ASC ownership and leadership have undergone significant changes in recent years, as more independent and physician-owned ASCs shift toward increasingly complex and consolidated arrangements involving hospitals, private equity and corporate stakeholders.
But for Charlotte, N.C.-based OrthoCarolina, physician ownership and leadership remain core to the organization’s success and future growth.
“OrthoCarolina is an independent, physician-owned, physician-led organization, which means we’ve got a deep physician committee structure, from our executive committee to all the subcommittees, finance, operations, you name it,” Leo Spector, MD, CEO of OrthoCarolina, told Becker’s. Dr. Spector originally joined OrthoCarolina to complete a fellowship in spine surgery and got involved in leadership early in his career.
He eventually earned his MBA, serving in multiple clinical and administrative leadership roles at OrthoCarolina before becoming CEO in 2024. As CEO, Dr. Spector still sees patients, performs surgeries and takes calls, along with his other physician partners.
His clinical, administrative and business experiences give Dr. Spector a perspective on leadership that centers physicians’ core skills with patient needs to deliver care that is high-value and increasingly accessible.
For example, in January OrthoCarolina decided to sell off its physical therapy business to Atlanta-based PT Solutions Therapy. In April, the practice made another decision to part ways with 18 MRI locations, which were sold to Charlotte, N.C.-based Novant Health and partner MedQuest Associates.
“As healthcare is shifting toward [value-based care], we started to look at what was ancillary to our core business, and does it align with value care?” he said. Among the numerous reasons that the practice decided to discontinue these services specifically, included upcoming shifts to certificate-of-need laws in North and South Carolina, which would enable OrthoCarolina to expand its ASC presence in the region.
“And to do that, it takes financial and human capital. So we looked at it and said, to deliver value for our patients, to expand access to these high-value sites of service, we’re going to have to invest in [ASC development],” Dr. Spector said. The shift away from ancillary services and back towards ASCs represents OrthoCarolina’s “core business.”
“If you try to be everything to everybody, you end up being nothing to nobody, right?” he added. “We really think that the best way that we can help lower the total cost of care and bring value to our patients is making sure that the right patient gets the right procedure from the right practitioner in the right location. And the one thing that we didn’t really have much control over was that location. CON reform gave us that ability to do that, and so we want to take advantage of that.”
Being physician-led means that these strategic decisions are not only informed by market conditions and economics, but by the day-to-day experience from physicians within the practice. This makes OrthoCarolina highly nimble and adaptable compared with larger, corporatized organizations.
“Oftentimes in big bureaucratic organizations — [and] most healthcare systems, just by the nature of what they have to do, are like that — there’s a lot of layers between the folks making decisions and the folks that are delivering the care,” he said. “You don’t get that immediate connection, that immediate feedback loop that allows you to iterate.”
OrthoCarolina’s future growth as an independent organization in an increasingly corporatized healthcare market will also rely on creative alternatives to consolidation.
“We as an organization need to continue to grow. We need to continue to consolidate. But consolidation doesn’t always have to be under a single tax ID as a single group,” Dr. Spector said. “You can form partnerships that allow for economies of scale.”
He specifically noted OrthoCarolina’s partnership with Durham, N.C.-based EmergeOrtho, formed in 2023. The groups could, in theory, form a singular organization — but a clinically integrated partnership had more to offer for the two independent groups, Dr. Spector said, such as a non-traditional path to consolidation that fueled future growth.
“And we can do that with other independent practices,” he said. “We can do that with hospital systems, right? We can partner with those that are willing to partner, as opposed to always having to be owned, employed, consolidated.”
