Value of specialized orthopedic urgent care centers

The past decade has seen a surging popularity in the rise of urgent care centers. These  centers are outpatient-based facilities that are intended to divert low-acuity and non-emergency conditions away from the hospital emergency room. The value proposition behind urgent care centers is that the cost to see a patient and the wait times  at the urgent care center vs. the hospital emergency room are lower.  However, for conditions that do require extensive diagnostic testing and/or specialized  provider knowledge, the general urgent care center can only “triage” the condition and  send the patient to a specialist for follow-up.  

The value proposition of specialized orthopedic urgent care is that the scope of focus and  expertise is narrowed to that of musculoskeletal and orthopedic care. This means that  only musculoskeletal and orthopedic injuries are seen, and only staff with clinical  expertise in these areas are hired. All diagnostics testing and treatment solutions relevant  to these specialties are co-located where the patient is seen. This means that in one visit,  a patient will get an expert opinion on their condition that will be informed by the  relevant tests needed to render that opinion (e.g. digital x-ray, ultrasound, MRI in some  cases, fluoroscopy). Furthermore, definitive treatment is rendered at the center and  without a need for the patient to see another doctor. This treatment could come in the  way of a cast, a splint, a steroidal or non-steroidal injection, a brace or rehabilitative  treatment. 



The past decade has seen a surging popularity in the rise  of urgent care centers. These centers are outpatient-based  facilities that are intended to divert low-acuity and non emergency conditions away from the hospital emergency  room. The value proposition behind urgent care centers is  that the cost to see a patient and the wait times at the urgent care center vs. the hospital emergency room are lower.  

The urgent care model has been successful in treating  conditions like sinusitis, diarrhea, flu, cold, and other conditions that do not require extensive diagnostic testing or  specialized provider knowledge. However, for condition that  do require extensive diagnostics testing and / or specialized  provider knowledge, the general urgent care center can only  “triage” the condition and send the patient to a specialist  for follow-up.  

This is certainly the case in the musculoskeletal and orthopedic specialties. When a patient with an orthopedic injury is seen at a general urgent care center, he or she is likely to receive nothing more than pain relievers, some ice, and a series of x-rays that are not interpreted by a specialist.

This is because general urgent care centers are staffed by  generalists who can see a wide range of conditions. The re sult is that the patient – intending to get convenient and  good care – ends up walking out of the urgent care center  having spent money to not be treated and with more things  to do (notably calling orthopedic specialists and making an  appointment).  

The value proposition of specialized orthopedic urgent care
is that the scope of focus and expertise is narrowed to that
of musculoskeletal and orthopedic care. This means that
only musculoskeletal and orthopedic injuries are seen, and
only staff with clinical expertise in these areas are hired.
All diagnostics testing and treatment solutions relevant to
these specialties are co-located where the patient is seen.
This means that in one visit, a patient will get an expert

opinion on their condition that will be informed by the relevant tests needed to render that opinion (e.g. digital x-ray, ultrasound, MRI in some cases, fluoroscopy).

Furthermore,definitive treatment is rendered at the center and without a need for the patient to see another doctor. This treatment could come in the way of a cast, a splint, a steroidal or non-steroidal injection, a brace or rehabilitative treatment.


The value proposition to the patient is that his or her con dition is treated definitively when they stop at an orthope dic urgent care center. This means the patient pays for one  doctors visit and get to move on with their normal life after  a 70 to 90 minute visit.  


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.  


Data collected from the American Academy of Orthopedic  Surgeons and data compiled by the Medicare and Medicaid  databases from the Centers for Medicare & Medicaid Ser vices (CMS) have among their highlights about patients the  following:  

  • Orthopedic complaints are the most common reason  to seek medical care  
  • One in seven Americans has an orthopedic impairment  


The data suggests that the need for specialized orthopedic care clinics exists. The general urgent care clinic model does not provide access to a trained orthopedic clinician  who has the expertise to provide specialized orthopedic  care to a patient walking in off the street with a sprain or a  fracture. Oftentimes, these general care clinics will recommend the patient visit an orthopedic specialist for follow up, or they might even direct the patient to their host hospital for follow-up, which the typical patient was trying to  avoid in the first place. In either of these scenarios, the patient is faced with delay in care or sometimes inappropriate  care.  

The issue of cost also enters the scenario as each patient  contact brings along a co-pay or charge oftentimes being a  significant charge if the patient goes the route of the hospital. If the patient went the route of the general urgent care  route, they are also charged for the inadequate care offered  for their orthopedic pain or injury and the outcome is still not addressing the original complaint.  

