Driven in part by an older population seeking elective orthopedic surgery and an increase in sports-related injuries in middle-age patients, Rothman Orthopaedic Institute is expanding its practice into the northern part of the state and beyond.
The Philadelphia-based orthopedic practice has over the past two years expanded in central and eastern New Jersey through affiliations with Brielle Orthopedics and Trenton Orthopedics. The firm plans to expand further west and north from the Monmouth area. Its most recent expansion includes Bergen County, Westchester County in New York and Manhattan.
“In many of the markets we are targeting the orthopedic providers who are fragmented and offer affiliation opportunities to Rothman Orthopaedics,” said Dr. Alexander Vaccaro, president of Rothman Orthopaedic Institute.
“We looked at the future of medicine and we wanted to consolidate and bring value-based health care throughout the Northeast,” he added.
Vaccaro said that in the northern part of the state there are large health systems but orthopedic groups are smaller in size – they have different types of alliances with different types of ambulatory surgical centers. “We want to bring that all together so we can direct value-based care.”
Vaccaro said simple orthopedic problems are generally referred to a small ambulatory surgical center and smaller community hospitals while for the more complicated problems, patients are sent to larger community hospitals. “We can do that if we have a united system — that’s our goal.”
Rothman currently has 205 doctors, 46 offices and works with seven health care systems in Pennsylvania, New York and New Jersey.
Rothman has affiliations with the Valley Hospital, Hackensack University Medical Center, Capital Health, Atlantic Care Medical Center, Jefferson Health System, Mainline Health System, and Northwell Health.
In Bergen County the firm has offices in Montvale, Glen Rock and Rutherford with a Paramus office scheduled to open soon.
What’s driving the expansion? Economy of scale; both operationally and clinically, Vaccaro explained.
“One place for growth is where there are a lot of independent physician practices. They have to make the decision: do I go to a university/large health care system? Do I join other orthopedic surgeons in a multi-specialty group? My vision is that I think large multi-divisional orthopedic practices consolidated, is the most efficient way of delivering care.”
That’s the scenario in Bergen County, said Vaccaro.
“You don’t have large health care systems buying everyone’s practices up. You have the independents. The goal is to organize that group.”
Vaccaro said that the cost of care could be cut by 30 percent by keeping patients who don’t need to be there out of university hospitals.
“We continue to focus on value-based care – high quality care at lowest cost,” said Vaccaro.
Dr. Frank Alberta, orthopedic surgeon and an associate at the Rothman Orthopaedic Institute, said that there is very little consolidation in northern New Jersey and the area is ripe for organization.
“Our practice is broken down like an orthopedic academic department; we have divisions within our group and they are run with separate division heads and quality control measures.” The goal of this setup, Alberta said, is to be able to match the patient with the most appropriate expert in their field.
“This allows us to maximize the quality of care as well as the patient and also doctor satisfaction. It’s what makes us unique among private orthopedic practices. And it’s not something that can be provided in small specialty practices. It’s why we felt that our model would be successful in Bergen County,” said Alberta, who is president of the New Jersey Orthopedic Society.
He added that people are looking to stay healthy and they are more active at all ages. “In Bergen County we are seeing a huge increase in weekend warrior-type injuries. Another driver is the expansion of youth sports, particularly girls’ sports. We are seeing an increase in the volume of athletic injuries overall,” said Alberta.
Alberta is affiliated with Hackensack University Medical Center and sees patients in Glen Rock and Rutherford.
Because people are surviving longer, surgical procedures that were unheard of in older patients years ago are more commonplace.
We looked at the future of medicine and we wanted to consolidate and bring value-based health care throughout the Northeast.
– Dr. Alexander Vaccaro
“Thirty years ago operating on a 75-year-old was rare,” Vaccaro said. “I routinely treat patients in their 80s that have elective orthopedic surgery. Thirty-five percent of the population is 60 or older and they are more active.”
Vaccaro said surgery for total joints and ACLs on patients in their 30s and 40s is not uncommon.
In addition, sports injuries that used to be confined to younger patients in high school or college are new occurring in patients in their 30s and 40s.
Vaccaro said that spine, joint, shoulder, elbow and hand procedures are booming and that demand for elective orthopedic surgery overall is on the increase.