In this episode of the Growing a Successful Orthopedic Practice Podcast, Kevin Joyce, executive director of Orlando Orthopaedic Center, joins Keith Landry to discuss how his team has successfully opened and scaled four orthopedic injury walk-in clinics in a little more than two years.
Joyce discusses the growing demand from patients and the challenges of operating the clinics without cannibalizing appointment-based business. He also gives details on the real estate considerations of opening the facilities, and why he believes the business model still has room to grow.
Tune in to discover:
- Insights on scaling from one to four clinics
- Challenges of staffing the clinics for expanded hours
- How to get buy-in from providers
- Factors to choose your location for short and long-term success
About Kevin Joyce
Kevin Joyce is Executive Director of Orlando Orthopaedic Center, serving in that capacity since 2006. Accomplished in orthopedic practice management, Mr. Joyce’s experience includes serving as the Executive Director of Orthopaedic Associates of St. Augustine and Administrative Director of the University of Florida Orthopaedic Department at Shands Jacksonville.
About Keith Landry
Keith Landry is Director of Public Relations at Insight Marketing Group. Keith has been a public relations consultant since 2010. He has more than 26 years of experience as a news anchor, news reporter and public affairs show host, which he uses to implement innovative public relations strategies for medical practice clients.
Keith Joyce: One of the main reasons we started the walk-in clinics to begin with is that we saw that demand of immediate care, no appointment necessary, convenient locations. So the demand does continue to increase.
Speaker 1: Welcome to the Growing a Successful Orthopedic Practice Podcast. Join us every episode to hear from fellow medical practice administrators, staff, and physicians as we break down current issues affecting the industry and share real stories from guests on their way to Growing a Successful Orthopedic Practice. Let’s get started.
Keith Landry: Hello and welcome to this episode of Growing a Successful Orthopedic Practice podcast. I’m your host, Keith Landry. Today, we’re giving orthopedic physicians and practice managers a behind the scenes look at launching and scaling orthopedic injury walk-in clinics.
We’re talking with Kevin Joyce, whose team has opened four of these clinics over the last two years. Kevin’s going to talk to us about the growing demand from patients he sees for these clinics, some real estate considerations of opening these facilities and why he believes the business model still has a whole lot of room to run and grow in the next few years. So lots of in-depth analysis on a hot medical trend ahead in this episode. And this episode of Growing a Successful Orthopedic Practice podcast is brought to you by Ortho ive.
Hello everyone. Thanks for listening in as we give you tips on how to grow and build a more successful orthopedic practice. And our guest today is Kevin Joyce with Orlando Orthopedic Center talking about knowing how to build a successful ortho practice. This is your guy right here. He’s the executive director of the largest independent orthopedic practice in central Florida; great to have you here with us today, Kevin.
Keith Joyce: Thanks Keith, good to be here.
Keith Landry: You bet. Looking forward to the insights you’re going to share for our listeners. So your company has four orthopedic injury walk-in clinics strategically located in central Florida. How many patients combined did those four clinics reach or serve in a month in general?
Keith Joyce: SO generally speaking, we’re seeing about just a little over 2000 patients a month through those four clinics. So it has become a big source of patients and new patients, as well as giving patients the option to use that as a resource in some cases for follow-up care. But generally speaking, just over 2000 per month.
Keith Landry: The walk-in clinic concept is growing pretty rapidly. As you observe it from when you launched, what are you observing about the demand for a center where you can just walk in off the street and get whatever services you need?
Keith Joyce: So the demand continues to increase. One of the main reasons we started the walk-in clinics to begin with is that we saw that demand of immediate care, no appointment necessary, convenient locations. So the demand does continue to increase just as people have busy lives and the need to not have to possibly wait a long time for their appointment, they can typically get in the same day into one of our four walk-in clinics without an appointment and they’re typically turned around very quickly within an hour or so they’re in and out of there from start to finish with the full examination and treatment that they’re requesting or requiring.
