For more than 50 years, OrthoIndy has operated on one principle: Provide comprehensive orthopedic care at a lower cost than other health systems
By Erik Cassano
In 1962, two central Indiana orthopedic physicians joined forces to found the Blackwell and Bruekmann Partnership. Their vision was to create a health system to provide the widest possible range of orthopedic treatment options in one place.
Today, the Blackwell and Bruekmann Partnership has evolved into OrthoIndy, and it has fulfilled the vision of its founders—and then some.
Tim Dicke is the managing physician of what is now a doctor-owned, full-service orthopedic surgery and treatment system with 10 locations, including OrthoIndy Hospital in Indianapolis. Each year, thousands of patients seek treatment at OrthoIndy’s 10 locations in a footprint that spans from Greencastle and Lafayette to the far west and northwest of Indianapolis.
“We have strived to add every subspecialty of orthopedics, so we have a full-service, soup-to-nuts system,” Dicke says. “We work on bones, joints, spine, foot and hand—any type of condition or injury to the musculoskeletal system.”
It has taken much work through several generations of physician-owners to grow OrthoIndy to its present state. Though it has existed since 1962, OrthoIndy didn’t open its first system-owned surgical center until 1997; OrthoIndy Hospital (originally called Indiana Orthopedic Hospital) opened in 2005.
To ensure it stays on a consistent growth path, OrthoIndy has closely adhered to a set of core principles: Find talent and keep that talent, maintain a smaller organizational structure that allows for high levels of interaction between doctors and patients, and keep care costs low compared to other area hospitals.
Health care systems across the country have branched into specialty areas, and with bone and joint problems increasingly common throughout the population, orthopedics is a growing specialty for many. As a result, most health systems have specialty doctors, clinics or hospitals in orthopedics, making it a competitive field.
That reality has caused Dicke and the OrthoIndy staff to take careful stock of what sets their organization apart and develop a business strategy that emphasizes those strengths.
“Because we’re completely focused on orthopedics, we have a natural ability to focus on what we do best,” Dicke says. “And because we’re physician-owned and physician-operated, we can control our prices better, offering an overall better value to the community.”
Dicke says that because doctors are managing their own business decisions, that gives them the ability to make decisions that are aimed at better care and managing costs, both to the benefit of patients. The doctor-owner model also allows physicians to stay closer to the ground when it comes to interacting with patients, and those who provide health insurance to patients.
“One of our biggest areas of concentration has been to develop relationships with businesses throughout Indianapolis and beyond,” Dicke says. “We know we can manage costs better than some larger outfits, so we can give employers high-value treatment options for their employees.”
He says they do that without sacrificing the quality of service, which positively impacts insurance costs for employers.
Because of the ability to manage costs better when banding together, Dicke says the longstanding independent-doctor business model for health systems is starting to wane.“Historically, most hospital systems had open staffing,” he says. “Most physicians were independent, running their own practices and utilizing hospital facilities. But that’s starting to disappear, because doctors are starting to see that when you own the facility and when you pool your resources, it is very much to the benefit of your patients.”
Finding new doctors
OrthoIndy is co-owned by about 80 doctors, and 50 are orthopedic surgeons. The remaining doctors come from other essential areas of specialization essential for a hospital, including internists, hospitalists and anesthesiologists.
Therein lies the challenge of the physician-owner model—finding doctors across different areas of specialty who are willing and able to buy in to the model, both literally and figuratively.
“The reason it has worked for us so well is because we have found doctors with specialties and subspecialties that complement what we already had,” Dicke says. “We are constantly recruiting doctors in new areas. We recently brought on two new surgeons, a joint surgeon and a hand surgeon. We want to be as inclusive as possible, because that will further improve the organization as a whole.”
To become a part of OrthoIndy, physicians must be singularly focused on what is best for their patients, even if it might mean less revenue for the doctor and organization.
“We have what we call pathways, which we use when deciding what to do for a patient,” Dicke says. “They’re guidelines that help ensure that we’re doing any procedure for the right reasons. If a patient has knee pain, we can certainly do a knee replacement, but there are criteria that have to be met.”
“What is the anticipated outcome for the patient 10 or 20 years from now? Will the implant hold up for that long? Is there is a less-invasive, lower-cost procedure we could consider? When you understand all of those factors, you can make better decisions.”
Doctors who apply to join OrthoIndy must also be board-certified and fully credentialed in their field, in addition to passing a vetting process to determine whether there is a specialty and cultural fit. Once candidate doctors meet all of the criteria, they are given the option to become a shareholder or partner in the organization.
That process can take some time, meaning there are doctors who are members of OrthoIndy but not yet full-fledged shareholders in the organization.
“A vast majority of our doctors are owners,” Dicke says. “The ones who aren’t yet owners are still coming along through that process. We want to maintain very high standards while also being as inclusive as possible.”
Word of mouth
All of the work Dicke and the OrthoIndy staff put in to developing and maintaining the system pays off when the time comes for a patient to seek orthopedic care. Even though OrthoIndy is smaller than some of the big health systems in central Indiana, in terms of volume of cases, it is one of the biggest players in the state. That’s largely because patients refer other patients. The system does market itself in traditional channels, but personal recommendations are far and away the biggest driver of new patient business.
“About 80 percent of patients come to see us through word of mouth, or simply because of our great reputation in the community,” Dicke says. “I think that’s a huge indicator. If you take care of your patients, they will spread the word for you.”
In the coming years and decades, Dicke would like to see OrthoIndy become more of a regional—even statewide—presence. To make it happen, the system will have to recruit new doctors from outside its current footprint and rely on reputation and word-of-mouth among patients even more.
“We know we can do it, though,” Dicke says. “We are going to be smart about growth, trying to continue to grow our market share and expand our footprint where we find a need. And as part of that, continue to attract high-quality physicians who believe in our model and our philosophy of putting the patient first in everything we do. If we continue to work at that, we’ll continue to find success.”
When OrthoIndy Hospital opened its doors in 2005, the OrthoIndy system didn’t have nearly the volume it does now. With increases in volume comes a need for more floor space, more exam rooms, more operating rooms and more offices.
As OrthoIndy’s primary bank, Huntington understood not only the challenges the hospital faced as it expanded but knew how to answer those challenges in a way that would allow OrthoIndy to better fulfill its mission of patient care.
“Huntington has been a great bank for us overall, but especially when it has come to our expansion projects such as the hospital, which now has main, west and south campuses,” says Tim Dicke, the managing physician at OrthoIndy.
Huntington worked with OrthoIndy to construct a line of credit that helped the hospital’s expansion plans become reality.
“They know us, and they know the quality of our balance sheet,” Dicke says. “That’s why they’re our go-to bank. They’ve worked hard to understand our business model and what is important to us as we grow. They’re a resource for us in multiple ways, and that’s why we have stuck with them and will continue to do so.”
For more information, visit www.orthoindy.com.