Value-based care

Orthopedic Practices: Staying Independent in Today’s Healthcare Environment

By Molly Van Oordt

Blog    Orthopedic Practices: Staying Independent in Today’s Healthcare Environment

The pressure is on to join larger health systems. With increasing regulation and declining reimbursement, many physicians relinquish independence and let an employer handle the business of healthcare. It’s easy to see why—with an array of possible concerns—from reimbursement reductions to losing referral sources, the pressure to give up autonomy is on.

But independence is like a drug—hard to give up. Providing care on your terms, managing your business your way—allows you the greatest control over how you practice medicine. Running a profitable practice requires increasingly more effort and a thoughtful strategy that balances care, quality, and costs with a fine-tuned level of efficiency. 

Value-based reimbursement exacerbates the challenge of profitable independence

The shift to value-based reimbursement has exacerbated the challenge of independence. The struggle to meet strict, burdensome and ever-changing federal regulations is exhausting. It requires an infrastructure that collects, manages, and reports data—without overwhelming amounts of staff time.

One possible solution for maintaining independence is to join a SuperGroup—a fully integrated organization that combines orthopedic practices and groups into a single practice with a single tax ID number. The advantages to SuperGroups are primarily that they can improve market position, which in turn eases contracting and recruitment, and fosters expansion and growth. While costly and complex to form and manage, the collective, strategic power of a SuperGroup can help sustain independence without the disadvantages of going it alone. 

Another possibility for leveraging collective sway is with an Orthopedic Network—an entity comprised of independent orthopedists and orthopedic groups who can jointly negotiate price and other terms with third-party payers. The formation of a sizable network with substantial market significance enables joint contracting with the flexibility and autonomy of sustaining your independence.

Work with—not for—hospital systems 

One strategy that fosters both relationships and independence is to partner with hospital systems, rather than working within them. Exploring ways of co-management, joint ventures, or Professional Services Agreements (PSA) with hospital systems may be mutually beneficial for quality, efficiency and process improvement. Alignment with hospitals in these types of arrangements allows for practice autonomy and can help increase practice revenue professional services, but the downside can be that a partnership with one hospital can limit the relationships and referrals of others.

Another way to maintain the political standing between independent practices and hospital systems is through Ambulatory Surgery Centers (ASC). This allows orthopedists to elevate their expertise in an affiliated, high-quality care environment without the procedural and clinical downsides of a hospital setting. ASCs enable procedural specialization that benefits both patients and providers, while also leveraging orthopedic talent in the community.

Sanity, security, and success in a new healthcare model

The shifting market and government reforms aren’t going away—in fact, like surgery operating on principles of chemistry and physics, so too is healthcare itself victim to gravity. And while the efforts to stay independent as an orthopedic practice aren’t always simple or singular, there are viable paths to ensure your success. Running a successful practice and enjoying a satisfying career while ensuring the safe, quality of care your patients deserve is far from easy, but finding the right partners can truly tip the balance.


Molly Van Oordt

Director, Specialty Solutions

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