The orthopedic care clinic model which OrthoNOW of fers a patient with an acute or chronic musculoskeletal issue grants them easy access to expert care. Our care clinics  operate with convenient hours by opening early in the day  and continuing to offer services into the night. The clinics  also offer the patient access to this care during weekends as  well.  

At OrthoNOW neighborhood care clinics, a patient will  have access to clinical staff trained to properly diagnose and  treat all orthopedic conditions. The clinics are equipped  with all the necessary equipment (digital x-rays, ultra 

sound, MRI and fluoroscopy) in order to make a definitive  diagnosis and to be able to prepare a treatment plan.  The patient experience is further enhanced by the fact  that OrthoNOW has an extensive network of orthopedic  subspecialists, who they communicate with using a HIPAA  compliant app, who the treating clinician has immediate  access to should a consult be needed for surgery or simply  because the clinician wishes to get a subspecialist’s opinion  on the case. By comparison, if the same patient were to ac cess care for the same condition at a general urgent care facility or a hospital, this level of collaborative expertise care  would typically not exist.  

OrthoNOW’s care model has built into its availability of  durable medical equipment, casting and splinting supplies,  medication dispensing, and pain management options such  as electro-neuromuscular therapy. The clinics are opioid free care centers practicing other treatment options such as  platelet-rich plasma therapy and stem cell therapy. In addition to these, OrthoNOW also offers patients the ability to  leave fully treated and be able to purchase pharmaceutical  grade supplements which were formulated with our orthopedic experts’ direction, to aid in inflammation and pain relief, as well as, joint pain reduction.  

At OrthoNOW, a patient needing to seek care for their orthopedic condition can expect to have fast access to expert  care, incur low cost to access that care, feel confident that  the care they receive is appropriate, and have an overall patient experience which results in positive clinical outcomes.



OrthoNOW has carved a place at the top of the funnel. Sub specialists, surgery centers, physical therapy, and employer wellness programs all ultimately benefit from the marketing prowess of the entity reaching the largest pool of prospects.

Moreover, adoption of a new method of health care delivery, and the resulting gains to public health, depend on a holistic strategy to connect the brand with people  who can benefit from it. An integrated marketing strategy  takes cues from leaders in retail and restaurants, but places  importance on being nimble, like the marketing savvy service disruptors AirBNB and Netflix. To market to the modern healthcare consumer, digital and traditional marketing  channels are employed.  

Most great marketing strategies are built from observation and common sense. The customer isn’t always knowledgeable about what’s available to them. The founder of  Ford Motors purportedly said,

Truth is that customers know what they want: faster  and less expensive expert solutions to their problems. Communicating the advantages and changing behavior are the  disruptive marketer’s goals. “

Social media is expectedly an important part of a modern  service delivery model and this new delivery model of orthopedic care is no exception. Social media channels obviously include Facebook and Twitter and YouTube, but it  soon became apparent that Instagram reached an active demographic, and LinkedIn was critical for reaching the work  comp coordinators and human resource executives. And to morrow it may be Snapchat or the sudden rise of XING or  WeHeartIt. The rapid adoption of social media platforms  underscores the necessity to have a nimble approach, while  still being integrated with data warehouses.  

Accurate data of the patient counter is conjoined with  digital marketing tools and is decoded to form and then  nurture a database which blends active consumers of the product, influencers who recognize its worth, and prospects  who could benefit from a new form of healthcare delivery.  Reputation management is a necessary element, with some  90% of healthcare consumers beginning their journey online.  

Challenges include integrating new tools and platforms  in an ever-changing backdrop of consumer engagement.  Lives are gradually transformed with the development of  technology. The patient experience is continually enhanced  by new and creative engagement tools. A new level of per 

sonalization is emerging, with promising results from arti ficial intelligence, and continued improvement will reduce  acquisition costs.  

Personalizing content requires careful consideration of  each target audience. Whether it be an employer, the payor  community, or direct to the consumer, the marketing tools  developed at OrthoNOW were designed for national growth,  so successful tools could be replicated and customized  based on demographic and psychographic variables.  

Communications are integrated across disparate chan nels, exponential improving likelihood of engagement with  the brand. Visuals are consistent and resonate with target  audiences. The collective worth of the brand is amplified  through consistent communications and iterative encoun ters. Digital tools including email campaigns, mobile ap plications, SEM, websites, social media are integrated with  event marketing, in-clinic presence marketing, and business development.  

