OrthoIndy tries urgent care to bring in more patients, cope with reform

Correction: In 2009, the OrthoIndy physicians that own the Indiana Orthopaedic Hospital sold a 20 percent stake in the hospital to St. Vincent Health. An earlier version of this post incorrectly said St. Vincent bought a minority stake in the OrthoIndy practice, but the two organizations remain entirely separate.

OrthoIndy is getting in the urgent care business.

The large practice of orthopedic surgeons is spending $3.8 million over three years to open seven urgent care clinics specializing in orthopedic-related injuries.

Four of those will be enhancements of OrthoIndy’s existing facilities in Brownsburg, Fishers, and the northwest and south sides of Indianapolis. Three of them will be new locations, probably in Westfield and Plainfield, and possibly downtown.

The idea is that patients who suffer an injury to their bones or joints might want more expertise in those areas than is typically available at most urgent care centers, but also might want to skip the sky-high bills that come from a visit to a hospital emergency room.

“There are so many people that have injuries and problems that are kind of in between,” said Dr. John Dietz, a spine surgeon who chairs the OrthoIndy committee spearheading the urgent care expansion. “They’re not bad enough for the emergency room, they can’t see their primary care physician till Monday, and I [an orthopedic specialist] can’t see them for three weeks.”

Dietz also said the urgent care centers will help OrthoIndy deal with two big changes coming from health care reform.

First, hospitals and doctors have consolidated, which means the hospitals encourage the physicians they now employ to refer patients inside their hospital network, rather than to independent providers such as OrthoIndy.

Also, OrthoIndy isn’t entirely independent anymore. It sold a 20 percent stake in its Indiana Orthopaedic Hospital in 2009 to St. Vincent Health, which ultimately led to a reduction in OrthoIndy’s relationship with the competing Indiana University Health hospital system.

OrthoIndy already gets more than half its patients via self-referral. And it continues to get referrals from physicians in multiple hospital systems. But with hospital systems increasingly hiring their own orthopedic surgeons, Dietz said, OrthoIndy can’t be sure that will continue forever.

“I don’t think that we’ve actually seen a substantial decline in primary care physicians referring to us,” he said, “but if you look over the horizon, we don’t know what’s going to happen.”

The second factor is that patients have more and more decision-making power in health care. This comes from the proliferation of high-deductible health plans, which have 49 percent of Hoosiers with employer-sponsored insurance shouldering deductibles of at least $2,500.

Those plans have grown steadily in prevalence since Congress granted them tax-favored status in 2003. But their growth has also been spurred by employers' trying to keep their health plans from triggering Obamacare’s Cadillac tax, which will kick in in 2018. Also, high-deductible plans dominate on the Obamacare’s health insurance exchanges for individuals and small businesses.

Those factors have driven growth in urgent care of all types. For example, IU Health is working to open 12 urgent care centers around the city this year and next.

In orthopedics, Methodist Sports Medicine offers a walk-in clinic at its Carmel location from 8 a.m. to 10 a.m., Monday through Saturday. Methodist Sports Medicine, which has a partnership with IU Health but is separate from it, touts that patients can see a physician on every visit.

But OrthoIndy’s approach to urgent care will rely on physician assistants and non-surgical physicians.

OrthoIndy created a training program about a year ago to help physician assistants with an interest in orthopedics be able to diagnose patients’ problems quickly, either treating them immediately, calling in the appropriate physician specialist to handle it, or recognizing that it’s more serious and requires a trip to the ER.

To back up the 12 physician assistants who are staffing the four urgent care centers now, OrthoIndy hired Dr. James Jagger, the former team physician to the University of Kentucky men’s basketball program. Jagger, whose career began as an ER doctor at Methodist Hospital, might even bring on additional physicians with similar skills, if patient volume demands it.

Dietz said that was the biggest hurdle for OrthoIndy’s leaders—to get comfortable with the idea that they could deliver the same level of quality in their care that has built the OrthoIndy brand over the past 50 years. He said he’s now confident they can.

“Really, the most valuable thing about this group is the relationships with the families in the communities,” he said. “When we get people in to OrthoIndy, we tend to keep them.”