Here are 10 tips from orthopedic group leaders that will help maintain a strong practice in 2012.
1. Practice evidence-based orthopedics. At the moment, there isn't a large amount of strong evidence-based research that supports orthopedic interventions. However, strong studies have become crucial for receiving reimbursement for orthopedic treatments and surgeries, which has prompted research institutions to accelerate their focus on evidence-based studies. "We'll need to show a positive impact in clinical results as well as financial results so people can see both sides of the equation," says James Silliman, MD, an orthopedic sports medicine physician and CEO of Steadman Hawkins Clinic of the Carolinas in Greenville, S.C.
Dr. Silliman and his partners are beginning a partnership with Blue Cross that aims to validate and document clinical outcomes and report financial resources to improve patient and employer satisfaction. The partnership encompasses orthopedic surgeons, neurosurgeons, physical medicine specialists, anesthesiologists, pain management physicians, physical therapists, ancillary providers and other medical professionals. "We want to reduce the indirect cost of care, streamline it and make it manageable and timely for our patients," he says. "If we can all work together, hopefully we can reduce the cost of care and receive better outcomes."
The study will be examining which treatment methods are most appropriate for each type of patient, when an MRI is necessary, how long it takes before the patient can return to regular work and the costs associated with care. "We have developed our own technology on the I-pad to work in real-time with our physicians and cater to the specific physician-patient visit," says Dr. Silliman. "It will complement the EMR, but in order to do this, we had to customize a program to our assets and our own flow of care."
2. Implement an EMR system. One of the biggest challenges private practice surgeons face when practicing evidence-based medicine is data collection and organization. Surgeons don't have time to input patient information multiple times into different databases and most practices don't have the resources necessary to hire another employee for this type of data management. However, implementing electronic medical record systems takes data input from the surgeon and organizes it in several different ways simultaneously. "We record the data like we would in the ordinary, every day process of seeing the patient," says Scott Trenhaile, MD, an orthopedic surgeon with Rockford (Ill.) Orthopedic Associates. "We collect the data on the front end so it can be extracted later electronically. That's how private practice practitioners can contribute on a grand scale."
3. Low staff turnover, high engagement. As a way to support patient satisfaction and manage expenses, orthopedic groups should also be focused on keeping their staff happy. "Practices have to remember that their most valuable resources are their staff and they have to work really hard to keep their staff happy," says John Wipfler, CEO of OA-Centers for Orthopaedics. "The average medical practice turnover rate is 18-19 percent and we are somewhere around 9 percent — half of the national average."
It's important to keep good staff members who know how to treat patients consistent with your group's patient-centered culture and can quickly answer any questions patients might have about their care. Training new staff members takes a great deal of time and money, and if they leave the practice quickly they are a drain on resources.
"If you want to retain experienced and good people, it makes sense to put resources into keeping them happy," says Mr. Wipfler. "Pay is only the beginning and it doesn't need to be at the top of the scale. Respecting their wisdom, giving them a voice in the practice, having working committees with staff and creating many channels for hearing about what they are thinking and feeling. We want to keep morale up and be very transparent about what is happening in the practice. Enlist them in helping you solve your problems."
4. 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 Daniel Murrey, MD, MPP, a spine surgeon and CEO of OrthoCarolina. "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."
5. Run a lean organization. Cost-effective orthopedic practices often employ lean management tactics, which means having only enough resources to run the practice, says Todd Albert, MD, spine surgeon and president of Rothman Institute in Philadelphia. For example, Rothman Institute makes sure all its space is revenue generating space. "We don't have a lot of empty offices," says Dr. Albert. Instead, the space is used for clinical purposes or business functions. The practice also employs a minimum number of full-time employees with each physician to keep costs low but still ensure patient comfort and practice efficiency.
