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ep. 4

One Surgeon’s Opinion on Fixing a Broken Healthcare System

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In this episode of the Growing a Successful Orthopedic Practice Podcast, Alejandro Badia, M.D., a hand and upper extremity orthopedic surgeon, joins Keith Landry, to discuss his observations on how to run more efficient orthopedic practices to help fix a broken healthcare system.

Dr. Badia discusses how thinking more like an entrepreneur and less clinically can help orthopedic physicians improve their business model and their bottom line. 

He talks about the need for orthopedic physicians to be viewed more like primary care physicians, where patients with orthopedic injuries see orthopedic physicians right away to reduce costs across the American healthcare system.

Tune in to discover:

  • How orthopedic surgeons fit into to America’s futuristic 3.0 healthcare system
  • Overcoming systemic hurdles so a patient can visit the right physician right away
  • Details to improve the patient experience starting in the waiting room 
  • How to use telemedicine to develop an international clientele

About Dr. Alejandro Badia

Alejandro Badia, M.D., is the Founder of Badia Hand to Shoulder Center and the OrthoNow orthopedic walk-in clinics. Dr. Badia is author of “Healthcare from the Trenches,” where he explores ways to help patients overcome barriers to getting the best care and to fixing what he calls a broken healthcare system in America. Dr. Badia is past worldwide President of the International Society for Sport Traumatology of the Hand (ISSPORTH).

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.

Sponsored by OrthoLive

Episode Transcription

Dr. Alejandro B…:          There’s been a bunch of obstacles and hurdles that patients have to basically overcome to get to see the right person. And this happens in most specialties.

Speaker 2:                    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.

Speaker 3:                    Hey there, welcome to another episode of the Growing a Successful Orthopedic Practice Podcast. If we’ve heard it once, we’ve heard it a million times, the health care system in the United States is broken. Well in this weeks show, we’re going to sit down with Dr. Alejandro Badia. A hand and upper extremity orthopedic surgeon. He’s going to sit down with Keith to discuss his observations on how to run more efficient orthopedic practices to help fix our broken health care system. He’s going to talk about how thinking more like an entrepreneur and less clinically can help orthopedic physicians improve your business model and your bottom line.

Now Dr. Badia is founder of Badia Hand to Shoulder Center and the OrthoNow Orthopedic Walk-In Clinics. We’ve gotten to know Dr. Badia by working with him on his OrthoNow concept. Dr. Badia is also an author. And most recently, he’s author of Healthcare from the Trenches, where he explores ways to help patients overcome barriers to getting the best care, and to fixing what he calls, our broken health care system in America. Now Dr. Badia is a past worldwide President of the International Society for Sport Traumatology of the Hand. Keith, have a great interview.

Keith:                           Thank you for listening in everyone. I’m joined today by Dr. Alejandro Badia, a hand surgeon in Miami with Badia Hand to Shoulder. He’s an orthopedic surgeon, he’s an author, he’s the founder of a company called OrthoNow, and he’s the founder of a cadaver lab, which we’ll get to briefly later on. Thanks so much for being here today.

Dr. Alejandro B…:          Thank you. Thanks for having me.

Keith:                           Quite a line up on the resume, and that’s why we’ve brought you in, to give some insights on how to grow a successful orthopedic practice. You’ve had quite a journey. Do you ever wake up in the morning and say, “Where have I been?”

Dr. Alejandro B…:          Yes. I think to myself, well I basically memorialized the journey in my book. And the idea was really to kind of make health care more efficient. And when I started into practice I was in a traditional group. And there were a lot of things I thought that really could be done better, quite frankly. That’s been the journey, and trying to achieve that. Particularly in light of the challenges in our health care system, you have the efficiencies and the cost. So I’ve always kept that in mind.

Keith:                           So your resume shows you’re clearly an entrepreneur, you think like one, you’ve demonstrated successes as an entrepreneur. Where along your journey did it click in your mind and you said, “Alejandro, I have to think like an entrepreneur, not like somebody who just came out of medical school with a clinical philosophy”?

Dr. Alejandro B…:          I think the realization came when I was in that group practice and I realized that I kind of look at issues and challenges differently perhaps, than a few of my partners. And it’s not a criticism, it’s just, I think that an entrepreneur sees a problem and it really bothers them. The simplest example is, I’m going down an avenue and I realize I keep hitting red lights all in a row, and I want to find out who is responsible for the synchronization of the lights, and I want to fix it. And so to me, it’s almost like a curse to be an entrepreneur.

I remember I went to a Cornell entrepreneur network and we talked about whether entrepreneurs are born or made. And I really don’t know, because I didn’t learn this from somebody, it just kind of happened. But I’ve tried to bring this to health care, and it has it’s own challenges. But it certainly has been exciting, on top of the clinical challenges.