Keith Landry: So Kevin, we have a free-standing emergency room that just popped up about five minutes from my house, but if I broke my wrist or I’m pretty sure I just broke my wrist, I’m pretty sure I’m not going there. I want to go somewhere with some orthopedic expertise.
Keith Joyce: Sure. Emergency rooms are great for a lot of things, but for your typical orthopedic or musculoskeletal injury, our walk-in clinics are really the best place for you to go. The staff are trained specifically on those types of injuries, whether it’s a broken wrist or a sprained ankle, it could even be a concussion because we do concussion testing at our sites as well. We specifically focus and concentrate on those types of injuries. Whereas a typical emergency room, they have to handle every type of an emergency coming in.
Plus now with COVID, those emergency rooms are at capacity in some cases, or there’s just the risk of other potential exposure with going to those facilities. So we feel specifically right now that we provide a valuable service for those patients out there looking for convenient and affordable orthopedic care because that’s the other thing comparing the pre-standing emergency department at these hospitals is they’re still billing an emergency room fee, which typically is going to be significantly higher for the patient than going to one of our urgent walk-in clinic locations.
Keith Landry: That’s a great insight right there. Let’s talk a little business. Why did your team decide to focus on the orthopedic injury walk-in clinic business model? What did you see there and how have you made that work?
Keith Joyce: Well, we identified the trend that was occurring in the market, not just in orthopedics, but just urgent care across the board, the need for quick, convenient and lower costs or more affordable care than the emergency room. So we saw a proliferation of these urgent care clinics popping up everywhere. We felt that a focused and orthopedic only would have great value in the market because of the expertise and the quality of care that you would get compared to a general or urgent care. So we were really just responding to the demand.
We were also responding to what other practices around the country who were not necessarily the earliest in this space or in this area, but we learned a little bit from our peers on some of the things we’ll probably talk about in a bit about, how do you get one of these off the ground? Where do you put it? And all that. And once we made that decision, it was very easy to see the value that we have to the practice and the patients and the need to even expand to additional offices or additional clinics once we opened up our first one.
Keith Landry: Great, and here’s a chance to share some real nuggets here, some real insider insights with our listeners about that process. What were some of the biggest challenges in opening up that first clinic?
Keith Joyce: Well, probably the first challenge is, you just don’t know until you open it up what’s going to happen. So there’s always that risk of you build it and nobody will come. We certainly had to put in a lot of effort just to market and to make our population of patients in the community aware of the fact that we have these clinics open. Some of that can be done by using our own channels of social media and how we currently communicate to our patients about our services, so it was just an add on to that. We also learned that having these clinics located in a populated area around retail establishments, our first one happened to be just almost across an alleyway from a large shopping complex, across from Target, a lot of foot traffic so eyeballs are important and people walking by your location is important, whether it’s driving or walking, the more eyes you can have on there is certainly the best. So those were some of the early ingredients for the success.
And as far as some of the challenges, probably the biggest challenge is we operate these clinics with expanded hours. We’re open on Saturdays, we’re open until eight o’clock at night. So the staffing was probably our biggest challenge, finding the staff that are willing to cover all of the clinic hours that we have to be open. It’s more than a full-time job for an individual working a 10 hour shift or a 12 hour shift, depending on how long you go in a day. That’s something that we had to really figure out because the normal orthopedic clinic that’s open from eight to five, that’s an easy thing. When you start adding late hours and weekend hours, now you’re talking about part-time staff, people working different shifts on different days. That was probably the biggest challenge is just coming up with the right equation for staffing, knowing that it’s not your traditional nine to five or eight to five work day.
Keith Landry: Interesting. So for somebody that’s just starting down this path and they’re considering the eight to five hours versus being open into the evening and weekends, the added patients you picked up and revenue from having the facility be open later in the evening and on weekends, did that sort of justify the model? Or if you’re starting a facility just now, should you just stick with eight to five and expand the hours as you go?
