Concussion, fracture, strained muscle, twisted ankle, swollen knee ... it's amazing how many injuries and insults to the human body fall under the heading of orthopaedic care and sports medicine.
"In 2011, the American Academy of Orthopaedic Surgeons put out a book - Orthopaedic Care of the Mature Athlete - and in the forward, it noted, 'Musculoskeletal ailments have surpassed the common cold as the number one reason for physician visits in the United States,'" said Sport Ortho Urgent Care CEO Bob Kaelin, MD.
Similarly, The Burden of Musculoskeletal Diseases in the United States, produced by the U.S. Bone and Joint Initiative, stated more than 50 percent of the U.S. population age 18 and older ... and nearly three out of four age 65 and over ... has a musculoskeletal condition requiring medical attention each year with an estimated annual cost in excess of $200 billion.
Kaelin, a board certified orthopaedic surgeon in practice in Middle Tennessee, began to see common themes emerging in terms of cost and expertise when patients wound up in an ER or general urgent care clinic following an orthopaedic injury.
"With higher utilization of orthopaedic services and people going to ERs, patients started to mention how expensive their bills were," he recalled. "In reviewing charges for patients, a set of ankle x-rays we routinely charged about $50 for were being charged at $500 and up for x-rays in an emergency room," he said.
That patient with the ankle injury wound up with an ER bill in excess of $2,600. Kaelin, who said he and his wife both grew up in situations where money was often tight, recognized how truly punitive that type of bill could be.
Additionally, he continued, "The odds of patients with common injuries never seeing an orthopaedist in the ER were high."
Kaelin noted, "The Academy (AAOS), as well as Harvard, have published articles highlighting high diagnostic error rates when non-orthopaedic trained staff treated these patients, often leading to unnecessary complications." In one case, he said, a pediatric patient had growth plate injuries that were missed, and the delay in getting to an orthopaedist resulted in surgery.
While Kaelin was quick to say physicians in the Emergency Department do great work, he noted it's easy to miss more subtle orthopaedic injuries without specialized training while simultaneously attending to patients with chest pain or life-threatening conditions. Those misses, however, could mean the window of opportunity for preferred treatment slips away.
And costs didn't stop with the emergency visit. "We found people would leave the ER with instructions to see an orthopaedist, and with often a couple of weeks wait, they would end up at their primary care physician or another urgent care. Sometimes we were the third or fourth provider they saw," Kaelin said.
Thinking about possible solutions, he and his wife, a nurse, began to discuss the possibility of offering an urgent care clinic that specialized in orthopaedics. "We wanted to give people a cost effective venue without sacrificing quality and opened the first one about three years ago," Kaelin said.
That original walk-in clinic, located in Mt. Juliet, offered an array of services by providers with specialized orthopaedic training. Originally open until 6 pm on weekdays, and now weekends, the clinic was set up to provide digital x-ray on site, casting, splinting, bracing, and a number of other treatments.
"We figured we saved patients about $1.6 million in the first 18 months ... and that's just the direct savings," he said.
Not only is the original clinic still going strong, but there are now five additional Sport Ortho Urgent Care clinics in Middle Tennessee, including the two newest in Hendersonville and in Nashville's 12South area. "Each clinic has x-ray - all digital, connected by PAC system - and orthopaedic PAs with orthopaedic surgeon support," he said, adding that after finishing physician assistant training, the PAs spend months undergoing additional specialty-specific training.
Kaelin said ligament sprains, strains and contusions are "by far" the most common ailments they see, followed by fractures and ligament tears. He added Sport Ortho also evaluates for concussion using the IMPACT protocol. If an injury or condition requires surgery, the team coordinates that, as well, reaching out to any surgeon of choice for the patient. He added the urgent care was specifically set up to be independent of any practice, including his own, in recognition that many people have allegiance to a specific physician or group.
Kaelin said the American Orthopaedic Association has just released an "Ethics of the Physician's Role in Health-Care Cost Control" statement that highlighted the profound high cost of medicine in American and called on experienced physicians to play a role in designing and executing a remedy, while adhering to evidence-based guidelines. As he expands the number of Sport Ortho Urgent Care clinics, Kaelin said the top priority remains having the proper infrastructure in place to assure delivery of quality, evidence-based care in a manner considerate of a patient's time and budget.