Delivery of Care

Ortho RI emerges as innovation hub

An interview with Dr. Michael Bradley, MD, president and CEO of Ortho RI, offers an insightful look at what happens when you put innovation into practice in health care

Photo courtesy of Ortho RI / James P. Jones | Photography RI

Dr. Michael Bradley, MD, is president and CEO of Ortho RI and Chief of Orthopedic Surgery at South County Hospital.

Photo by Richard Asinof

The Ortho RI ambulatory surgery center in Warwick.

By Richard Asinof
Posted 11/6/23
An insightful, in-depth interview with Dr. Michael Bradley, MD, the president and CEO of Ortho RI, one of the largest orthopedic practices in the state, that has created an innovative model of care, focused on putting the patient at the center of all its health care delivery services, in a non-hospital centric model of care.
What kinds of reforms are needed at the health insurance level when it comes to reimbursement rates for biologics being fully integrated into the treatment strategies for orthopedics? With Attorney General Peter Neronha pursuing a new regulatory framework for health care in Rhode Island, how can the non-hospital centric model for delivery of services practiced by Ortho RI create an innovative model that improves access and equity? How can the nascent RI Life Sciences Hub investigate new models of health care delivery, looking at the Institute of Applied Life Sciences at UMass Amherst? What kind of coordination around data and research can be created that links data on the nonprofit sector, data on affordable housing, and data from the health information exchange into an easy-to-access data hub for Rhode Island?
The new push by Gov. Dan McKee to address the ongoing problem of chronic absenteeism in Rhode Island’s public schools, with its emphasis on creating better data to track tardiness and absences of students and holding students, families, teachers, and parents to a higher standard of accountability has lots of bells and whistles to it. But what is missing is a better understanding of the root causes of the problem.
The biggest root cause of student absenteeism in Rhode Island is chronic asthma – a chronic health condition precipitated by air pollution from highways and poor housing conditions. To improve student attendance, the most effective solution would be to reduce the sources of air pollution and to improve the air quality in schools. The introduction of Corsi-Rosenthal Boxes, clinically proven to reduce indoor air pollution, in every school classroom, could serve as a low-cost, innovative solution to improve attendance – and to improve educational outcomes.
Similarly, stepped up enforcement of the state’s laws to protect children from lead poisoning can also serve to reduce chronic absenteeism – and to improve the performance of students in standardized educational testing outcomes.
The biggest problems, of course, are the false narratives being promoted by the Governor and by his Education Commissioner that ignore the root causes and substitute corporate public relations gimmickry.

WARWICK – On Thursday, Nov.9, beginning at 6:15 p.m., the Venture Café Providence will be hosting what is being calling a “Fireside Chat: Unlocking the future of Life Sciences in Rhode Island.”

It will feature Carol Malysz, the executive director of RI Bio, an industry trade group, and Neil Steinberg, who’s been nominated to serve as board chair of the new $45 million quasi-public, RI Life Sciences Hub.

“Carol and Neil will share their insights on how the Hub is set to revolutionize the local life sciences economy through strategic infrastructure enhancements, pioneering workforce development initiatives and support for entrepreneurial endeavors,” according to the public relations pitch hyping the event. “The Fireside Chat promises to be a key moment, where Carol and Neil will provide valuable insights into how this Hub will drive innovation, create jobs and foster a vibrant biotech ecosystem in Rhode Island.”

Wow wow wow! The overheated public relations prose used to pitch the “fireside chat” promises that the hour-long conversation will deliver “valuable insights” and that it will serve as “a key moment’ in the future development of state’s innovation economy focused on medtech, healthtech and biotech industries. To quote WPRO’s intrepid reporter, Steve Klamkin, “Really?”