Keith:                           Well you have so many insights that I want to share with our orthopedic doctors and practice managers. What’s your advice to them about thinking more like an entrepreneur so they can run their practice more efficiently and scale it more quickly?

Dr. Alejandro B…:          Well I think you must think of your patient as a customer, not just as a patient. They already come to you with expectations and, hopefully, confidence that you can resolve your clinical problem. But if you can have, not only yourself, but your staff treating them really like a customer. And in the end, they don’t necessarily know what scientific papers you’ve written on a certain subject or even where you went to medical school or where you trained. What they see is really how you treat them as a person and how your staff treats them. Not just in terms of the niceties, but also being efficient. Having things in the office that solve their problem. All of that is something that you just have to have the mindset.

Keith:                           Seems to me like you have quite a bit of attention to detail just in talking to you a few times. What are some of those attention to detail matters that a practice manager in an orthopedic practice can hone in on to be more effective?

Dr. Alejandro B…:          As you know, I’m a hand surgeon. We’re often called hand weenies. So because we work in such small areas we do pay attention to detail. And again, in terms of approaching the patient, it’s the little details that they’ll remember. So whether it be informing them in their waiting room why you’re delayed, or maybe bringing them a pitcher of cold water, or some coffee. Or ensuring that they have WiFi access, because everybody’s connected. And then right from the beginning, we start the patient experience. So details such as patient education, I don’t have them watch Oprah or CNN in my waiting room, but they watch a loop of educational videos that most of them pertain to what I do, but there’s other things thrown in there.

And even before they get to you, meaning how they reach you. So I mean, my case, my website. I personally answer every inquiry that comes from a patient. But then I immediately attach the right person. So if it’s somebody from out of the country, my international patient coordinator will help them with logistics. If it’s somebody locally, my main scheduler will help them procure the appointment. So all those details lead to the fact that before they’ve even met you, they’re happy with your staff, with how they were treated they’ve already gotten some education about their problem and then once they’re in the office of course, you’ve got to make sure you have all of the tools to be able to make the diagnoses.

So I invested in an office MRI. A lot of people won’t do that, but it’s not because I was capturing the income, which by the way, it’s it’s own challenge with imaging unfortunately, but I was interested in the fact that the patient could have one stop shop. The patient could see me, have an x-ray, maybe have a fluoroscopic exam, have an ultrasound exam if it’s a soft tissue problem, or an injection, and then they can have an MRI. Sometimes in the same visit.

And then afterwards, we have a treatment plan. And in the same building I have the surgery center, Surgery Center at Doral, which is down the hall. And then I have the rehabilitation in the same building. So patients notice that and the referral sources notice that, because all of a sudden, you can just be much more efficient and time is money, right Keith?

Keith:                           Absolutely. And these are the things you have to think through as you manage the practice. So let’s switch gears a little bit, talk about the new book, Healthcare from the Trenches. The premise is, we have a broken health care system in America and that we have to do some things to fix it. What would you say about what is broken with the way that we do orthopedic medicine in the United States?

Dr. Alejandro B…:          Well I think the most basic premise is that, when somebody has an orthopedic issue it often is very cumbersome and costly for them to get to the right person. So as proud as I am as a proud American and immigrant, by the way, I am extremely proud of the scientific achievements of health care in our country. What happens is, there’s been a bunch of obstacles and hurdles that patients have to basically overcome to get to see the right person. And this happens in most specialties. Certainly in orthopedics, it’s very typical that the patient may go to say, a general urgent care center, they see a very well meaning family practice doctor who’s seeing everything, right? But that person can’t possibly know enough about how to determine what’s causing their shoulder pain. Or, if little Johnny has a fracture, they don’t know how to correctly apply a cast, or certainly reduce or set a fracture, right?

So the fact is that there’s a lot of money that’s spent. And then once they see the right person, there’s additional hurdles put there by the bureaucracy of health care. A large part of that’s the insurance industry. If they were listening I would say that we want to collaborate. We understand the need obviously, for health insurance. But they should work with us, not against us. I mention in my book that word, authorization, is actually a four letter word. It really does not make sense that a patient is seen by a specialist and then somebody sitting at a desk who doesn’t have medical training has to actually give you a little authorization number. That person has a salary and benefits, and delays the process.

And maybe that’s what they want is to delay the process. But again, time is money. And if you treat things more efficiently, it ends up being less costly. If it’s less costly, we actually have money leftover to be able to care for the less fortunate in society, right? So there goes Medicare for all. With an efficient health care system we definitely can take care of the uninsured and the ones who are most in need in our society.

Speaker 5:                    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 today. OrthoLive, the world’s leading orthopedic specific telemedicine platform.

