"I spend a lot of my time trying to help groups think bigger than they see themselves as being," says Levitt. "Doctors have never seen themselves as a big company. I give them statistics that we are equivalent to the 60 largest private corporations in the metropolitan Washington area. When they see that … they begin to feel empowered and they see the benefit of the negotiations we had that were never possible before. Those are the wins."
There is currently no "litmus test" for other orthopedic groups wanting to join CAO, but that could change with its development of a Quality Committee they hope will establish best practices and clinical pathways. Grosso says they are trying out the committee process with easy diagnoses such as tennis elbow and sprained ankle, but he's hoping to move into total joint replacements, ACLs, and rotator cuffs soon.
Levitt offers another explanation for not having many barriers to joining CAO. He says it is because asking independent physicians to "conform" is against their philosophy.
"When the institution sets up best practices, I actually believe underlying all of it is, 'How do I save money, and how do I reduce services?'" he says. "One of the reasons we set up as we did is [because] we believe best practices actually improves the quality of healthcare and improves the quality of patient experience, and it's not driven by profit and so much efficiency. I really do believe that the difference between [this and] the hospital model is they do set up obstacles. The owners of this company are all physicians and they, in fact, will set up guidelines that truly benefit the patient and not as obstacles to the practice."