Orthopaedic Urgent Care Clinic Leverages Model by Franchising

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Alejandro Badia, M.D., was frustrated that he was the second and sometimes third stop for patients with hand and upper limb injuries. He was frustrated that he was called to the ER at midnight to attend patients who had been waiting for hours. He was frustrated that the public conversation on healthcare wasn’t producing efficiency fast enough.

Seeking to provide direct access for injury care and complement his practice, Badia opened a franchise of a national urgent care company. Its nondescript name and a lack of franchisor support moved him to shutter the place one year later and create a more focused urgent care: OrthoNOW.

“I realized that if we’d just make healthcare more efficient, we wouldn’t be looking for these solutions, we would be saving money,” Badia says. “For any orthopaedic injury, if a patient can get to a provider who understands the injury better, she won’t require multiple care visits. Not only could you cut down the patient’s number of encounters, but you would be treating her injury right the first time, which also saves money.”

OrthoNOW is a walk-in clinic for treatment of broken bones, sprains and sports and workers’ compensation injuries. It cuts out the general practitioner and allows the orthopaedic surgeon to promptly recommend care, whether that be cast, surgery or rehab – all of which can be performed at OrthoNOW.

Badia’s research identified 50 orthopaedic urgent care clinics around the U.S. To leverage the growth of these clinics, he’s entered the franchise market again and is now spreading his OrthoNOW International model. He shared with us the OrthoNOW concept and explained why it’s a growing trend.

ORTHOPRENEUR: Describe OrthoNOW, please.

Alejandro Badia, M.D.: If you visit a regular urgent care facility – and there are five within walking distance of me – all of them will give you a prescription for pain, they’ll splint you, they may or may not get the diagnosis right, but they will inevitably send you to somebody like me. When a patient walks or crawls in to OrthoNOW, they will be evaluated better, treated better and more efficiently, and routed to the right subspecialist orthopaedist if need be.

A large part of getting patients to use OrthoNOW requires marketing and education. People have to discover that when they have an injury, they can access these services without an appointment—just like you would any urgent care center or ER.

ORTHOPRENEUR: How many orthopaedic surgeons do you have on hand?

Badia: Today, there are three of us. Two of them see elective patients in the OrthoNOW facility. One is a foot and ankle doc and the other a spine surgeon. I’m always here because my office, Badia Hand to Shoulder Center, is downstairs. There are always one or two orthopaedic PAs at hand who run the patients as they come in. You don’t necessarily need an ankle specialist to see every single patient with a sprained ankle. We always have the orthopaedic surgeon physically right there or in the facility.

ORTHOPRENEUR: OrthoNOW can handle all orthopaedic urgent care situations?

Badia: Yes. There are different models. Say a big orthopaedic group decides, “Boy, we’re tired of running to the ER” – the same frustrations I had. They may establish a small OrthoNOW in a strip mall or near a big school or university. They might put only three or four exam rooms, plain x-ray, that’s it. You don’t have to install the Cadillac model everywhere. We do have that here in this facility: ultrasound, digital x-ray, MRI and operating rooms, which I find to be optimal. I don’t go to the hospital at all. I haven’t stepped foot in the hospital in 14 months, and I do shoulder replacements, trauma, humerus fractures – all ambulatory work.

ORTHOPRENEUR: What kind of volume are you seeing?

Badia: Not as much as we’d like, but it’s simply a matter of public education. Every community is different.

ORTHOPRENEUR: How are you educating the public?

Badia: We have an iPhone app that shows the nearest OrthoNOW on a map, including a web site with contact information. Our email is checked constantly. We have branding: fiberglass casts with the OrthoNOW logo imprinted. Casts are conversation pieces; people want to know how this happened. They’ll ask, What is that cute logo with the smiley face? We have a methodology of how to educate and where to attack. You get one of your providers to talk at a local gym. (I just operated on a shoulder of the manager of the biggest CrossFit in our area.) We have branded materials, so you can give that gym water bottles with the OrthoNOW logo, ice packs, informative articles about how to handle knee pain or the causes of shoulder pain, and so forth. When you think about it, we physicians haven’t done a good job of reaching out to the public, to the people who need our services.

We’re all speaking to each other at orthopaedic surgeon meetings, but really, the people who need to be educated are those who need the services. Our patients.

ORTHOPRENEUR: Why do you believe this kind of clinic will become more popular?

Badia: Because of the problem that is access to care. When a patient is injured, he doesn’t know where to go or what treatment is needed, and becomes increasingly confused. That’s what led to my frustration. The patient has to get an authorization and all of this nonsense to see a specialist. OrthoNOW allows him direct access to a specialist. He still has to jump through a few hoops with his insurance company, but nowadays things are going so bad that people aren’t even using their insurance all the time. If they have an acute injury and as long as they’re not destitute, what we charge for additional consultation, x-ray and application of a cast is less than what my plumber charges. We all know there is a major healthcare revolution underway. Systems that are cost effective are going to do well.

ORTHOPRENEUR: What advice do you have for other surgeons with entrepreneurial ideas?

Badia: Surround yourself with the right people with the right expertise. I also have a little company with three other hand surgeons where we come up with minimally invasive devices for hand surgery, but you have to get the right engineer to actually make your device – you have to get the right people to work with you. Synergy is something that you can’t replace.

For new endeavors, it’s smarter not to reinvent the wheel. For instance, we’re thinking about suites that allow patients to stay overnight. Obviously that doesn’t have much to do with OrthoNOW. I know there’s a company that helps organize that, so I’d rather go to somebody else who has already done it and pay that fee.

The challenge for me is surgeons tend to be headstrong. We think that we can do everything all by ourselves. But if someone else has figured out a way to do something new and has made all of the mistakes, why not learn from that and save yourself a heck of a lot of aggravation and money?