Maryland's largest orthopedic group to kick off 1st risk-based contract in 2022: Q&A with Dr. Nicholas Grosso

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Many orthopedic providers found initial success in bundled payment initiatives but later found themselves in a "race to the bottom" as certain payment models sought to continuously reduce costs while maintaining high-quality care.

Now, more orthopedic groups are considering shared savings programs — ultimately taking on both upside and downside risk — as a start into value-based care.

Nicholas Grosso, MD, president of the Centers for Advanced Orthopaedics in Bethesda, Md., told Becker's about the biggest opportunities for growth and his practice's goals for 2022.

Editor's note: Responses are lightly edited for style and clarity.

Question: What do you see as the most pressing issue facing independent orthopedic practices?

Dr. Nicholas Grosso: There are a number of pressing issues facing independent orthopedic practices, all related to the transition from fee-for-service to value-based care. How organizations manage this pivotal moment in healthcare will ultimately determine their path forward.

Q: What are the top three healthcare trends you're following?

NG: The top healthcare trend we're following is the transition from fee-for-service to value-based care.

Separately, but related, we are also monitoring the continued consolidation of orthopedic groups. There is a great deal of financial risk for practices that are adopting value-based care, and we're all making significant investments in personnel and technology needed to succeed through this transition. Thus, many smaller groups are turning to consolidation.

Third, this transition to value-based care is prompting hospitals to purchase smaller practice groups and lower-cost sites of care — such as ambulatory surgery centers — at an increasing volume.

Q: Where are the biggest opportunities for growth in orthopedics?

NG: The biggest opportunity for growth lies in the shift to the outpatient setting. Here in Maryland, there are a significant number of one-room outpatient centers. We can increase efficiencies while remaining accessible for patients and providers alike by consolidating some of these existing surgery centers into multiroom facilities.

Q: What skills are critical for healthcare leaders to thrive in today's environment?

NG: The current healthcare environment is ever-changing, so being flexible and having the right mindset for change is critical to success. Leaders in healthcare must also have strong communication skills. Here at CAO, we're most successful at implementing change when we communicate the "why" behind decisions to ensure all team members are involved and can rally behind new strategies or investments. 

Q: What are your practice's goals for 2022?

NG: We will be implementing our first risk-based contract through Maryland's Episode Quality Improvement Program in 2022 and aim to sign one to two more risk-based contracts by the end of next year. In 2022, we will continue to build and invest in the infrastructure needed to succeed with risk-based contracts. This will not happen overnight, but we are prepared for delayed gratification as we make this exciting transition.

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