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Orthopedic Practice Management

Orthopedic practice management is deciding where to perform services, who to partner with, and how to stay profitable. We've led healthcare groups through every part and beyond.

Orthopedic Practice Management Starts With Where Cases Happen

A total hip replacement can happen in a hospital outpatient department, an ambulatory surgery center, or increasingly in a procedure suite attached to your office. The implant is the same. The surgeon is the same. The patient goes home the same day in all three settings. What differs is who owns the facility, what you pay for the room, what you collect for the case, and who handles the dozen administrative functions that sit between procedure and payment.

Orthopedic groups that own ASC capacity operate a different business than groups that rely entirely on hospital access. Neither model is wrong. Both require administrative infrastructure matched to how the practice runs day to day. SMCG works with orthopedic organizations across this spectrum, from groups weighing their first ASC investment to health systems trying to figure out why their employed orthopedic surgeons produce less than the independents across town.

Site economics is where orthopedic practice management starts. The decisions that follow from it touch billing, credentialing, vendor relationships, staffing, and whether the practice generates the margin that makes everything else possible.

For groups that own or want to own surgical capacity, the first question is usually whether the investment makes sense.

Orthopedic practice management consulting services

ASC Ownership for Orthopedic Surgeon Groups

Orthopedic surgeons own ambulatory surgery centers at a higher rate than almost any other specialty. The economics make sense when procedure volume supports the investment. A joint replacement that generates a few hundred dollars in surgeon fees at a hospital can generate thousands in facility revenue at an ASC you own. Multiply that across several hundred annual cases and the math becomes hard to ignore.

The operational requirements are harder to see from the outside. Facility licensing, payer contracting separate from your professional contracts, supply chain for implants and consumables, staffing models that maintain quality without killing margin, and accreditation requirements that add administrative overhead. Some groups build this capacity internally. Others partner with management companies that take a piece of the revenue in exchange for handling the work.

We help orthopedic groups evaluate ASC decisions before capital gets committed. That means modeling the economics against your payer mix, identifying the operational requirements you'd need to build or buy, and comparing ownership structures that range from full control to joint ventures with hospitals. Our operations consulting covers ASC feasibility, and when groups move forward, we help build the administrative infrastructure the facility needs to perform. Some clients want us involved through opening day. Others want the analysis and handle execution themselves.

Owning the facility changes the revenue equation. Controlling implant costs determines whether that revenue translates to margin.

Implant Economics in Orthopedic Surgery

A spine fusion cage costs what a family medicine practice collects in an entire day. A total knee system runs five figures. Orthopedic surgery involves device costs that no other specialty except cardiac approaches, and those costs either get recovered from payers or absorbed by the practice. The difference between groups that handle implant economics well and those that don't often exceeds six figures annually.

Hospital outpatient cases typically bundle implants into facility payment, which means the device cost is the hospital's problem. ASC cases may allow separate billing above certain thresholds, or may require the practice to negotiate implant carve-outs payer by payer. Some payers reimburse invoice cost. Others cap at a percentage of wholesale. Others refuse separate payment entirely. Your billing operation needs to know which rules apply to which payer and which facility, then bill accordingly.

Vendor Relationships and Cost Control

Implant costs are negotiable in ways that most practice expenses are not. Surgeons have preferences, but multiple vendors make comparable products for most joint and spine applications. Groups with volume have bargaining power. Groups that track utilization by surgeon have data that supports negotiation. Groups that don't end up paying list price while their competitors pay less.

We work with orthopedic groups on the revenue cycle side of implant management: making sure billable costs get billed, recoverable costs get recovered, and payer contracts support the device utilization patterns your surgeons prefer. We also connect groups with supply chain resources when the issue is vendor pricing rather than billing capture. RCM support from SMCG includes implant billing as a standard part of orthopedic engagements, not a specialty add-on.

Implant economics matter most in groups where multiple subspecialties operate under one practice umbrella.

Orthopedic surgery practice operations consulting

Managing a Multi-Subspecialty Orthopedic Group

A fifteen-surgeon orthopedic group with spine, sports medicine, total joints, hand, and trauma coverage is running five different billing profiles, five different documentation requirements, and five different payer dynamics under one practice name. Spine cases carry implant costs and prior authorization burdens that sports medicine rarely sees. Joint replacement billing follows patterns that hand surgery doesn't share. Trauma coverage involves call arrangements and hospital relationships that elective subspecialties can ignore.

SMCG works with large orthopedic groups on building administrative operations that handle subspecialty differences without requiring separate back offices for each. That means billing staff who can move between coding requirements, credentialing processes that account for different hospital privilege categories, and operational workflows that flex for the procedure mix on any given day.

The alternative is a billing operation that works well for whichever subspecialty gets the most attention while leaving money behind on the others. We see this pattern regularly when groups grow by adding subspecialties but don't adjust their infrastructure to match.

Spine, Sports, Joints: Different Billing Realities

Spine surgery involves device costs, multi-level coding decisions, and prior authorization requirements that create billing demands sports medicine rarely encounters. Sports medicine generates volume through clinic visits and minor procedures that move fast and bill in patterns closer to primary care. Total joints involve episode-based payment models and quality reporting requirements that neither spine nor sports typically faces. Each subspecialty has coding patterns where errors concentrate, and those patterns differ.

