Excelsior Orthopaedics Makes the March Cover of Outpatient Surgery Magazine

Excelsior Orthopaedics Makes the March Cover of Outpatient Surgery Magazine

Despite countless offers from hospitals and corporate management companies to buy into their ASC, Excelsior Orthopaedics has big plans for expansion while remaining 100% physician-owned. “Our freedom is what’s most important to us and losing it is our biggest threat. So, we’re resisting,” said David Uba, CEO. Hold the line! Read more.

Health Care Certificate-of-Need Repeal Approved by South Carolina Senate

Health Care Certificate-of-Need Repeal Approved by South Carolina Senate

The OrthoForum celebrates the recent news out of South Carolina: The Senate has approved the certificate-of-need repeal, stripping development regulations of the constant “red tape” and allowing affordable, quality healthcare to be made available to patients throughout the state. “We are hopeful that the CON will go through the House as easily as it did through the Senate,” said Ron Chorzewski, CEO of OrthoForum member Midlands Orthopaedics & Neurosurgery. “It is a great opportunity for high quality, low cost providers to provide patients with the care they need.” Read more: https://bit.ly/3uhEniX

Image: Palmetto Promise Institute

Washington’s Proliance Surgeons and Minnesota’s Revo Health Strike Blockbuster Partnership

Washington’s Proliance Surgeons and Minnesota’s Revo Health Strike Blockbuster Partnership

Proliance Surgeons announce Troy Simonson as new Chief Executive Officer to lead growth and innovation for the 250+ physician practice. Read more.

Crystal Clinic Orthopaedic Center Announces New CEO

Crystal Clinic Orthopaedic Center Announces New CEO

“As the new CEO of Crystal Clinic, I recognize our people, including our world-class surgeons and the entire team of healthcare professionals are essential to our reputation of nationally-renowned care by attaining exceptional outcomes and delivering an outstanding, award-winning patient experience.”

– Dan Ferry, CEO, Crystal Clinic

Read more here.

The OrthoForum Celebrates 20 Years of Progress

The OrthoForum Celebrates 20 Years of Progress

The past ten months have been challenging, to say the least, but as we bring the year to a close, we would like to take a moment to recognize a major milestone: 2020 marks the 20th anniversary of the OrthoForum.

In the late 90s, OrthoForum CEO Glenn Sumner and Col. George Kellum, former CEO of OrthoIndy, noticed a bifurcation between physicians and administrators in the world of private, orthopaedic practices. There were other orthopaedics-related conferences and meetings happening at the time, but none specifically addressing the industry’s business needs and how physicians and administrators could best work together to advance their practices. After attending a conference in 1999, Sumner and Kellum agreed there was a better way and discussed getting a few large (20+ physicians) groups together for a new kind of meeting. That discussion continued over the next nine months. Then, according to Sumner, “One day, I said ‘We’re going to do this.’ I called George and said, ‘Let’s go find seven or eight of our friends with similar practices and see if they’d be willing to come to a meeting.’ That’s how it started.”

In 2001, the first meeting of what was to become the OrthoForum took place at the Grove Park Inn in Asheville, North Carolina. Attendees included members of Campbell Clinic, OrthoTennesssee, OrthoIndy and organizations that would eventually become OrthoCarolina and Tennessee Orthopaedic Alliance, as well as a few others. “It was really very much an organizational meeting,” said Sumner. “We discussed what we wanted to do, what made sense, and what didn’t.” One of the things that became quickly obvious was the need for good benchmarking data that was specific to large orthopaedic practices. Mike McCaslin with Somerset CPAs, who Glenn and George had worked with was also invited to the initial meeting and offered his and Somerset’s expertise to help us meet that need.

As the team came together and the meetings continued, two things were recognized. First, to have the intimacy, openness, and the ability to discuss issues transparently, we needed to keep the number of member groups small. Second, there were too many good, independent groups throughout the country that could benefit from the networking and interchange that had been set up. Most of the original groups were located in the Southeast, which we named the Asheville OrthoForum. But in 2006, the first expansion occurred with the creation of the Western OrthoForum for groups in the Western United States. Shortly after, in 2009 and 2010, the Amelia Island Forum (now Atlantic OrthoForum) and Reynolds Plantation Forum (now Reynolds OrthoForum) were added, as well as an annual meeting that would bring together members from all the regional Forums. As Sumner recalls, “The idea behind an annual meeting was to bring all the member groups together to discuss issues that we could address collectively, where we could drive new opportunities and benefits based on the combined strength of all the groups.” Along the way, those discussions would allow the organization to grow strategically and to create initiatives in group purchasing, advocacy, recruitment, and outcome metrics.

While the original intent of the organization was to help groups in similar situations address challenges that they all were facing, the mission has evolved over the years to advocate for and promote private, independent orthopaedic clinics. As Mike McCaslin explains, “When you look at healthcare decision making, physicians are best positioned to make medical decisions. When physicians are owned by somebody else who is responsible for their pay, those people influence the decision making. Physicians should be free to make the right decisions regarding diagnosis, procedures, and costs to get the best outcome for their patients. Physicians are the only people involved in healthcare delivery that can act as the steward of a patient’s healthcare dollars.”

