1. Be adaptable when it comes to technology upgrades. When the two practices merged to form OrthoCarolina, the physicians constructed a new technology standard that included electronic medical records, digital radiology and a data warehouse. “This technology has created a platform that’s fairly robust and has allowed us to serve as an alternative for smaller practices looking at the landscape and saying ‘I need to be part of something bigger.’ They are either looking at joining hospitals or large specialty groups, and we have the infrastructure to support them,” says Daniel Murrey, MD, MPP, a spine surgeon and CEO of OrthoCarolina. The new technology also increases compliance needs with RAC audits and Comprehensive Error Rate Testing audits. Implementing these new technologies can be stressful for staff and drain financial resources because the staff must be trained on the new system. However, adaptability is a feature of a profitable practice. “The culture here is so accustomed to change that the staff gets nervous when things stay the same,” he says. “The groups that are the most successful are the ones that are adaptable.”
2. Handle disagreements with compromise. All physicians in orthopedic practices have a wealth of knowledge and opinions about practice management. The elected leaders are the liaisons between practice physicians and administrators and reconcile the needs of the clinical practice with the board of directors. “The physicians at OAA operate very democratically,” says Rich Battista, MD, president and physician with OAA Orthopaedic Specialists in Allentown, Pa. “We try to think about what is best for the organization while taking into account individual needs.” Sometimes, however, physicians and administrators disagree about the best ways to solve problems and make decisions for the practice.
The best solution is often agreeing to disagree, agreeing to compromise and looking forward, says Dr. Battista. If a particular physician is constantly hindering the decision-making process, it could be necessary to part ways with that individual for the betterment of the group. “At times, making group decisions can be like herding cats. We’ve not been immune to partners making the professional decision to leave the organization,” says Dr. Battista.
3. Have strong leadership that exercises transparency. It’s important for a orthopedic groups to have a strong administration to preserve the integrity of the whole group. “Each of the subspecialty groups has their own pull and interests they focus on, and a strong administration allows us to make sure each of the other groups and individual physicians have their needs met with the overall goals of the whole group in mind,” says Larry Parker, MD, a spine surgeon with The Orthopaedic Center in Huntsville, Ala. “It’s key to have a neutral administration so that personalities and political influxes that may occur on a day-to-day basis don’t overcome the group as a whole. Our group is very strong politically and internally because of the administration.”
His center includes an executive committee of five physicians elected from each subspecialty group, and the members are rotated out every two years. The executive committee meets bimonthly to discuss the issues and serve the group as a whole. “Any year there is a representative from every subdivision so everyone has a voice at the table from the executive side,” he says. “In large groups, there are usually one or two strong personalities that make decisions for the group, but in a changing executive committee, we let everyone have a chance to serve.”
A strong administration is transparent, he says. Every physician should have access to the discussions and understand the issues. People on both sides of an issue should understand that the final decision was made as the best decision for the group as a whole.
4. Hold weekly teaching conferences to bring all specialists together. All specialists at the Virginia Spine Institute gather for weekly meetings to discuss cases, which keeps all the specialists on the same page. The meetings also serve as a time to educate the different specialists about what their colleagues do in the practice to make sure everyone speaks the same language. “Everybody understands who does what and they work together to provide the best experience for the patient,” says Thomas Schuler, MD, a spine surgeon, founder of the Virginia Spine Institute “That’s something we have done which has taken our organization to the next level.” Specialists are also cross-trained in different areas to promote advanced understanding of the different services at the practice.
5. Foster an environment where positive relationships with hospitals are possible. A primary goal of the practice physicians at Rothman Institute is establishing strong relationships with a hospital partner, which allows practice physicians to integrate with the hospital but remain independent. “One of the ways we are able to do integrate is through co-management arrangements where we partner with the respective hospitals by getting our physicians to participate in leadership positions,” says Mike West, CEO of Rothman Institute. “We think that by integrating with the hospitals, we are able to serve the same roles that hospitals are looking for when they hire physicians. We try to meet the hospitals’ strategic needs while giving the physicians an option to remain independent.”
These relationships will become even more important as the healthcare landscape continues to evolve, Mr. West says. “We look to the future and regardless of whether there are patient networks or provider networks, we want to make sure we feel comfortable partnering with key hospitals in our perspective areas,” he says. “We understand the importance of great hospital relationships and integrating more with hospitals in the future, especially post-healthcare reform.”
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