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On-demand Portland-area medical clinic puts new spin on fast-growing urgent care model

Dr. Steve Madey examines patient

This article was original published by Portland Business Journal on Friday, December 7, 2017
Written by Elizabeth Hayes, Staff Reporter, Portland Business Journal

About 36 percent of emergency room visits involve injuries according to a National Hospital Ambulatory Medical Care Survey.

While not all are life-threatening, many do require an urgent response. That doesn’t always happen in over-taxed ERs. Meanwhile, orthopedic clinic appointments can book up weeks in advance.

Enter Go To Ortho, an immediate care clinic focused on injuries, the first of its kind in the Portland area. Four orthopedic surgeons, who have long treated patients at local hospitals, launched Go To Ortho in July.

“We’ve noticed through the years a lot of cases come to us that didn’t necessarily need to go through the traditional ER setting, so we thought it would be easier for people without limb-threatening, life-threatening problems to have direct access, to not wait and go through the hoops of a large institution,” said Dr. Steve Madey, one of the partners and a specialist in hand and microvascular surgery.

Go To Ortho streamlines the process considerably compared to an ER setting, where a patient usually sees a triage nurse, then an emergency medicine doctor before seeing an orthopedic specialist to definitively diagnose and treat.

The ortho-urgent care setting is also less expensive. One study of an orthopedic urgent care clinic in Reno, Nevada found the average charge to be $461, compared with $8,150 in a hospital ER. During the course of the year-long study, the orthopedic urgent care model saved the health care system $98 million.

While Go To Ortho currently has the one clinic in Lake Oswego, Madey said his partners would like to grow organically throughout the metro area, if the demand is there. At this point, they’re relying on growth through word of mouth.

“We’re giving access to specialized care in an expedited fashion at a reasonable cost,” Madey said. “Our clinic is not the type of thing you need every day, but when you need it, it’s really important. How you get treated really impacts the next three to six months of your life.”

Fractures and sprains

Orthopedic urgent care may be rare in Portland, but such clinics have cropped up around the country as the industry, in general, has migrated from hospital-centric to more dispersed models of care. NowCare, a neuro and ortho walk-in clinic in Bend where Rep. Knute Buehler practices, is one example.

Madey and his partners — Drs. Britton Frome, Corey Vande Zandschulp and Amer Mirza — specialize in trauma, though Mirza also does joint replacements.

“We each venture into elective (procedures), but we’re primarily dealing with people who have just gotten hurt,” Madey said.

The new Go To Ortho Clinic is connected to and a subsidiary of Summit Orthopaedics, where the doctors also practice. Patients who are treated at Go To Ortho would be referred to the other practice if they need ongoing care.

The clinic, which takes both walk-ins and appointments, is geared to treating any type of musculoskeletal injury — those involving the joints, muscles, nerves, bones, ligaments, tissue, tendons and skin. The doctors do a lot of reconstruction of nerves and small vessels.

Go To Ortho doesn’t perform surgeries on site, but it can treat sprains, fractures, cuts, and wounds and do splints, casts and stitches. Some patients have injured themselves at home or in car accidents, whereas many others sustained injuries on the job. Go To Ortho surgeons can perform surgeries at an area hospital for patients who may need them.

“We’ve seen a lot of falls, a lot of cuts, quite a few broken bones, and dislocations, those types of things,” Madey said. “We’re very industrial-injury oriented as well — chop your hand off, your finger off or crush your hand.”

The right balance

How much competition is out there is hard to say. Obviously, area hospitals all have ERs that can and do treat orthopedic injuries, but average wait times tend to be much longer, not even counting the extra time to see a specialist. The average Go To Ortho visit takes 30 minutes vs. 146 minutes on average in Oregon hospital ERs, according to federal data.

Urgent care clinics have popped up all over the metro area, though not necessarily specialty urgent care. ZoomCare, which has about three dozen “on demand” clinics around Portland and Seattle, experimented with more narrowly focused clinics, including a surgery center, but the model hit some bumps. Rather than a dedicated orthopedic site, Zoom staffs many of its locations with orthopedic surgeons and PAs, who also perform surgeries at partner surgical centers.

“Applying the same principles of radical price transparency, distribution in neighborhoods, on-demand with a precision of start and stop times and clear packages of care are incredibly hard to do in a specialty line,” said Zoom co-founder Dr. Dave Sanders. “We’re still very much getting that right, and anybody entering the space will find it a challenge. That doesn’t mean it’s not worth doing. I think folks like that have certain advantages, coming at it as a team of surgeons, bringing that singular focus to it.”

Building an independent brand outside of the established hospital systems takes time, Sanders said. A standalone orthopedic quick-care clinic also needs to offer the higher-reimbursed procedures such as surgeries to be successful, he added.

“If you want to ultimately capture the routine outpatient orthopedic services, you have to have insurer- supporters and self-funded employers and be sustainable, then you have to change the cost structure,” he said. “I do think the next level beyond the entry points that are ripe for disruption are those where costs remain bloated, service poor and there’s a lack of access. They’re absolutely going in the right direction and are lined up with what the consumer expects.”

As Madey sees it, there are two problems in patient care — overtreatment and undertreatment, and therein lies the value proposition for a clinic like Go To Ortho.

“We aim to treat people appropriately for what happened to them,” he said. “Our priority is maximizing quality, not price.”

He and his partners are trying to “nail down the business model” at the Lake Oswego clinic before expanding around the metro, likely close to industrial areas.

“People get hurt every day,” Madey said. “There’s definitely a need and we’ll grow slowly to meet that need.”

On-demand Portland-area medical clinic puts new spin on fast-growing urgent care model