Amid growing cost pressures and evolving care demands, orthopedic groups are rethinking traditional operations to achieve smarter growth.
At Becker’s 22nd Annual Spine, Orthopedic and Pain Management-Driven ASC Conference, leaders from Sierra Pacific Orthopedics and NextGen Healthcare shared how strategic use of data, AI and workflow redesigns are enhancing operational efficiency and positioning practices for future success.
Here are four key takeaways from the session:
1. Scaling with intention
Jeremy Ealand, CEO of Fresno, Calif.-based Sierra Pacific Orthopedics, emphasized that sustainable growth isn’t accidental. Sustainable growth requires a measured approach, grounded in a clear understanding of current operations and the long-term impact of today’s decisions.
“Scaling smart is usually identifying the levers that you can pull today that are going to impact your practice or your organization in the near future,” said Ealand. “Recognizing what your needs are going to be in five years is crucial.”
As part of his leadership approach, Mr. Ealand prioritizes robust data ownership and utilization. From new patient referrals through imaging and surgical outcomes, Ealand stressed that data creates a foundation that enables organizations to truly understand their goals and strategies.
“If you don’t have a systematic approach in place and individuals that understand things from beginning to the end, then we’re probably not doing a good enough job,” Ealand said. “If we don’t recognize our opportunities, whether that’s through data or through understanding the operational aspects of our practices, then there’s no way that we’re ever going to be able to improve.”
2. AI’s expanding role in RCM
Sri Velamoor, president and chief operating officer of NextGen Healthcare, detailed how automation and AI are transforming revenue cycle management (RCM).
Velamoor explained that capturing charges accurately from the outset, generating clean claims by predicting payer-specific denials, automating prior authorization requests and leveraging bots for denial follow-up can deliver significant financial impact.
Velamoor estimates that, when deployed correctly, these technologies can yield a 5% to 10% uplift in revenue.
“Once the denials come back from the payer, these models can go back to payer websites and do all the dirty work of evaluating what’s wrong with your denial,” Mr. Velamoor said. “Some of these models can go ping a payer website a thousand times a day until you get the responses you’re looking for, and these are otherwise administrators that are sitting on the phone trying to get through to an insurance company.”
3. Modernizing workflows to do more with less
Faced with California’s rising healthcare minimum wage, Sierra Pacific Orthopedics moved parts of its administrative operations out of state and implemented digital workflows that enable remote coordination. Ealand noted the initiative succeeded because the team acted decisively and adopted technologies that centralized and standardized workflows.
Key to success was engaging staff early and clearly communicating benefits.
“Instead of being distracted by the downsides and the negative impacts, we as administrators were able to act on it,” Ealand said. “Sometimes there was some risk and while we would never take those risks in an exam room, we as administrators need to be willing to adopt these new technologies and adopt these new practices to remain competitive in our market.”
In addition to staffing model changes, Ealand and Velamoor pointed to hidden operational inefficiencies that can undermine performance. Ealand described how decentralization in pre-op testing created costly delays and duplicated work. Centralizing services and creating a dedicated department slashed costs and improved the patient experience.
Velamoor cited variability among physicians and fragmented tech stacks as major culprits. Using analytics to identify practice-level inefficiencies and standardize workflows can yield outsized returns.
“Variability is the silent killer for efficiency in most practices,” Velamoor said. “Having the right analytics view that’s telling you the differences between how different physicians traverse the workflows and where there’s variability is critically important, otherwise you’re not going to know that you’re actually making a difference.”
4. Why change management is essential
Velamoor shared lessons learned from rolling out NextGen’s ambient AI documentation tool. Despite evidence of major time savings, adoption lagged until the company embedded support staff in clinics for live guidance. Within a month, usage scaled from two to 200 physicians.
“We have to accept that we’re recommending to folks that they’re fundamentally changing the way in which they practice medicine,” Velamoor said. “It’s no easy feat to make the investments not just in the tech, but in supporting them through that change process.”
Setting a clear baseline of the problem to solve is a critical first step, according to Velamoor. Making results measurable and then providing resources on the ground leads to efficient transitions. Ealand added that success also depends on leadership trust and decisiveness.
“Own the process,” Ealand said. “If you trust the direction that your team took and the progress that they made, trust them to implement it. That’s the most valuable thing you could add to your practice because they’re likely talented individuals with great ideas.”
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