No marketing strategy is complete without engaging internal customers. Everyone at the company has a role in  marketing. Every interaction with the patient or prospective  patient represents an opportunity to share the benefits of a  groundbreaking healthcare delivery model. Moreover, great  marketing insight is found on the front line.  

Transformation of the US healthcare system depends on  a groundswell of support and edification about a different  and better way to approach obtaining direct access to the  right care at the right time, and the marketing approach  supports this goal. 


In seeking to disrupt the classic delivery model of orthope dic healthcare, it was important to define and build an op erational structure that enabled a new mixture of improved  access and leading edge patient engagement, while keeping  costs low. OrthoNOW® clinical treatments and protocols  are largely similar to those found at traditional orthopedic  practices — with some notable differences mentioned else where herein — but how the patient accesses these services  is quite different. The structure must be scalable, replicable, and yet adaptable to various regions and unique locales.  The details of this operational structure are delineated  in an extensive and detailed Policy & Procedures manual,  borne out of an early expansion strategy that included franchising. Franchisors have an obligation to create an operating manual, necessitating its creation. The OrthoNOW  manual was created without a template, as few others have.

orthonow business comparison
Figure 1 : Attempted franchising healthcare delivery, and there were few examples of on-demand orthopedics. The result is a liv ing, breathing manual with appendices that continues to guide business partners, enables replication, and ensures consistency at corporate locations.


The operational structure is the heart of a customer-fo cused organization. OrthoNOW® views each patient as a  customer with high demands for personalized service, easy  transactions, and lower costs. Millennials have led a move ment of instant gratification at a lower cost and are driving  change in the workplace and marketplace. Amazon fueled  these demands with low costs, easy transactions, social  confirmations, and speed of delivery. OrthoNOW® is dis rupting healthcare operations by greatly improving access  to care, removing costs from the system, and by providing a  transparent pricing model.  

In each example, technology played a significant role.  OrthoNOW® similarly employs technology to meet the de mands of the modern customer. Highlights of the relevant  technology are found below.  


The social impact of the OrthoNOW disruption is smoothed  by leading edge technology, reducing potentially destabilizing effects on the patient experience and perception. A  technology roadmap was designed to ensure integration of  information and a foundation for growth.

OrthoNOW Mobile app


A Mobile app simplifies the patient journey and serves to  transition the paradigm. The idea of arriving unannounced  at a specialized medical facility is a big shift for many. In  order to maintain the established reputation of specialized  orthopedic services, but bridge the thinking to a new way of  accesses such, the “On my way NOW®” feature was created.  The patient downloads the OrthoNOW mobile app to their  smartphone, a first step in realizing this is a different kind  of a medical practice. By selecting “On my way NOW®” the  patient (or parent or coach or other interested party) can  choose an OrthoNOW location and estimated arrival time.  The journey is now one step closer to the familiar and some times expected model of setting appointments and receiving confirmations.  

Similar to a restaurant that doesn’t take reservations, but  allows call-aheads, OrthoNOW allows the user to notify the  front desk that they are en route.  

Later versions of the continuously updated app allowed  integration with another disruptor, Uber ridesharing, so  now patients can order a ride and pass info directly to Uber.  Telehealth was added, allowing patients to have remote sessions with an orthopedic clinician. A recently added feature streamlines the referral process to and from clinics.  


Patient-facing telehealth now connects patients with  providers over a secure connection, further simplifying ac cess, lowering costs, and maximizing productivity. Effective  use of telemedicine can promote orthopedic health and  wellbeing, and orthopedics is an underserved segment of  medicine in this regard. The solution must have ease of ap pointment setting, processing of payments, and secure con nections.  

Supplementing an existing telehealth solution for com munication between healthcare professionals, the patient  solution was easily adopted internally. The development ef fort built a foundation for expansion among business part ners and other members of the network.  

In many medical subspecialties, telehealth is beginning  to change traditional healthcare delivery. Both acute and  chronic conditions may present with symptoms that range  from mild to severe. Examples of acute medical conditions  that may be diagnosed effectively by video-based telehealth  include uncomplicated cases of low back pain, swelling,  joint pain, trigger finger, contusions. The virtual medium  is also an appropriate tool for consultations regarding prevention and wellness services. Prescribing is generally accepted (depending on local and federal regulations) within  the context of real-time video sessions when information  can be provided that approximates the in-person exam. The  practitioner must be aware of and follow all relevant regulations regarding the modality of technology used when  choosing to provide care to patients via telemedicine, and  in particular when considering prescribing medications.  There are several common attributes of care in an on-demand setting and video-based telehealth, including timely  service, a trust relationship, and opportunity for follow-up.  The Agency for Healthcare Research and Quality (AHRQ)  definitions are inclusive; healthcare delivery is not simply  defined as a location but as an organization that delivers the  care.  

