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‘Musculoskeletal prompt care’: We can meet some patient needs better with a new ancillary service
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I feel it is time for orthopedic surgeons to evaluate the idea of setting up “musculoskeletal prompt care centers” or “walk-in-clinics” in association with their practices.
How would it work?
First, think of how many children and young athletes get injured every day, and how many elderly and active people take a fall, or sustain an injury at home or during physical activity. The workplace sees many daily musculoskeletal injuries too. Many of these injured ambulatory individuals want evaluations quick — within a few hours.
Instead, they usually have trouble getting into a doctor’s office the day of injury. The first point of contact often refers them to the local overburdened emergency room. That often means a 4-to-6-hour ordeal (check in, waiting, evaluation, X-rays and then a disposition). At that point they are often referred to a specialist, but can expect to wait again — from a few days to 1 or 2 weeks — for an appointment. With all that comes a duplication of time and costs.
Time to adapt
Now imagine a no-appointment, “walk-in quick clinic” for musculoskeletal injuries and complaints, and $49 covers the visit plus additional costs for X-rays if neccesary. The patient would be seen within 30 minutes and their disposition completed within an hour. That is low-cost, time-efficient quality care, and both the marketplace and patients are ready for it, at least for some of their medical care.
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Whatever problems you may see with such a service, it would overcome a fundamental flaw in our system: orthopedic surgeons are not able to address all patients with ambulatory musculoskeletal injuries and complaints on the day of injury.
Even if we wanted to, we simply could not do it. Orthopedic surgeons today do not see or treat most minor and less-severe musculoskeletal injuries because of the high volumes and time constraints. In fact, orthopedic surgeons today treat less then one-third of the ambulatory musculoskeletal patients treated by all physicians. Depending on one’s definition of less-severe musculoskeletal injury and problems, I estimate we treat less then 5% of all of these patients. The family physician, internist, ER physician, pediatrician, rheumatologist, physiatrist, neurologist, neurosurgeon and other medical specialists together treat most of the ambulatory musculoskeletal injuries and complaints from patients seeking physician care. Nonphysicians (chiropractors, podiatrists, physical therapists, trainers, acupuncturists, naturalists and others) treat even more of the less-severe musculoskeletal complaints.
The quick fix
Can you imagine visiting a no-appointment “musculoskeletal prompt-care center” associated with an established orthopedic practice that is open until 9:00 p.m. and sees patients within 30 minutes, including X-rays and an immediate reading? Patients needing further treatment could be triaged to the orthopedist overseeing the prompt care that day.
This type of immediate-care facility ideally would be adjacent to the full-service orthopedic clinic. The screener and the person working in the prompt-care area would be a well-trained, experienced orthopedic physician assistant or nurse practitioner. Their assessments and dispositions would include the following: no problem, give it some time; start physical therapy; obtain further studies; see an orthopedist (appointment arranged); or see an orthopedist immediately.
Why should orthopedic surgeons explore this option? The key reasons include:
- The marketplace suggests that many patients need a more time- and cost-efficient way to evaluate unexpected injuries then the local ER offers.
- If we do not do open these “walk-in and immediate-care” facilities, entrepreneurs will. In fact, they are already cropping up in chain stores (ie, Wal-Mart and CVS pharmacies). This will continue regardless what we do. Orthopedists have an opportunity to open the “quick clinic” concept and do a better job for musculoskeletal patients.
- The insured, uninsured and insurance companies are looking for ways to cut costs out of the expensive ER visit/referral system, and large carriers have already shown a willingness to work with existing quick clinics. They can reduce patients’ costs by 2-to-3-fold, with high patient satisfaction.
- Patients’ service expectations are changing regarding the medical evaluation of their immediate problems. We can learn by looking at other industries that offer immediate, reasonably priced consumer-friendly service (eg. 10,000- plus Starbuck locations).
I feel we need to look into offering this new service for some patients. It fits into our mission as guardians and caregivers for the musculoskeletal system and offers our profession the possibility to become more involved in primary care of the musculoskeletal system. It makes us more accessible and improves the quality of patient care.
I realize some of you will prefer to deal only with screened referrals and more severe problems, but many of you will consider setting up such clinics and the possibility of offering enhanced patient care and convenience.
No calls or appointments
Imagine again: no phone calls, no appointments, no physician referral or drawn out ER experience. In addition, the local overburdened emergency room might even refer the less- serious musculoskeletal injuries to the quick clinic to help decompress waiting times.
Personally, I am going to be involved in trying this in conjunction with my partners. It appears from preliminary experience that it may take as few as 12 patients a day to cover expenses in this new venture.
I know that with the creativity orthopedic surgeons possess, if this can be done well, it will be. Please share your thoughts and experiences as we explore this new potential ancillary service.
You may want to read the round table in this issue that further introduces this concept and gives some direction on ways to get started.
Douglas W. Jackson, MD
Chief Medical Editor