Most of healthcare is moving toward consolidation. Travis Doering, MD, is betting the future may move in the opposite direction.
After years practicing in a large orthopedic group, the Austin, Texas-based hand, upper-extremity and peripheral nerve surgeon recently launched two independent practices — Upper Extremity ATX and Regen ATX — focused on surgical care, regenerative medicine and office-based procedures.
The move was not just about opening a new practice.
It was a response to a broader shift Dr. Doering believes is coming to healthcare.
Between rising administrative burdens, growing pressure to reduce healthcare costs and the potential expansion of site-neutral payment reform, he sees an industry that may increasingly favor smaller, physician-led organizations capable of delivering care more efficiently.
“I really think that taking ownership is something that physicians for the last few decades have unfortunately been giving up to healthcare systems and insurance companies,” Dr. Doering said. “This is my one soldier’s stand by trying to take back some of that independence and really be the surgeon and physician that I want to be.”
The frustration that pushed him to leave
The decision emerged after years working inside a high-volume orthopedic practice that accepted virtually every major insurance plan. While caring for patients remained rewarding, the administrative complexity surrounding that care became increasingly difficult to ignore.
Prior authorizations, denials and insurer requirements often created obstacles even when diagnoses and treatment plans were straightforward.
“Even if something was perfectly documented, perfectly diagnosed, it was still getting auto-rejected by whatever the latest AI system from the insurance company was,” he said.
Those experiences convinced Dr. Doering that many of healthcare’s inefficiencies stem from a system that has become increasingly detached from physicians and patients. At the same time, they pushed him to explore alternative models for delivering care.
“The complexity of health insurance is obviously daunting,” he said. “But that complexity also allows narrow little pathways where hopefully I’m going to be successful in delivering highly effective, highly efficient care for patients.”
Why site-neutral payments could change orthopedic economics
One of the biggest factors shaping his thinking has been the ongoing debate around site-neutral payment reform. For years, hospitals have received higher reimbursement for many services delivered in hospital outpatient departments than independent physicians performing the same work elsewhere.
Dr. Doering believes that dynamic has played a significant role in driving physician practice acquisitions and healthcare consolidation. But if site-neutral payment legislation continues to gain traction, he expects the economics supporting those acquisitions could begin to change.
“There exists a reality that a few years from now a hand surgeon just like me is no longer going to be making more money for the hospital because they’re seeing patients in an HOPD,” he said.
If reimbursement becomes increasingly tied to the service itself rather than where it is delivered, he believes independent practices may become more financially competitive.
“I’m envisioning a shift back toward independent practice and a shift back toward smaller group practices,” Dr. Doering said. “There’s really not that financial motivation for consolidation that we’ve seen over the last few decades.”
The prediction runs counter to much of healthcare’s recent trajectory. Yet he believes many physicians are already thinking about what comes next.
“We know where this story is going,” he said.
Bringing transparency into healthcare
Part of Dr. Doering’s strategy involves experimenting with payment models that bypass some of healthcare’s traditional complexity. He is working with organizations such as Mark Cuban’s Cost Plus Wellness and Better Way Health, an eCommerce company that specializes in premium and evidence-based supplements, both of which seek to create more direct relationships between physicians, employers and patients.
The appeal, he said, is transparency. Healthcare pricing often remains opaque even for patients with similar insurance coverage.
“You can have two patients who seem to have the same insurance and the whole process is wildly different for them,” he said. Direct-pay and employer-based arrangements create a different dynamic. Patients understand costs. Employers understand costs. Physicians understand costs.
“Everything’s public. Everything’s transparent,” he said.
While those models remain relatively small today, Dr. Doering believes they reflect growing demand for simpler and more predictable healthcare transactions.
The migration out of hospitals
If site-neutral payment reform represents one major shift, the movement of care into lower-cost settings represents another. Dr. Doering believes orthopedics is still in the early stages of that transition.
Procedures that once required hospitalization moved into ASCs. Increasingly, some are moving into physician offices. In hand surgery, that shift is already underway.
Using local anesthetic techniques that allow patients to remain awake throughout surgery, procedures such as carpal tunnel release can often be performed safely in an office environment.
Patients avoid anesthesia. They drive themselves home. Recovery often begins more quickly.
“I think patients are happier,” Dr. Doering said. The benefits extend beyond convenience. For certain tendon repairs, surgeons can evaluate movement immediately during the procedure while patients are awake.
“You can show the patient that their finger is moving again,” he said. “All of those things really just accelerate the rehabilitation protocol.”
For Dr. Doering, office-based surgery is not simply about reducing costs. In some cases, he believes it may offer a better patient experience.
What orthopedic care may look like in five years
Looking ahead, Dr. Doering expects insurers to increasingly push physicians toward lower-cost sites of care whenever clinically appropriate. In some cases, he believes procedures currently performed in surgery centers may eventually be expected to occur in physician offices.
“I think there is a reality in the near future where, unless there’s a good reason, you’re required to do a carpal tunnel release in the office,” he said. He sees similar shifts occurring in diagnostics.
Emerging technologies already allow physicians to perform in-office needle arthroscopy for some knee conditions, potentially reducing reliance on imaging and creating faster pathways to treatment. Taken individually, those changes may appear incremental.
Together, he believes they point toward a broader transformation in healthcare delivery.
“These are the sort of things that, when technology, legislative changes and market forces all collide, are really going to bend the curve on healthcare costs,” he said.
Rather than waiting for that future to arrive, Dr. Doering is building his practice around the assumption that it is already beginning.
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