Alejandro Badia, MD, FACS CEO/CMO, OrthoNOW LLC - Orthopedic Urgent Care Franchise

Hand & upper limb surgeon

Badia Hand to Shoulder Center

Consumer oriented

Outpatient services expanding

Aging population

Bureaucracy/regulations paradoxically increasing

Automation/depersonalization

Less invasive (orthobiologics/ gene therapies…)

Healthcare changing drastically…

Expensive

Inefficient

Redundant

Unpleasant

Unfriendly

Perfect Storm of Healthcare

Ambulatory Surgery Centers

Diagnostic Centers

Retail Medicine

Urgent Care Centers

Medication Dispensing

Telemedicine and Mobile Apps

Cost effective shifts….

National survey of Ambulatory Surgery in US (2006) 35 million amb surgeries, of which 20 million in hospital systems

Time spent: 146 minutes vs 97 minutes for free standing ASCs

GI scope, cataracts and spinal injections top 3 procedures

Approx. 6000 free standing ASCs . Driven by MDs as first one opened in early 70s by 2 physicians in Phoenix.

Medicare pays an ASC 55% of the fee paid to hospital outpt dept for same surgery. This number has continued to worsen….

Technological advances facilitate ability to do cases on outpt basis

Medicare and many carriers do NOT cover cost of implants at an ASC

Ambulatory Surgery Centers

Specialty urgent care centers have similar goals as generalized entities Improved pt access Decreased cost Quality similar or superior to traditional ERs Specialty UC/ retail medicine can partner to

avoid hospital referrals Emphasis on multi-partner ambulatory system

Diagnostics ASCs Rehab facilities

Emerging Healthcare Entity

General urgent care centers

Primary care walk in facilities

Retail walk-in clinics (MinuteClinic)

Pediatric urgent care

Cardiac/vascular urgent care

Ob/Gyn or Women’s urgent care ctrs

Orthopedic urgent care

Urgent care/walk in Healthcare

Most musculoskeletal injuries are seen late in the game

Unless injury is open and/or severe, many orthopedic/sports injuries are shuffled between hospital, primary physician and urgent care centers long before the appropriate specialist is called in.

This is time consuming, expensive and frustrating (mostly for patient and providers)

The issue

Long waits

Expensive (copays or full bill if uninsured)

Correct diagnosis may be missed

General urgent cares may not be adept at certain musculoskeletal injuries i.e. “Jammed finger concept”

Inefficient

Trainer/parent STILL has to take athlete to orthopedist for f/u or definitive treatment in most cases

Delay can adversely affect outcome and athletic performance

Current initial step can be modified/altered

Problem with current protocol

Obtain timely emergency care

Maximize clinical result in order to regain premorbid level of function for athlete

Minimize costs and inefficiencies

Maximize communication to referral source (coach/trainer/supervisor/carrier)

All facets of treatment under one roof (outpatient)

Avoid litigation issues

Orthopedic injuries: dilemmas

Involve the specialist early, preferably the subspecialist.

Allow that provider to order the appropriate tests NECESSARY to formulate treatment plan

Concept of a center is optimal for efficient and quality care • Accepts emergency visit from trainers, coaches, parents, ER and

general “urgent care”

• On-site radiographs, MRI, lab capabilities and creating an alliance with operating rooms is the ideal scenario. Therapy is beneficial as well so clinician can closely follow the recovery process and intervene early communicating with ATC

The Solution

Cost-effective Healthcare needed

People frustrated with hospitals

Orthopedics has huge direct/indirect impact to society and costs

Increasing age of society

Major shift towards fitness - Crossfit - Triathlons - Gimmick Races - X-games mentality

Business community recognizes cost benefits of prompt , high quality Orthopedic care….

Physicians often receive blame for high costs/inefficiencies

Patients don’t understand R&D and regulatory challenges affecting medical device/pharma industries

Pts continue to feel that employers/insurers will “take care of them”

Frustrations misdirected. (lack of education to public/consumer)

Public perception issues

Change ingrained culture of healthcare delivery

Acceptance by public/referral sources

Adoption of insurance (networks…..)

“AUTHORIZATION”

Disruptive Innovations in Healthcare

Impingement commonly termed “bursitis”

Common in general population as well as sports world. Nuances to each group, however.

Rotator cuff tears and labral tears usually need repair and respond poorly to therapy /NSAIDs

Identifying this early saves time/money and can improve outcome

Clinical Example: Shoulder pain

Physical exam, radiographs and MRI: 1 visit!

Dispense meds, begin Rehab or ARP neurotherapy, alter activity

Surgical problem: Arthroscopic procedure can scheduled first visit depending on clinical and imaging findings

Streamline evaluation process

Terrible and nonspecific misnomer

May be one of many different pathologies PIP collateral ligament tear / dislocation Phalangeal fracture (articular?) Jersey finger Mallet finger Boutonniere Volar plate injury

Clinical Example: “Jammed Finger”

Salvage procedure for delayed referral from urgent care center

Severely crushed Middle phalanx base At PIP joint of finger

Hamate graft From wrist in place With two screws

Hamate bone from wrist

rom Patient’s personal Facebook page

Alternative protocol for care???

Clavicle fx in surgeon/avid cyclist

Pt fell in mountain bike trail.

He considered ER visit but his brother, another surgeon, recommended orthopedic urgent care, OrthoNOW

Seen within minutes, on a weekend, with subsequent x-ray images transmitted TO the appropriate subspecialist orthopedic surgeon, who happened to be lecturing abroad.

Pt. directly scheduled for procedure in adjacent outpt surgery center upon surgeon’s return.

Total time of assessment/decision making: 70 minutes

Next step: surgical plating at same facility: NO hospital

Seen at OrthoNOW Doral Saturday AM

Patient missed no work after clavicle ORIF The surgeon shown here 72 hours after procedure!! Working…..

He attended OrthoNOW triathlon symposium 90 minutes (Fit Triathlete) after leaving OR#1 at surgery center at doral !! Sling and dressing in place…

Major procedures, including arthroplasty surgery (joint replacement) can be done safely in outpatient environment with good anesthesia/nursing team with less complications (nosocomial infections), hassle AND cost.

Fast, efficient, and Precise orthopedic care With Less Stress, Less Wait And less Cost

Orthopedic industry depends on clinician not end-user for product adoption

Involvement in healthcare delivery affects product/implant utilization

Patients increasingly becoming “Healthcare Consumers” not passive recipients

Hospital/Insurance domination beginning to shift

-Obamacare paradoxically leading to increase cost

-High deductibles takes insurance out of equation.

-Avoidance of expensive healthcare delivery (i.e. hospitals)

Ortho Industry/ Clinical synergies

Educate patients and referral sources in network copays often similar to straight cash pay

Encourage specialty care (paradoxically the most cost effective)

Strengthen industry/clinician synergies (despite “Sunshine laws”)

Patients are consumers and free market system should prevail

Quality of care should influence cost and drive progress/innovation

Health insurance should be seen as “Catastrophic Care Insurance”

Cost savings would fund “safety net” for those patients in need

How to influence/benefit from shifts?

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