Value of specialized orthopedic urgent care centers

While of great benefit to the healthcare system and society  as a whole, the primary beneficiary of the OrthoNOW con cept is perhaps to the practicing orthopedic surgeon. The  concept was created out of necessity to fill an unmet need in  the patient journey; namely the accurate and timely assessment with early management of orthopedic issues, whether  acute or chronic. Furthermore, the fact that it was developed by a practicing solo private practice orthopedic sub specialist supports the simple fact that it can be of immense  value to the orthopedic practitioner.  

US healthcare is going through an incredibly tumultuous  period. While many hurdles and barriers remain in place,  the innovative practitioner will ultimately experience a  great advantage within the healthcare paradigm if opportunities are leveraged. A variety of market and contrived  external forces have led the majority of orthopedic resi dents to pursue a salaried position, whether with a large  multispecialty orthopedic group or even a hospital system.  Engagement with an orthopedic walk-in center allows the  practitioner, within or outside of a group, to remain largely  independent of these larger entities, assuming that is desired. 

Most US physicians entered medicine with the notion  that they would have independence, both financially and  in clinical decision-making. Recent trends only within the  past decade have eroded that independence and the OrthoNOW model helps facilitate the ideals of those practitioners who want to maintain that original goal.  Practicing orthopedists receive most patients via a few  limited options: direct referral by a primary care physician,  word-of-mouth from satisfied patients or the classic emergency room. The evolving healthcare marketplace has led  many primary care providers to become salaried physicians  within a healthcare system that either obligates or strongly  encourages them to refer to orthopedists within that network or hospital system. 

Therefore, any orthopedists outside of that system will no longer benefit from that traditional source of patient referrals. Similarly, the emergency  room is no longer a consistent source of acutely injured patients since the respective orthopedic specialist within that  system will have preferred and direct access. In many cas es, even orthopedic subspecialized surgeons are full-time  employees of many hospital systems which will automatically transfer care to these practitioners. 

Therefore, the  community independent orthopedic surgeon is forced to re ly on a dwindling source of referrals. Naturally, word-of mouth references by satisfied patients remains a preferred  and gratifying source of new patients but even this is be ing hampered, partly due to the increasing intrusion of so called “networks” imposed upon by insurance carriers who  are also increasingly consolidating. 

Therefore, an orthopedic walk-in center, strategically placed and positioned with in the community, may eventually become a prime source of  patient referrals. While one would think this applies mainly to acutely injured patients, extensive data analytics has actually shown that the majority of patients present for pain  and simply come to an OrthoNOW because access to other  orthopedists has become increasingly onerous and cumbersome.

The orthopedic surgeon wishing to remain independent will find this model can be a vital component of their  patient lifeline as healthcare systems increasingly dominate  their communities.  Alternate and synergistic sources of revenue will become  increasingly important as reimbursements continue to  dwindle, as well-known by private practitioners. In past  decades, a variety of strategies were developed and enacted  in order to increase revenue via ancillary modalities in a  manner consistent with patient care.

A classic example is  imaging, where many orthopedists might invest in an MRI  machine that would allow them to more efficiently care for the patient, but also redirect that income stream to themselves, rather than a savvy healthcare focused businessman.  Like many sectors, even imaging modalities had been hit  with major pay cuts and surgeons have looked for other options. A current trend is to offer the administration of OrthoBiologics (PRP, stem cell injections etc), to supplement  their income partly because other less qualified clinicians  in the MSK realm are already doing this with much success.

Physical therapy models have also been hit by major reimbursement cuts and there is increasing scrutiny of physician  dispensing medication despite all of these strategies positively serving the healthcare consumer since they centralize and streamline care. However, none of these strategies  actually increase patient volume. Increasing direct access  to patients will actually feed these other practice modalities the decreasing reimbursement in many of the categories. 

Moreover, the primary goal of initial specialist consultation is to harness patients that may lead to surgical  intervention. This latter step is the primary goal of most  orthopedists since that is the niche where there cannot be  any real competition yet also serving the majority of pa tients who simply need conservative care. The OrthoNOW  model allows patients to receive timely and expert care by  a mid-level, specialized provider while facilitating direct re ferral to the appropriate orthopedic surgeon.

The irony is  that the initial step of care remains largely under the indi rect control of the surgeon and represents an additional but  highly appropriate source of revenue, previously relegated  to the busy emergency room, or the convenient general ur gent care center. Neither of these options is advantageous  for the patient or even the healthcare system, let alone the  orthopedic clinician who should really be directing, as well  as benefiting from that initial step in the patient journey. 

When one analyzes cost of care, as well as quality and  timeliness of that specialty care, it becomes readily apparent that the greatest savings come by simply starting at the  right point. Simply said, “see the right clinician at the right  time”.  As for the orthopedist, it can be assumed that each surgeon has particular preference in the type of cases they either are qualified to treat or perhaps even want to focus  on. Direct control of an orthopedic walk-in center allows  the specific surgeon to focus on providing the care they feel  most qualified for. This simply means that some of the patients presenting to the walk-in center may be referred to  other more qualified orthopedists for that particular pathology, naturally of benefit to the patient and the provider. 

Furthermore , due to the prevalence of “networks” a particular surgeon may not be enabled to provide the downstream  definitive care but can still benefit from the initial step, followed by referral to the most qualified.

Simply put, why should the family practitioner working a  shift in a general urging care center be paid for the initial  step in assessment of a distal radius wrist fracture, when the  orthopedists or even orthopedic mid-level provider are eminently better qualified and can then perform direct referral  to the right specialist, even within the insurance network.  This represents a paradigm shift in the delivery of health care.  

Orthopedic surgeons should not be compensated only  when they pick up the scalpel….  

Due to market influences and changes in the healthcare  environment discussed, many orthopedic surgeons are not  seeing the type of cases they feel best qualified to care for.  An orthopedic walk-in center can be an excellent vehicle for  that physician to market and educate the public about particular pathology or procedures they are interested in man aging.

For example, a minimally invasive spine surgeon can  make the case that a specific and very effective procedure  may be the optimal solution for the patient who might otherwise be seen and managed by the chiropractor- simply be cause of easy patient access. The orthopedic walk-in cen ter completely disrupts that notion and can gradually shift  appropriate patient volume to the engaged orthopedic specialist.  

Perhaps the most compelling reason to consider engagement with a walk-in center as an orthopedic surgeon, is  to truly contribute to the lofty, but necessary, goal of US  healthcare reform. Demanding clinical work schedules have  gradually allowed non-clinician players in the healthcare  market to dominate decision-making and trends in health care delivery. Owning or engaging in an orthopedic urgent  care center allows the orthopedist to directly influence  these healthcare changes while benefiting in the most appropriate manner.