A leg up: North Carolina orthopedic care providers are uniting practices and advancing procedures to help patients recover faster and spend less money.

• Position: SPONSORED SECTION: ORTHOPEDICS

Raleigh-based Triangle Orthopaedic Associates opened in 1952, and it had three physicians in 1984. More than 30 years later, it had more than 65 doctors, treating and rehabilitating patients at 23 locations in 12 counties. It had seven MRI machines, several physical therapy offices and orthopedic urgent-care centers in Apex, Chapel Hill, Durham, Oxford, Raleigh, Roanoke Rapids, Wake Forest and Wilson. "The resources we have are important," says Triangle COO Karen May. "We have a data analyst that crunches numbers. You wouldn't think a medical practice would have that, but it means we're not just a mom-and-pop shop." But that's not enough anymore.

Thomas Dimmig is a surgeon at Durham Regional Hospital and was Triangle's president when he had an idea two years ago: What if several orthopedic practices united to create one that took better care of patients and wielded more bargaining power with insurers? "It became obvious to me, with the changes in medicine and the changes in insurance companies, that in order for an independent practice to survive it would need to be a much larger entity. To have the ability to invest in all the resources to be successful, we'd have to bring big groups on."

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Dimmig's dream became reality on Aug. 1, when Raleigh-based EmergeOrtho started. It unites four orthopedic practices from across the state: Asheville-based Blue Ridge Bone and Joint; Hickory-based Carolina Orthopaedic Specialists and its five Piedmont offices; OrthoWilmington; and Triangle. Two practices near Greensboro are being courted, and they could join by early next year. If that happens, EmergeOrtho would have 170 physicians.

"We're looking to change the whole paradigm of how health care is delivered," says Dimmig, who is EmergeOrtho's president. "Initially, we adapted and innovated just to survive, and when we figured out how well that worked, we used it to thrive. This is 100% physician-owned, independent physician owned, driven and led. The physician is the one with the pen who orders the MRI, who orders the surgery, and the one who knows how to take care of patients. We think we should make those decisions rather than the big company who doesn't have that [patient] contact day to day. The goal is to provide high-quality care at accessible locations. It's about quality and cost. We at Triangle have been driving that train for so long, but we feel this new organization can do a better job."

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Dimmig first brought his idea for EmergeOrtho to OrthoWilimington, which added 23 fellowship-trained and board-certified physicians and offices in New Hanover, Brunswick and Onslow counties to the new practice. It grew from there, says Ortho-Wilmington CEO Steve DeBiasi. "We wanted it to be more than just two groups coming together. It made sense to bring in multiple practices and create a model that would allow us to continue to grow and develop. As we created that model, more groups became interested. I think the one-and two-doctor practices out there may survive, but I think the groups of our size--five to 50--are the ones that will continue to evolve and grow, because that's how the market is changing, in terms of hospital-employed physicians and the way payment methods will continue to evolve."

Charlotte-based OrthoCarolina has 150 surgeons and 30 offices, from Boone to Pembroke. "Everyone coming together gives you the ability to provide...