A problem with the narrative?
As much as the upcoming conversation with Steinberg and Malysz promises a high degree of revelation for those who attend, there remains a problem with the narrative, in ConvergenceRI’s opinion, when it comes to talking about the current disrupted state of the Rhode Island’s health care delivery system – the dire lack of access to primary care providers, the growing discontent of health care workers, the financial instability of the acute care integrated hospital system, and the failure by the General Assembly to increase Medicaid rates. And, the growing threat of private equity investors to engulf and devour hospital systems, as evidenced by the efforts of Prospect Medical Health [CharterCARE] to sell off its Rhode Island hospitals, Roger Williams Medical Center and Our Lady of Fatima, to The Centurion Foundation, which apparently has the private equity firm Medical Properties Trust, waiting in the wings.

What is missing from the conversation, it would seem, is a discussion about the truly innovative approach being undertaken by Orthopedics Rhode Island [Ortho RI], with its Ambulatory Surgery Center in Warwick, to create a non-hospital centric approach to delivering health care, with its mantra of putting the patient first.

In less than a decade, Ortho RI has emerged as one of the two biggest orthopedic practices in Rhode Island; it has recently launched its own research foundation focused on conducting clinical research. Ortho RI’s use of robotic surgery for joint replacements has put it on the health care innovation map when it comes to job creation, the integration of biologics into its strategic approach to treatment, and advances in using telehealth as an integral part of its physical therapy network.

Perhaps Steinberg and Malysz should consider booking a tour of Ortho RI’s surgery center in Warwick, which began operation just two and a half years ago, as an example of how the innovation ecosystem in Rhode Island is growing – so that the two leaders can listen, rather than just talk, about the promises inherent in the state’s innovation ecosystem.

Equally important, the leaders of the R.I. Life Sciences Hub should consider inviting the leaders of Ortho RI to share their insights into what has made their operation so successful.

As Dr. Michael Bradley, the president and CEO of Ortho RI, told ConvegenceRI during a recent interview, in response to the question: How does Ortho RI, which is really in a leadership position when it comes to innovation, how do they get a seat at the table?

“That’s a good question,” Bradley said. “There’s been a lot of movement around Brown and its ability to expand. There’s obviously been some discussion lately about Lifespan renaming itself at some point. We would love to be part of that. When it has more legs and starts to crystallize, I can tell you we’ll be making some phone calls.”

Here is the ConvergenceRI interview with Dr. Michael Bradley, MD, MBA, the president and CEO of Ortho RI, which recently announced that it had completed the 1,000th total joint replacement surgery at the Ortho RI Surgery Center in Warwick, since the facility’s doors first opened in March of 2021. The procedure by Dr. Robert Marchand was completed using state-of-the-art robotic-assisted technology.

ConvergenceRI: The number of joint replacement surgeries Ortho RI is conducting at its new surgical center is phenomenal. Are you at capacity? Do you need to think about expansion?
BRADLEY: The number of cases that come out of the hospital and go to a free-standing surgery center, theoretically and in real time, will decrease the cost of the care, right?

What we do, essentially, is to provide that operation at a much lower cost than a hospital has, because it has all the associated costs of running the hospital.

I think we have to do this in a way that is responsible and in partnership with some of the hospitals, because we live in an area that is very dependent on the hospital systems that support us, whether it is CharterCARE, Care New England, Lifespan, South County and maybe even Yale down in Westerly. But they all play an important role

So, in migrating cases to the ASC [Ambulatory Surgery Center], we’ve done a very good job. We are targeting 9,000, or a little over 9,000 total procedures, in the ASC.

We’re totaling close to about 6,000 or 7,000 per year now. We’ve been up and running for two and a half years. We made it to a 1,000 total joints at the ASC over the first two and a half years

But, it looks like in 2024, we will probably do almost 1,000 in one year, so, the amount of – I don’t know if migration is the right word, but shift I guess – to an outpatient [surgery] center has been, in our area, significant. In other areas of the country, the Northeast is little bit behind, but we like to think that we’re trying to catch up,

It’s an important move. We’ve got to do it with a lot of thoughts in mind – what’s your patient population, what are their wishes, quality, safety – I would say there are a lot of factors that go into it. But hopefully, that answers some of your questions.

