A restrictive referral process can quietly cap a practice’s surgical volume long before administrators notice the pattern in the numbers. That was the case at Austin Regional Clinic, a multispecialty practice serving about 800,000 patients across Austin, Texas, and its surrounding suburbs, where a legacy referral model had been limiting how many spine patients ever made it to a surgeon.
Akshay Yadhati, MD, joined Austin Regional Clinic in October 2025 as the practice’s sole orthopedic spine surgeon. The organization, which has been operating for about 45 years and began folding specialty practices into its multispecialty model roughly 10 to 15 years ago, had gone several years without a dedicated spine surgeon on staff before Dr. Yadhati’s arrival.
What he found was a referral system that was working against the practice’s own growth.
“The legacy model, especially for spine care within the practice, was a relatively restrictive referral model for the group,” Dr. Yadhati said during an interview with the Becker’s Healthcare Podcast at the 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference. “It ended up actually choking off patient flow and then surgical volume.”
Rather than adjust the model at the margins, Dr. Yadhati said he reversed it entirely.
“When I came into the practice, I employed the opposite model and just made it so that patients really had unfettered access,” he said. “Any and all patients that were dealing with some sort of spine complaint were able to come in and see us.”
The change registered almost immediately, according to Dr. Yadhati.
“Volume really took off pretty quickly, especially, obviously, in the office,” he said. “But even the operative volume really did take off very quickly.”
Dr. Yadhati said opening access was paired with a deliberate push to establish the practice as a market leader, bringing procedures to Austin that hadn’t been widely available there. Within a couple of months of his arrival, he said his team performed the city’s first robotic-assisted spinal fusion procedures, using navigation technology he had used in his previous practice in Rhode Island.
“We’ve done the most endoscopic decompressions in Austin within, honestly, the past six months,” he said.
That kind of expansion, he said, required treating the market itself as something to be won over, not just served.
“What we really had to go up against was a number of things,” he said. “In terms of creating market presence — not only for the practice, but also for the city of Austin itself — it was about coming in with a mindset of, honestly, disruption, and approaching the market with the things that we are going to change for the area.”
But Dr. Yadhati is careful to frame open access as the first step of a two-part model, not the finished product. He described the current stage as a deliberate follow-up to the volume surge his practice created.
“Phase one was really just to establish market presence, not only for the practice, but really for the region as well,” he said. “Now phase two is really to clean that model up and to refine the care pathway for patients, so that patients that really don’t need to spend time speaking to a surgeon are gonna be then spending their time working with our physician extenders.”
As the practice brings on interventional physiatry and pain management providers, Dr. Yadhati said the goal is to route non-surgical spine patients to those specialists so that his own time is reserved for the highest-acuity cases that need surgical care quickly.
For other practices watching their own surgical pipelines stall, Dr. Yadhati’s experience points to a sequence rather than a single fix: open the front door first to establish volume and market presence, then build the downstream infrastructure — physician extenders, nonoperative specialists, refined referral pathways — needed to manage that volume without burning out the surgeon who created it. Removing the bottleneck is what starts the growth. Building the pathway behind it is what makes that growth sustainable.
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.
