An orthopedic surgery practice formed by 11 doctors who resigned last year from SSM Health Dean Medical Group will open in Madison Feb. 20, the group said this week.
The practice, called Orthopedic and Spine Centers of Wisconsin, will be in the Arbor Gate complex off the Beltline near Todd Drive. It was previously referred to as Orthopedic Physicians of Wisconsin or Madison Orthopedics.
The group will be managed by Phoenix-based Healthcare Outcomes Performance, or HOPCo, which operates in more than 30 states. HOPCo often takes on financial risk with insurers and employer groups, accepting gains or losses through set payments per patient for whatever orthopedic services are needed, an arrangement known as “value-based care.”
The bill, which mirrors similar legislation that failed to pass last session, would ensure that health plans count copay assistance and coupons toward the patient's maximum out-of-pocket cost or annual deductible.
Orthopedic and Spine Centers was started by Dr. Jason Sansone, who was SSM Health’s regional director of orthopedics, and 10 other surgeons who worked for SSM Health in Madison, Baraboo and Janesville: Kashif Ali, Aaron Carpiaux, Rajit Chakravarty, Richard Glad, Brian Keyes, Dayton Opel, James Prosser, Joseph Sizensky, Brian Steffin and David Wolff.
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Sansone said all of the surgeons have maintained privileges to operate “at all SSM hospitals in the region,” even though they are no longer employees, and plan to expand to other hospitals.
He said the practice has contracts with Monona-based WPS Health Insurance and The Alliance, a Fitchburg-based cooperative of 300 self-insured employers that purchase medical services collectively. It is “at various stages of contracting with all other payors in the region” and can take patients on Medicaid and Medicare, he said.
Cheryl DeMars, CEO of The Alliance, has said she supports the group’s value-based approach, saying it could lower cost and improve outcomes.
“We need to lead the charge as it relates to delivering improved quality and lower costs for our patients,” Sansone, CEO of the new group, said in a statement.
SSM Health Dean in late November sued Sansone and Keyes, saying the doctors violated their employment agreements through “actions designed to disrupt, sabotage and harm Dean Medical Group.” The doctors used property and equipment during business hours “to plan a competing business,” and “induced and encouraged” the other surgeons to breach their contracts, the lawsuit said.
The lawsuit also said Sansone violated another agreement saying he could not work as a medical executive for a year after his departure within a 45-mile radius of Madison.
In a response filed last week, Sansone and Keyes said their contracts didn’t prohibit the actions they took to start an independent practice. The 45-mile stipulation for Sansone is “overbroad," their response said.
“Dean has no right to the existing or future business of patients,” the response said. “Patients are always free to seek care wherever they choose; they are not a contractual commodity used to drive corporate revenue.”