6. Include ancillary services for increased revenue. Orthopedic practices can provide ancillary services, such as injections, radiologic studies and orthotics to increase practice profits. The increased revenue from these services has allowed Rothman Institute physicians to pursue academic endeavors, which is an important part of the practice's mission, says Dr. Albert. The ancillary revenue also provides an extra layer of protection against downgrades in the insurance markets. When reimbursements decline, these services can help support the continuation of the practice.
7. Utilize electronic media to promote the practice. Create a practice website that includes information about the physicians, patient outcomes and patient satisfaction. Use search engine optimization to make sure the practice website is the first site that comes up when patients search for orthopedic surgeons in your area, says Peter Althausen, MD, an orthopedic surgeon at Reno Orthopaedic Clinic and chairman of the board of directors of The Orthopaedic Implant Company . Practices can also install computer terminals in the waiting rooms so patients can access the practice website and data while they wait.
You can also market directly to patients through e-mail. "You can send an e-newsletter out to patients every month that gives updates on new procedures, features a new physician and provides them with information about upcoming seminars," he says. "The newsletters can be created pretty easily and they don't cost any money to send."
8. Highlight cash-based services in your practice. Geoffrey Connor, MD, founder of D1 Sports Medicine in Birmingham, Ala., made the decision last year to begin targeting cash pay patients for his practice. While he is a trained orthopedic surgeon and performs joint replacement surgeries regularly, he also offers services such as platelet-rich plasma injections and in-office fiberoptic arthroscopy on a cash basis. Additional cash-based services include sports performance measures, such as body mass index and nutritional analysis, to create an environment of concierge sports medicine.
"If more subspecialists turn to the cash patient model, Medicare patients may have to wait longer for care or choose to pay more out-of-pocket," says Dr. Connor. "I don't want to scare Medicare beneficiaries, but hip implants and surgeries are expensive and the proposed rates just aren't viable. I set up a system like plastic surgeons or bariatric care; I'm trying to evolve an orthopedic practice that captures patients who need medical services with added value."
9. Merge with other practices. The costs of owning a medical practice have risen over the past few years while reimbursements stagnated or decreased, which has made an increasing number of orthopedic surgeons choose hospital employment over private practice. When small group practices feel the pinch of today's circumstances but aren't willing to sign a hospital employment contract, many choose merging with other practices to form a larger group practice that can leverage power within the community.
"Physicians groups have been getting larger over the past few years in an attempt to gain bargaining power with insurance companies," says David Ott, MD, a surgeon with Arizona Orthopaedic Associates in Phoenix. "Now, more are assimilating because of the political mandates. We've created a merger of 19 orthopedic practices with 27 locations and 30-plus PAs or nurse practitioners."
Dr. Ott's practice became a limited liability company and functions as a single group with multiple divisions. "You have to give up some of the autonomy and freedom that you had as a smaller group, but at the same time, the safety net provided by a larger group is substantial," he says.
10. Don't react to changes in the healthcare system with fear. When you are merely reacting to the fear of uncertainty, you will miss potential opportunities for taking advantage of a tumultuous time. Instead of fearing potential changes, orthopedic practices should identify their competitive advantages, especially over hospitals, and find ways to exploit them. "It's hard for large hospital organizations to feel friendly to patients, like a smaller practice does, which is a competitive advantage we could exploit," says Mr. Wipfler. "Large hospital organizations can also be clunky, and one of the things we can do is create a high level of customer service that hospitals find hard to compete with."
Another point that Mr. Wipfler often highlights is the group's ability to spread throughout the community while the hospital is fairly grounded within the walls of a single facility. "A hospital is locked where it is, but we are able to have satellite offices in a number of areas," he says. "Local hospitals can't as easily build somewhere else, but we can be nimble and create facilities that are closer to our patients."