Keith Joyce: Yeah, so there’s a lot of different variations of how these clinics work across the country and different orthopedic practices have come up with different models, whether it’s the, “We’re just going to be open the same hours that our regular clinics are open,” so we don’t have to adjust hours and employees, what hours they’re working and find these part-time employees to fill in. So you have to make that decision. And when you’re going to open up a new clinic, certainly it’s easier when you have those traditional hours.
However, what I’ll say is from a justification standpoint, definitely the later hours are attractive. Definitely the Saturday office hours are very attractive. And I would say in almost every case that if we do have a clinic that is open later hours or on a Saturday, the demand is there to justify the added expense and the, let’s call them, added challenges of running expanded hours.
One of the things we’ve done just as a small little side story on that particular topic is that we have currently four walk-in clinics. We’ve developed kind of a hybrid with some of them where we keep certain clinic hours at certain offices from eight to eight and have Saturdays. Whereas at one particular office, we don’t do Saturday clinics because we felt like, okay, well we had Saturday pretty well covered. Now those things can change. We can always evolve. And eventually if we feel like the demand is there for one of those offices to add a Saturday clinic, it’s an easy thing to do, obviously we just have to find the staff and the providers make sure that there’s adequate coverage. So that’s a little bit of our story that with our four clinics that we have open, they don’t all exactly function the same way from their hours. However, we still offer the extended hours in the evening and on Saturday in other offices around the Orlando.
Keith Landry: So Kevin, there’s so many aspects to consider to open and manage and scale a walk-in clinic like this model you’re doing, I want to talk just a little bit about real estate, picking the right location. Should I buy the location or lease it? Is it going to still be a good location seven years from now where those things you had to wrestle with?
Keith Joyce: Yeah. So definitely location is a big component to the decision of where you’re going to put a clinic. What we’ve done is, again, we have a hybrid in our model of how we’ve handled that. We have certain walk-in clinics that stand on their own in their own freestanding building and that just happened to work out that way and not to go into the details of it, but that worked on its own and was a good recipe based on the location, based on the market, it was good. It was a busy street, it was an existing physician office that we converted into a walk-in clinic that was not a previous Orlando Orthopedic Center office.
And then we have another example in our model where we, from the very beginning, developed an entire orthopedic practice. We expanded to a newer part of central Florida, and we essentially commingled the traditional orthopedic office in with the walk-in clinic, still having some of the expanded hours and the ability to see patients on Saturdays. But what that did was it allowed us to leverage the space, leverage the equipment so we’re not in purchasing two of everything for that particular location. Still had to look at the location in general. Again, we chose in that particular location a busy retail complex, where there was a drug store, a bunch of restaurants, where we knew we would get a lot of eyeballs and foot traffic and also vehicle traffic.
We look at vehicle studies that they conduct or traffic studies around our market to say, “Okay, on this road on a daily basis, there’s 150,000 cars that drive by.” Well, that’s important for us because number one, we want to be on a major thoroughfare artery, we want to be where a lot of the people in the populations is driving so that the more times they drive by they’re going to eventually see us.
So all those things factor into making those decisions. And again, I could go on and on about a lot of little nuances, leasing versus owning, that’s really in some ways more of a personal preference or choice, it doesn’t really change a whole lot the equation. Sometimes it’s nice to lease because it gives you that option that, hey, if a better location comes up in the near future, I can maybe get out of this location and go into a better one. Whereas if I own that real estate or I own the land, your options are far less in terms of potential future expansion, maybe, or the ability to find even better locations if the need arises.
Speaker 1: Today’s episode is presented by OrthoLive, designed by an orthopedic surgeon for orthopedic practices. OrthoLive is a comprehensive telemedicine platform that puts the features you need front and center, increasing practice revenue without adding to your already full plate, like consent forms and patient readiness indicators that visually guide patients to fill out the necessary legal consent forms before an appointment can begin and then automatically save them so you don’t have to. When a patient is ready for their appointment, you’ll see a green indicator light. If there’s no light, that means your providers can focus on other patients on their schedule until the icon turns green. For more on how OrthoLive can increase efficiency, practice revenue and patient satisfaction, visit ortholive.com today. OrthoLive, the world’s leading orthopedic-specific telemedicine platform.
