Delivery of Care

The success story of Ortho RI

Where putting the needs of patients first pays off

Image courtesy of Ortho RI

Mary Ellen Donovan, Executive Director of Ortho RI.

By Richard Asinof
Posted 6/13/22
Ortho RI is an astounding success story, emerging from the disrupted health care landscape in Rhode Island to fashion a business model that puts the patient first.
Will other physician-run practices in specialty care consider adopting a non-hospital based model of care, focused on what the patient needs? How can same-day surgery reduce the costs of procedures? Will Care New England and Lifespan consider making a woman the new CEO and president of their health system? Given the increased frequency of incidences of long COVID occurring, and the resulting needs of physical therapy to assist with recovery, how are the major insurance plans adjusting to those needs? How will the legalization of recreational marijuana change the way that therapeutic prescriptions are dispensed for pain?
One of the skills required in making the delivery of health care more patient-centric is the ability to listen, a skill that is not taught in medical school or in business schools or, that matter, in communications work. Instead, arrogance is rewarded and revered, particularly in the male-dominated medical profession. Imagine the gall of holding an “Endometriosis Masterclass,” which features head shots of seven male doctors. As one Twitter cognoscenti asked: “Do any of these guys have endometriosis or have had it? Any lived experience?”

WARWICK – All too often, the successes within Rhode Island’s health care delivery system go unrecognized by the news media, in large part because their focus has been skewed by the big troubles within the state’s hospital-based systems – the financial fragility of Lifespan, Care New England, and CharterCARE.

The misguided attempt by Lifespan and Care New England to force a merger was soundly rejected by both R.I. Attorney General Peter Neronha and the U.S. Federal Trade Commission. [See link below to ConvergenceRI story, “Getting to no.”]

One unintended consequence is that the leadership at both health systems, Lifespan’s Dr. Timothy Babineau and Care New England’s Dr. James Fanale, are departing.

What has been missing from the dominant narrative is the astounding success story of Ortho RI, a non-hospital-based system of orthopedic care, which opened its flagship facility in Warwick in March of 2021, championing its vision and mantra of the physician-owned, physician-run practice; “Think like a patient.”

In an interview with ConvergenceRI, a few months before the new flagship facility opened, talking about how Ortho RI views itself in the competitive health care marketplace in Rhode Island, Mary Ellen Donovan, the executive director of Ortho RI, spoke confidently about the future.

“We have top-notch, world-class surgeons, the latest in technology, innovation, and robotics, and a state-of-the-art building. We are confident that we can be competitive,” Donovan said, stressing the core principle around which the orthopedic group practice was first organized: putting the patient’s need first.

Now, 15 months later, Ortho RI is thriving. ConvergenceRI recently caught up with Donovan to learn more about the reasons for Ortho RI’s success in the disrupted world that that is health care in Rhode Island.

ConvergenceRI: What is the latest news from Ortho RI, now that it is a little more than a year since your new facility opened in Warwick?
DONOVAN: We have experienced a great deal of growth. Since the 300 Crossings opened, we have added seven new physicians and ten+ advanced practitioners.

We have expanded our service lines to include non-surgical specialties, including: biologics, rheumatology, physical medicine and rehabilitation, non-surgical pediatrics and pain management.

ConvergenceRI: What can other health care businesses learn from the innovative way you have built out your enterprise?
DONOVAN: Clearly define your values and vision early on and instill your values into every aspect of your organizational culture and decision-making.

Every physician and employee at Ortho Rhode Island can tell you what our values are. Every decision we make is patient-centered, from how we design our facilities to how we craft our job descriptions and develop our staff.

We continually challenge ourselves to ask whether an innovation, be it technology, robotics, process improvement: Is it improving the patient experience and improving patient outcomes? And, we measure everything we do.