Today, the OrthoForum is stronger than ever. It is the nation’s largest network of orthopaedic physician groups dedicated to the support and advancement of the private, independent practice of medicine. It includes many of the largest, privately-owned orthopaedic practices in the US. It continues to support its membership by offering services and opportunities in benchmarking, networking, innovation, and advocacy to help them remain independent and thrive in the ever changing healthcare environment. In addition, the OrthoForum is helping the smaller orthoapedic practices through its OrthoForum Network member OrthoConnect (for groups less than 20 physicians). Plus, as Sumner states “We are especially excited about the road ahead. Our grand vision is how we can not only help our groups remain successful in providing services in their current setting, but how can we act as one in the delivery of value-based care.” McCaslin continues, “I think one of the next steps is driving the delivery of musculoskeletal care through direct contracting with employers and developing risk-based arrangements with innovative payers for population health management.”

We remain incredibly thankful to our membership, our sponsors, and our leadership, without whom we would not be where we are today – looking forward to driving change and serving our patients for many successful years to come.

Proliance Surgeons Partners With Regence and Signify Health to Accelerate Value-based Care

Proliance Surgeons Partners With Regence and Signify Health to Accelerate Value-based Care

This new partnership is designed to reduce overall cost of care while offering a more profound relationship between the medical professional team and its patients. Read more.

Crystal Clinic Orthopaedic Center Earns 5-star Rating from CMS

Crystal Clinic Orthopaedic Center Earns 5-star Rating from CMS

Crystal Clinic Orthopaedic Center has earned the five-star rating in patient experience from the Centers for Medicare & Medicaid Services (CMS), reinforcing its leadership position as a provider of Nationally-Renowned Orthopaedic Care. Read the full press release here.

Price Transparency Spotlight

Price Transparency Spotlight

Price transparency is frequently discussed in the media as employer and consumer groups clamor for a competitive healthcare marketplace that functions like the rest of the economy. Fierce opposition primarily from health systems and traditional insurance plans has slowed the pace of this change and convinced many practice leaders that we still have plenty of time to respond. When considered in the list of competing priorities that includes navigating regulatory changes, physician comp formulas, daily practice operations, collecting outcomes, maintaining patient satisfaction, recruiting physicians and keeping peace with the local hospitals all in the midst of a pandemic, making time to create a transparent price structure most often falls to the bottom.

Establishing price transparency within a practice is hard, but it matters.
The OrthoForum’s AnnMargaret McCraw, CEO of Midlands Orthopaedics & Neurosurgery, can attest to the difficulty and importance. “Surgical bundles are the hardest because multiple services and providers are involved: office-based consult with x-rays, surgeons, ASCs, implants and anesthesia. Ideally, the practice owns the bundle and pays all other parties. Still, you must achieve consensus with those parties to establish a price. It’s tedious work, but not doing it means you are willing to lose local self-pay or employer-steered patients to practices in the next town or several states away. Perhaps only a few patients this year, but momentum is building to seek out physicians who are willing to display a price.”

In addition to building the bundles, charge entry and reporting without CPTs is tricky since we are conditioned to evaluate everything we do with CPTs and RVUs. Administering FFS and alternative payments simultaneously creates multiple workflows and reduces back-end efficiency. Beyond that, local market factors must be considered. AnnMargaret suggests reflecting on any unintended market consequences at the outset so your strategy can proactively mitigate them:

“Is your market dominated by one large insurer, hospital or several large employers? Does your practice have many % of charge-based contracts or accept a lot of personal injury work? How does transparency impact those relationships?”

Despite the hurdles, price transparency is a key differentiator. “Similar to online scheduling quickly becoming a core offering even while the majority of patients still call for an appointment,” AnnMargaret believes, “displaying prices will become a hallmark of practices perceived to be high quality and customer-focused even by patients who continue to file private insurance.”

Self-funded communities often have a disdain towards the traditional BUCAH model, pushing patients towards practices with published prices even when closer groups could offer the same procedure at an equivalent value. Simply put, self-funded plan administrators aren’t going to call you to find out the cost for various procedures. A known price tag steers patients to the perceived ‘good guy’ in an otherwise secretive healthcare marketplace.

Furthermore, referrals from Direct Primary Care (DPC) physicians to practices with published payment models is on the rise. DPC physicians have led the provider community in posting prices and they like to support specialists who do the same. Lastly, transparency rulemaking and legislation has bi-partisan support. The DC District Court just upheld CMS authority to require hospitals to publish prices, including negotiated rates with insurers effective January 2021.

The Healthcare PRICE Transparency Act was introduced to the Senate last month, requiring hospitals and insurers to post negotiated rates for providers, further pushing healthcare to become a real marketplace. While opposition to these measures will rage on, private practices are uniquely positioned to embrace a model that all consumers respect and appreciate whether or not they have insurance.

Understanding the value, the question then becomes, “How to begin?”
Don’t let the prospect of building bundles or case rates deter you from getting started. Consider beginning with office-based services. Locate partners and platforms that relieve some of the burdens. As AnnMargaret reflects, “We could have started sooner if I had focused on office-based rates first as they are simply easier to build. Also, don’t wait until you have a comprehensive offering before you publish. Tackle office visits, injections, MRI and therapy first. Add surgeries as you develop them. Just get started.”