Rothman Orthopaedics to become national brand, but no 'aspirations to go beyond US'

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Philadelphia-based Rothman Orthopaedic Institute is growing rapidly and has set its sights on evolving into a national brand with a presence in several states across the country.

The independent group has more than 190 physicians and locations in Pennsylvania, New York and New Jersey. Most recently, Rothman expanded into Florida, where it aims to have 50 physicians by 2025, and the practice is now looking to the West.

Alex Vaccaro, MD, PhD, president of Rothman Orthopaedics, spoke to Becker's Spine Review about Rothman's growth strategy, what markets are ripe for expansion and why he wants his practice to remain private and independent.

Question: What is Rothman Orthopaedics' roadmap for growth?

Dr. Alex Vaccaro: We're expanding pretty rapidly. When we think about expansion, we examine a particular geographic location and what the orthopedic landscape is like. Some areas have a great orthopedic landscape; the communities are being serviced well, they've got great value-based programs and surgeons that buy into that philosophy. If that's the case, we feel that we may not provide further value. We go into places that may be a little bit behind when it comes to  innovative value-based bundled payment programs, outpatient ambulatory care services or there is fragmented care delivery. 

Those are prime markets we think are appropriate to expand into. Then we evaluate the type of health system partners that are present: Do they share our vision of quality, efficiency and value-based healthcare? If they share that vision and have an appetite to share risk — as well as the upside of our collaboration — we usually do business with them. It takes a certain amount of financial investment to get a new group into a new territory. We typically develop a shared risk investment, but if the health system is willing to invest and is aligned with our values, then we feel our presence in the market will benefit patient care.

Q: What updates can you provide on the growth of Rothman?

AV: We're about 5 percent ahead in terms of our revenue pre-COVID. Everyone took a hit in 2020-21. The growth is in terms of new patients, consults and surgery. We're on the brink of signing a 10-year exclusive contract with our academic partner Jefferson Health in the greater Philadelphia region. We started two big initiatives: the woman's sports medicine program and the Orthopaedic Integrative Health Center. We've strengthened our relationship with our ASC partner, ValueHealth. We're partnering with them in northern New Jersey alongside [Edison, N.J.-based] Hackensack Meridian Healthcare. 

I'm most excited about our new partner: [New York City-based] NYU Langone. We align perfectly in terms of our academic mission; we're both extremely dedicated to academics, teaching and research; and we can't find a better partner in New York under the leadership of Joseph Zuckerman, MD. As a result of that, our business has grown exponentially in terms of new patients, consults and surgical procedures. Additionally, all the various divisions are collaborating on research projects aligned with our shared values of research, education and excellence in patient care. 

In terms of our partnership with [Altamonte Springs, Fla.-based] AdventHealth, we currently have 15 physicians in Florida. Those physicians are in sports medicine; orthopedic trauma and fracture care; hip and knee; hand and wrist; shoulder and elbow; and Daniel Fassett, MD, a former neurosurgical chair from the Midwest, is starting in spine. We have 12 new physicians who will be starting by the end of this year for what we estimate will be 40,000 patient visits in 2022. The Innovation Tower on the AdventHealth main campus in Orlando will be completed later this year and will serve as our Florida headquarters. By the end of 2022, we will have eight operational offices across the region and we're planning more locations. The goal is to have 50 physicians in that region by 2025.

Q: Is Texas still a state that interests you?

AV: We are in exploratory mode conversations with groups in Texas and are pretty far down the line with a large health system that covers Seattle and California. The thing I think about the most is to not overly tax our management and executive staff, who have a ton on their plate at the moment. We're growing very quickly, and we're doing it with our money along with an investment with our health system partners, so growth has to be measured. We haven't sought any outside capital and we remain debt free.

Q: What's your vision for the Rothman brand 15 years down the line?

AV: By following our mission of providing excellence in patient care with a focus on education and research, we hope to be a national brand with a presence in many states, depending on local regulations and the medical landscape. We never had any aspirations to go beyond the U.S. borders, which we have seen recently with larger healthcare systems. It sounds interesting to go to London, Ireland, Dubai, etc., but I'm not sure that's in the best interest of our group unless locally you have an arrangement with the government where you are able to provide culturally sensitive care at an affordable price, educating local physicians as the primary caregivers. 

It is difficult as an outsider to understand the customs, habits and what is considered the standard of care in a foreign country. In the future, Rothman Orthopaedics wants to remain private and independent and not consumed by a large healthcare system. As long as physicians stay independent, we will have a very strong voice for the patient. I think once you begin to work for a larger organization and lose your identity, the patient loses their voice in a sense. Independent physicians are what makes us Americans and I think that's what patients want. It boils down to choice.

It's very challenging right now. Even larger orthopedic groups are merging with multispecialty groups. In a sense, they may still lose their identity, because now they are sharing their vision with non-musculoskeletal providers such as internists, cardiologists, radiologists, anesthesiologists, etc., where everyone has a say and it becomes more difficult to find a compromise. I think it's best for orthopedic surgeons to have an independent musculoskeletal voice.

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