This is Carly Beam with the Becker Spine
and Orthopedics podcast,
and I'm thrilled to be joined today by
doctor Robert Broad Orthosinci.
He's gonna share some great insights about private
practice,
outpatient
migration,
among some other topics in orthopedics.
So, doctor Roe, thank you so much for
being here today.
Carly, thanks for having me. Appreciate the opportunity.
So before we dive into our discussion, I'd
love if you could introduce yourself and tell
us a bit about your background.
Certainly. I'm doctor Rhode, Robert Rhode, and I'm
in Cincinnati, Ohio. Our group is OrthoScentsy.
I'm an orthopedic surgeon, and I specialize in
hand, wrist, and elbow.
My background is orthopedics
and
trained at University of Pennsylvania and then trained
for David Green in San Antonio
and came to Cincinnati where our group, Wellington
Orthopedics, over the years
merged into OrthoCinci
to form a pretty good sized group in
Cincinnati, Northern Kentucky, Indiana,
and now also with a division in Louisville.
So we've grown over time and hope to
be able to stay independent as
physician owned independent orthopedic group.
Excellent.
And so first, I want to touch on,
outpatient migration in orthopedics.
What is your outlook for that, and what's
been working at your practice in this area,
and where do you see things growing?
Absolutely, Carly. You know, we, as an independent
group here in Cincinnati area, we work with
just about every hospital system around.
Within all of that, there is definitely a
steady trend of services moving
from perhaps inpatient but to outpatient. That that
would include
from the inpatient hospital to an outpatient
environment, but also
to an ambulatory surgery center and then ultimately
office based care.
When considering that, as we know, one of
the first questions we ask is, hey. Can
we do this logistically?
And then
perhaps more importantly, can that be done safely
with comparable or even improved outcomes?
And then finally, are the patients that we're
treating very satisfied with the experience and their
own,
patient reported outcome and at the time of
the procedure and then later looking back?
So, obviously, that requires a lot of different
change in delivery model, but,
also insurance payers are definitely interested in that.
In our organization,
whether it's taking care of a wrist or
a hand or a total shoulder, total knee,
total hip,
We wanna make sure we're improving and optimizing
those patients before surgery and precare
to make sure that these are appropriate patients,
and and they're definitely viable
for outpatient care.
We also would say that we're looking to
grow our in office services
with time.
Things that we can do such as in
my practice,
trigger fingers, carpal tunnels, even fingertip amputations for
trauma,
as opposed to in a larger hospital. Those
are some of the things we're looking at,
I think, around the all all across the
country,
very similar kind of trends.
Yeah. I'd love to, you know, dive in
a bit deeper about, specifically these office based
procedures. How are you, you know, thinking about
what you could, you know, potentially move to
that setting suppose, say, you know, even in
ARC?
Well, definitely with patients, there are some that
are going to be comfortable with that and
some that may not. And so my own
practice is I don't force that. But for
some of the patients,
who are looking for the convenience,
the simple soft tissue hand cases are ideal
for that. And if you have the right
staffing and if you have the right patient
and the right,
safety level in a healthy individual,
I think trigger finger carpal tunnel release
and some small fists in the fingers can
be done very safely with excellent outcomes just
in the office based setting.
Yeah. And then are there any
key considerations
that
physicians and practice leaders should think about when
it comes to,
expanding what cases they
offer outpatient?
Well, I think certainly
if you have the space and you have
the staff
and then you have
gone through a developmental program to look at
the different important
parameters of safety.
And,
I would recommend that when somebody is looking
to do so is visiting
an established, well run,
and,
mature
office based program to really look, watch, learn,
and get an understanding of equipment, staffing, practices,
before diving in.
Yeah. And can you talk about, you know,
a lot of these orthopedic practices, you guys
are adding, you know, walk in services, and
I wanna hear what you think is Mhmm.
Really driving this,
this trend.
Certainly. Well, with regards to walk in service,
we,
we definitely know that from a a standpoint
of convenience
and cost, these are main drivers with walk
ins.
When we talk to our patients, a lot
of them are very eager to avoid
physically being in an emergency room. And if
they have a a sprain or a strain
or something that doesn't require being in a
hospital, they'd like to stay away from
contact with illness, but they also value the
shorter wait times and pretty quick access to
specialists in those offices.
I can tell you, Carly, as a consumer,
each of my three adult sons at one
point in his years has utilized our services.
And and I can say from that customer
perspective, it's a pretty effective and efficient
service for any age group.
Absolutely. And, you know, we think about the
orthopedic landscape
as a whole, are you
optimistic
or nervous when it comes to just thinking
about independent groups like, like, where you work
at?
Certainly.