Telemedicine has been used effectively to provide  healthcare for patients who live in rural or remote access  and have limited access to care or specialists. But it is also  for the technologically savvy, the millennial population,  those in a dense or high traffic setting, or with complicated  work/life schedules. There is further benefit to the system  because telemedicine can be used as a triage mechanism to  help ensure that patients see the appropriate clinician, and  that they are only seen in person when absolutely necessary.  

Telehealth is not meant to replace traditional, in-person  visits. Patients with complex problems or conditions must  be seen in person. Remote diagnostics and IoT devices are  still limited. However, the technology provides an adjunct  to the delivery of high-quality care.  


Implementation of an integrated, streamlined workflow of  data collection with ubiquitous access is paramount. Data  flows from patient to practice management software, cloud based full-featured orthopedic electronic health records  (EHR) system, customer relationship management programs, marketing automation software, and reporting dashboards. Vendors are carefully vetted for ability to integrate  and contribute.  


A company developed and hosted intranet provides staff  and business partner access to analytics, policy updates,  marketing calendars, brand guidelines, and other critical  information. The intranet provides a communications hub  for the network, coalescing ideas and defining standards.  KPIs appear on a dashboard. 


Modern clinics meld state-of-the-art technology with modern conveniences and expected medical facilities. The brick and-mortar location, whether a de novo development or  conversion of an ethnic restaurant in a strip center, is chosen based on established site selection guidelines and extensive analysis of local data.  


  • Clinics need to be convenient, placed where the pop ulation lives and works — not in a medical office park.  • High visibility locations are important— one clinic  occupies the space of a former Starbucks.  
  • Ease of access includes on-site free parking and well lighted building entrances.  
  • Clinic interiors are warm and inviting. The “waiting  room” became known as the “greeting room.”  • Closed circuit tv plays educational and promotional  content.  
  • Patient flow and provider collaboration areas are optimized.  
  • Pervasive, reliable, and fast internet connectivity is  assured.  


Periodic audits complement a quality assurance program  built to maintain compliance with governing authorities,  prevent brand damage, monitor performance to goals, promote higher productivity, and ensure high functioning  teams.  


Clinics are staffed with midlevel providers, reducing traditional costs of orthopedic specialized care. Staff members  are cross-trained on administrative and customer service  roles. Support of labor fluidity is important for the model  to work. Technology assists via a peer-to-peer telemedicine  network. The orthopedic trained Physician’s Assistant (PA)  or Nurse Practitioner (NP) enjoys autonomy and is supported by a supervising physician and a network of subspecialists.  

Clinicians must pass competency exams and receive frequent new procedure and skills training and clinical preceptorships.  

By looking at patients as customers, staff is well aware  of the power of each transaction in influencing others —  through reviews and ratings. An engaged staff, utilizing an  approach championed by leading retailers, leads to an engaged and happy patient. And a happy patient is a com pliant patient, improving outcomes and further enhancing  productivity of the workforce while reduce direct costs


A key enabler to innovation, growth, quality, and cost containment is the engaged supplier. Careful vetting of suppliers and definitions of roles must be part of the operational structure. Supplier management ensures value is maintained across the supply chain, including GPOs, distributors, and key service and technology vendors. The  modern orthopedic care system must implement system wide supply chain monitoring, and a disruptor seeks supplier partners with vision and spirit of partnership: 

  • Create and ensure consistency of delivery and reputation  
  • Build awareness among existing network  
  • Make connections, engage peers and other customers  


There’s no turning back. The informed and demanding  consumer of healthcare services is here to stay, and health care delivery organizations must continuously modify and  improve operations or face obsolescence. 


Dedicated orthopedic and / or musculoskeletal urgent care  clinics operated by OrthoNOW are extremely beneficial to  patients, physicians, and the health care system. They at  once improve access to specialized care when needed most,  significantly decrease overall health care costs for patients  and insurers, and reduce the strain on hospital emergency  rooms. In addition, they can be financially beneficial to pa 

tients, particularly those without health insurance or for  those with high-deductible insurance plans.  