We build orthopedic billing operations with depth across the subspecialty range. That means training billing staff to recognize where each subspecialty loses revenue, building QA processes that catch the errors before claims go out, and tracking performance by subspecialty so problems surface before they compound. Groups that treat billing as a single function regardless of subspecialty typically find one area subsidizing the errors on another.

Subspecialty coordination extends beyond billing into referral development and market positioning.

Physical Therapy, Imaging, and Ancillary Integration

Orthopedic practices sit at the center of referral patterns that extend into physical therapy, diagnostic imaging, and durable medical equipment. A patient with a knee injury may need an MRI, surgery, and twelve weeks of PT before returning to activity. Practices that own or partner with ancillary services capture margin at each step. Practices that refer out watch that revenue flow to other organizations.

The decision to integrate ancillary services involves capital, compliance, and operational bandwidth. PT clinics require licensed therapists, scheduling systems, billing operations, and space. Imaging requires equipment, accreditation, and technical staff. Each line adds revenue potential and administrative burden. The question is whether your organization can run additional business lines without distracting from surgical practice.

We help orthopedic groups evaluate ancillary integration opportunities and, when they proceed, build the operational infrastructure to run them. That includes marketing support for referral development within the ancillary services, since PT clinics and imaging centers require their own patient flow strategies. Some groups add these services and watch them struggle for volume. Others build referral patterns that fill capacity from day one.

Regardless of practice structure, every provider needs to be credentialed everywhere they work.

Credentialing Orthopedic Surgeons Across Multiple Sites

An orthopedic surgeon operating at your main office, a satellite location, an ASC, and two hospitals needs enrollment with every payer at every location. Each combination represents a separate application, a separate timeline, and a separate set of follow-up tasks that someone has to track. Add a new surgeon to the group and multiply the work. Open a new facility and multiply it again.

Groups in expansion mode often discover that credentialing becomes the constraint on revenue from new capacity. Every week a new surgeon waits for payer enrollment is a week of compensation without matching collections. An ASC that opens before payer enrollment completes has a facility generating cases it can't bill. The gap between operational readiness and revenue readiness can run longer than anyone expected when the hire got approved.

Facility and Provider Enrollment Together

Provider credentialing and facility enrollment run on parallel tracks that both need to complete before revenue flows. We handle both for orthopedic groups through our credentialing services. That means tracking every application across every payer and every site, following up before deadlines slip, and closing the gap between when a provider starts working and when they start generating revenue.

For groups building new ASC capacity, we map enrollment requirements against construction timelines so payer contracts are in place before the first case. The goal is billing on day one, not month four. The revenue lost to enrollment delays often exceeds what anyone projected when the project got approved.

With credentialing supporting provider and facility capacity, the remaining question for many orthopedic groups is what comes next.

Practice Transition and Partnership Decisions

Orthopedic practices field acquisition interest from private equity, partnership offers from health systems, and merger proposals from competing groups at a higher rate than most specialties. The procedure revenue is attractive. The ASC ownership adds asset value. The surgeon shortage means every group with capacity becomes a target.

We work with independent orthopedic practices on understanding their options before signing anything. That starts with knowing what your practice is worth, not the number a buyer floats to start a conversation. It means understanding how your payer contracts, billing performance, credentialing status, and operational efficiency affect valuation. It means knowing which problems would surface in due diligence and whether to fix them now or discount for them later.

SMCG doesn't broker transactions, but we help practices get ready for them. Clean financials, documented processes, credentialing in order, revenue cycle performing at a level that justifies valuation claims. Some clients use that preparation to sell from strength. Others use it to stay independent with confidence. Either way, you negotiate better when your operations are tight.

Some orthopedic surgeons end up in health system employment, whether by choice or acquisition. Those programs face their own management questions.

Health System Orthopedic Service Lines

Hospital orthopedic programs often underperform the independent groups in their markets. The surgeons may be as skilled. The facilities may be as good. But the administrative infrastructure wasn't designed for high-volume procedural practice, and that mismatch shows in productivity numbers, surgeon satisfaction, and program economics.

We consult with health systems on orthopedic service line performance. That includes co-management arrangement design, employed surgeon productivity benchmarking, credentialing processes that don't add months to provider onboarding, and billing operations that capture procedural revenue rather than leaving it in unbilled charges. The average orthopedic surgeon generates over $3 million annually for their hospital according to Merritt Hawkins physician revenue data, so productivity gaps between your employed surgeons and independent group benchmarks translate directly to budget shortfalls.

The issues are usually addressable. Health systems that invest in orthopedic-appropriate infrastructure can match independent group performance. The question is whether leadership understands what that requires and commits to providing it. We help system executives understand what their orthopedic program needs and build the case for getting it.

Whether you run an independent practice or a hospital program, the conversation starts with where you stand now and what you want to change.

Orthopedic practice management consultants

Start With What Needs to Change

Tell us where your orthopedic organization is and what isn't working the way it should. ASC economics that looked better on paper than in practice. Implant costs eating margin you expected to keep. Subspecialties generating volume but not revenue. Credentialing delays backing up your expansion plans. Partnership questions you haven't answered yet. We'll tell you whether we can help and what it would take.

We scope to what needs fixing. No extended discovery phases that bill hours without moving anything. The first conversation tells you whether working together makes sense.

Schedule a Consultation

Talk with us about where your orthopedic organization stands and what comes next. Whether you're an independent group managing ASC operations, a multi-subspecialty practice coordinating growth, or a health system building an orthopedic service line, we can help you think through the decisions ahead.

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