Podcast Summary: EJ Ledesma, CEO of 360 Orthopedics

Podcast: Becker’s Healthcare Podcast
Host: Francesca Matthews (Becker's Healthcare)
Guest: EJ Ledesma, Chief Executive Officer, 360 Orthopedics
Release Date: November 13, 2025

Overview

This episode features an insightful conversation with EJ Ledesma, CEO of 360 Orthopedics, a midsize orthopedic practice serving Sarasota and Manatee counties. The discussion dives into major industry trends in ambulatory surgery centers (ASCs), the transformative role of artificial intelligence (AI), innovative growth strategies for orthopedic practices, and the evolving landscape of partnerships and reimbursement in healthcare.

Key Discussion Points & Insights

Ledesma’s Background & Practice Overview

• EJ Ledesma introduces himself and his diverse background spanning healthcare administration, finance, AI, consulting, private equity, and hospital systems.
• 360 Orthopedics sees about 80,000 patients annually, with 125 employees and three locations. They offer multi-specialty orthopedic care and a robust array of ancillary services.

“I think it puts me in a unique position to be able to run the orthopedic practice here, especially with everything that’s going on in the healthcare landscape today.”
— EJ Ledesma [01:45]

Three Top Trends Shaping Healthcare & ASCs

• Artificial Intelligence (AI):
  How AI is being leveraged for both clinical and administrative improvements.
• Shift to Outpatient/Ambulatory Settings:
  Ongoing migration of procedures to the outpatient and ASC environment, and the resulting competitive dynamics.
• Creative Revenue Strategies & Partnerships:
  Private practices are seeking non-traditional revenue streams and partnerships (e.g., joint ventures, new specialties) to maintain margins amid difficult cost curves.

“The AI movement, the sort of move to outpatient... and then... seeking new alternatives to grow the revenue base in specialty practices, knowing that things... are a little bit tough and are cost prohibitive, but there is still a lot of opportunity if the organizations are willing to think outside the... box.”
— EJ Ledesma [04:32]

Leveraging Agility as a Smaller Practice

• Francesca notes that smaller and midsize practices can be nimble and adapt rapidly to market changes, a point that Ledesma affirms.

Excitement Around AI and Partnerships

• AI’s Potential:
  Ledesma is most excited about using AI to improve the patient and customer experience, citing applications in clinics, call centers, scheduling, and authorizations.
• Encouraging Inter-Organization Collaboration:
  Highlights the importance of partnerships—even among traditional competitors—to improve care and operating margins.

“What I’ve seen and I 100% endorse is organizations to examine ways to use artificial intelligence to improve the customer experience... So access to being able to get the answers that they need is very big.”
— EJ Ledesma [05:47]

• Focus on Quality of Earnings:
  Emphasizes focusing on margins and earnings quality over pure volume:

  "You can generate 10,000 cases a year, but if you’re making a 4% margin, it’s not better than 5,000 cases a year with a 35% margin."
  — EJ Ledesma [07:33]

Approaches to Growth Over the Next 12 Months

1. Launching New Service Lines (Vein Program)

• 360 Orthopedics is leveraging its existing patient base to introduce a vein ablation program, keeping more care in-house for satisfaction and additional revenue.

“Our data showed that roughly 50% of our population, that’s 50 and over, that come to our practice probably have some sort of venous insufficiency... So we will be providing those services to our patients rather than referring them out.”
— EJ Ledesma [08:10]

2. Affiliate Practice Model

• Exploring affiliations with nearby practices, allowing those practices to retain independence and branding while benefiting from 360’s stronger reimbursement and administrative infrastructure.
• Aims to help smaller practices improve economies of scale, margins, and resilience without a full acquisition or PE involvement.

“We are going to be speaking to them next month about an opportunity to join our group as an affiliate, which allows them to benefit from our reimbursement model, which is the best in our area, in addition to seeking economies of scale through our revenue cycle, our authorizations team, our scheduling department.”
— EJ Ledesma [10:15]

The Impact of AI on Reimbursement and Strategy

• Ledesma raises concerns that, as tech and AI create efficiencies in healthcare delivery, payers (including CMS) may reduce reimbursement rates on the premise that AI lowers operating costs.
• Suggests a coming wave of pressures on small practices to adopt AI or risk financial disadvantage.

“Will it be a matter of time before CMS or other payer entities start to lower reimbursement... Because the assumption is efficiencies create value and... what used to pay at... $100, can now pay at $90 because the cost to deliver those services are lower based on technology.”
— EJ Ledesma [12:02]

Memorable Closing Thoughts

• Encourages the industry to learn from innovative organizations across and outside healthcare, always remember the importance of community and patient-centeredness, and embrace diverse perspectives for a brighter long-term outlook.

“I would encourage organizations... to continue to think outside the box and look outside of healthcare to find opportunities to scale and create better strategies... Make sure that they always put the patient first.”
— EJ Ledesma [15:01]

Notable Quotes & Memorable Moments (with Timestamps)

• [01:45] — “It puts me in a unique position to be able to run the orthopedic practice here, especially with everything that’s going on in the healthcare landscape today.” (EJ Ledesma)
• [04:32] — “...Seeking new alternatives to grow the revenue base in specialty practices... but there is still a lot of opportunity if the organizations are willing to think outside the... box.” (EJ Ledesma)
• [05:47] — “Organizations to examine ways to use artificial intelligence to improve the customer experience... access to being able to get the answers that they need is very big.” (EJ Ledesma)
• [07:33] — “You can generate 10,000 cases a year, but if you’re making a 4% margin, it’s not better than 5,000 cases a year with a 35% margin.” (EJ Ledesma)
• [10:15] — “Opportunity to join our group as an affiliate, which allows them to benefit from our reimbursement model... seeking economies of scale.” (EJ Ledesma)
• [12:02] — “Will it be a matter of time before CMS or other payer entities start to lower reimbursement... Because the assumption is efficiencies create value...” (EJ Ledesma)
• [15:01] — “I would encourage organizations... to continue to think outside the box and look outside of healthcare... Make sure that they always put the patient first.” (EJ Ledesma)

Timestamps for Important Segments

• [01:03]–[02:24]: EJ Ledesma’s background and overview of 360 Orthopedics
• [02:44]–[05:09]: Top trends in healthcare and ASCs
• [05:34]–[07:48]: Excitement around AI and quality-focused strategies
• [07:58]–[11:17]: Growth strategy—vein clinic and affiliate model
• [11:36]–[13:21]: AI’s possible impact on reimbursement and industry changes
• [13:55]–[15:25]: Final thoughts on industry innovation, community focus, and long-term strategy

Summary

EJ Ledesma provides a detailed look at the evolving business and clinical strategies in orthopedic practice management. He highlights the expanding role of AI, the shift to outpatient settings, and the importance of innovative, partnership-based models for sustainable growth. Ledesma urges peers to embrace outside-the-box thinking, prioritize patient outcomes, and prepare for changes in reimbursement as technology reshapes healthcare economics.