••• SPONSORED SECTION •••
KEEPING STEP
Demand for orthopedic care is growing as North Carolina’s population grows and shifts slightly older. Providers are using technology, expansions and cooperation to meet it.
Medical education provider American Academy of Orthopaedic Surgeons expects knee-replacement surgeries to increase a staggering
180% nationwide by 2030. That increased demand is already being seen in North Carolina.
Wayne McFatter, executive director of surgical services at FirstHealth of the Carolinas, estimates the healthcare system’s surgeons perform about 5,000 orthopedic procedures across its 15-county region in central North Carolina, which is home to a large population of retirees, each year. “This is an extremely busy practice area for us, and we’re strategically located in an area where we’re just far enough away from the big centers like UNC, Duke and Charlotte and even Greensboro,” he says. “We want to treat patients in our community, and at the same time, they want to stay close to home, experience a fast recovery and save money.”
Orthopedic practices statewide are keeping care and costs top of mind as a fast-paced system of ever-changing laws, policies and insurance reimbursements reconfigure the healthcare landscape. As they strive to keep pace, their leaders are implementing unique ways to ensure quality care is available for their patients.
Growing demand
Pushed by a growing population that’s led by aging baby boomers and Gen-Xers, demand for orthopedic surgery is rising. American Joint Replacement Registry’s database surpassed 4 million hip and knee arthroplasty procedures in March 2024, a milestone announced in the 11th edition of its annual report. Published by the American Academy of Orthopaedic Surgeons Registry Program, the 2024 report analyzed more than 3.7 million procedures — 18% more than the year prior — and reflected data submitted between 2012 and 2023 from nearly 1,500 institutions nationwide.
There are about 1,200 orthopedic surgeons practicing in North Carolina, according to North Carolina Medical Society and North Carolina Orthopaedic Association. Dr. Michael Marushack, NCOA’s immediate past president and an orthopedic surgeon in Wilmington, started his practice with a small group of Brunswick County practitioners in 1999. He says the number of orthopedic surgeons in the state has remained consistent the past few years. “The patient population is changing, and more and more people need to see orthopedists,” he says. “Not all procedures involve major orthopedic issues like broken hips and arthritis. Some of them are ankle sprains and things that could be taken care of by a nurse practitioner or a physician assistant who has expertise in that area.”
Injecting technology
One way to improve outcomes and cut costs is robotic knee-replacement surgery. It allows surgeons to better tailor implants to a patient’s musculoskeletal anatomy. McFatter says FirstHealth has robotic knee-replacement surgery systems at its Moore Regional Hospital in Pinehurst and satellite locations in Hoke and Richmond counties. They’ve been recognized as one of America’s 100 Best Hospitals for orthopedic surgery by Healthgrades, a leading resource that consumers use when searching for a doctor or hospital. Moore Regional also earned the 2025 Orthopaedic Surgery Excellence award and ranked as a five-star recipient for total knee replacement for 2025 and hip-fracture treatment for four years in a row.
Robotic surgeries perform life-impacting surgeries in less time, less invasively and with greater precision than traditional approaches, creating better outcomes, especially for older patients. Orthopedic care providers are leveraging technology in other ways. The HURT! app, for example, quickly connects users to an orthopedic expert, who is ready to discuss symptoms and receive patient-taken taken photos, providing guidance on next steps, including helping a patient decide if a trip to the emergency room, many times a costly move, is warranted.
Stronger together
For some physicians, playing a leadership role in their practice is important. But it often requires assembling an ever-expanding set of skills to address healthcare’s business end. Charlotte spine surgeon Dr. Leo Spector, sparked by a desire to sharpen his management acumen, enrolled in Duke University Fuqua School of Business’ MBA program in 2020. He became Charlotte-based OrthoCarolina’s CEO in January 2024. It has proved an ideal move for him, and he believes it has been positive for his patients, too. “In my dual role as a physician and CEO, I bring a unique perspective to both patient care and organizational strategy,” he says. “I can see firsthand the individual patient’s needs, how to best support our teammates and the larger strategic view of our organization.”
