Summary6 min read

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.

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Transcript23 lines

[00:02]
A
At athenahealth. We know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger Bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth. See how simpler is healthier@athenahealth.com.
[00:44]
B
Hello, this is Francesca Matthews with the Beckers ASC Review Podcast. I'm thrilled to be joined today by EJ Ledesma, Chief Executive Officer of 360 Orthopedics. EJ, thank you so much for being here today.
[00:56]
C
Thank you for having me.
[00:58]
B
Of course. To start us off, could you please introduce yourself and tell us a little bit about your background?
[01:04]
C
Sure. My name is E.J. leDasma. I am the CEO of 360 Orthopedics. As you've mentioned, we are a mid size orthopedic practice in the Sarasota County. We service Manatee and Sarasota County. We multi specialty. So we have not only the vast array of specialties within orthopedics including joint replacement, spine pain, foot and ankle, et cetera, but we also have ancillary services at each of our three locations. So all in all we see roughly 80,000 patients a year and we have roughly 125 FTEs. My background is a little bit diverse. I have a Master's degree in Health Administration, but also have additional education in finance, AI, etc. I've worked in the not for profit healthcare world. Big system healthcare, hospital systems. I've done some consulting at one of the big five at the time. Now I think it's the Big three. Done a little bit of life sciences work, some private equity. So I've done have an opportunity to do a vast array of different things within the healthcare arena that I think 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.
[02:25]
B
Absolutely. I was just about to say it's always great to talk to people who have kind of a wide range of backgrounds and hear sort of what lessons you're able to apply to administration and practice management and whatnot kind of jumping in here. What are the top three trends that you're following in Healthcare and ASCS today?
[02:45]
C
Well, I think it's very interesting. I would say it's a little bit market specific and I would preface that with saying, depending on where you're at, if you're in a con state or certificate of knee state or not, how big the landscape is in terms of I'll call big system healthcare, where big hospitals have a little bit of an entrenched control over the market. But I would say generally we've talked a lot about what's happening in the world of artificial intelligence and that how can that benefit an organization, whether it's an ASC or whether it's a private practice, etc. The second is we continue to see a, what we've already been discussing for the last two decades, the growth or the movement of cases being in the outpatient setting, whether that be in a hospital outpatient setting or an asc, more so ASC and how hospital systems are being able to compete and the dynamics of which, depending on the market, whether it makes it difficult for physicians to privately be able to open ASCs or are they in de facto having to partner with health care institutions, big systems to be able to make it work. And then the last is, is I think there's been a lot of talk and again, market specific, depending on how segmented the market is with I'll say de novo or unique ideas of how to grow the their respective businesses. I see this a little bit more in private practice where they're looking at ways to be able to maintain margins, knowing that the cost curves are not working in their favor and diversifying their revenue streams and especially adding either new specialties or creating joint ventures with other orthopedic or healthcare organizations in their market to be able to leverage reimbursement and scale on areas that they can seek efficiency. So I think those are the three key things. The AI movement, the sort of move to outpatient, which we've already known. But what does that mean as it relates to new strategic decisions? And then the last one is seeking new alternatives to grow the revenue base in specialty practices, knowing that things are, you know, are a little bit tough and are cost prohibitive, but there is still a lot of opportunity if there are, if the organizations are willing to think outside the stereotypical traditional health care box.
[05:10]
B
Mm, absolutely. And I think, you know, something we hear a lot is that ASCs, especially sort of, you know, medium sized practices or even small practices, you know, while some of those the things that you've mentioned, like ASCs have to be mindful of sort of Their bottom line is smaller practices. It's also they're more easily able to adapt to the market and can be sort of nimble due to their size as well.
[05:33]
C
Absolutely.
[05:34]
B
And what are you most excited about right now in healthcare and ASCs.
[05:41]
C
Personally and professionally? I would say how to leverage the AI component because I am not a clinician, but what I've seen and I 100% endorse is organizations to examine ways to use artificial intelligence to improve the customer experience. And that may be, you know, whether it's describing in the clinic to be able to allow the face to face interaction with a physician and a provider or a provider and a patient to be that much better. The other piece would be in call centers or scheduling environments, authorizations, areas that allow the individual that's contacting the practice or the organization to be able to get the answers that they need or the direction without having to wait. So access to being able to get the answers that they need is very big. So I'm very excited with that. And the other, as I mentioned, is this exploration of partnerships or collaborations with what would have been known as competing organizations to try and figure out a way to improve their bottom line by taking advantage of teams that do things better than they do and try to just be open ended partners. And look, knowing that we're all facing the same challenges and, and that takes a little bit of courage, but those are the things that excite me the most right now and how we can bring that to the. We have a 34 ownership in an ASC and one of the things we've been discussing with them is, is how to look at, at the, of course the revenue per case and not focus so much on how much quote unquote volume we bring in. But more so what are the quality of earnings and how can we get the best value for the cases that we push through while maintaining high margins and by default not necessarily having to have the highest level of staffing or cost structure because at the end of the day 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 market.
[07:48]
B