I think that we've seen pendulum swings over
the years.
And, certainly, for some time,
orthopedic surgeons would
gear towards employment
and then in the years more recently, private
equity.
Right now, I think that there is an
a very heightened interest in remaining independent as
our group is. Mhmm. Within that,
it takes some
extra work and it takes some ingenuity.
Our group and myself,
I am one of the representatives to our
board with,
PELTO, which is an organization that really empowers
independent groups from,
East to West Coast, and and that's been
an exciting opportunity for us.
Yeah. And can you dive more into your
partnership
with Kaltel and where you've seen some of
the most benefits from them compared to, you
know, out of you are ever considering
other types consolidations,
etcetera?
Sure. And and, again, I think that the
way I look at it is preserving position
independence overall. And
every area, every group will have its own
culture.
But with the group Palta, which which stands
for physician empowered leadership of transformational organizations, which
is a mouthful, but the organization,
we're able to, you know, allow groups with
help and collaboration to maintain their independence if
that's what they so wish to do.
We can leverage some of the collective
different resources, whether that be ingenuity, whether it
be brainstorming,
shared services, etcetera.
And sometimes when I'm in meetings, I think
of this as we're serving as a think
tank for other similar minded independent groups. And
each group may have their own
business focused challenge or opportunity,
and we can share innovation and ideas. We
we do carry then a pretty deep bench
of expertise where we can offer advice and
leadership, even some fractional services.
And,
you know,
these are definitely some growing areas of interest,
and and we see that organization growing. It's
been it's been exciting as we figure out
a lot of ways we can help people
achieve what their goals are independently.
I like the idea of, like, a a
think tank and learning from just all the
other leaders at orthopedic practices across the country,
really.
Are there any particular
changes that you or anything you've any changes
you made in response to something you've learned
from another group?
Well, let's see. I I can think off
the cuff. I I think that we are
definitely interested in some of the cutting edge,
opportunities to use our collective
involvement. And some sometimes that can be just
innovation, whether
bouncing ideas
in terms of back office,
artificial intelligence,
even utilizing,
fractional advising between smaller groups, and then development
of other ancillary enterprises such as helping someone
build an ASC.
And I think that sometimes within our organization,
if we're evaluating
an opportunity, if we're evaluating a service or
even a technology,
having this
trustworthy organization
where we can, you know, like we were
saying, just sort of bounce an idea off
one another, but get a good founding board
can be really valuable.
Got it. And, you know, do you think
collaborations
like this will become inevitable for
any, spine orthopedic independent group to thrive?
I don't know. And I think it probably
depends on what's the goal and the nature
of each group. And if the goal is
to remain independent and maybe you're in an
area where you don't necessarily have the scale
or the size to have some of those
services,
this would be an opportunity for someone to
gain the expertise, the assistance,
or
join in to be able to kind of
enjoy a larger scale. This is maintaining independence,
not another private equity venture, but
it allows a group to reach out and
have some of the,
different value areas where it'd be purchasing power,
strategic resources,
and and still maintain that physician led kind
of structure.
Got it. Very well said. And then, doctor
Rhode, I was wondering, you know, in upper
extremity care, what are some of the most
exciting innovations that you've been watching?
Sure. I there's so many different things every
year. You know, we we're always changing. We're
always looking for something new. But
one of the things, Carly, I've seen in
the last few years that I think has
really
impacted patients has been the opportunity
to maintain a pretty active lifestyle,
especially when we consider the
our senior population. So with fracture care, with
injuries, with treating
some of the issues,
I think we're seeing great evidence, and we
are
personally seeing excellent
experiences
where our senior population now has the opportunity
to be sometimes considering
what might be what might be thought of
as a more aggressive younger person's procedure such
as fracture,
fixation, and care with the goal of getting
people back
to an activity that's really important. That could
be music. It could be golf, tennis, pickleball,
yoga, Pilates.
And I think what we're realizing here now
is that these are not just healthy lifestyles,
but they're also
one's
quality of life, social interactions.
And,
you know, when we talk to our patients,
what are they missing? Well, they miss the
physical activity, but they're missing sometimes
that really crucial social interaction that they get
with those activities.
And so if we can stabilize a wrist
or a metacarpal fracture
and and offer a rapid return within reason,
then oftentimes just that quality of life and
their enjoyment of life and those human interactions
get back to, you know, what they're looking
for as well. I think that's been really
exciting and not just because we like to
operate, but we can bring that to the
patient.
Got it. And, well, doctor Rowe, thank you
so much for
taking the time to talk on today's podcast.
It's been a great conversation. I look forward
to connecting again in the future. Thank you
so much. It was an honor to be
with you.