The typical protocol for a patient entering an emergency department (ED) with a sports- or fall-related injury is to take an X-ray, wrap up the injury and send the person home to make a future appointment with an orthopedist.
But, according to Lonnie Davis, M.D., this protocol wastes time and money for both the patient and the healthcare system—so he introduced a different approach.
Earlier this year, Davis launched Ortho OIC (Orthopedic Immediate Care) in Arlington, Virginia, a full-service orthopedic clinic meant to eliminate a trip to the ED or urgent care. Davis wanted to create a space where patients could have an orthopedic physician see the injury immediately and begin proper treatment on the first visit.
“In my outpatient orthopedic practice, I had been witness to a changing dynamic in the patients that I was seeing,” Davis told FierceHealthcare. “As there has been a shift from the hospital-based emergency facilities to the general urgent care clinics, I was seeing a deterioration in the quality of orthopedic care delivered.”
Davis gives the example of patients with common orthopedic injuries who are seen two or three times in non-specialty urgent care clinics because they receive an incorrect diagnosis or improper treatment. Ultimately, this approach meant more clinical visits and higher costs.
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“The general urgent care clinics have been successful in giving patients an alternative to the hospital-based emergency facility. Unfortunately, the time and cost savings were significantly offset by the lack of specialty training, associated delays and increased cost of treatment of non-emergent orthopedic injuries,” he said.
Time and money saved
Davis’ new facility in Virginia is a stand-alone clinic that is not associated with a practice, and located in a mixed-use retail environment. The clinic sees patients as young as two years old and with injuries ranging from chronic conditions like arthritis flare ups, to weekend warrior injuries or children with acute fractures.
Davis says that there is significant cost savings up to 75%, for non-urgent orthopedic injuries treated in a specialty urgent care setting versus emergency department where patients are often charged facility and physician encounter fees.
He said insurance covers the service in the same way it would cover the traditional protocol.
“This was the driving force behind our business model—the right care in the right place," he said.
And critical to building this "right" care place was offering the right hours, he said. The facility offers service every day of the year and initially the hours are Monday through Friday, 11:00 a.m. to 7:00 p.m., and Saturdays from noon to 4:00 p.m. But he expects these hours to expand as he opens more facilities throughout the region.
Patients that are seen at Ortho OIC are often treated to the end of care. This point differentiates Ortho OIC from all other options currently available for treatment of ambulatory non-emergent orthopedic injuries. In general, when these patients are seen in the ED or a general urgent care, they are then referred to a outpatient orthopedic office. There are significant friction points in this process. Patients often encounter delays in scheduling to see a specialist, or they find out that the specialist does not treat their specific injury.
Entering the clinic
When patients visit Ortho OIC, they are first evaluated by an orthopedic specialist, who will determine the initial course of treatment. This process may involve digital X-ray, which is available on-site, injections, casting or bracing. If necessary, the patient will be referred to physical therapy.
Moving forward, all follow-up patient visits will happen at the Ortho OIC clinic. In fact, more than 90% of the patients that are seen in the clinic will be treated to end of care. Furthermore, if patients are found to have an injury that requires orthopedic surgical consultation, including MRI review, this is generally done in the Ortho OIC clinic.
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“This has been a particular point of patient satisfaction, because they are not burdened with finding a specialist for definitive treatment after being seen at our facility,” Davis said.
Over the past six months, Davis has been met with praise and appreciation from patients.
“In fact, we had one patient (who we have since seen on several separate occasions) who initially came to our clinic after his wife called us while they were sitting in a local ER and she immediately realized that the treatment that they were receiving was less than ideal.”
Davis says this patient behavior is typical of how Americans have become more informed consumers of healthcare services.
“In fact, it is my feeling that we have entered into a new era of healthcare with the patient as the gatekeeper,” he added.
Of course, as with any new business, Ortho OIC has seen its challenges. One of the biggest challenges has been educating the public about this unique urgent care clinic—an option that exists between outpatient specialty orthopedic surgery practices and ED facilities.
Still, even this early on, Davis has been pleased with the willingness of the public to embrace his clinic.
“What I take away from this is that the general public knows that this is a problem with the current healthcare system, they just didn't know it could be solved,” Davis said. “Furthermore, when presented with a solution to the problem, it is almost universally embraced enthusiastically.”