ConvergenceRI: I was curious: Do you need to expand? You built this new outpatient facility. It seems to be humming along. Clearly, you haven’t reached your capacity yet, so that you can still grow. Does it seem like you may need to expand your facility?  
BRADLEY: What a great question! The market share, now, early on, it’s almost been too easy, because you are picking the cases that belong in the outpatient center, and we’ve gotten, I would agree with you, we are moving along, humming along a little bit, which is exciting.

The next step is really to become more efficient in case selections. And so, it’s harder to jump from where we are now to a 25-percent increase or a 30-percent increase, which would require expansion at that point, versus trying to get a 10-percent or a 15-percent increase and more efficiency in the system – and whether that is [staying open] slightly longer during the day, or moving the lower efficiency cases back to the hospitals to open up space.

That is the analysis that we’re going to [conduct], probably over the next six months. But, if you’re asking [whether it is] in our two-year or three-year plan, I think it is in our plan to try to expand our current services.

ConvergenceRI: Let me ask a related question. Which is, you seem to have really moved aggressively, if that’s the right word, into biologics. I was wondering, how do biologics fit into the treatment strategy as complementary to surgery?
BRADLEY: Another great question. Biologics have always been interesting in orthopedics. Unfortunately, over the course of the last 10 or 15 years, the promise has been better than the results.

Right now, our current biologics offerings have many different versions. Essentially, it is platelet-rich plasma where people draw blood, they spin down the healthy cells, and, into the same person, they inject their own healthy blood, this platelet-rich plasma, that then goes on to stimulate a healing process.

And whether that’s [targeted at] a chronic tendonitis or early arthritis of a joint space, all of those [therapeutic uses] have a good role.

The biggest issue with biologics moving forward is, because it’s innovative and new, that the payer reimbursement model for it has not caught up.

And so, a lot of the biologic offerings are currently an out-of-pocket cost. It’s not astronomical, but in a world where health care reimbursements have been challenging in their own right, it’s a tough model.

It’s kind of our first model to deal with, [asking]: What’s a concierge model look like? Because we don’t feel comfortable charging what Boston, New York, and Europe charge – which is somewhere [between] $3,000 or $4,000 for these injections. We are at one-sixth of the cost of those. And so, we’re trying to find a role for it. Do I think it’s valuable? Does it have a place? Absolutely!

It’s one of the most promising things we’ve seen in recent years. I hope we can still be innovative and move in that direction.

ConvergenceRI: When you began Ortho RI, the mantra was: “It’s all about the patient.” How has that grown and been maintained as you have grown?
BRADLEY: Another good question!  So, it’s funny. As you look at the workflow in our Warwick facility, the entire clinic space is built around the patient.

We don’t have a lot of chairs in the waiting room. We have online check-in. We have online bill paying. We try and take patients and move them to the next place of service. A lot of focus is put toward patient and physician online reviews. We pay a lot of attention to it. There is a patient satisfaction survey we use.

What we did was to model what the new Warwick office looks like – that’s how we built our smaller Wakefield office. And, that’s how we will expand and utilize our Providence office where we are just breaking ground on a renovation right now.

I would argue that [patients] are still at the center of what we do. Because, as we’ve grown, it hasn’t become less important; it’s probably grown more important. I think it was something that we thought was going to work. And now, we know it’s going to work. And, we’re going to continue to utilize it.

ConvergenceRI: Have you been approached by other players within the Rhode Island health care industry landscape about potential partnerships, moving forward? Given that there is, I think, still a strong appetite for consolidation in the marketplace?
BRADLEY: Yes. The way that orthopedics works in Rhode Island. I would say that there are two large players in the state – University Orthopedics and ourselves. Both are very relevant and very important.

It wouldn’t work for us to consolidate, because it would trigger a kind of restriction of trade and create almost too big of a group. I think both of those groups are going to continue to do well and stay relevant.

Together, Ortho RI and University Orthopedics make up between 80 percent and 90 percent of all of the orthopedics practices anyway.

We’re always interested in partnerships with other groups. I would say that the bigger opportunity for us is to continue to partner with the ACOs [accountable care organizations] and the primary care groups – and to keep providing top-notch care. And, then maybe in the world of physical therapy, the same kind of opportunity [to pursue] where we may have strategic partners in that avenue.

