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Dr. Alejandro Badia started an orthopedic urgent-care center out of frustration. “Every patient that came to see me had already been somewhere, and that somewhere didn’t do much for them,” he said. “I said to myself, ‘Why can’t somebody reach me more directly?'” Badia, who’s based in Miami-Dade County, established OrthoNOW orthopedic urgent care in 2010, and by 2014 he turned it into a franchise. “Our mission is to change the way expert orthopedic health care is delivered. It’s a simple mission. Like Uber. It’s a simple concept,” said Badia, a practicing hand surgeon. He has sold 10 practices so far, one of which is slated to open in Winter Park later this year.
OrthoNOW and its franchisees, most of whom are not doctors, are capitalizing on one of the fastest-growing segments of health care in the United States: urgent care, which took shape in the 1980s but has taken off in the past decade. There are more than 7,000 urgent-care centers in the United States, according to a 2015 benchmark survey by Urgent Care Association of America. The industry is expected to grow 4 percent to 6 percent a year in the next several years. Shortage of primary-care providers, overfilled emergency rooms, a growing and aging population, and an increase in the number of people who have health insurance are among the drivers of this growth.
Meanwhile, “the industry has gone through tremendous growth, primarily driven by increasing consumer demand for immediate treatment,” said Steven Sellars, the newly elected president of the board of directors for the Urgent Care Association of America and CEO of Premier Health. In the health-care continuum, urgent-care centers fall between the doctor’s office and the emergency room, providing care for illnesses and injuries that don’t rise to the emergency level. The majority provide primary care and pediatric services, but there’s a growing number that provide specialty care in areas such as orthopedics and cardiology.
The centers were at first mostly independently owned, but with the recent shift to outpatient care, hospitals and health insurance companies are getting in the game. “It’s a move toward retail medicine. There’s a shift from business to business, to business to consumer,” said Dr. John Cherf, president of The Chicago Institute of Orthopedics and chief of orthopedics at Advocate Illinois Masonic Medical Center. With higher co-pays and out-of-pocket costs and overall value, “patients have more skin the game and they’re shopping around for better costs,” he said.
In Central Florida, Centra Care Urgent Care centers is owned by Florida Hospital, and GuideWell Emergency Doctors is owned by GuideWell, the parent company of Florida Blue. Orlando Health has Express Care in West Orange County.
Jewett Orthopaedic Clinic, an independent practice, was one of the first to open an orthopedic walk-in clinic. And some like Badia are creating franchises that can spread across the nation and create competition for local centers. “We’re planning to double in size every year for the next five years,” said Christine Dura, OrthoNOW’s chief development officer. “We’ve already done the research and we believe 11 franchise locations can fit in the greater Orlando metro.”
The cost of an OrthoNOW franchise is between $450,000 and $850,000. The main providers in the clinics are orthopedic physician assistants who work under the supervision of a physician. The clinics work with local solo or group practices, none of whom so far have been affiliated with a hospital. Some franchises offer subcontracts to physicians to work in the clinic one or two days a week.
The centers accept commercial insurance, Medicare and cash pay. It’s still not clear whether urgent-care centers will improve access to care and reduce ER visits and hospital readmission rates, and whether they can lead to cost savings. “In my mind urgent care is another facet of primary care and frankly, there’s nothing they can do that we can’t,” said Dr. Wanda Filer, president of American Academy of Family Physicians. “But the idea is that regardless of which urgent care you go to, the goal is to get your information back to your medical home. The goal is for urgent care to supplement patients’ care and not to replace it.”