How orthopedic surgeons can develop partnerships that will drive future success

Practice Management

Spine surgeons and orthopedic surgeons are looking at new partnerships to help them bolster patient care and control costs. James Sanfilippo, MD, an orthopedic spine surgeon with Marlton, N.J.-based Reconstructive Orthopedics discussed the benefits of these partnerships and key considerations before jumping into a joint venture.

Dr. Sanfilippo will be speaking at the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference. To learn more and register, click here. Contact Maura Jodoin at or Kristelle Khazzaka at for further information about sponsorship and exhibitor opportunities.


Note: The following responses have been edited slightly for clarity and style.


Question:  What new partnerships are spine and orthopedic surgeons eyeing in the increasingly competitive marketplace?


Dr. James Sanfilippo: Today's rapidly changing and chaotic medical climate is opening opportunities, and [in] some instances forcing them, for surgeons to partner with complementing physician groups, healthcare systems and payers. These partnerships focus mostly on access for patients and on cost containment.  


Surgeons are more frequently exploring collaboration with non-operative physicians such as primary care musculoskeletal medicine, rheumatology and pain management. This allows for a controlled flow of patients to the appropriate provider depending on the patients response to conservative treatment. In most cases, these physicians can collaborate on an algorithmic patient care protocol to limit therapies and treatments that may not be producing results, thus driving down unnecessary costs of care.


Partnering with healthcare systems will also allow surgeons to open more access for patients, especially in systems that are self insured. Through centers of excellence, co-management agreements or through clinically integrated networks, surgeons and systems can come together to lower costs of care by reducing variations in preoperative, perioperative and postoperative protocols, reducing system waste and using data analytics to drive best practices. Partnering with vendors can also drive down the cost of care, but this requires both the surgeons and the system to be tightly aligned.  


Finally, surgeons are focusing more closely on their relationships with payers, including CMS and private insurers. Bundled payment programs are gaining increasing traction and some payers are moving to full risk contracts directly with surgeon groups. These types of alternative payment arrangements focus on outcomes and cost, aligning the goals of the surgeons, healthcare systems and payers. However, surgeon groups should proceed with these types of arrangements only when prepared as they mandate the surgeons to be very protocol driven, to be hyper-vigilant in tracking their costs and outcomes and to be closely aligned with the healthcare system in order to reduce variations of care and cost that will disrupt the budgets.  

Q: What are some core factors to consider before physicians jump into a joint venture with a hospital?


JS: Obviously the goals of the hospital system and surgeons must be aligned; this doesn't just mean volume goals. The two partners need to understand the current orthopedic and spine climate in their area and broader region. They must be aligned in their vision of where orthopedic and spine care is moving over the next five to 10 years and design the JV to lead this transition.


They need to coordinate their care pathways to allow for better patient access, lower cost of care driven by best practices and procedures and really help each other drive an improvement in patient outcomes and satisfaction. Both the surgeons and hospital system need to understand the other's cost structure, outcomes, complication rates and payer mix. But perhaps most importantly, there will need to be a trust between the two partners that the JV will only be successful if "all boats rise," meaning that both the hospital and the surgeons see a benefit to the program and that both partners are willing to actively work together to ensure that success.


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