Keith Landry: Interesting. A lot of insights there. So like to sort of jump ahead to expansion and adaptability of the model. You have the first clinic, you felt like you worked out the bugs and really sort of got it going well, how long was it before your team said, okay, let’s tackle the second clinic now?
Keith Joyce: It was really only about a year from the opening of the first walk-in clinic, which was at our downtown location or what I’ll call our main campus. And again, we’re in a busy and highly trafficked retail mixed use. It’s got apartments, it’s got office, it’s got restaurants, shopping. And obviously we found that that model and that first clinic worked well. It was really only about a year from the time that we opened that that we opened up our second one. And I would say probably no more than six months after that that we opened up our third and probably no less than two years opening up our fourth.
So within about a two year period from the first clinic opening, we had four, mainly because we had some expansion that took place and some different opportunities where we saw the demand and we saw the opportunity to open up more of these and all of them that have been successful and we’re happy that we made the decision to expand.
Keith Landry: Did it become easier to open the third and fourth ones or did all four of them sort of have their own unique challenges that may distract your head a little bit?
Keith Joyce: So they all have some unique challenges for sure. I mentioned earlier whether this in a walk-in clinic that’s now just kind of being squeezed into an existing office where you’ve got existing staff and existing equipment to support that versus building it out free-standing on its own, but we’ve done both. We’ve learned a lot from doing those different types of projects, but by and large, when it comes down to it, the staffing, the support, the resources you need become pretty cookie cutter or boiler plate from one to the other in terms of those ratios and what we need to run the clinic.
There’s some small nuances from one to the next. And we’ve learned, again, a little bit along the way that certain providers are still the more cost-effective or valued. We run a combination of physicians and physician assistants within our walk-in clinic, all at our little walk-in clinic network and we find that PA, physician assistant, can be just as productive as a physician can be in terms of number of patients they see, what they can generate productivity wise. And so that was one of the things we learned a bit about that as we opened up and expanded these clinics, we could do them just as effectively with a physician assistant as we could with a physician. And of course that comes at a cost savings and it comes at higher return on investment.
But as far as what’s needed resource-wise and staffing and equipment and just space, they pretty much all kind of come out at this sort of same ending that it’s very similar one to the other, not a whole lot of difference. We have figured it out. It definitely gets easier as you go along. Although, again, as I mentioned at the very beginning, it’s definitely more challenging than running your sort of bread and butter orthopedic practice because of, again, the types of patients that come in are sometimes unique, you don’t know what’s going to walk in the door, so you got to be ready for anything, and you’re running expanded hours and weekends, which just makes it that much more challenging from a coverage standpoint to cover all the hours that you need in the clinics that you need.
Keith Landry: Interesting. So it sounds like it’s all about flexibility and adaptability. And when you talk about adapting to change in 2020, I think maybe the hottest trend in healthcare in 2020 has been the adoption of telemedicine and maybe folks were a little hesitant to use it at first, but after they tried it once or twice, they’re quite comfortable with it now. How are you using telemedicine as part of your business model for the walk-in clinics? Is it a critical strategy for you?
Keith Joyce: I would call it an emerging strategy for Orlando Orthopedic Center in our walk-in clinic. So last year, we made the decision to add telemedicine to our service line. I mean, it really isn’t that much different than opening up another clinic and having another provider on board, although it’s nice because you can use existing providers and you can use existing facilities, or you can even be in the comfort of your own home and conduct these, which we actually ended up having to do during the first phase of the COVID pandemic, we were doing telemedicine visits at physician homes as a way to work through the volume. But again, as I mentioned, this is still an emerging strategy, specifically where the walk-in clinic, we felt that patients are looking for a convenient and, again, a quality convenient and affordable option to have something looked at that relates to an orthopedic injury or some sort of musculoskeletal condition.
