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Joint venture for orthopedic surgery is eyed by Rice, ACMC

WILLMAR — Hoping to stabilize local orthopedic surgery services, Rice Memorial Hospital and Affiliated Community Medical Centers are developing a plan to provide orthopedic surgery through their Willmar Medical Services joint venture.

Although several details are still being worked out, much of the plan has already taken shape and will be finalized in the next few months, Dr. Ronald Holmgren, president of ACMC and Willmar Medical Services, said recently.

“We’re fairly well down the road with the structure,” he said.

The partnership should help bring more stability to a service that is critical to the community, clinic and hospital officials said.

“We have to have a long-term solution,” said Mike Schramm, chief executive of Rice Hospital.

Rice and ACMC already provide imaging, anesthesia and sleep medicine services through the Willmar Medical Services joint venture. They also operate the Willmar Surgery Center, the Willmar Regional Cancer Center and the Willmar Diabetes Center through the joint venture.

By adding orthopedic surgery, ACMC and Rice can do more together to strengthen local orthopedic care than they can accomplish separately, Holmgren said.

“I think we’ve had a long-term history of working together to solve the orthopedic need,” he said. “This will be going to a different level. I think we both can contribute to the success and try to build a program here.”

Willmar has struggled for several years to sustain orthopedic surgery services. Orthopedic surgeons, who are in demand nationally, have been difficult to recruit and retain. Various solutions, including at one time an independent orthopedic practice established by the hospital, have been tried with mixed success.

Orthopedic surgery and orthopedic-related care became more available with the arrival in 2007 of Heartland Orthopedic Specialists, an Alexandria group that began providing outreach services in Willmar and recently opened its own clinic here where patients are seen five days a week.

But Rice and ACMC leaders say that gaps remain, especially for evening and weekend emergency care. The latest impetus to do something about orthopedic surgery stems from the recent departure of one of ACMC’s two orthopedic surgeons and unsuccessful negotiations with Heartland Orthopedic for their surgeons to join the on-call schedule at Rice.

It underscored the need to “ramp up our efforts,” Schramm said. “There’s absolutely a commitment to try to address it.”

He and Holmgren said a joint venture through Willmar Medical Services will help Rice and ACMC develop a more sustainable practice model for orthopedic surgery services, as well as strengthen their ability to attract orthopedic surgeons to Willmar.

There has been some success in recruiting surgeons “but not to the extent that we want to be,” Holmgren said.

An analysis by Rice Hospital estimates a need for at least three to four orthopedic surgeons, all practicing locally full time.

Under the new joint venture through Willmar Medical Services, the immediate gap for orthopedic surgeons will be filled with locum tenens doctors who can see patients and help cover evening and weekend call, Schramm and Holmgren said.

“We’re hopeful that together, with this change, we can temporarily fill the gap and then go on and try to be successful in recruiting,” Holmgren said.

In the longer term, a sustainable program could include physician assistants and other mid-level professionals in addition to surgeons, he said.

Rice Hospital leaders and members of the hospital board openly expressed disappointment last month over failed efforts to enlist the Heartland orthopedic group as members of the active medical staff, which would have required them to provide on-call coverage.

“We bent over backward, really. It’s unfortunate,” said Dr. Fred Hund, chief of staff. “We all wanted to make it work. It’s a very important service to offer here.”

The surgeons with Heartland Orthopedic Specialists are on the Rice Hospital affiliate staff, which allows them to perform up to 15 procedures per surgeon at Rice each year but does not require them to take call. Doctors on the active staff may perform more procedures at the hospital and also must participate on committees and the call schedule.

Heartland is committed to continue providing services in Willmar, said Mike Doyle, the practice administrator.

But with the group’s current number of orthopedic surgeons and the limited number of days they are in Willmar, “it logistically doesn’t work” for them to provide call at Rice, he said.

The Heartland orthopedic surgeons had been performing more than 15 procedures per surgeon at Rice each year but will be reducing this to meet the hospital’s affiliate staff requirements, said Doyle. The group’s orthopedic surgeons will continue to perform same-day procedures at the Willmar Surgery Center, he added.

The group is recruiting for a full-time orthopedic surgeon at Heartland’s Willmar location, Doyle said. “That’s always been our intent since we got to Willmar, and continues to be our intent.”

Holmgren and Schramm said both Rice and ACMC have invested considerable effort over the years in trying to make local orthopedic surgery services more sustainable.

“It’s not that people haven’t worked hard,” Schramm said.

Willmar competes nationally to bring in new doctors, said Holmgren. The national supply of orthopedic surgeons also has difficulty keeping up with demand, he noted. Although medical schools have increased the number of training slots, residency slots remain underfunded, creating a bottleneck in what is already a lengthy pipeline to prepare orthopedic surgeons for future practice.

“I think we have a lot to offer but for communities our size, it’s a real struggle to get some of the subspecialty areas out here to practice. Part of that is call,” Holmgren said. “I think this speaks to the overall shortage of physicians and surgeons in this country.”

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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