Park, N.Y.-based Northwell Health, which will expand their geographic footprint. "Our market base is Philadelphia and South Jer- sey historically, however, with the market changes we felt it was necessary to expand our geograph- ic footprint into Central North Jersey and New York," says Rothman Institute CEO Michael West. Alex Vaccaro, MD, PhD, MBA (President) and Mr. West began conversations with Northwell CEO Michael Dowling at health conferences and the two found their organizational philosophies were very similar. "Their vision as far as quality service and providing value-based care are consistent with what we are trying to do," says Mr. West. The New York market is admittedly very complex, but Mr. West and Roth- man are up to the challenge. "Working with a large system like Northwell where they understand the market very well makes it easier for us to come in and be successful because we are working closely with them." The partners expect to develop orthopedic center of excellence locations in Manhattan, Westchester and Greenwich Village, where Northwell already has an ASC and medical office building. The group will likely add 20 to 30 surgeons and 10 to 15 non-op- erative physicians to fill the new practice locations. Rothman Institute already has an established prece- dent for strategic partnerships with health systems; the practice has an academic and teaching relation- ship with Jefferson Health System in Philadelphia, PA, and plans to bring a similar model to its new partnership in the New York area. In addition to developing orthopedic centers of excellence, the practice looks to partner in sur- gery center syndications as the current inpatient orthopedic volume shifts to the outpatient setting. Over the next three to five years, anywhere from 25 percent to 35 percent of the current inpatient orthopedic surgeries could be shifted to outpa- tient settings. Rothman Institute currently has ownership interest in two surgical specialty hospitals in Pennsylvania and surgeons perform both inpatient and outpa- tient cases. They also have six patient ASCs and are currently developing four more in the Philadel-