Twin Cities Orthopedics: Dr. David Holte, President

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Being the second-largest single specialty orthopedic group in the country gives an organization like Twin Cities Orthopedics, PA (TCO) advantages and opportunities equal in size. Facilities of that caliber have the ability to recruit good doctors, pool resources to provide total quality care and give back to the community.

TCO handles about 27,000 patient visits per month with 500 employees at 31 practice locations throughout the Minneapolis area. The organization’s medical staff includes 79 physicians, 74 of which are orthopedic surgeons.

“Because of our size, and good reputation in the community we’ve been able to recruit excellent doctors,” said Dr. David Holte, president of Twin Cities. “Through word-of-mouth, people come to us looking for employment opportunities,” he said.

With numbers like these, TCO is able to keep its support services in house, yet doesn’t become overwhelmed by the administrative aspects of running such a large organization.

“One of the things we try to do is keep support services within the organization that we think we can do as well or better than others,” he said. “We try to do things ourselves rather than hire consultants. For example, we have our own human resources department, our own billing and collection department, and our own IT department. When we look at what other organizations are paying for those services, we find we are able to do it cheaper and better if we do it ourselves.”

Dr. Holte, who has been president of Twin Cities Orthopedics since 2002, said the organization is extremely efficient with its billings and collections, accounts payable and accounts receivable.

“Our AR days are very low as compared to the national average,” he said.

Technology Advancements

Imaging is a vital part of any orthopedics practice. In 2008, the organization took a step toward improving that aspect of the practice by switching to digital radiography. This allowed TCO to improve the quality of its films, as well as the speed with which they are taken. Maintaining images digitally also allows for better access to patients’ films from one clinic to the other and decreases storage issues.

Digital imaging is just one step toward converting to a complete electronic medical record-keeping system. Holte said he is hoping to have a system in house and running by 2011.

Structural Additions

TCO has added to its space with a number of new buildings, as well as recently completed remodeling projects at existing clinics.

“Altogether we have three new clinics being built in different locations around Minneapolis and three or four remodeling projects,” he said.

One additional project includes the consolidation of three or four different clinic locations into one. This facility will include imaging with MRI scans and digital radiography, as well as ancillary services for physical therapy and hand therapy. The new consolidated location will also include a surgery center.

“This will help provide a little better continuity of care for the patients,” Holte said. “They can come to one location and their records will all be in one place. They can meet with the doctor and the physical therapist at the same time, develop a treatment plan and then move forward with that.”

Quality and Patient Safety Initiatives

Other initiatives in which Twin Cities Orthopedics has its patients in mind involve quality outcome studies. “We’ve been able to pool resources so that we can perform outcome studies and provide continuity of care to our patients from the initial diagnosis to the end of treatment. We can efficiently take care of patients and still provide quality care.”

The organization is currently conducting a total knee replacement study that has been ongoing since 2007. Next on the agenda is an outcomes study for total hip replacement and one on carpal tunnel syndrome will follow that.

“These studies demonstrate to insurers and the industry in general the quality of our physicians,” Holte said.

In regard to patient satisfaction, TCO is developing a service center culture, looking at the results from customer satisfaction surveys. Looking at where patients are most satisfied with the care they receive, employees attend monthly training sessions where they complete written exercises with the goal of developing a service center culture within the organization.

Work Environment

One strategy TCO uses to recruit and maintain physicians is to reduce the “buy-in” process for them to become partners.

“It used to be, in days past, there was an onerous process for becoming a partner, which became an obstacle for some people,” Holte said.

The practice is managed by a board of directors.  All of the 11 members of the board are physicians, so staff members feel equally represented. In addition, everyone is up front with information regarding what’s going on within the group.

“We have a philosophy within the organization of transparency,” he said. “Everybody can see what everybody is doing and there’s a lot of sharing of information between regional groups so that people can see what the successes of one region is compared to another. They can incorporate those successes into their business strategy. There is healthy competition between regions.”

Healthcare Reform

With the advent of healthcare reform, Dr. Holte believes that it’s going to be a challenge for medical professionals to understand all the aspects of that and how it might affect reimbursement. He anticipates some potential cuts from Medicare, which recently presented a 21% cut in reimbursement to physicians.

“Currently that is on hold but if that goes through we’ll have to try to adapt to that,” he said.

There are also some challenges with malpractice liability reform that physicians there are looking at that closely.

“We are supportive of that because we feel that a lot of tests that we order and some of the ways we practice are directly related to defensive medicine and trying to avoid liability,” Holte added.

With healthcare reform, it’s difficult to predict where the organization will be in five years, Holte concluded. However, he anticipates growth, incorporating new technologies such as electronic medical records and thinks that the organization will continue to develop ancillary care, such as physical therapy, some imaging and other things are part of the practice. Growth will continue at Twin Cities, but with a watchful eye to federal initiatives and their affects on the organization’s bottom line.

-by Kathy Knaub-Hardy

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{ 2 comments… read them below or add one }

Maureen Scherwinski January 28, 2011 at 12:51 pm

Good morning:

I have been a patient of Dr. Ed Szalapski for more than ten years and,most recently, I have come to know and respect your TCI your organization while experiencing his excellent care. I am especially grateful for your After Hours Clinic. Congratulations on your superb new building your terrific staff.

During an appointment with Dr. Szalalpski last week, I mentioned how much I would like to work with TCI and Dr. Szalapski, Joe Bianski and their Secretary, Jessica indicated that I would be an excellent addition to your organization and they all encouraged me to apply. I would like to do exactly that, but I have been unable to locate an apprporiate site. I have significant experience, top skills and a very strong work ethic and would like to learn of any part-time opportunities you may have now and in the near future.

Thank you in advance for your assistance. Please advise,

Maureen Scherwinski


Maureen Scherwinski February 21, 2011 at 11:00 am

Please see above.

Thank nyou


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