It’s very likely they can get at least a decent level of evaluation and not so much treatment, but really the evaluation and triaging of their condition via telemedicine. We just felt, look, if this technology is out there and it’s working, which we know it is, why bot incorporate it into our walk-in clinic model, where it’s not just whether a patient wants to get in their car and drive down to visit one of our walk-in clinics, again, without an appointment necessary, we now can give them the option of just dialing in or clicking a link to schedule a telemedicine essentially walk in, they just don’t have to walk in. They can just do it from the comfort of their own home. And it’s, again, very convenient. Of course, it’s limited what you can do. We can’t do x-ray, we can’t really do a physical exam, but it does help to triage a patient to determine that, hey, this is something you really need to come in for and have looked at.
Or in some cases, it could be a direct referral to a surgeon based on what the injury looks like. And we’ve had a handful of those that said, “Look, the only place you really need to go to is surgical console, because that looks pretty bad and it’s probably going to require either surgery or some other type of higher level examination than we can do via a telemedicine appointment or even a traditional walk-in appointment.” Again, one of the conveniences we have with that over an emergency room or over at a traditional urgent care is we have a direct connect with surgeons that allows that care to get transferred much more quickly. And the telemedicine is almost the ultimate efficiency of, how do you get someone from having their injury looked at and getting them to the right care or to the right specialist, whether that’s a hand specialist, a foot and ankle, it could be a spine?
And that’s what we are able to do, that the emergency rooms and the other urgent care clinics, they hand you a piece of paper and say, go figure it out on your own and that may take you a few days. And time is of the essence in many cases, especially when it’s an acute injury, you don’t want to wait too long to have that wrist fracture or set or something else that needs to be addressed immediately. And I think that’s one of the things that we provide. In addition to the convenience of the actual walk-in clinic and the telemedicine visit, there’s a high level of convenience of the fact that that patient, if they need higher level care or specialty care, can be referred immediately and actually sometimes be seen that same day. So it works well. It works very well.
Keith Landry: Interesting. And earlier in the beginning of the podcast, I mentioned about this freestanding emergency room that’s right down the street from our house. This is sort of the scene playing out across the country, walk-in clinics and free standing emergency rooms popping up on any good piece of real estate that’s left across America and urban locations. So how do you compete against that trend? How do you send the message to make sure that folks are going to see you for the specialized care they can get versus walking into the freestanding ER room?
Keith Joyce: Yeah, it’s some of what I mentioned before. Number one, we’re going to be at a much lower cost or a price point than the emergency rooms will be. The staff and the providers in our walk-in clinics are specifically trained just in orthopedics, they’re not cross trained in stroke and cardiology or other issues that patients may come in to the emergency room for. It’s a healthier and safer environment, you’re not going to have as much risk for exposure to other illnesses that may be sitting in an urgent care center or sitting in an emergency room, especially in the current environment.
So again, I would say that it’s the convenience of getting in quickly, no differently maybe than showing up at an emergency room, but typically in an emergency room, you’re probably going to spend three or four hours at a minimum there. Our goal is to have you in and out within less than an hour so you can get back to work, get back to your family, do it at a high quality with our staff and our providers who are trained specifically in this type of care and do it at the lowest price point that we can offer to patients.
Many of them come in are uninsured and self pay, especially, again, in this current situation environment and here in Orlando or central Florida in particular, we have a high number of unemployed and uninsured because of the pandemic. And these services are now at an even higher value and critical need for our community. Many of these patients coming in are self-pay and uninsured, and so the same service they would get at an emergency room would cost them thousands of dollars, we’re trying to keep it within a few hundred dollars if we can. So that’s…
Keith Landry: And Kevin, that’s a great point because what we’re seeing across the country right now during this second wave of the pandemic is people that are deciding not to get care because they just can’t afford to get it so they put it off and they just stay in pain. And so it’s good for people to know there’s an affordability aspect of the clinics.
