The next major growth opportunity for ambulatory ASCs may lie in partnerships with other outpatient facilities, such as urgent care clinics and orthopedic walk-in centers, according to Alejandro Badia, MD, founder and chief medical officer of Miami-based Badia Hand to Shoulder Center.
“Once a patient is seen in a hospital emergency room, for example, that patient will likely undergo surgery at that facility, often whether urgent or not,” he told Becker’s. “Collaboration between a convenient walk-in facility, for example, an orthopedic urgent care center and as ASC, will drive up musculoskeletal surgical volume, while lowering overall healthcare system costs.”
Orthopedic urgent care centers serve as a critical entry point for patients who might not otherwise be referred to an ASC, Dr. Badia said. Unlike hospitals or general urgent care centers, these facilities specialize in musculoskeletal injuries, ensuring more patients are directed toward ASCs for surgical care.
Partnerships with orthopedic walk-in clinics also reduce ASCs’ reliance on surgeon referrals, he said. Independent ASCs, in particular, often depend on their physician partners to bring in patients.
By collaborating with urgent care facilities or other walk-in clinics, ASCs can create their own patient pipeline instead of relying entirely on surgeons.
“What orthopedic urgent care does is provide that access point because it’s so convenient,” Dr. Badia said. “An orthopedic urgent care, even if it doesn’t have a formal relationship with an ASC, should at least have a way for the patient to access one. That brings in revenue and patients without the ASC depending entirely on the surgeon for referrals.”
These partnerships can also lead to faster diagnoses and treatment. With on-site imaging, such as MRI capabilities, orthopedic urgent care centers can diagnose conditions like ACL tears or rotator cuff injuries immediately.
“The process is seamless,” he said. “We’ve had cases where a patient comes in, gets diagnosed, and literally has surgery the next day or two days later.”
In contrast, patients who visit a hospital — especially with the growing trend of surgeon employment — are “almost guaranteed” to have their procedure performed in a hospital setting, Dr. Badia said. “These partnerships provide patients with more choices and an alternative to hospital-based care.
“That’s why ortho walk-in centers are so important — they’re very patient-driven,” he said.
They’re designed to be highly visible and convenient, with good signage and accessibility.”
Convincing payers to embrace this model remains a significant challenge, Dr. Badia said.
“If we could get insurers to understand that this is so much better for their patients — and obviously better for their bottom line — it would make a huge difference,” he said. But I’ve also written about the medical loss ratio, and I’ve come to learn that sometimes, if a solution is too cost-effective, insurers don’t necessarily embrace it. Because if they save too much money, they can fall out of compliance with the MLR.”
Additionally, hospital lobbying and education pose challenges, as large healthcare systems dominate industry messaging, according to Dr. Badia.
“Let’s face it, the ASC industry is up against the hospital lobby,” he said. And don’t get me wrong—people assume I bash hospitals, but I don’t …. But I think patients, the healthcare system and the economy all recognize that you don’t need a big expensive hospital to perform a rotator cuff repair with three tiny incisions.”
Cultural resistance and entrenched habits are also obstacles to these partnerships, Dr. Badia said. Despite establishing an orthopedic walk-in center and a network 15 years ago, he has seen “very little engagement” from the ASC industry.
“One thing I’ve noticed after the last three decades in healthcare is that it’s very hard to introduce new ideas and new methodologies, which is unfortunate given the huge challenges we’re facing,” he said. “But I think it really comes down to culture and habit, and perhaps not fully understanding the value proposition.”
The relative novelty of orthopedic urgent care centers also presents regulatory challenges.
“There are 11 exceptions to the Stark law, but there isn’t a specific one for this,” he said. “That being said, I don’t see why ASCs necessarily have to own an orthopedic urgent care. As long as patients know they have a choice, that’s what matters.”
