Orthopedic and musculoskeletal (MSK) care leaders are facing a mounting challenge: how to grow sustainably amid flat reimbursement, workforce shortages, and increased patient demand. The answer isn’t necessarily more resources—it’s smarter, more intentional efficiency.
At NextGen Healthcare, we’ve worked closely with large specialty practices to identify the seven “efficiency levers” that consistently deliver measurable financial, clinical, and operational results. This framework is designed for real-world execution—no major tech overhauls or outsourcing needed—and has helped MSK groups unlock 3–5% revenue growth and 10–15% EBITDA improvement.
A key challenge for orthopedic practices today is lack of real-time visibility into their operations. According to industry advisors, many independent groups are struggling to understand where bottlenecks exist—whether it’s in scheduling, patient throughput, or staffing. Without this clarity, it’s nearly impossible to make the pivots needed to remain competitive against hospital systems and private equity acquisition pressures.
Staffing shortages further exacerbate the problem—and not just in administrative roles. Ortho and PT groups are facing shortages in critical areas like X-ray technicians, billing teams, and even physicians. In this environment, every efficiency lever becomes a potential path to sustaining independence.
Ahead of our live session at Becker’s Orthopedic, Spine & ASC Conference, here’s a look at how each lever applies specifically to orthopedic and physical therapy organizations.
1. Revenue Optimization at Scale
Pain Point: Complex orthopedic billing requirements and high denial rates strain resources and delay revenue.
Efficiency Tools (Expanded):
- AI-powered Clean Claim Generation
- Denial Auto-Resolution Engines
- Procedure-Linked Coding Validation
Inspired by client experience:
Orthopedic and PT clients have reported smoother billing workflows and fewer denied claims after implementing clean claim automation and AI-powered coding tools—allowing staff to shift focus from manual corrections to higher-value tasks. With complex multi-specialty structures, groups need smarter rules engines to manage nuances across subspecialties like spine, pain management, and rehabilitation.
2. Contract and Referral Performance
Pain Point: Missed or incomplete referrals and underperforming payor contracts leave revenue on the table.
Efficiency Tools (Expanded):
- Referral Completion Analytics
- Embedded Smart Routing
- Contract Uplift Models
Inspired by client experience:
Several practices have begun using referral tracking and smart routing to reduce referral leakage and improve patient follow-through, helping them close care gaps and better manage relationships with community providers.
3. Smarter Staffing and Site Models
Pain Point: Over- or under-utilized providers and sites hinder throughput and hurt margins.
Efficiency Tools (Expanded):
- AI-Powered Visit Template Optimization
- Provider and Site Benchmarking
- Load-Balancing Schedulers
Inspired by client experience:
Leaders managing multiple clinic sites have seen early benefits from AI-supported scheduling optimization—resulting in better alignment of provider capacity with patient demand, and improved throughput without expanding headcount. One emerging strategy involves dynamic staffing management across X-ray, MAs, and support teams, ensuring operational flexibility even when last-minute changes occur.
4. Patient Access and Retention
Pain Point: Phone-based scheduling, incomplete intake, and poor digital engagement drive no-shows and low satisfaction.
Efficiency Tools (Expanded):
- Self-Scheduling Portals
- Automated Intake Forms
- Real-Time Eligibility and Pre-Pay Tools
- Patient Education Campaigns
Inspired by client experience:
Groups that enabled self-scheduling and digital intake workflows noted a noticeable drop in no-shows and increased patient satisfaction, especially among working-age adults seeking more convenient appointment options. In orthopedic settings, reducing friction at check-in and ensuring pre-authorization workflows are integrated directly into the visit flow is critical to preventing delays in diagnostics or imaging.
5. Provider Workflow Transformation
Pain Point: Documentation burnout and time-consuming manual charting reduce visit capacity and job satisfaction.
Efficiency Tools (Expanded):
- Ambient AI Documentation
- Virtual and Mobile Scribes
- Visit Summary Automation
Inspired by client experience:
Providers using ambient documentation and virtual scribing solutions report reduced after-hours charting and less documentation fatigue—leading to more focused patient interactions and increased willingness to take on slightly higher visit volumes. Tools that reduce reliance on EHR clicks are especially valuable in high-volume musculoskeletal practices.
6. Back-Office Cost Reduction
Pain Point: High labor costs and human errors in scheduling, authorizations, and billing create avoidable expense and revenue leakage.
Efficiency Tools (Expanded):
- Pre-Authorization Bots
- Eligibility & Coverage Validation
- Claim Scrubbing & Automation
- Exception-Based Workflows
Inspired by client experience:
Organizations that introduced real-time eligibility checks, automated auth workflows, and exception-based claims handling have seen operational improvements and a gradual reduction in RCM staffing needs for routine tasks. With prior authorizations becoming required even for injections with imaging, real-time rule prompts at the point of order entry can reduce denials and downstream rework.
7. Revenue Expansion Opportunities
Pain Point: Ortho groups often miss high-margin opportunities due to limited insight into utilization patterns or patient needs.
Efficiency Tools (Expanded):
- Utilization Heatmaps
- Predictive Service Line Modeling
- Referral Conversion Dashboards
Inspired by client experience:
Some MSK groups have used data and pattern analysis to identify underutilized service lines or locations, leading to targeted expansion efforts—such as launching new imaging or DME offerings based on patient needs and market demand. With visibility into provider-level conversion rates, practices are also optimizing high-value procedures like surgical implants.
The Takeaway for Orthopedic Leaders
While reimbursement pressure and burnout dominate the headlines, the real opportunity lies in redefining efficiency—not as cost-cutting, but as strategic reinvestment. By leveraging these seven efficiency levers, MSK leaders can streamline operations, unlock revenue, and create the kind of experience that patients and providers want to be part of.
Join Sri Velamoor live at the Becker’s Ortho Conference on June 19 or set up time with us here for a deeper dive into how top orthopedic groups are turning this framework into action—and how you can, too.