Keith Joyce: Yes. I think it’s what everyone’s looking for right now, for all these different reasons that we’ve brought up. So again, I think that’s why the trend will continue to be a favorable trend in terms of the demand and the need for these types of services and we’ll probably continue to look at expanding our footprint of walk-in clinics. We’ve got one more actually already kind of in the works to add, to make it a fifth walk-in clinic, orthopedic walk-in clinic. So again, for us, the trend is all looking very favorable. In particular now with COVID-19 happening and probably staying around for the next year or so, I think we’re offering, and what we provide, is a safe, less risky, low cost affordable option than what else is out there especially if it’s compared to your freestanding emergency room type or hospital emergency room service that are out there.
Because as you said, they’re all over the place and there’s reasons are all over the place, they want to make sure that all those cars driving by see their big building and their signs, but there’s a price to pay for those large buildings and those very complex emergency rooms that have to basically provide all kinds of different care and all kinds of different services. So again, we think it’s going to continue it and still be a very successful part of our business here at Orlando Orthopedic Center.
Keith Landry: So there’s one last area I’d like to talk to you about where you can really give some interesting insights for our listeners on how to build that orthopedic practice. And it’s an area, a part of the business model some folks might not have thought of, and that’s the workers’ compensation sector and using these walk-in clinics to capture workers’ compensation business. You’re of leading the way on that.
Keith Joyce: Yes. Again, one of the reasons we looked at opening up a walk-in clinic service line was to tap into that demand of needing quick, affordable and high quality orthopedic care for the injured worker. Injured workers are kind of a different type of patient than your typical sports medicine or your patient who’s just dealing with chronic pain. These are patients who are now looking to be able to get back to work in a timely fashion, be able to go back to full functionality and what their job is. And sometimes that has a direct impact on their ability to have a job or to keep the same job that they had. And of course, there’s also a lot of pressure on the employer who has to continue to pay some level of work comp benefits to that employee during the time that they’re out of work or injured.
And so what we really do is provide a dual service to both the patient themselves who’s motivated to go back to work, but get back to full functionality and full duty, but also to serve the needs of the employer who has a business to run and wants that employee back fully functioning so they don’t have to go rehire someone at an added cost or potentially have to pay other benefits while that employee is out of work for a long time, they may have to pay wages, they may have to play medical expenses and all that has an impact financially on the employer themselves.
So we saw that again as a great opportunity to provide a service that really wasn’t being provided that well in the market, again, being convenient, where they can just show up, they don’t need an appointment, they get the quality care and the right care at the right time. We understand the work comp industry so we understand that, look, the goal here is to try to accommodate the patient and there may be other people involved in the claim that we want to try to make sure that, hey, our goals are all aligned, we want to get this employee back to work, get them back to full functionality.
And again, it’s a lower cost option for the employer. The patient themselves in this case is not paying anything in terms of the care, because that all gets paid by the employer or by their insurance company but we also want to meet those needs and balance the needs of the employer who is paying the bill, that we are the, again, high quality and low cost option that’s going to give them the best results.
Keith Landry: Awesome. Some great insights over the last half hour here. How can folks get ahold of you, Kevin, if they want to learn more about the Orlando Orthopedics Center?
Keith Joyce: So it’s easy. Anyone at any time can reach out and contact me, email’s the easiest and they can reach me at my email address, which is firstname.lastname@example.org. And I think my information is on our website, as well as, the contact, you can call the main number and just ask for me, and they’ll transfer you over to my phone or my voicemail, but email is the best. So I would appreciate if there are any questions or additional thoughts on this, feel free to reach out in an email and I’ll be sure to respond quickly and get back to you with any answers I can provide.
Keith Landry: And the website, orlandoortho.com?
Keith Joyce: Orlandoortho.com is our practice website where they can get information about what our walk-in clinics and all other things related to Orlando Orthopedic Center at orlandoortho.com.
Keith Landry: All right, Kevin Joyce Executive Director of Orlando Orthopedics Center and thanks so much for sharing your insights on these walk-in clinics and where that’s all headed. We sure appreciate your time today.
Keith Joyce: Thank you, Keith. I appreciate it as well. Thanks.
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