How 2 regional orthopedic practices view larger groups

Practice Management

Durham, N.C.-based EmergeOrtho and Spine Center Atlanta both have locations in North Carolina and Georgia, respectively. As some larger orthopedic practices set their sights on expansions, leaders of both groups recently addressed collaboration and competition.

Question: We're seeing some larger groups, such as Rothman Orthopaedics, expanding into other states. Does there come a point where independent orthopedic groups become too big?

Frank Aluisio, MD. Physician President and Surgeon at EmergOrtho: I think it's a fine balance between being large enough to effectively serve the geographic area you cover versus being too large that it dilutes your leadership. If you have too many people on your board or leadership council, then it becomes much more difficult to get everybody on the same page to make efficient and effective decisions. I think if you're in one geographic area or state, you can only grow a certain amount. We're at a perfect size now, and how I envision our growth in the future is through different relationships. 

I see us collaborating with other groups, not with full-on integration, but through strategic relationships, such as clinically integrated networks, to work together on large value-based projects. I also see us growing similar to Rothman, not so much by adding more groups to the "mother ship," but by managing smaller groups through management services organizations where they can remain independent and not have to fully merge with us. We can help them with back-office functions and streamline other processes to keep their practices alive and independent.

Q: Large orthopedic groups and MSOs are branching out in the South. How will Spine Center Atlanta remain competitive?

James Chappuis, MD. Founder and spine surgeon at Spine Center Atlanta: The key today is you have to be better than your competition or you have to be willing to do something that your competition doesn't really want to do. For us, I do a lot of failed spinal surgery, and many of those patients will come from long distances. That's one area that keeps us competitive.

I like to say that we're sort of the Neiman Marcus or Saks Fifth Avenue of medical practices. By that I mean we spend time and we don't rush patients through. We try to give quality care, give patients the time they need and deserve. So especially if someone's going to be paying out of network or paying cash, they're going to get the extra time that a lot of the other practices just don't have the time to give. If you're in a Medicare in-network practice, you've got to really keep the wheels turning. You've got to maximize the number of patients and surgeries you're doing each day. So there isn't a lot of time in practices like that for the art of medicine.

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