The biggest advantages and challenges for large orthopedic groups: Q&A with OrthoCarolina's CEO

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Since 2016, Bruce Cohen, MD, has served as CEO of Charlotte, N.C.-based OrthoCarolina, which has more than 135 physicians and more than 30 orthopedic locations.

As healthcare continues its push toward the outpatient setting, OrthoCarolina is focused on growing its ambulatory surgical services and expanding its regional footprint.

Dr. Cohen spoke to Becker's about the biggest opportunities and challenges facing large orthopedic groups and how his practice aims to evolve in the coming years.

Note: Responses were lightly edited for length and clarity.

Question: What advantages does your orthopedic group have over smaller practices or hospitals in your market?

Dr. Bruce Cohen: A large, independent practice has the advantage of being able to control the continuum of care for many patients. This allows us to deliver high quality, cost-effective care that a smaller practice or even a hospital cannot effectively deliver. With the recent accelerated transition of musculoskeletal procedures to the ambulatory setting, these discrepancies are amplified.

Q: What are the biggest challenges for large orthopedic groups with multiple locations and a high number of physicians?

BC: Managing a large group of providers creates many challenges, particularly with culture and aligning incentives. Multiple locations create differences in hospital and referral alignment as well as demographic/practice differences. We have an integrated model versus a more divisional model, so we must manage these variations and align with the overall strategic goals of the group. Another significant challenge in the governance and leadership of a large group is communication and transparency.

Q: How big can orthopedic "supergroups" get? How big is too big?

BC: Scale is very important. Whether it is through affiliated networks, [management services organization] structures or group aggregation, it will be critical for independent orthopedists to align. We must be the leaders in musculoskeletal value-based care and population health. The only way to do this is through large groups or networks. So, at present, I do not believe "too big" is a barrier.

Q: Do you believe consolidation through supergroups or other mergers will be inevitable for smaller practices?

BC: I wouldn't say inevitable, but it will become more challenging to compete and survive as a smaller entity. The future for medicine to be successful during these challenging healthcare times is to embrace value-based care and evidence-based approaches to care. This transition is going to be difficult and consume resources, which will be very challenging for smaller groups. One additional challenge for smaller organizations will be access to proper IT platforms and cybersecurity over time.

Q: How do you plan to grow in the next five years? Are you planning to add more physicians and/or practices?

BC: We are strategically planning to grow our footprint regionally. We continue to look for opportunities that complement our current structure and coverage. A significant focus is on the ability to deliver value-based care and manage musculoskeletal population health. This requires regional growth and coordination. We also continue to grow our current practices to meet the needs of the communities that we currently serve. Finally, we are focusing on increasing our ambulatory surgery access and capacity and optimizing this critical service line.

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