Keith:                           So your book talks about removing the hurdles between patients and the specialists. How do we remove the hurdles that you right about in the book?

Dr. Alejandro B…:          Well you could start by saying that once a patient is seen by the appropriate type of physician, and that’s where the insurance oversight should come. The insurance company should care that that person is seen by the right type of clinician, right? Even if it’s a mid-level provider, it could be a nurse practitioner, or a physician assistant, or maybe even a physical therapist from the get go, that they might be able to see that person as long as they have the right credentials, that person should not be encumbered in delivering the care, okay? And that right there is just a basic, basic viewpoint that could revolutionize how care is delivered.

Basically get out of the way, but have oversight. It doesn’t mean that there isn’t bad apples, there are physicians who may overprescribe, may over order tests. I recognize that. But you just work on the outliers. For me it’s kind of like TSA. I think it’s crazy the billions we spend on the way that we screen everybody, when really what we can do is be smart about it and hone in on the more at risk people. And it’s the same thing with health care.

Keith:                           Great point. So the book talks about trying to solve the problems with the health care system, and we talk about how the pandemic has clearly exposed some of the flaws in our health care system. But you talk about a health care 3.0 in the future. And what I’d like to know is how do orthopedic practices fit into the health care 3.0 that you see?

Dr. Alejandro B…:          I think we have to be thought of as more of almost a primary care specialty. Many years ago, right, the country doctored, delivered babies, set fractures, did a lot of things. And increasingly there’s been different specialties have been thought of as primary care, right? So a good example almost is, ophthalmology, right? Nobody would think of going to their family doctor with an eye problem, right? And I think that unless it’s something quite minor, I really think that patients should have access to see an orthopedist early on when they have a musculoskeletal complaint. Because that speeds the treatment, the diagnosis definitive of a treatment, and that saves money, in and of itself. So I really think that if orthopedics could be thought of as more front line primary care almost, that will be a huge benefit to society and to the delivery of health care.

Keith:                           Interesting. So one of the things we’ve seen growing rapidly during 2020 was the implementation of telemedicine services. And we know that orthopedic doctors and practice managers are very focused on this. But I want to have you offer a little guidance on how you use it, and start by telling us quickly, the story about your patient in Barbados who had a telemedicine visit with you.

Dr. Alejandro B…:          Sure. I started doing telemedicine about six years ago because a lot of my patients, I would say almost 30% of my operative patients, my operative cases, come from abroad. And it really instills confidence if a patient could at least speak to the physician, get an idea of what their clinical problem is based upon imaging studies they might have had in their country, and then have this kind of face to face with me so that when they jump on a plane we already have a battle plan. And it may change somewhat when I sit down with them and actually examine them in person, but you can do a lot with telemedicine. And it saves a lot of time and money.

So in Barbados, I recently just had a polo player, right? Who had a shoulder problem. And the x-rays showed there was an arthritic lesion in the shoulder. So I could see that on a plain x-ray, I didn’t even need MRI for that. And had had conservative treatment in his country, and he needed a type of shoulder replacement. I do what we call a resurfacing hemiarthroplasty. It’s basically, you put a titanium cap on the humeral head. And that patient starts therapy within several days of that, while they’re still in Miami. But we had a plan, through telemedicine, before he even got here. And that increases the efficiency. So I say, why not deliver that kind of efficiency at home? I mean, Miami traffic can be pretty bad. So why have to be an international patient when it could be somebody who lives 40 minutes away, and at least they have an idea.

And during COVID, of course, that went from I think, a utilization of about 13% to 84%, I believe, amongst practitioners. So there was an incredible escalation in utilization of telehealth services. And I think a lot of that’s going to continue.

Keith:                           So you have a demonstrated record as a savvy marketer, somebody who knows how to market yourself effectively frankly. And what would you say to orthopedic doctors and managers about just trying to grow the sphere of influence and scale that practice beyond their city limits, state limits, and maybe outside the US? I mean, you recently did a surgery on a Russian soccer player.

Dr. Alejandro B…:          Yeah actually, well he plays for the Premiere League in Russia. But he’s originally from Venezuela. And they put him on a private plane, he was here two days after the injury, and I, very next day, I put the two plates on his ulna and I just saw him about 20 minutes ago. He’s actually still here doing his second therapy session. So today’s Tuesday, he had surgery Thursday. And my goal is really to get him playing within about four to five weeks. In his case it was not telemedicine, it was pretty clear what the problem was. He just needed to get here.

But the way that happens, I think, is that you have to be available to patients, right? The As, right? They’re affable, amiable, and accessible, right? And if you are accessible, meaning that you’re willing to answer inquires from patients or referral sources on the internet, that’s going to separate you from a lot of people who don’t spend the time doing that. But that pays big dividends because people realize that you’re accessible and willing to answer questions. So that would be my best advice for that.

