If you missed our recent webinar, Growing Pains: Scaling Orthopedic Growth in Competitive Markets, you missed a candid masterclass in independent practice survival.
We sat down with Wayne Fraleigh, CEO of the Orthopaedic & Spine Center of the Rockies (OCR), to discuss how his group is navigating two very different worlds. They manage a captive market in Northern Colorado alongside a hyper-competitive market in North Denver.
While the industry trend leans heavily toward hospital employment—private practice ownership dropped to just 42% in 20241—OCR is doubling down on independence.
Here are the four major takeaways from the conversation, including Wayne’s strategy for "Project SOAR" and why practices must ruthlessly audit their administrative workflows.
A common hurdle in independent healthcare is app sprawl, which refers to patches of software cobbled together over decades. Wayne was transparent about OCR’s reality: they are currently operating with roughly 24 different systems to manage operations.
You cannot scale a business when your data is siloed in two dozen different places. This operational fracture initiated what OCR calls "Project SOAR". This is a massive consolidation effort to move to a single, unified EMR and reduce their tech stack from 24 systems down to about seven or eight.
The Takeaway: Growth is not just about adding providers. It is about infrastructure. If your operational foundation is fractured, your patient experience will be too.
From Wayne:
"You have to have the infrastructure and the toolkit in order to be able to get patients in timely... We're effectively going from 24 systems down to seven or eight. It’s about understanding what tools can help reduce the manual processes and redundancies we have today."
Access is no longer just about having an open appointment slot. It is about the medium of communication. Fraleigh noted a distinct generational shift where younger commercially insured patients (ages 18–45) effectively refuse to use the phone.
This aligns with broader consumer data showing that 68% of consumers now text more than they talk on their smartphones2. To capture this demographic, OCR piloted a 24/7 injury chat expert line.
The results of the 90-day pilot were telling:
The Takeaway:If your front door is only a phone number, you are locking out a massive segment of the market.
From Wayne:
"Patients are paying more out of pocket, so they’re going to want care how they want it, when they want it, and where they want it. I'm finding that with the new generation... they just want to text. They don't want to talk to anybody. If we couldn't give them a way to access us, they would have looked somewhere else."
Read More: OCR isn't the only group seeing these results. Read how 3 other orthopedic practices use chat guidance to drive new patient volume.
Debating between chat and online booking? Compare the pros and cons in our guide: Patient Self-Scheduling vs. 24/7 Patient Chat.
As deductibles rise, large employers are increasingly bypassing third-party administrators to contract directly with orthopedic groups. However, Wayne warned that winning these contracts isn't just about offering the lowest bundle rate.
It is about offering a concierge experience. Employers want assurance that their employees will be navigated through the system efficiently without billing errors.
The Takeaway:
Differentiation in the employer market comes from workflow rather than just price. You must be able to flag these patients in your system to prevent billing errors and ensure they feel prioritized.
From Wayne:
"We’re looking at how to use technology... to create almost a concierge service for direct-to-employer self-funded plans... The part that these employers don't want is us accidentally billing the patient... We need to flag these folks coming into our system to ensure only the employer gets that bill."
Go Deeper: Employers are facing a $380B spending crisis. To win these contracts, you need to understand their pain points first. Read why Growth-Minded Orthopedic CEOs Must Rethink Employer Partnerships.
In an era of declining reimbursements and rising costs, practices can no longer afford to spend capital or human energy on tasks that do not move the needle.
With administrative costs accounting for nearly 30% of U.S. healthcare spending3, efficiency is a survival mechanism. During the webinar, Fraleigh used a colorful metaphor to describe the need to stop wasting time on tasks that don't generate revenue.
The Takeaway:
Identify the low-ROI tasks that consume staff time—the "mice"—and automate or eliminate them.
From Wayne:
"A peer taught me a term: we just gotta stop 'milking mice.' ...There are a lot of things we do within our practice that don't generate revenue. We need to understand what those are and focus on putting resources on things that are going to generate more revenue."
Diversify Your Revenue: Wayne emphasized the need for revenue diversification to offset declining reimbursements. One often overlooked channel? Workers' Comp. Get 7 Tips to Become Your Market’s Go-To Workers' Comp Provider.
As Wayne illustrated, scaling today requires a diversified approach. You must consolidate your tech stack, open digital doors for younger patients, and treat employers like strategic partners rather than just payers.
1. Share of physicians working in private practice continues to fall (Healthcare Dive)
2. Texting vs. Calling: What Patients Really Want in 2025 (RingRx)
3. High U.S. Health Care Spending: Where Is It All Going? (Commonwealth Fund)