ConvergenceRI: My first question was a leading question. My sense was that your opportunities to grow were, right now, [addressing] problems with people finding primary care physicians in the state. It would seem like, and tell me if I am wrong here, it would make a natural sense for your you to be able create a primary care access point through Ortho RI, which would complement all the other services that you offer. Am I projecting too much there? BRADLEY: No, that’s a good thought. And, we have given some thought to: “Is there a role for a multi-specialty group?” Because we’ve done orthopedics so well.

I think the only issue with that is, you know, it’s probably one of those things that when you look at your core competency, [you need to ask]: “Are we stretching outside of what we would do best?”

I think our better play, which is along the same lines of what you are thinking, is: Is there an alliance or partnership with a primary care base that already does have some consolidation in it. And, I think there is a rich opportunity for that, for sure.

ConvergenceRI: I hope that wasn’t too leading of a question. It might get me thrown out of court….
BRADLEY: [laughter]

ConvergenceRI: Are you planning to expand your research capabilities and presence

BRADLEY: We are just in the process of establishing a research foundation that is part of Ortho RI. It is a 501 (c) 3 nonprofit that is focused on mostly clinical research development. We are never going to be an academic institution that does bench top or lab experiment-type things. We just don’t have the resources or the space for that. But, from a clinical research standpoint, we can focus on the treatments and the surgical offerings that we have and mix that with patient outcomes.

We are also expanding our teaching capability. We have partnerships with many of the physician assistant programs in the area. We now have a “total hip” and “total knee” fellow. So, we have a fellowship now that hopefully would expand into other service lines in the next couple of years.

It is really amazing how, in a short period of time, in probably the last three or four years, these opportunities have come up.

ConvergenceRI: What role does physical therapy play in uniting all the aspects of patient care at Ortho RI?
BRADLEY: For us, it’s been essential, because obviously it is our first line of non-operative treatment. It’s also essential in the post-operative period. I think that there are things that we can do that are innovative in delivering PT care. So, whether that is virtual PT or self-regulated PT, where we get feedback and we utilize numbers or computers to see how somebody is doing, based on the feedback they give.

For me, physical therapy is a great opportunity to start to utilize telehealth as an important aspect, to continue with the in-person care that we need and how we identify the patients that need it, and then move to virtual or digital health resources. We are utilizing a lot of those things already, but we probably could be doing a better job. And, I hope we can do so in the future.

ConvergenceRI: What questions haven’t I asked, should I have asked, that you would like to talk about?
BRADLEY: Rhode Island is an interesting state, with its 1 million people and convoluted, multiple integrated health systems and reimbursement systems; it’s a little bit of a challenge. And, we sit between Boston and New York, which have much higher reimbursements.

My biggest worry is how do we figure out how to continue to recruit talented providers, whether that’s physicians, PAs, or PTs. I want to make sure that people want to come to Rhode Island to deliver health care..

I think everybody belongs at that table – and that includes the payers, the health care systems, the providers – and even the employers that are paying the premiums for the health care.

We need to find something that continues to incentivize people [to come to Rhode Island]. You alluded to it when you said: Why is it so hard to find a primary care physician? And, why is access [proving so difficult]?

ConvergenceRI: Given your busy schedule, do you regularly get a chance to read ConvergenceRI?  

ConvergenceRI: Is there anything that you feel that I should be doing differently? Or better? Or stories that you like to see more coverage about?
BRADLEY: That’s a good question. I enjoy it. You can’t cover everything. It usually has a kind of potpourri that walks through different aspects [of health care], it usually has a good mix of what’s happening in innovation, on the academic side and in health care delivery, and what is happening with payers. I quite enjoy reading ConvergenceRI.

© | subscribe | contact us | report problem | About | Advertise

powered by creative circle media solutions

Join the conversation

Want to get ConvergenceRI
in your inbox every Monday?

Type of subscription (choose one):

We will contact you with subscription details.

Thank you for subscribing!

We will contact you shortly with subscription details.