Nicholas Grosso, MD, is the president of The Centers for Advanced Orthopaedics, a practice based in Bethesda, Md.

The Centers for Advanced Orthopaedics launched in January 2013, bringing together more than 20 private practices looking to merge with like-minded independent orthopedic groups, rather than sell to large hospital systems. Today, the practice boasts 174 physicians on staff and 65 locations throughout the Maryland, Virginia and Washington, D.C., area.

Dr. Grosso, an orthopedic surgeon, spoke with Becker's Spine Review about his approach to leadership and challenges in private practice.

Question: How did the founding of The Centers for Advanced Orthopaedics come about?

Dr. Nicholas Grosso: We founded The Centers for Advanced Orthopaedics to empower the private practice model, which we believe, and studies have proven, delivers the most efficient, compassionate and highest quality orthopedic care to patients.

In 2011, my private practice was exploring the idea of merging with other Maryland orthopedic providers, and we heard of like-minded groups in Washington, D.C., trying to achieve the same thing. At the time, private practitioners were facing mounting pressure to sell to large institutions and hospital systems, where an MGMA study found physician productivity can fall as much as 25 percent from seeing less patients and performing fewer timely procedures. We were determined to buck this trend, preserving the personalized service and standard of care that is unique to private practice medicine.

Before we knew it, we had more than 20 private practices trying to unite, and together we identified our business model. Our model preserves physician autonomy while providing incredible new opportunities for sharing of best practices, pooling resources and collaborating on patient education and orthopedic research. After about 18 months of planning, we went live in 2013 with 128 orthopedic physicians and a footprint stretching throughout Washington, D.C., Maryland, Virginia and West Virginia. Immediately, we were one of the largest orthopedic groups in the country.

Q: How has The Centers for Advanced Orthopaedics developed since its launch?

NG: At the outset, as a young and promising company, we needed to focus on building a strong foundation for growth. That entailed developing and refining a strong revenue cycle management platform designed to be scalable, establishing critical compliance protocols and fostering internal communication to help build cohesion amongst such a large and diverse group of doctors and employees. When we launched The Centers, we made it easy for groups to leave if the model wasn't working for them. One of the things I'm most proud of is that no groups have exercised their option to leave.

Organically, the success of The Centers has attracted other orthopedic groups who share our vision and passion for private practice medicine. We have seen strong growth within the founding care centers and also added several new groups to our ranks. It's rewarding to see our footprint grow, enabling us to care for more patients in the communities we serve. While we are a large organization, though, we really consider ourselves to be similar to "mom and pop shops" that have joined together to be able to continue to deliver the personalized service our patients love.

Lastly, one of the biggest developments we've made as a group is how well we have embraced The Centers. As you can imagine, it wasn't easy for doctors to give up the practice identities they had developed, some over decades, but we have been able to really come together as The Centers for Advanced Orthopaedics in both our branding and internal processes. It was a gradual change that gained momentum as our members became increasingly aware of the shared potential we could collectively tap into. As they say: the rising tide lifts all boats.

Q: How has your approach to leadership evolved since your start?

NG: I have always been a person who sought a diverse set of opinions and tried to encourage my peers to take initiative and drive progress. When people feel they have a voice, they buy in and really want to help make things better. That's why we have always felt strongly that our physicians and employees should have a voice in the organization. After all, they're what make the company so special.

One thing I have learned is the virtue of patience, focusing on the day-to-day tasks that need to get done in order to make the big picture ideas a reality. In my role, I'm fortunate to get calls every day from doctors and executives with incredible ideas, but you can't just drop everything to run in a new direction, you have to stay disciplined and focused on your top priorities. I have learned that big ideas take time in an organization as large as ours, and we make sure we are prepared for everything we do.

One example that comes to mind is advertising. From the beginning, many of our physicians have expressed interest in a large scale advertising campaign, but it was essential that we first unify our brand and processes, so there wasn't a disconnect between our branding and the actual patient experience. Now that we have a powerful and consistent brand across all of our locations, we can maximize any external marketing efforts.

Q: What do you see as the biggest challenges facing private practice in the coming year?

NG: Uncertainty is a huge challenge facing the entire healthcare industry. We really don't know what changes we can expect from the new presidential administration, so private practices need to comply with existing laws but be nimble enough to adapt as things change. The Centers for Advanced Orthopaedics is well positioned for disruption because of our size and resources.

No matter what, it looks like the trend towards value-based care models will continue, as they have proven to reduce costs and improve quality. In my view, the biggest opportunity we face is bundled payments, which will give orthopedic physicians the role of "care manager;" the surgeon is responsible for making a clinical plan from pre-op all the way through discharge and physical therapy. Through this new value-based model of care, we can improve outcomes, decrease costs and preserve the cherished physician-patient relationship that private practitioners value. With so much overhead and bureaucracy, hospitals won't be able to achieve these efficiencies and outcomes as easily as private practitioners.

I'm amazed by all that we've been able to achieve together as The Centers for Advanced Orthopaedics. Private practices that once felt they were in competition with one another have united, and we have learned that we aren't competitors. We can grow the pie for everyone if we work together, and our entire organization is on board with that line of thought. We are reversing the trend in which private practice physicians change course and opt for hospital employment, and this new path is allowing us to thrive in our communities as we continue to offer a personalized level of orthopedic care.

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