Physician-owned EmergeOrtho and OrthoCarolina are the two largest orthopedic practices in North Carolina. Both offer numerous office locations and specialty clinics across the state. OrthoCarolina was born out of two orthopedic practice groups — Charlotte Orthopedic Specialists, founded in 1922 by Dr. John Stuart Gaul, and Miller Orthopedic Clinic, founded by Dr. Oscar Lee Miller. The two doctors worked together, managing and treating patients suffering from polio until Dr. Jonas Salk developed a vaccine in the early 1950s. They shared their knowledge and techniques with other physicians. That collaborative spirit continued until their practices merged in 2005.
Spector says OrthoCarolina has about 130 physician shareholders, more than 470 medical providers and 1,700 employees. “We have more than 40 orthopedic practices from Winston-Salem to Bennettsville, South Carolina, and as far west as Boone,” he says.
EmergeOrtho formed when five orthopedic practices — Ortho Wilmington, Triangle Orthopedic Associates, Greensboro Orthopedics, Carolina Orthopedic Specialists and Blue Ridge Bone Joint — came together between 2016 and 2019. “Our easternmost point is the Morehead City area, and we go west all the way through Asheville to Clyde and Brevard,” says EmergeOrtho CEO Allison Farmer. “We have 63 locations and 170 physicians.”
Farmer says the trend of smaller practices merging into larger ones won’t reverse anytime soon. “The continued burdens on a practice, from purchasing equipment to staffing, electronic medical recordkeeping and payer negotiation, reaps larger rewards if we operate on a larger scale,” she says.
Adding capacity
American Academy of Orthopedic Surgeons’ 2024 report also noted ambulatory surgery centers’ continued importance to delivering total joint arthroplasty care; they handled 62,110 procedural cases last year. That’s a 70% increase since 2022. But building more to alleviate growing demand for orthopedic care isn’t as easy as choosing a site, putting up bricks and mortar, and outfitting with technology and staff. There are rules to follow and needs to meet.
Placement and operation of ambulatory surgery centers, which specialize in same-day procedures, are controlled by government regulations. When North Carolina expanded Medicaid in 2023, significant changes were made to the state’s Certificate of Need law, the regulatory mechanism for approving major capital expenditures and projects for certain healthcare locations. It aims to control costs by preventing duplicate services and determining if proposed projects meet a community’s needs. North Carolina is one of 35 states that have a CON law.
Tucked inside the Medicaid expansion were exemptions to CON law. One was for “qualified urban ambulatory surgical facilities” in counties with a population greater than 125,000 people. MRI scanners in urban communities were made exempt from review, and thresholds for establishing diagnostic centers and acquisition of replacement equipment were relaxed. “We are thrilled that these reforms open opportunities for ambulatory surgery centers and MRI growth, and we hope further relief will continue to be prioritized,” Farmer says. “However, we’re continuously burdened with the decrease in Medicare reimbursement from Washington.”
Paying the bills
Many small communities, especially those in rural regions, are home to more residents using Medicaid and Medicare than private insurance. Farmer says that creates a challenging business environment for practices. But a buzz is being created around an initiative that address those and other financial concerns. In 2023, EmergeOrtho and OrthoCarolina announced they were joining forces with administrative partner SCA Health to create HiVE of the Carolinas. HiVE — Health Innovation Value Enterprise — uses a framework of data analytics, patient-engagement technology, advanced-care models and evidence-based protocols to identify areas for improvement.
Spector says HiVE’s goal is to shift the system to a point where providers are rewarded for the quality of care they deliver and positive outcomes rather than traditional fee-for-service medicine. He’s quick to point out that the collaboration does not signal a merger between EmergeOrtho and OrthoCarolina. “Rather, we are collaborating … to leverage our collective strengths, expertise and resources while maintaining our individual brand identities to provide a higher standard of orthopedic care,” he says. “Together, our two independent groups comprise just over 50% of the orthopedic surgeons in North Carolina, and we take care of approximately 50% of musculoskeletal spend, creating a tremendous opportunity to deliver value to our patients throughout the state.”
Spector hopes other healthcare organizations replicate HiVE. “We aspire to be a catalyst for positive change in healthcare by fostering collaboration, ultimately leading to more patient centered, cost effective and value based healthcare models,”
he says. ■
— Teri Saylor is a freelance writer in Raleigh.