When Drew Ratner, MD, opened American Orthopedics in Greenville, S.C., on Oct. 14, he said he expected to see only a few patients a day in its first week. His practice saw more than 60 patients in its first days.
Opening a practice out of residency was a “massive undertaking,” Dr. Ratner told Becker’s. He said he had the vision for the practice in 2024 and began exploring his options for getting the business off the ground.
Forging partnerships were especially important in the process.
“There’s a lot of reasons why I wanted to go into private practice, and a big part of that was definitely trying to move as much surgery as I could to an ambulatory surgery center,” he said. “In this day and age of orthopedics, a huge percentage of what we do in orthopedics can very safely and effectively be done in an ASC. Not only is it the best thing for the physicians, but I think it’s also the best thing for the patient to not have to go into a hospital after a joint replacement. Being able to get a relationship with the ambulatory surgery centers was kind of crucial to start my own practice and do what I wanted. I also needed to know that there would be at least one hospital system that worked with me as an independent practitioner, because inevitably you do need the hospitals for certain patients and certain surgeries.”
In the year ahead, Dr. Ratner said he’s readying himself for the challenges that come with running a private practice from scratch.
“You need cash flow being a brand new practice with no investors,” he said. “Cash flow is going to be the most important, and it’s kind of hard to predict how the revenue is going to work and the delays from the insurance companies. There’s a lot of unknowns, but I have a pretty good sense on what expenses are going to be, so I have a really good angle on that part, but it’s very difficult to predict revenues.”
Dr. Ratner said he’s also preparing to face obstacles with reimbursement and insurance models.
“Sometimes I feel like I’m fighting against a stacked deck, because the reimbursement model is very stacked against independent doctors,” he said. “Our reimbursement rates aren’t close to the same as in a hospital. There’s a lot of things with the way our system is set up that is just kind of stacked against us. But I do think that as time goes on, I think cash services are going to become more and more prevalent with premiums getting as high as they are for insurance companies, and deductibles getting as high as they are. It’s almost becoming the cash system, even within the insurance market, and I think independent doctors are by far the most set up to take advantage of that and accommodate that aspect.”
Despite the unpredictability ahead, Dr. Ratner said he’s optimistic about his work and the future of private practice.
“You’re working towards building something bigger than just yourself, and you feel like an owner and not an employee,” he said. “Every day just flies by. I’m learning so much, but I don’t feel like you’re punching the clock at all. And I do think it’s the best way to provide care. I think it’s the most efficient way to provide care, because I have so much versatility. If something’s just not working, I can immediately change it. There’s no bureaucracy in the way.”
