As healthcare continues to shift toward value-based care, the future of independent orthopedics is often framed as uncertain, but that narrative may be outdated.
For David Jevsevar, MD, CEO of Richmond-based OrthoVirginia, the question isn’t whether the model can survive, it’s whether the rest of the system is ready to recognize its value.
“In independent practice, we’re delivering better outcomes at lower cost because of our model, not in spite of it,” Dr. Jevsevar told Becker’s.
That conviction is shaped by a career spanning private practice, large health systems and academic medicine. Now leading one of the nation’s largest independent orthopedic groups, he believes independence, when paired with scale, is uniquely positioned for the next phase of healthcare.
Scale built around physicians and patients
Independent orthopedic groups have grown significantly over the past decade, but Dr. Jevsevar argues that not all growth is created equal.
“For us, we’ve built scale around physicians and our patients,” he said. “We haven’t built around real estate or things that are less important to the care of patients.”
That distinction, he said, is what allows groups like OrthoVirginia to deliver on healthcare’s most important metric, value. “If you define value as outcomes over cost, we can provide equivalent or better outcomes at a much lower cost,” he said. “That’s where independent practices have a real advantage.”
Unlike hospital systems, which often carry significant fixed costs tied to large facilities, independent groups can operate with greater flexibility, a difference that becomes more pronounced as reimbursement pressures continue.
Ownership as a philosophy
As physician reimbursement has declined over the past two decades, independent groups have been forced to fundamentally rethink how they operate. At OrthoVirginia, that has meant building a broader care ecosystem, investing in surgery centers, imaging and physical therapy, not just to grow, but to remain viable in a changing payment landscape.
But for Dr. Jevsevar, the strategy goes deeper than diversification.
“Scale is a tool,” he said. “Ownership is our philosophy.”
That philosophy is reflected in how the organization is governed. The physicians making decisions about the practice are the same ones caring for patients. “You get alignment of incentives that don’t always exist in other models,” he said. “This isn’t aspirational, it’s structural.”
Lessons from across the system
Dr. Jevsevar is quick to note that large health systems play a critical role in the broader healthcare ecosystem. But his experience across different care settings revealed consistent tradeoffs.
“In some environments, there’s a strong focus on operational efficiency and delivering high volumes of care,” he said. “In others, there’s a deep commitment to measuring and understanding outcomes. The challenge is consistently bringing both together.”
“You need both to deliver value,” he added.
That realization ultimately shaped his return to independent practice.
“If I truly believe in value, I need to be in a place where we can achieve great outcomes at a lower cost,” he said.
Preserving culture at scale
As independent groups grow, maintaining a physician-led culture becomes more complex, particularly as younger surgeons enter organizations that are already large and established.
To address that, OrthoVirginia is investing heavily in leadership development and business education for physicians.
Dr. Jevsevar said many younger physicians entering large practices have had limited exposure to governance and the business of healthcare, making intentional leadership development essential.
At the same time, not every physician needs or wants to take on a leadership role, but strong physician governance remains essential. Despite ongoing pressures, Dr. Jevsevar sees independent orthopedics not as a model under threat, but as one positioned to lead.
“We’re delivering better outcomes at lower cost because of our model, not in spite of it,” he said.
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