Absolutely. Yeah. And that definitely echoes other things that we hear here in our reporting. And how are you thinking about growth over the next 12 months?
[07:59]
C
So we are currently, and we're doing this, our approach is twofold. The first one is a little bit easier, is if being in orthopedics it's, I'm just going to use our Example is a lot of our joint doctors see individuals that have venous insufficiency. And we know that there are vein centers that do vein ablations, either in a vascular specialty setting or in an interventional radiology office. 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 it's thousands of patients a year that we are now poised to launch our vein program in the clinic. So we will be providing those services to our patients rather than referring them out. So it's, again, it's a additional revenue line for the practice that can generate significant return while providing great customer satisfaction. Because what we try to do in our organizations is try to provide as many services as possible so that we can retain the patient in our circle. So this adds another wonderful addition to what we can offer the patients in our communities. So that's very exciting because we're expanding our reach beyond orthopedics with the same population. The second one is what I'll call the affiliate model. So we are in the process of having conversations with a practice that's south of us that we are very friendly with, but they have their own market share, their own providers. They do great work, but they're facing what a lot of other small practices are facing, which is higher cost. They are. They don't have the negotiating power to seek better reimbursement. So they're facing something that they know is going to come over the next 12 months, which is potentially significant margin erosion while having two of their providers aging out. So 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. So at the end of the day, both practices can. Can work together to create a. A more profitable organization that allows our affiliate practices to retain their independence, their brand, et cetera. So we're providing, if you will, those management services on the back end to benefit both organizations. I think, and I would hope that other organizations, whether orthopedics or not, would look at that as an opportunity for the future. If indeed they're not looking to sell to private equity, they're looking to improve their bottom line, and they're open to seeking best practices and economies of scale without having to entrench in each other's market share.
[11:17]
B
Absolutely. And I Think those kind of, you know, exploring new types of non traditional acquisition models, partnerships, joint ventures. That's definitely something we're talking about a lot with leaders over here at Beckers. Is there anything else I haven't touched on or asked you about today that you'd like to add?
[11:36]
C
No. I've been thinking and I don't know if this is something that your organization, your team has talked about, but in all the conferences that I've been with Beckers, I mean, as you may know, AI is a big thing they're talking about whether it's robotics in the clinical setting or AI as it relates to support services, back office, etc. And one of the things that I just can't help to think is will it be a matter of time before CMS or other payer entities start to lower reimbursement on average, like they have been over the last couple years? Because the assumption is efficiencies create value and, and therefore what used to pay at, I'm using this number, a hundred dollars, can now pay at $90 because the cost to deliver those services are lower based on technology, et cetera. So I would not be surprised if over the next five years we see changes in reimbursement and not to the better, but lower. Because these agencies are going to apply AI to their systems if they already have, which they've already had in many cases, but they're going to by default push private practices, push hospitals, et cetera, to adopt AI in their organizations as a means to define lower reimbursement because there's opportunities to seek better efficiencies. And I think that may happen. I really do. And it's going to force smaller organizations or organizations that are not very AI focused right now to have to look at that as a ways to compete.
[13:21]
B
Absolutely. I could definitely see that happening being the case. I mean, it reminds me of one conversation I had at our Health IT conference where someone asked a question of sort of. Yeah, like, you know, we have AI, but it, it's only as good as sort of this system that it exists in. And if it's, you know, modeled and sort of molded in a system based on, you know, the processes we have for reimbursement, then, you know, something like that is definitely a possibility, it would seem.
[13:49]
C
Yep.
[13:50]
B
But yeah, that. That's actually all I have for you today, ej, Unless there's anything else.
[13:56]
C
Well, I would say first of all, thank you so much. My experience with Becker so far has been fantastic. The first meeting I went to was almost 20 years ago and then took a little sabbatical and then started going back in in June. I've had a tremendous amount of fun, have learned a tremendous amount. But one of the things that I take away every time I, I go to the, the conferences is how a lot of organizations are, are trying different things. And I would encourage organizations, whether ASCs or medical practices or hospitals, to continue to think outside the box and look outside of healthcare to find opportunities to scale and create better strategies to deliver care and be members of their communities and have strong roots in the communities that they serve and make sure that they always put the patient first. Even though we all struggle with the challenges of, of the ever changing dynamics in healthcare and the fact is we have to do the right thing, even if it means we have to work a little harder at that. And in the short term might be a little bit challenging, but if the long term is what we're all looking for, which I hope we are, our strategic outlook, I think looks bright if we have a good diverse set of diverse opinions and thoughts at the table. Regardless of whether you're in hospitals or ASCs or private practice, et cetera.
[15:26]
B
Absolutely. I like ending it there. Well, thank you so much for joining us today. It's been a pleasure speaking with you and I look forward to connecting with you again in the future.
[15:35]
C
Thank you so much, Francesca. Have a wonderful day.
[15:38]
B
You too.
[15:41]
A
At athenahealth, we know your ambulatory practice wants healthier, a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions. Reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com.