Related Articles on Orthopedic Practices:
Improving Orthopedic Patient Care: 7 Tips for Developing Physician-Patient Partnerships
5 Principles of Rothman Institute's Innovative Orthopedic Practice Business Model
10 Tips for Aspiring Orthopedic and Spine Group Leaders
1. Practice evidence-based orthopedics. At the moment, there isn't a large amount of strong evidence-based research that supports orthopedic interventions. However, strong studies have become crucial for receiving reimbursement for orthopedic treatments and surgeries, which has prompted research institutions to accelerate their focus on evidence-based studies. "We'll need to show a positive impact in clinical results as well as financial results so people can see both sides of the equation," says James Silliman, MD, an orthopedic sports medicine physician and CEO of Steadman Hawkins Clinic of the Carolinas in Greenville, S.C.
Dr. Silliman and his partners are beginning a partnership with Blue Cross that aims to validate and document clinical outcomes and report financial resources to improve patient and employer satisfaction. The partnership encompasses orthopedic surgeons, neurosurgeons, physical medicine specialists, anesthesiologists, pain management physicians, physical therapists, ancillary providers and other medical professionals. "We want to reduce the indirect cost of care, streamline it and make it manageable and timely for our patients," he says. "If we can all work together, hopefully we can reduce the cost of care and receive better outcomes."
The study will be examining which treatment methods are most appropriate for each type of patient, when an MRI is necessary, how long it takes before the patient can return to regular work and the costs associated with care. "We have developed our own technology on the I-pad to work in real-time with our physicians and cater to the specific physician-patient visit," says Dr. Silliman. "It will complement the EMR, but in order to do this, we had to customize a program to our assets and our own flow of care."
2. Implement an EMR system. One of the biggest challenges private practice surgeons face when practicing evidence-based medicine is data collection and organization. Surgeons don't have time to input patient information multiple times into different databases and most practices don't have the resources necessary to hire another employee for this type of data management. However, implementing electronic medical record systems takes data input from the surgeon and organizes it in several different ways simultaneously. "We record the data like we would in the ordinary, every day process of seeing the patient," says Scott Trenhaile, MD, an orthopedic surgeon with Rockford (Ill.) Orthopedic Associates. "We collect the data on the front end so it can be extracted later electronically. That's how private practice practitioners can contribute on a grand scale."
3. Low staff turnover, high engagement. As a way to support patient satisfaction and manage expenses, orthopedic groups should also be focused on keeping their staff happy. "Practices have to remember that their most valuable resources are their staff and they have to work really hard to keep their staff happy," says John Wipfler, CEO of OA-Centers for Orthopaedics. "The average medical practice turnover rate is 18-19 percent and we are somewhere around 9 percent — half of the national average."
It's important to keep good staff members who know how to treat patients consistent with your group's patient-centered culture and can quickly answer any questions patients might have about their care. Training new staff members takes a great deal of time and money, and if they leave the practice quickly they are a drain on resources.
"If you want to retain experienced and good people, it makes sense to put resources into keeping them happy," says Mr. Wipfler. "Pay is only the beginning and it doesn't need to be at the top of the scale. Respecting their wisdom, giving them a voice in the practice, having working committees with staff and creating many channels for hearing about what they are thinking and feeling. We want to keep morale up and be very transparent about what is happening in the practice. Enlist them in helping you solve your problems."
4. 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 Daniel Murrey, MD, MPP, a spine surgeon and CEO of OrthoCarolina. "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."
5. Run a lean organization. Cost-effective orthopedic practices often employ lean management tactics, which means having only enough resources to run the practice, says Todd Albert, MD, spine surgeon and president of Rothman Institute in Philadelphia. For example, Rothman Institute makes sure all its space is revenue generating space. "We don't have a lot of empty offices," says Dr. Albert. Instead, the space is used for clinical purposes or business functions. The practice also employs a minimum number of full-time employees with each physician to keep costs low but still ensure patient comfort and practice efficiency.
