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1. Hire business professionals to manage the practice. Physician leaders are responsible for the management aspects of their practices as well as seeing patients, which means they must learn to delegate other responsibilities or hire additional staff for management positions. “Many small practices are run by low level staff because the intensity and case volume is low, but as these practices experience an increase in significant contracts and patient volume, the leaders will have to rethink their business strategies,” says Rich Battista, MD, president and physician with OAA Orthopaedic Specialists in Allentown, Pa. “Larger practices have CFOs, COOs, CMOs and CIOs because these people have specific training in these business areas. To move your practice to the proverbial next level, you have to have these people.” Hiring the right people to help manage the practice can be challenging because the best candidates don’t always have knowledge about the clinical aspect of the practice.
When expanding his practice to the corporate level, Dr. Battista explored options, such as outside consulting venues, promotion from within the practice and posting the positions on public forums. Regardless of where the candidates came from, it was important that the physicians felt they could trust their new administrators. “You should hire the person that has the right fit, commands respect from the physician and employees to manage the business,” says Dr. Battista. However, he did say that it was easier to transition from having a medical background and learning business than having a business background and learning about the clinical aspects of the practice.
2. Provide patient care coordination. One of the reasons why DISC Sports and Spine Center in Marina del Rey, Calif., was able to contract with the U.S. Olympic Team and Red Bull athletes is their ability to provide quick coordinated care. The center has a VIP athlete coordinator to arrange each athlete’s care before they arrive at the practice. Many times the athletes are flown in from locations around the country; once they arrive, the coordinator has their appointments with different specialists scheduled so the care is as seamless as possible.
“Our VIP athlete coordinator takes the call from Red Bull America or the Olympic athletes and coordinates their appointments,” says Robert S. Bray, MD, founder and president of DISC. “If a BMX Biker for Red Bull North America goes down, they want to call up and have the athlete imaged, diagnosed and treated the next day so they can return to practice as soon as possible. Many times, the treatments aren’t surgical and we can provide them the same day. With that kind of concierge sports medicine, we were able to develop our relationships with elite athletes.”
3. Connections with referring physicians. It’s important for orthopedic surgeons and practices to have a good relationship with primary care physicians because they are often the first medical professional patients see about their pain. Primary care physicians often refer patients to specialists who they have a relationship with because they know those specialists will treat their patients well. “We consistently work through our physician referral network to make sure primary care physicians are happy with our services, and we are always responsive when they call upon us,” says Mike West, CEO of Rothman Institute in Philadelphia.
4. Support onsite ancillary services. It’s very helpful for orthopedic practices to add ancillary services, if they haven’t already, and fully integrate all services to provide the best continuum of care possible, says John Wipfler, CEO of OA-Centers for Orthopaedics based in Portland, Maine. OA includes fully integrated X-ray, MRI and physical therapy services and a surgery center in addition to its clinic, so patients can benefit from several specialists who are all in communication about their individual care.
“The patients understand that their care is communicated from point to point, and they appreciate it,” says Mr. Wipfler. “Ancillaries are a big part of our ability to survive over time, in part because it is more cost efficient as well as improves quality of care as a result of the continuity of care by providers who are all on the same page.”
5. Gather practice-level data for evidence-based medicine. Orthopedists at academic medical centers and large hospitals can gather data on orthopedics to further the practice of evidence-based medicine. However, it’s also important for surgeons practicing in smaller orthopedic practice settings to gather data on surgeries and outcomes. “Evidence-based medicine in a private practice setting is compelling, but has unique challenges other institutions may not encounter as frequently,” says Scott Trenhaile, MD, an orthopedic surgeon with Rockford (Ill.) Orthopedic Associates. “There are a lot of patients who are treated in private practice settings that aren’t reported on in the studies at larger facilities and that’s an important aspect that we need to consider pushing forward. There’s another side to the story that will contribute significantly.”
One of the biggest challenges private practice surgeons face when practicing evidence-based medicine is data collection and organization. Surgeons don’t have time to input patient information multiple times into different databases and most practices don’t have the resources necessary to hire another employee for this type of data management. However, implementing electronic medical record systems takes data input from the surgeon and organizes it in several different ways simultaneously. “We record the data like we would in the ordinary, every day process of seeing the patient,” says Dr. Trenhaile. “We collect the data on the front end so it can be extracted later electronically. That’s how private practice practitioners can contribute on a grand scale.”
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