For Micah Richardson, MD, the case for private practice in joint replacement comes down to control — over where she operates, how her practice runs, and how it responds as CMS reimbursement grows more closely tied to efficiency and value. Dr. Richardson, who earned her medical degree from Drexel University College of Medicine, completed her orthopedic surgery residency at Penn State Milton S. Hershey Medical Center, and finished an adult joint reconstruction fellowship at Midwest Orthopaedics at Rush in 2026, recently joined Panorama Orthopedics & Spine Center in Colorado.
She shared with Becker’s why she chose independence for a specialty increasingly shaped by outpatient migration and reimbursement pressure.
Why private practice, and why now
Joint replacement’s shift toward ASCs and outpatient care shaped Dr. Richardson’s decision from the start.
“The transition to outpatient arthroplasty at ASCs comes with several advantages for patients such as decreased risk of infection, rapid recovery and a more comfortable and quick return to activities at home,” she said. “Coming out of fellowship, I knew I wanted to care for patients in an ASC so they could receive these benefits.”
Dr. Richardson pointed to decision-making authority as another key difference between independent and employed practice.
“In joining Panorama, I know I have a meaningful voice in decisions that directly impact patient care,” she said. Operating room time and scheduling, implant and technology choices, staffing, and post-operative protocols all shape patient outcomes and experience — decisions that, in a larger employed system, often get made “outside the operating room at an executive level where not all physicians may have a voice.”
In private practice, she said, “the physicians performing the procedures have a seat at the table where we consider the evidence, quality, value and ultimately what we believe is best for our patients.”
Building a practice under reimbursement pressure
Dr. Richardson is early in building her practice, but she said CMS’ proposed changes are already shaping how she thinks about growth.
“The recent changes proposed by CMS make efficiency and value of care more closely tied to reimbursement,” she said. “When reimbursement is under pressure, we have to look beyond striving to see more patients or perform more surgeries. The focus has to be on getting the right patient to the right treatment with as little unnecessary friction as possible.”
She said independence gives her the ability to partner directly with Panorama’s administrative team to examine the entire episode of care — from appointment access and imaging to physical therapy, ASC utilization and surgical readiness. That visibility, she said, helps identify inefficiencies, improve coordination and make better use of APPs and other practice extenders, creating “a more streamlined experience for patients and for me as a surgeon, while also making the practice more sustainable in a challenging reimbursement environment.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