But even in your own community, when you start in practice, you’ve got to not only go meet with the other doctors, but for example, the business community. When I left the Miami Hand Center which I had cofounded, I came to Dural which is a burgeoning small business city, right next to the Miami International Airport. Very active business community. And I was the only doctor, certainly the only surgeon, that would attend these Business Chamber of Commerce type meetings on a monthly basis. I would have a great cup of coffee and a breakfast, of course, and I got to meet some nice people. But at the same time, I also got to tell them that, okay, there’s an orthopedic surgeon in town, the first one, and I only do upper limb.

And soon afterwards, I created OrthoNow. So now they understand they have a walk-in center for any musculoskeletal problem right within the confines of this small city. And that just means getting the message out. And I think that many times us physicians, we’re very busy, we have to realize that you have to step outside your shell and outside your practice to meet people and tell them about what you do. You can have the best hands or best practice management skills anywhere, if people don’t know about it you’re not going to benefit.

Keith:                           Absolutely true. So let’s look ahead to the future now. What’s your advice for a group of doctors that’s running that private practice, they’re trying to keep the place running every day, balance the employees, and the patients, and the schedule and everything, but what they can’t take their eyes off of is remaining nimble and adaptable as the industry continues to change? So in the coming years, what are the trends you’re watching closely that you can share with them so they can stay in the game effectively?

Dr. Alejandro B…:          Well certainly, as we saw COVID also, like many other things, has pushed our hand. So certainly telemedicine has to be a component. And not so much for new patients, except during this difficult time, but I think going forward, there’s no reason that all of your patients have to have a follow-up visit and get into a car, disrupt their day, when they can do exactly what we’re doing now and communicate, right? Virtually. And have a follow-up visit maybe to discuss the results of that MRI. Or, once they’re progressing well in therapy, to answer questions, to check their range of motion and their function, without necessarily having to lay your hand on them. That’s a game changer.

The same thing in terms of the actual surgery. More and more surgery is going to out-patient. It just makes sense economically, time efficiency-wise, there’s no question that most surgeries now can be done out-patient. I’ve been doing shoulder replacements for the past seven, eight years, all out-patient. In our center we’ve been doing knees, and I think we’re the first in the state of Florida to do an anterior, a lumbar fusion. Obviously I didn’t do that, my colleague spine surgeon did, Dr. Hyde, and the general surgeon opened the abdomen and instrumented the spine from the anterior, front approach. That is a game changer.

Now the other thing is, how to actually track patients. And I think the days of just hanging a shingle and telling people what you do, certainly the younger generation, millennials want really, immediate access. So the growth of orthopedic urgent care centers has been almost exponential. The problem is, a lot of the groups start them on their own and do just extended hours. In that sense, you’re cannibalizing your practice. What I really recommend is a separate from the practice patient funnel, patient access to orthopedic walk-in centers. And I don’t say urgent care because it’s not always urgent. At OrthoNow we have amazing data analytics that show that 70% of our patients actually come in for pain. And the number one diagnosis for example, last month, was right knee pain. Number two was lumbar pain. Number three I think, was left shoulder pain. And number six was ankle sprain. Meaning that the top five diagnoses are not urgent. But patients want access. They don’t want to have to wait for an appointment. And that’s what something like OrthoNow does, which by the way, we have a licensing program, so they don’t have to reinvent the wheel.

And certainly, I would highly suggest to administrators to not start from scratch when really, you can collaborate with somebody who’s done it before and really grow a network. That’s what our goal is. So all of these strategies I think, will not only get you more patients, but allow you to practice more efficiently. And that’s oftentimes what patients are going to remember.

Keith:                           So Dr. Badia, if our listeners want to get more information about you, and the new book, and the practice, where can they go?

Dr. Alejandro B…:          My website’s very easy. In Miami I tell them, Badia is the name of a famous spice and condiments company. So it’s the same spelling but in my case it’s Dr. Badia. D-R B-A-D-I-A. So If you go, that obviously takes you to the page so you can read about the book and order it through Amazon that way. And then there’s links to the surgical center, so you can see how that is. And certainly links to OrthoNow. The OrthoNow’s website is And all that information is there. I’m very good about responding and I like to learn from people, so I’d love to hear ideas that people have.

Keith:                           Dr. Alejandro Badia, great insights today. Thanks for sharing them, and we appreciate your time, and thanks for joining us.

Dr. Alejandro B…:          Thank you Keith.

Speaker 2:        Thanks for listening to the Growing a Successful Orthopedic Practice Podcast. Please consider pressing subscribe on your podcast player so you never miss a future episode. And if you haven’t given us a rating or review on Apple Podcasts already, we ask that you take a spare minute to help us reach and share our medical practice growth stories with peers.

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