ConvergenceRI: What role does physical therapy play in building out your network of services?
DONOVAN: Non-surgical services play an instrumental role in musculoskeletal care. Physical and occupational/hand therapy, biologics rheumatology, physical medicine and rehabilitation, non-surgical pediatrics and pain management are all services that help patients along their journey to get back to enjoying their daily lives.

Specifically with therapy, Rhode Island has had a shortage of therapists over the last few years, making access tough. We were fortunate this year to recruit almost 10 new therapists.

We are expanding our therapy at our new site at 70 Kenyon St. in Wakefield. That site is opening the week of June 6.

We are also exploring augmenting our in-person therapy with virtual therapy. Some patients have indicated they would like a virtual option and it would help in providing greater access to therapy.

ConvergenceRI: How has the current health care workforce crisis affected your capabilities?
DONOVAN: The workforce shortage has been a challenging, but we have fared pretty well. For positions that can be structured to work remotely, or a hybrid of in-office and remote work, we have had more success with recruitment and retention.

It has been more difficult to recruit and retain staff who work on the front lines – meaning they are working in the clinics five days per week. There is a lot of competition and salaries are increasing.

ConvergenceRI: Can you talk about the kinds of strategic partnerships you have created with other health care providers in Rhode Island?
DONOVAN: It’s a very dynamic environment. We maintain collaborative relationships with the large primary care groups, all major payers in Rhode Island, the health systems, and ACOs. We are in regular and active conversations with these organizations.

ConvergenceRI: What is your takeaway from the failed merger of Lifespan and Care New England?
DONOVAN: Well, it sounds like their vision was unified, but they faced a lot of hurdles. So, I can’t really comment effectively on their efforts, but I can speak to ours.

Since we formed, our vision has been patient-centered and focused on creating a great patient experience and value for our patients and the health care system overall.

We have also been working diligently to reduce costs. Some examples are:

• When we began in 2015, we had 16 physical locations throughout the state of Rhode Island and one in Massachusetts. Today, we have 5 locations and one small satellite office. We still have great access, but our facilities are more patient and environmentally friendly and less costly to run.

• In 2021, we opened our ambulatory surgery center [ASC] in Warwick and we perform same-day surgery there. The ASC has allowed us to significantly reduce the cost of surgery while offering our patients excellent quality, innovative technology, and something as simple as, but important to patients – ample free parking.

ConvergenceRI: How important is the patient perspective in building out Ortho RI?
DONOVAN: Thinking like a patient is the single most important strategy we have, followed by our employee experience.

ConvergenceRI: When it comes to orthopedic surgery, what are the latest advances in technology that are changing the way that such surgeries are conducted?
DONOVAN: We utilize a lot of technology – robotics, computer assisted technology, biologics, etc. But, the biggest, most important consideration is outcomes. We utilize patient-reported outcomes and have a research team that measures outcomes.

ConvergenceRI: As a woman leading a major health care firm, what are the cultural barriers that the health care industry faces in delivering care that is patient centered?
DONOVAN: I consider myself very fortunate and grateful for the opportunity to work with the forward-thinking physician leaders of Ortho Rhode Island. Health care is a female-dominated industry, particularly in the front line and supervisory ranks.

I spent many years in the banking and consulting space where we had strong organizational development programs. Those programs are not often available to women who work on the front lines of health care – thus it’s difficult for them to develop the business skills necessary to successfully move upward into management or executive positions.

Most went into health care because their lens is patient-centric; it’s the business and management skills that they need to move ahead. The leadership of Ortho Rhode Island strongly supported the idea of creating a career path for our young female staff and allowed me to introduce an organizational development and training program.

It’s now entering it’s third year. We have about 25 high-performing staff enrolled, mostly women, with varying degrees of formal education ranging from high school diplomas to Ph.D.s.

They are taking management assessments and learning everything from how to have difficult conversations to creating their own scorecards to measuring goals and outcomes. Many, if not all have been promoted.

Working with physicians who share my commitment to providing greater economic opportunity to women and also providing flexibility in terms of working hours and schedules brings me great professional and personal satisfaction and joy.

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