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How an Orthopedics Practice Stays Independent Despite Evolving Practice Models

   March 10, 2016

Competition from hospitals and health systems forces private practices to focus on efficiency and patient experience.

A group of Mid-Atlantic orthopedic practices joined forces two years ago to retain their independence amid market forces that were driving health systems to grow by acquisition. Now, The Centers for Advanced Orthopaedics (CAO) is bigger and preparing for price transparency, bundled payments, and giving patients the "Four Seasons" experience.

"2016 is the year of doing things we want to do," says CAO President Nicholas Grosso, MD.

CAO grew from 128 physicians in 2014 to 150 physicians and 50 locations in 2016. Grosso calls the growth "incremental," but to other independent physicians who are trying to figure out a way to stay in business without selling to a hospital or health system, CAO's growth represents a reason to be optimistic.


Christopher Raffo, MD, is with Maryland Orthopedic Specialists, a two-location, three-person practice that was one of the first groups to sign up with CAO in 2014. He says CAO's buying power as a group of nearly 130 physicians immediately began to see "significant savings."

"There is a cost to join [CAO]. Physicians were upset we had to pay money every year to be part of this organization," Raffo says. "But in our practice, we saved more on the group malpractice policy than it cost to join the group."

Raffo says revenues are stronger too. The major benefits, however, are elusive to small practices because of their size. For example, CAO is examining claims data to prepare for initiating bundled payment projects with insurers.

"That's the most exciting thing," Raffo says. "We're trying to be proactive. It gives us an opportunity to positively affect changes in healthcare so we aren't stuck with somebody else's model."

Raffo says that kind of project wouldn't be possible in a standalone, private practice of three physicians. He credits Grosso as a visionary who can break through the inertia that comes with large groups of physicians.

Grosso says his leadership style is democratic. He points to one number that shows the CAO model is working: Zero. That's the number of physicians who've dropped out.  "No one has quit us," he says. "Like any organization with 150 orthopedic surgeons, there are certain physicians who aren't agreeable to everything but we communicate so it doesn't come across as top-down. I've gotten calls for advice on how to do what we've done."


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Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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