His practice is the ‘best of both worlds’
Adam Bruggeman, MD, a 42-year-old spine surgeon who is CEO of Texas Spine Care Center, a solo practice in San Antonio, said he has “the best of both worlds.”
“As a solo physician, I have total control over how I practice,” he said. “But I also have access to value-based contracts and the data and staff needed to implement them.
“You need a lot of administrative overhead to take on these contracts, which a private practice normally doesn’t have,” he said. But Dr. Bruggeman gets this work done through a clinically integrated network (CIN) of private practices, Spinalytics of Texas, where he is chief medical director.
The CIN represents 150 musculoskeletal care providers and provides access to bundled networks, such as a total joint bundle with Blue Cross Blue Shield of Texas, as well as fee-for-service contracts.
He is also building a new ambulatory surgery center (ASC) that is scheduled to open in January. There, he plans to perform total joint and spine surgeries at a lower cost than at the hospital, which will be useful for value-based contracts through the CIN.
Dr. Bruggeman said it would be hard to run his private practice without the CIN and the ASC. “Private practice has changed,” he said. “The days of hanging up a shingle and immediately being successful are gone. You’ve got to be smart about business to run a successful practice.”
He started his practice while the pandemic raged
Joe Greene, MD, 42, an orthopedic surgeon in Louisville, Ky., had to open his hip and knee surgery practice when the COVID-19 pandemic was raging a year and a half ago, but that did not stop him.
“Federal financing of small bank loans completely stopped, but that only amounted to a small delay because our bank took care of it,” said Dr. Greene, who codirects his new practice with another orthopedic surgeon.
Even during the pandemic, “we could be very nimble,” he said. “For instance, when we want to institute new technology or a new patient-centric educational platform, we can do it immediately rather than going through an approval process at a health system.”
The partners, both ex-employees of a health system, also have an ASC, which allows them better control over their surgery schedules. “At a hospital, you can be bumped from the schedule by other surgeries, and you can’t be as productive as an ASC in the number of surgeries per day,” he said.
Dr. Greene attributes the practice’s success to long and careful planning. “We had to learn about business,” he said. “We did 3 to 4 years of research to find the right business model and implement it.”
As they were considering the new practice, a survey of patients showed that more than 75% chose them by word-of-mouth – because they specialize in complex and revision surgeries – rather than through referrals within their health system. This meant they could survive without their employer.
Planning for the new practice took up all his free time, but now he can relax and spend time with his three daughters, ages 12, 10, and 8. Dr. Greene currently coaches two of their teams. “We’re loving it,” he said.