Based on OrthoNOW’s data, OrthoNOW estimated that  the cost of care savings realized with Miami-Dade County,  for example, would exceed $2.3 million dollars annually,  based on the following assumptions:  

  • Approximately 920 workers compensation injuries  per fiscal year, of which 90% are musculoskeletal or  orthopedic in nature  
  • $12,500 total cost of care when the workers starts care  at the emergency room or occupation health center

between 6/22/17 and 6/22/19. Total visit time, time until be ing seen by provider, time until consultation with orthopedic surgeon, total visit charges, and effect on orthopedic (the status quo). This includes all imaging, diagnostic  testing, treatment and professional fees from multiple referrals  

  • $700 total cost of care at OrthoNOW, had the care started at OrthoNOW.  

While this analysis is for one county, it is indicative of  the total impact orthopedic urgent care can have in cost re duction in the US healthcare system. It is also a good proxy  for the total cost savings a self-insured (or partially self-in sured corporation) can realize by using orthopedic urgent  care.  




In the last 10 years, the United States has seen rapid growth  in the establishment of urgent care centers. There are currently over 9,000 total such urgent care centers operating in  the United States. These centers are predominantly owned  by financial sponsors or hospital chains and are intended  to see and treat non-life threatening and non-acute conditions (e.g. sinusitis, the common cold). Additionally, approximately 30% of the spend occurring in these urgent care  centers are to treat orthopedic and / or musculoskeletal injuries. Yet, less than 1% of all of the urgent care centers in  the United States have expertise in delivering effective and  

definitive treatment or care for these injuries.  In May of 2010, OrthoNOW opened its first “orthopedic  only” urgent care center in South Florida. The purpose of  OrthoNOW is to treat (not triage) non-traumatic orthopedic  and musculoskeletal injuries in 70 minutes or less (including check-in and check-out). OrthoNOW is staffed by mid level orthopedic specialists – who are either well-trained  physician assistants or nurse-practitioners – under the supervision of a team of orthopedic surgeon sub-specialists  (upper limb, spine, foot and ankle, sports medicine, total  joint).  

OrthoNOW’s data shows that its delivery of specialized  orthopedic care in an urgent care center i) definitively treat  about 75% of all patient injuries (the other 25% need surgical intervention); ii) reduces the total cost of care vis-à-vis  care initiated at the general urgent care center or the hospital emergency room; iii) increase access to orthopedic specialists; iv) is a convenient and desired form of care that patients want; and v) is valued care by our patients  

This data was evaluated retrospectively and collected  from the centers that OrthoNOW operates. The data consists of a series of patients seen at OrthoNOW (n = 37,129) Practice revenue were all factors that were evaluated.  The results of OrthoNOW’s study are as follows: 

Orthopedic Immediate Care 

  • During the 24 months of study, 37,129 patients were  treated in OrthoNOW.  
  • The average urgent care wait time until being seen by  a provider was 15 minutes.  
  • The top 30 primary diagnoses (measured by frequen cy) accounted for 80% of all diagnoses seen at Or thoNOW. Of the 30 primary diagnoses, 13 (or 43%)  were related to pain (e.g. pain in left knee).  
  • Total visit time was 70 minutes or less in OrthoNOW  (inclusive of check-in, assessment, imaging, treat ment(s) and check-out).  
  • 75% of the patients received at OrthoNOW were de finitively treated.  
  • The other 25% were referred to a supervising sub-spe cialist, as surgical intervention was indicated. The av erage charge for an OrthoNOW visit was $776 (billed  charge, not actual collections).  
  • The average South Florida emergency room charges  per patient are $2,224, thereby indicating that Or thoNOW saved the South Florida economy a total of  $53.8 million by treating the 37,129 patients that  would have otherwise gone to the hospital emergency  room.  
  • The payor mix for the patients seen during the study  was 67.2% commercial, 9.5% workers compensation,  8.5% Medicare and Medicaid, 1.8% PIP, and 13% self pay.  
  • OrthoNOW cost to build a new center ranged between  $250,000 and $300,000. Its urgent care operating bud get averaged $70,000 per month between the two fis cal years in the study.  


Dedicated orthopedic and / or musculoskeletal urgent  care clinics operated by OrthoNOW are extremely beneficial  to patients, physicians, and the health care system. They at  once improve access to specialized care when needed most,  significantly decrease overall health care costs for patients  and insurers, and reduce the strain on hospital emergency  rooms. In addition, they can be financially beneficial to patients, particularly those without health insurance or for  those with high-deductible insurance plans. 


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