Orthopaedic Groups growth parallels local health care expansion

As Columbia Orthopaedic Group’s physicians and staff settle into their new building on Keene Street with nearly twice the space of their former location a few blocks to the north, President Mark Adams can now say with confidence, “We’ve reached a size we’re comfortable with.”
Adams then exhibited the company’s typical attitude toward the status quo: “We’re comfortable, still looking to expand, but doing so judiciously.  In an era with increased emphasis on primary care, we intend to watch the market closely.”
Spend a few minutes talking about Columbia Orthopaedic Group with co-founder Garth Russell, and you soon realize the discussion parallels the history of Columbia’s rapidly expanding medical industry since the 1960s.
“My ambition was to build a large orthopedic group,” Russell said.
And that’s what happened.  The group formed officially in December 1965, when Russell joined physicians John Payne and Glenn McElroy in private practice after working as assistant to Dr. William James Stewart in the University of Missouri School of Medicine, the region’s first orthopaedic surgeon.
“The split was apparently not entirely amicable, and so began a ‘town-gown’ rivalry that has often characterized orthopaedics in Columbia,” according to a brief history of the School of Medicine’s Orthopaedic Surgery department on its Web site.
The Orthopaedic Group’s physicians were originally housed in an old home on Broadway west of Boone Hospital, next to the Stephens College gymnasium, but they soon moved to the east wing of the nearby doctors building. Because Boone Hospital’s facilities were limited, most of the town’s orthopedic work was performed at the university, Russell said.
The group decided to cover central Missouri, setting up satellite clinics in Boonvillle, Fayette, Marshall, Mexico, Moberly and Brookfield, offices the group no longer operates.  The physicians rotated among the outlying clinics, with someone at each location each week, working half days in each town and handling occasional emergency surgery in those locations, Russell said.
“Soon there was more to do than the three of us could handle,” Russell said.  “Within two years, we added a fourth orthopedic surgeon, and we have added one more surgeon about every two years since.”
Patients came from as far away as southern Iowa, eastern Illinois and even St. Louis because the group sub-specialized early on, offering joint surgery, trauma, spine and sports medicine before other similar clinics around the state.  The group became team physicians for the University of Missouri-Columbia in the 1960s, a relationship that has remained to this day.
“The university didn’t have anyone qualified at that time,” Russell said.  “Dr. Jim Baker was the team physician, but the orthopedic injuries were cared for by us three.  We did the work at Student Hospital on campus.”

At that time, demand for medical services in Columbia was rising rapidly.  Even though a 1956 expansion had made Boone County Hospital six times larger than its original size, according to a 1968 article in the Columbia Missourian, the hospital was bursting at the seams a decade later. Patients were often housed in hallways, and elective surgeries took six weeks to schedule, Russell said.  Meanwhile, Columbia Orthopaedic Group’s physicians were getting more referrals from farther afield, adding pressure for more space.
The orthopedic group pushed Boone Hospital to expand again, but at the time it needed a two-thirds majority vote of the county to do so.  Expansion plans were rejected three times by the voters, getting as high as a 65 percent majority, but not enough to pass, Russell said.
After the three failed initiatives, the group decided in 1972 to build a new hospital and clinic for the group.  Since they still planned to perform some procedures at Boone Hospital, they wanted a location nearby that would be visible to both Interstate 70 and U.S. Highway 63.  Assembling a group of doctors in support of the project, they met with Byron Keene at his home and asked to place the hospital and clinic on his land near Boone Clinic, which was under construction at the time.
According to Russell, Keene simply walked out on his front porch, pointed northward and asked, “Where do you want to put it?”
Construction began after the land was purchased on February 7, 1972, and the new Columbia Regional Hospital and 33,000 square-foot orthopedic clinic to the south opened in 1974. At first, the clinic building housed several other medical offices, including Columbia Eye Consultants and Dr. Robert Thomas’s ear, nose and throat practice.  Eventually, the group would fill up its original clinic building as other offices moved out.
When the new Columbia Regional Hospital was one-third built, Russell said, Boone Hospital offered to purchase it from the doctors to make it the new Boone Hospital. The group instead decided to lease the building to Medenco, which later became Lifemark Corp.  With a potential for 350 beds, the new hospital filled up immediately.
“The group of docs had seen the future and didn’t take the offer,” he said.  “We were full, owned by doctors, and we liked it that way.”
Ten years later, Lifemark purchased the hospital and then sold it to American International Hospital Corp., which in turn became Tenet Inc.  Meanwhile, Columbia Orthopaedic Group quickly grew into one of the largest orthopedic groups in the Midwest, further sub-specializing and handling patients from a 12-state area, with 20 percent of patients coming from outside Missouri.
In 2000, Boone Orthopedic Associates, a rival group based at Boone Hospital Center, joined forces with Columbia Orthopaedic Group.
In 2002, after decades of competition, and sometimes conflict, the Orthopaedic Group  approached the university with a proposition to form one large, combined clinic. Because the university had purchased Columbia Regional Hospital, a closer relationship seemed to everyone’s advantage, Adams said.
However, there was opposition to the move among university physicians.  The agreement ran aground when the university insisted on 51 percent ownership of the combined entity, Russell said.  “The university’s primary function is education,” Russell said.  “They are a teaching facility, and patients are subjected to the teaching of students.  Their function is education, service and research, and our function is just service and research.”

The Orthopaedic Group later began plans to build a large orthopedic clinic and institute.  The group purchased vacant land on the south end of Keene Street and built a 72,000 square-foot building. Completed in April 2008, the new headquarters includes a surgical center, clinic, MRI facilities and offices, nearly doubling the group’s original 47,000 square feet of space, including space the group once rented in the Boone Hospital Medical Park on Broadway.
Shortly after the building’s completion last spring, the university announced its own plans to build a 113,512 square-foot Missouri Orthopaedic Institute, which is scheduled to be finished in the first quarter of 2010.
Conflict with University Hospital flared in 2007 when President Elson Floyd formalized Columbia Orthopaedic Group’s long-standing relationship with the athletic department, leading to the resignation, effective last month, of the chairman of the MU’s orthopedic surgery department, Dr. Jason Calhoun.  Dr. McElroy, of the Columbia Orthopaedic Group, had become team physician in 1990. The group later recruited the current team doctor, Pat Smith, one of the most highly trained sports medicine physicians in the country, Russell said.
During a teleconference with the Board of Curators last summer, University of Missouri System President Gary Forsee said the MU Orthopaedic Surgery department should start being responsible for the care of all of the university’s athletes after the contract with the Orthopaedic Group ends in 2012.
But while the Orthopaedic Group and the university’s orthopedic department remain divided, Adams said, “We will keep exploring the idea of working together. The public and the marketplace may well determine what happens.  We have a lot in common.”
Columbia Orthopaedic Group now serves more than 83,000 patients a year, drawing from an area 50 miles east and west on Interstate 70, north and south along the Highway 63 corridor, and into southern Iowa and western Illinois.
Having moved into their new home in April 2008, the group is quickly moving to become a paperless office, adapting to the use of digital records and digital rays, a move the Obama administration believes can save as much as $10 billion nationally in postage and paperwork across the industry, Adams said.
“We really want to keep the focus on quality orthopedic care,” Adams said.  “We don’t want to lose sight of it in all the arguments between government, insurance and doctors.  I don’t think that’s changed since the days of Hippocrates.”
Seven months after moving into its own building, the Columbia Orthopaedic Group donated $160,000 to the Central Missouri Food Bank so that the charity could pay off its mortgage during tough economic times.
The move was another example of the homegrown group’s historic connection to the community.