The increased expansion of private equity, hospital consolidation and insurance companies have fundamentally changed the way that orthopedic care, and healthcare in general, is being delivered. Each operates with a business-first incentive structure that has, in many cases, pushed patient experience, physician autonomy and affordability to the margins, according to Louis Levitt, MD.
More physicians are working outside of private practice, and those who remain in private practice are having to find new ways to capture patients and develop revenue streams to make up for declining reimbursements.
Dr. Levitt, who is vice president of The Centers for Advanced Orthopaedics and chief medical officer of MedVanta, recently connected with Becker’s to talk about the business of medicine versus the business of care delivery.
Bethesda, Md.-based Centers for Advanced Orthopaedics is one of the largest independent orthopedic groups in the U.S., with a network of more than 180 physicians.
Note: Responses were lightly edited for clarity and length.
Question: How has consolidation changed the healthcare industry?
Dr. Louis Levitt: Consolidation has shifted healthcare away from patient-centered decision-making and toward institutional control. From an industry perspective, whether insurance companies, private equity firms or hospital systems, consolidation has largely prioritized profit over patient care.
The result is simple and concerning: patients are paying more and receiving less. Hospital-based care can cost as much as three times more than care delivered in the private sector, while patient satisfaction and access continue to decline. Insurance companies increasingly control what care is delivered, when it is delivered and how much physicians are paid, often creating barriers rather than pathways to care.
What has suffered most is the doctor-patient relationship. When healthcare decisions are driven by business models instead of clinical judgment, both quality and trust erode.
Q: What are some of the challenges that physicians are facing today?
LL: Physicians are under unprecedented financial and professional pressure. Reimbursement has steadily declined while the cost of practicing medicine has increased dramatically.
Personally, I’m paid about half today for comparable care delivery than I was decades ago, despite rising overhead, regulatory burden and complexity. Simply practicing clinical medicine is no longer financially sustainable for many doctors.
Physicians are not paid for empathy, time or thoughtful clinical judgment. They are paid based on codes, on whether a service was delivered, not on quality or cost control. The art of medicine has lost its value in the current reimbursement system.
As a result, many physicians are forced to seek alternative revenue sources such as imaging, physical therapy or surgery centers. Others are approached by private equity firms, equipment manufacturers or insurers offering lucrative arrangements that may not align with long-term patient outcomes. These decisions are often driven not by choice, but by economic necessity.
Q: Why are fewer physicians in private practice settings today than in the past?
LL: Private practice has become increasingly difficult to sustain. Young physicians graduate with significant debt, face rising malpractice costs and encounter overwhelming administrative and compliance burdens. Many choose employment because it offers predictable income and relief from operational risk.
Autonomy, once the cornerstone of private practice, has faded. Independence has lost its shine in a system that rewards scale and corporate control. Many physicians no longer want to worry about payroll, regulatory scrutiny or insurance denials; employment removes those stressors.
That said, private practice remains deeply meaningful. The autonomy to make decisions based solely on what is best for patients, and the ability to build true relationships with them, is invaluable. Patients become partners in care, not transactions defined by CPT codes. That relationship, and the trust it builds, is what medicine was always meant to be.
Q: How has The Centers for Advanced Orthopaedics been able to remain independent through these changes and challenges to independent practice?
LL: We recognized early that patient access was becoming the new battleground. Hospitals and insurers are actively trying to control patient flow through narrow networks they own. To survive as an independent group, we had to be creative about how we acquire and care for patients. Scale has been essential. By coming together, we gained the gravitas needed to negotiate more effectively, invest in infrastructure and protect physician autonomy. But size alone is not the answer; innovation is.
We have developed new care models that bypass traditional insurance pathways, including direct-to-employer solutions that allow us to manage the entire episode of musculoskeletal care from beginning to end. This approach avoids fragmented, private equity-owned point solutions and allows us to deliver higher-quality care at a lower cost.
We have also expanded direct-to-consumer offerings in response to rising out-of-pocket healthcare spending. These models provide high-quality, best-practice care for patients who want price transparency, access and efficiency.
Our analytics and financial modeling allow us to understand utilization, outcomes and cost drivers in ways most institutions cannot. These tools help us bend the cost curve downward while improving patient experience, not by obstructing care, but by facilitating it.
At the heart of it all is a belief that physicians should remain the caretakers of medicine’s future. Corporate entities may be good at managing business, but doctors are best positioned to protect patients, outcomes and the integrity of care. That principle is what has allowed us to grow, innovate and remain independent in an increasingly corporate healthcare system.