6. Include ancillary services for increased revenue. Orthopedic practices can provide ancillary services, such as injections, radiologic studies and orthotics to increase practice profits. The increased revenue from these services has allowed Rothman Institute physicians to pursue academic endeavors, which is an important part of the practice's mission, says Dr. Albert. The ancillary revenue also provides an extra layer of protection against downgrades in the insurance markets. When reimbursements decline, these services can help support the continuation of the practice.
7. Utilize electronic media to promote the practice. Create a practice website that includes information about the physicians, patient outcomes and patient satisfaction. Use search engine optimization to make sure the practice website is the first site that comes up when patients search for orthopedic surgeons in your area, says Peter Althausen, MD, an orthopedic surgeon at Reno Orthopaedic Clinic and chairman of the board of directors of The Orthopaedic Implant Company . Practices can also install computer terminals in the waiting rooms so patients can access the practice website and data while they wait.
You can also market directly to patients through e-mail. "You can send an e-newsletter out to patients every month that gives updates on new procedures, features a new physician and provides them with information about upcoming seminars," he says. "The newsletters can be created pretty easily and they don't cost any money to send."
8. Highlight cash-based services in your practice. Geoffrey Connor, MD, founder of D1 Sports Medicine in Birmingham, Ala., made the decision last year to begin targeting cash pay patients for his practice. While he is a trained orthopedic surgeon and performs joint replacement surgeries regularly, he also offers services such as platelet-rich plasma injections and in-office fiberoptic arthroscopy on a cash basis. Additional cash-based services include sports performance measures, such as body mass index and nutritional analysis, to create an environment of concierge sports medicine.
"If more subspecialists turn to the cash patient model, Medicare patients may have to wait longer for care or choose to pay more out-of-pocket," says Dr. Connor. "I don't want to scare Medicare beneficiaries, but hip implants and surgeries are expensive and the proposed rates just aren't viable. I set up a system like plastic surgeons or bariatric care; I'm trying to evolve an orthopedic practice that captures patients who need medical services with added value."
9. Merge with other practices. The costs of owning a medical practice have risen over the past few years while reimbursements stagnated or decreased, which has made an increasing number of orthopedic surgeons choose hospital employment over private practice. When small group practices feel the pinch of today's circumstances but aren't willing to sign a hospital employment contract, many choose merging with other practices to form a larger group practice that can leverage power within the community.
"Physicians groups have been getting larger over the past few years in an attempt to gain bargaining power with insurance companies," says David Ott, MD, a surgeon with Arizona Orthopaedic Associates in Phoenix. "Now, more are assimilating because of the political mandates. We've created a merger of 19 orthopedic practices with 27 locations and 30-plus PAs or nurse practitioners."
Dr. Ott's practice became a limited liability company and functions as a single group with multiple divisions. "You have to give up some of the autonomy and freedom that you had as a smaller group, but at the same time, the safety net provided by a larger group is substantial," he says.
10. Don't react to changes in the healthcare system with fear. When you are merely reacting to the fear of uncertainty, you will miss potential opportunities for taking advantage of a tumultuous time. Instead of fearing potential changes, orthopedic practices should identify their competitive advantages, especially over hospitals, and find ways to exploit them. "It's hard for large hospital organizations to feel friendly to patients, like a smaller practice does, which is a competitive advantage we could exploit," says Mr. Wipfler. "Large hospital organizations can also be clunky, and one of the things we can do is create a high level of customer service that hospitals find hard to compete with."
Another point that Mr. Wipfler often highlights is the group's ability to spread throughout the community while the hospital is fairly grounded within the walls of a single facility. "A hospital is locked where it is, but we are able to have satellite offices in a number of areas," he says. "Local hospitals can't as easily build somewhere else, but we can be nimble and create facilities that are closer to our patients."
Related Articles on Orthopedic Practices:
Improving Orthopedic Patient Care: 7 Tips for Developing Physician-Patient Partnerships
5 Principles of Rothman Institute's Innovative Orthopedic Practice Business Model
10 Tips for Aspiring Orthopedic and Spine Group Leaders