How Partnerships Have Helped a Florida Orthopedic Practice Thrive

This article originally appeared in Becker’s Spine Review on February 10, 2022

Partnerships have been key to Jacksonville, Fla.-based Southeast Orthopedics Specialists’ growth in the last few years. In 2019, the practice banded with Healthcare Outcomes Performance Co (HOPCo). Since then, practice also partnered with Jacksonville-based Ascension Florida & Gulf Coast, and with Orthopaedic Associates of St. Augustine (Fla.).

Southeast Orthopedics Specialists CEO Donnie Romine told Becker’s about the factors that bolstered the practice’s growth, 2022 plans and competition in the Florida orthopedic landscape.

Note: Resonses were lightly edited for style.

Question: What were the major contributors to Southeast Orthopedics Specialists’ growth over the last two years?

Donnie Romine: To start, I think you have to look at how we view growth. We don’t think of growth as being a part of our strategy. We think of growth as being our strategy. Our growth teams focus on current service line potential, new service line development and overall market development. All three of these focus areas are interrelated and support each other.

In market development, we’ve focused on expanding our physical presence with the addition of clinic sites, increasing our number of providers and partnering with other groups. Of course, it helps to be located in a growing market, northeast Florida, and we monitor our growth rates to make sure we’re outpacing overall market growth.

While orthopedic surgery is the foundation of Southeast Orthopedic Specialists and is the core of what we do, we’ve committed to transforming ourselves into a comprehensive musculoskeletal healthcare system. To achieve this, we’ve added service lines such as pain management, nonoperative orthopedics, orthopedic trauma and fracture care, chiropractic and podiatry. Additionally, we’ve added services like in-house kyphoplasty, orthobiologics and in-house dispensing to improve outcomes and provide better service to our patients.

One of the key metrics we track is new patients to the practice. We’ve seen an increase of about 20 percent over the past two years; while that is impressive and shows we are growing market share, it has also put additional stress on our current ancillary services like MRI, PT and DME. To meet the needs of our patients, we’ve increased our capacity by expanding locations, expanding hours and improving throughout.

Even during the peak of COVID-19, we grew substantially, both in size and revenue, as we were able to pivot and ensure we maintained our commitment to the care of and service to our patients. Our teams stepped up to the challenge and HOPCo helped provide additional bandwidth and infrastructure to support us while we pivoted to telehealth and urgent ortho models to continue to care for patients.

Q: What were the biggest benefits Southeast Orthopedic Specialists saw after its partnerships with Ascension Florida and Gulf Coast under the Performance Orthopedics and Spine that weren’t there before?

DR: To answer this, it’s important to go back to 2019, when we made the decision to partner with HOPCo. As a company, we looked at where we were, where we wanted to go and the resources it would take to get there. We knew that we wanted to accelerate our transition to true population health and become not just participants but leaders in the transition from volume to value. What we lacked, but HOPCo had, was the deep infrastructure, tools, analytics, medical economics expertise and a payer contracting team that understands alternative payment models and the ability to build, scale and manage clinically integrated networks. This decision helped accelerate our growth in these areas, expand into additional markets and strategically align with additional health systems and payers.

Following our HOPCo partnership, Ascension Florida and Gulf Coast was a natural health system partner for us as they share our vision of shifting from volume-based to value-based care. An initial step was creating the Performance Orthopedics and Spine service line as well as the Performance Orthopedics and Spine Specialty Hospital, a first-of-its-kind musculoskeletal specialty hospital in Northeast Florida. This unique model aligns Southeast Orthopedics Specialists and other community physicians around HOPCo’s proven clinical excellence and integrated value-based care model.

With this specialty hospital and our existing outpatient centers, we can offer patients multiple sites of care, which allows us to provide the optimum care for patients in the optimum setting. This not only reduces costs for the patients and payers but also helps improve clinical outcomes.

Q: What are your 2022 goals for growth?

DR: In 2022, we are expanding our current footprint in Northeast Florida and through our Ascension partnership, expanding into the Florida panhandle. Earlier this year, we announced our partnership with Orthopaedic Associates of St. Augustine. OASA has a significant presence in St. Johns County and shares our desire to transform the delivery of musculoskeletal care. OASA joined us on the HOPCo platform in 2021 and is transitioning to become fully integrated with Southeast Orthopedic Specialists. Later this year, we will operate under a single name and expanded care platform. Adding their team of experts to Southeast Orthopedic Specialists now creates one of the largest musculoskeletal care platforms in the region with over 100 providers. To support this growth, we will also be developing multiple new clinic and ASC locations in the region.

Q: Where do you see the biggest growth opportunities for orthopedic practices?

DR: I think the first step is understanding that the business of orthopedics is changing and the pace of that change is accelerating. Over the past couple of decades, we’ve seen significant consolidation at the hospital/health system level and that consolidation is now well underway in orthopedics.

There’s probably not an orthopedic practice, at least in Florida, that hasn’t been approached by somebody looking to do some type of transaction. The important thing to consider is what your practice looks like after the transaction happens. Through our partnership with HOPCo, we’ve developed a model that is physician governed and professionally managed. This platform allows physicians to remain independent and provide high-quality care to their patients while delivering sustainable growth and operational effectiveness through expert management supported by HOPCo’s well-developed platform.

I think the idea that consolidation, without a road map to true value, results in better reimbursement through leverage with payers is not reality. Consolidation by itself does not adequately take into account the integration infrastructure needed to achieve long-term, sustainable growth.

I think the biggest opportunity for growth is partnering with organizations that have a robust, scalable infrastructure and management system along with a proven track record of results. This allows physicians to focus on the practice of medicine while their strategic partners focus on driving growth and scale.

Q: How will the Florida market change in the coming years as large orthopedic groups such as Rothman and Hospital for Special Surgery expand into the state? How will this affect competition in orthopedics?

DR: I believe we’ll continue to see consolidation, in some form, for several years.

With the overall growth of Florida, coupled with the aging of the population, new market entrants are not unexpected. I think the key to the success of any organization in this space will be their willingness to think differently, shed the ideas and models of the past and embrace a willingness to bring all stakeholders to the table. We have seen in Florida that payers and health systems are focusing on those organizations with an integrated platform that can effectively drive outcomes and value in sustainable ways across markets, especially as greater patient choice and consumerism are playing a key role.

Q: What are the top three healthcare trends you’re following closest?

1. The continued downward pressure on reimbursements.

2. The continued migration to outpatient sites of care.

3. The continued transition to alternative payment models.