There are several factors that contribute to an orthopedic practice's long-term stability and growth. OrthoCarolina is a large orthopedic practice that encompasses several locations around Charlotte, NC, and continues to expand through mergers with other area practices. Here, Daniel Murrey, MD, MPP, a spine surgeon and CEO of OrthoCarolina, discusses five factors contributing to the practice's success.
1. Partner or merge with others for increased profitability. With reimbursements decreasing and provider costs for technology and healthcare reform upgrades increasing, it's a lot more economical for private practice physicians or small group physicians to join a larger practice than to strike out on their own, says Dr. Murrey. Larger practices have the access to capital and negotiating structure with hospitals and payors that can help individuals increase their profitability. These partnerships also benefit the larger practice because the mergers spread fixed costs across a larger group of shareholders. It also standardizes care delivery by the practices, which drives down healthcare costs. "We continue to see opportunities to partner with like-minded orthopedists and hospitals that share our strategic goals," he says. "In many cases, both sides benefit substantially."
However, make sure there is a comfort level between both groups before the partnership occurs. Don't merge with an unfamiliar practice or someone who is new to the area until you know they will fit within the practice culture. All of the merging practices with OrthoCarolina were longstanding referral partners of the physicians.
2. Create one group ethic. When OrthoCarolina was formed in 2005 as a result of a merger between Miller Orthopaedic Clinic and Charlotte Orthopedic Specialists, the partnering physicians made a commitment to devote their efforts to the group and provide excellent care. Now, any physicians or groups wishing to merge with OrthoCarolina must also make the same commitment to foster a singular practice culture. "It's more important to support the interests of the group than of one individual," says Dr. Murrey. "We are also fortunate to have a great core group of surgeons who have stuck to an ethic of taking care of the entire community and really partnering with our healthcare system and providers to make sure we are improving the system of care."
When partnering with other physicians or groups, be explicit about practice values. "We let people know that a lot of what sets us apart is how we express our vision," says Dr. Murrey. "Anybody that joins us would support our reputation for service and access to quality care and will be compliant with the rules and policies of the practice."
3. Apply technology upgrades. When the two practices merged to form OrthoCarolina, the physicians constructed a new technology standard that included electronic medical records, digital radiology and a data warehouse. "This technology has created a platform that's fairly robust and has allowed us to serve as an alternative for smaller practices looking at the landscape and saying 'I need to be part of something bigger.' They are either looking at joining hospitals or large specialty groups, and we have the infrastructure to support them," says Dr. Murrey. The new technology also increases compliance needs with RAC audits and Comprehensive Error Rate Testing audits. Implementing these new technologies can be stressful for staff and drain financial resources because the staff must be trained on the new system. However, adaptability is a feature of a profitable practice. "The culture here is so accustomed to change that the staff gets nervous when things stay the same," he says. "The groups that are the most successful are the ones that are adaptable."
4. Create policies and hold surgeons accountable. Have a written set of practice policies that all physicians agree to uphold. When a surgeon breaks the rules or goes against the policy, make sure you hold them accountable for their actions. "You want policies that reward people for doing the right thing, not for people to get away with doing the wrong thing," says Dr. Murrey. "Surgeons don't want to see others getting away with doing the wrong thing. Our physician leadership is willing to call people out when they don't follow our policies. This is uncomfortable for a lot of physician groups, but it's a key to our success."
5. Exercise transparency of physician data. Every physician in the practice should have access to every other physician's practice data. This information includes production, compliance, and business office performance data such as payer mix, sessions worked, charges generated, denials, on-time dictation completion and total patient volume. "In the absence of information, everyone assumes the worst," says Dr. Murrey. "It really is important that transparency exists to keep people comfortable as part of a large organization. We've developed a data warehouse here that has become an integral part of management and governance. It takes the suspicion off the table because everyone knows everybody's score."
Learn more about OrthoCarolina.
