9 Keys to OrthoCarolina's Success

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OrthoCarolina is an independent orthopedic practice based in Charlotte, N.C. With 80 physicians, 15 locations and 800 employees, it offers comprehensive orthopedic care including foot and ankle, hand, hip and knee, shoulder and elbow, spine, sports medicine and pediatrics. It was formed in 2005 through the merger of Miller Orthopaedic Group and Charlotte Orthopedic Specialists, two of the region's largest and oldest orthopedic practices.


Here are nine keys to OrthoCarolina's success, as described by spine surgeon and OrthoCarolina CEO Daniel B. Murrey, MD, MPP.

1. Strong physician governance structure. "Many people believe they can practice medicine and not be involved in managing the group or managing the business side of the practice, and the reality couldn't be farther from the truth," Dr. Murrey says. Physicians may not have to have a finance degree, but they do have to participate in and endorse their practice's governance structure for the practice to succeed.

OrthoCarolina's governance structure includes an executive committee made up of physicians and a number of subcommittees that review and endorse policy decisions. "Because our executive committee has taken the stance that they won't yield to every physician's desire, it allows us to be much more effective in moving the practice towards its vision," Dr. Murrey says.

2. Commitment to clinical quality. OrthoCarolina has invested in both improving and measuring quality and has developed data systems that document how well the practice measures up "on even the most mundane things," Dr. Murrey says, such as how often patients' allergies are documented in their charts and what percentage of surgical patients have had follow-up appointments.

The practice has a data warehouse that allows it to monitor quality daily and report back to physicians. "These are all things we've traditionally taken for granted, but it turns out if you don't shine a light on it and document it, it doesn't always happen," Dr. Murrey says.

3. Transparency. One corollary to the commitment to quality is transparency of data. OrthoCarolina's physicians have access to data about all aspects of the practice, including the number of patients seen, revenue generated, charges dictated, referrals made and payor mix. Each physician at OrthoCarolina has access to this information about every other physician in the practice, which has cut down on arguments about which physicians might be seeing a higher volume of patients or might deserve special treatment for one reason or another.

"When you have the data there, it really quiets those arguments," Dr. Murrey says. "If you don't have the data, then physicians will question the decision-making until you have the data available." Physicians also buy into the practice's vision more readily when they can see for themselves the outcomes in the database, he says.

4. Investment in the practice. OrthoCarolina has invested in its practice in a number of ways — from making its facilities more patient-friendly to updating technology to allow the more seamless transfer of information between hospitals, physicians and the practice. It has also invested in its leadership, Dr. Murrey says, and has been willing to commit to physician leadership of the organization.

5. Customer service mentality. In an ultra-competitive environment where hospitals are luring orthopedic surgeons away from independent practice and drawing in patients through primary care networks, independent practices like OrthoCarolina have to work hard to differentiate themselves. "For us to provide a meaningful alternative over time, we have to create a patient experience that is far beyond what they can get at a hospital-based physician practice," Dr. Murrey says. "Patients can't always tell the difference, frankly, in how good the clinical quality is. They only have their experience. They can judge service quality much better than clinical quality."

At OrthoCarolina, staff and physicians are trained in customer service, he says. The practice relies on patient satisfaction surveys, the data from which is distributed weekly to physicians and staff. "We're also trying to develop things that aren't available in other places, things that anticipate the needs of patients and their families," Dr. Murrey adds. Whether it's providing up front financial information about a procedure or helping patients figure out how much time they might need to take off from work for recovery, these extra efforts have an impact on the patient experience, he says.

6. Dedication to the community. For OrthoCarolina, serving the community means both the Charlotte, N.C. region and the broader community of orthopedists. Being part of a larger community means providing trauma coverage for nearby hospitals' emergency departments, providing residency and fellowship training to physicians, accepting indigent-care patients and trying to be progressive about giving to charities or other medical-related groups in the area.

"It's not enough to say we gave at the office," Dr. Murrey says. His involvement in the community includes serving on the county commission. "I challenge all of our partners to find a way to give back to the community."

7. Commitment to research. Through a separate, independent 501(c)(3) research institute, OrthoCarolina fosters scientific research in orthopedics and is currently involved in some 60 studies, according to Dr. Murrey. "That attracts talented young surgeons who want to work with us," he says. "Those that would go to places like the Cleveland Clinic or Mayo can come here and get a research opportunity."

8. Comprehensive array of services. Overall, the healthcare industry is still plagued by a compartmentalized approach, which can be confusing to patients who might have to fill out a new patient history each time they see a different provider or deal with multiple bills all related to the same medical episode. "We try to bring all that under one umbrella," Dr. Murrey says. "We find that comprehensive care is something our patients appreciate." Services offered at OrthoCarolina range from surgical procedures to physical therapy, MRI and post-surgical support.

9. Good relationships with hospitals. Finally, in spite of the competition independent specialty physicians often face from hospitals wanting to provide some of the same services, OrthoCarolina is committed to working with hospitals in the region. "They're competitors, but they're not the enemy," Dr. Murrey says. "We need to work together. My preference is to have a long-term stable relationship with our hospital partners. We need to figure out how we can provide value back to them and feel like they don't need to go out and hire a bunch of new orthopedists, that we're going to help them meet their goal, achieve their mission."

Learn more about OrthoCarolina.

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