Background

 

A fast-scaling orthopedic services organization built around a flagship specialty practice embarked on an acquisition strategy to form a national platform of orthopedic, sports medicine, and musculoskeletal care providers. The platform included high-volume surgeons, ambulatory surgery center (ASC) relationships, imaging, physical therapy, and ancillary services tightly linked to orthopedic workflows.

The organization’s differentiator was clinical depth and procedure complexity—not back-office sophistication. As acquisitions accelerated, leadership identified post-merger integration as a growing operational risk. Integration was slowing expansion, disrupting surgical throughput, and placing excessive strain on a lean corporate team. To support continued growth and prepare for institutional capital scrutiny, the organization engaged an external consulting firm to redesign its merger integration model with a purely orthopedic workflow lens.

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Challenges

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Complex, Surgeon-Driven Operating Model
Orthopedic care delivery was tightly orchestrated around surgeon preferences, ASC block time, implant selection, imaging coordination, and physical therapy protocols. Post-acquisition integration frequently underestimated how interconnected these elements were, leading to workflow disruptions.

Integration Interfering with Case Throughput
Central integration resources routinely stepped into operational issues—resolving block-time conflicts, coordinating imaging access, troubleshooting PT referrals, and aligning implant vendors—pulling focus away from strategic integration design.

No Standard Approach for Orthopedic Service Lines

There was no consistent model for integrating:
 

• Surgical scheduling and OR block utilization

• ASC partnerships and case sequencing

• Imaging and diagnostics turnaround

• Physical therapy and post-op recovery pathways

• DME and implant supply chains

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Each acquired practice required a ground-up approach.
 

Fragmented Visibility into Orthopedic Economics
Key data—procedure mix, payer reimbursement by CPT, implant costs, ASC utilization, surgeon productivity—was distributed across systems and practices. This limited leadership’s ability to make informed integration and scaling decisions.
 

Growth and Capital Readiness Pressure
As external investors evaluated the platform, scrutiny focused on whether complex orthopedic operations could be replicated predictably across markets without eroding margins or surgeon satisfaction.

 

 

Solutions

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The consulting firm designed and facilitated an in-person, half-day merger integration working session with approximately 20 senior participants spanning orthopedic operations, surgery center management, revenue cycle, IT, compliance, HR, and M&A.

Orthopedic Workflow–First Integration Design
Rather than starting with functions, the group decomposed the orthopedic care journey end-to-end:

Referral → Imaging → Surgical consult → Authorization → ASC scheduling → Surgery → PT/DME → Follow-up

This exposed where integration decisions directly impacted surgical capacity, patient flow, and revenue realization.

Redefining the Role of Integration

A new operating principle was adopted:
 

• Integration sets standards, sequencing, and guardrails

• Orthopedic operations teams run day-to-day workflows

• Corporate teams stop intervening in case-level execution

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This realigned integration from “fixing problems” to enabling scale.

Orthopedic-Specific Integration Tiers

Required Platform Integrations
 

• Financial reporting and controls

• Payroll, credentialing, and HR compliance

• IT security and enterprise system connectivity

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Orthopedic Workflow Enablement (Optional but Structured)
 

• ASC scheduling optimization and block-time strategy

• Imaging and diagnostics integration

• Physical therapy coordination models​

• Implant vendor alignment and cost management

• Market-specific operational support

 

This respected surgeon autonomy while enforcing platform discipline.
 

Centralized Orthopedic Integration Intake
 

A standardized integration intake captured orthopedic-specific data:
 

• Case volumes and specialty mix

• ASC relationships and utilization rates

• Implant and DME contracts

• Imaging and PT dependencies

 

This eliminated repetitive data requests and accelerated planning.
 

Orthopedic Integration Playbook
 

A formal playbook was defined covering:
 

• Orthopedic workflow transition checkpoints

• Ownership between practice, ops, and corporate teams

• Required data sets and readiness gates

• Escalation rules tied to surgical impact

 

 

Outcomes

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• Protected Surgical Throughput During Integration
  Clear sequencing minimized disruption to OR schedules, ASC utilization, and post-op care coordination in newly acquired practices.

• Scalable Integration Without Added Headcount
  By removing operational dependency on the integration team, the platform supported higher deal volume without linear staffing increases.

• Repeatable Expansion of Orthopedic Services
  The standardized model enabled consistent rollout of orthopedic procedures, ancillary services, and ASC operations across markets.

• Stronger Diligence Narrative
  The orthopedic-specific integration framework demonstrated to investors that the platform could scale complex, surgeon-led operations with discipline and predictability.

• Refocused Leadership Attention
  With integration stabilized, leadership and physicians concentrated on growth, innovation, and expanding advanced orthopedic service lines.

 

 

Conclusion

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By grounding merger integration in orthopedic workflows rather than generic corporate functions, the organization transformed integration into a durable, scalable capability. The new model preserved the precision and autonomy required in orthopedic care while enabling platform-level growth, operational consistency, and long-term value creation—without compromising surgeons, patients, or performance.