Read other coverage on orthopedic practice management:
- 4 Tips for Cost-Effective Orthopedic Practice Staff Management
- 4 Leadership Tips for Orthopedic Practice Presidents
- 6 Challenges for Orthopedic Physician Practice Leaders and How to Overcome Them
1. Partner or merge with others for increased profitability. With reimbursements decreasing and provider costs for technology and healthcare reform upgrades increasing, it's a lot more economical for private practice physicians or small group physicians to join a larger practice than to strike out on their own, says Dr. Murrey. Larger practices have the access to capital and negotiating structure with hospitals and payors that can help individuals increase their profitability. These partnerships also benefit the larger practice because the mergers spread fixed costs across a larger group of shareholders. It also standardizes care delivery by the practices, which drives down healthcare costs. "We continue to see opportunities to partner with like-minded orthopedists and hospitals that share our strategic goals," he says. "In many cases, both sides benefit substantially."
However, make sure there is a comfort level between both groups before the partnership occurs. Don't merge with an unfamiliar practice or someone who is new to the area until you know they will fit within the practice culture. All of the merging practices with OrthoCarolina were longstanding referral partners of the physicians.
2. Create one group ethic. When OrthoCarolina was formed in 2005 as a result of a merger between Miller Orthopaedic Clinic and Charlotte Orthopedic Specialists, the partnering physicians made a commitment to devote their efforts to the group and provide excellent care. Now, any physicians or groups wishing to merge with OrthoCarolina must also make the same commitment to foster a singular practice culture. "It's more important to support the interests of the group than of one individual," says Dr. Murrey. "We are also fortunate to have a great core group of surgeons who have stuck to an ethic of taking care of the entire community and really partnering with our healthcare system and providers to make sure we are improving the system of care."
When partnering with other physicians or groups, be explicit about practice values. "We let people know that a lot of what sets us apart is how we express our vision," says Dr. Murrey. "Anybody that joins us would support our reputation for service and access to quality care and will be compliant with the rules and policies of the practice."
3. Apply technology upgrades. When the two practices merged to form OrthoCarolina, the physicians constructed a new technology standard that included electronic medical records, digital radiology and a data warehouse. "This technology has created a platform that's fairly robust and has allowed us to serve as an alternative for smaller practices looking at the landscape and saying 'I need to be part of something bigger.' They are either looking at joining hospitals or large specialty groups, and we have the infrastructure to support them," says Dr. Murrey. The new technology also increases compliance needs with RAC audits and Comprehensive Error Rate Testing audits. Implementing these new technologies can be stressful for staff and drain financial resources because the staff must be trained on the new system. However, adaptability is a feature of a profitable practice. "The culture here is so accustomed to change that the staff gets nervous when things stay the same," he says. "The groups that are the most successful are the ones that are adaptable."
4. Create policies and hold surgeons accountable. Have a written set of practice policies that all physicians agree to uphold. When a surgeon breaks the rules or goes against the policy, make sure you hold them accountable for their actions. "You want policies that reward people for doing the right thing, not for people to get away with doing the wrong thing," says Dr. Murrey. "Surgeons don't want to see others getting away with doing the wrong thing. Our physician leadership is willing to call people out when they don't follow our policies. This is uncomfortable for a lot of physician groups, but it's a key to our success."
5. Exercise transparency of physician data. Every physician in the practice should have access to every other physician's practice data. This information includes production, compliance, and business office performance data such as payer mix, sessions worked, charges generated, denials, on-time dictation completion and total patient volume. "In the absence of information, everyone assumes the worst," says Dr. Murrey. "It really is important that transparency exists to keep people comfortable as part of a large organization. We've developed a data warehouse here that has become an integral part of management and governance. It takes the suspicion off the table because everyone knows everybody's score."
Learn more about OrthoCarolina.
Read other coverage on orthopedic practice management:
- 4 Tips for Cost-Effective Orthopedic Practice Staff Management
- 4 Leadership Tips for Orthopedic Practice Presidents
- 6 Challenges for Orthopedic Physician Practice Leaders and How to Overcome Them