Dedicated Orthopedic Express Care Centers: A Guide to Successful Implementation and Growth Strategy
DOI:
https://doi.org/10.55576/job.v6i3.81Keywords:
Orthopedic express care, urgent care, musculoskeletal, Value-Based Care, healthcare economics, patient accessAbstract
Objectives: To report the 11-year clinical volume, financial performance, patient demographics, payer mix, and operational outcomes of a physician-owned orthopedic express care (OXC) program, and to benchmark these against published emergency department (ED) utilization and cost data.
Design: Retrospective, observational, single-practice study with a narrative synthesis of implementation, operational, and governance considerations.
Methods: Patient visit volume, charges, revenue, expenses, net income, collection rate, and overhead percentage were obtained from internal practice financial and scheduling records across all OXC sites for the period 2014–2024 (11 years). Patient age distribution and diagnostic case mix by body part were reported for the most recent complete annual period (2025). Payer mix was compared between OXC and primary clinic settings. Previously published data from the authors’ 2016 study served as the main benchmarking comparison for OXC versus ED wait times, visit duration, time-to-specialist, and cost per encounter.
Results: Annual patient visits increased from 2,562 in 2014 (single-site) to 21,693 in 2024, with a peak of 22,729 in 2023 (multi-site), reflecting a 747% increase over the period. Total charges grew from $1,997,509 to $9,712,336, and revenue rose from $713,145 to $4,461,752. Overhead stabilized at 75.2% after peaking at 100.6% during staffing model transitions (2020–2021), resulting in a net income of $1,098,801 at maturity. Collection rates improved from 35.7% to 45.9%. The OXC captured a significantly higher share of commercially insured patients (64.7%) compared to the primary clinic (42.1%). Compared to published ED data, the OXC achieved 62% shorter wait times (17 vs. 45 minutes), 72% shorter visit durations (43 vs. 156 minutes), 65% faster access to specialists (1.2 vs. 3.4 days), and 94% lower cost per encounter ($461 vs. $8,150).
Conclusions: The physician-owned OXC model described was linked to sustained volume growth, a favorable payer mix, and financial stability over a decade of development, along with reductions in costs and better access compared to ED-based care. A phased implementation approach that includes dedicated APP staffing, surgeon oversight, and targeted marketing offers a reproducible framework for orthopedic groups considering OXC development.
Level of Evidence: Level IV – Retrospective Observational Study
Key Words: Orthopedic express care, urgent care, musculoskeletal, value-based care, healthcare economics, patient access
References
National Center for Health Statistics. Emergency Department Visit Rates by Selected Characteristics: United States, 2022. NCHS Data Brief No. 503. August 2024. Available from: https://www.cdc.gov/nchs/products/databriefs/db503.htm
Allen L, Cummings JR, Hockenberry JM. The impact of urgent care centers on nonemergent emergency department visits. Health Serv Res. 2021;56(4):721–730. doi:10.1111/1475-6773.13631
Anderson TJ, Althausen PL. The role of dedicated musculoskeletal urgent care centers in reducing cost and improving access to orthopaedic care. J Orthop Trauma. 2016;30(Suppl 5):S3–S6. doi:10.1097/BOT.0000000000000712
Pean CA, Bird ML, Buchalter DB, Yang SS, Egol KA. Orthopaedic urgent care versus the emergency department: cost, utilization, and visit lengths for fracture patients. J Am Acad Orthop Surg. 2022;30(3):e371–e374. doi:10.5435/JAAOS-D-21-00638
Henry TW, Lutsky K, Beredjiklian PK, Matzon JL. The five-year growth of an orthopedic urgent care center: identifying patient and center trends. Cureus. 2022;14(12):e32176. doi:10.7759/cureus.32176
Dlott CC, Metcalfe T, Khunte A, et al. Evaluating musculoskeletal urgent care center triage and transfer of emergency conditions for surgical assessment. Medicine (Baltimore). 2022;101(51):e32519. doi:10.1097/MD.0000000000032519
Sahni NR, Cutler DM, Birnbaum HG. Physician shift to lower-cost sites of care: economic potential for the U.S. health system. Health Aff (Millwood). 2024;43(4):509–517. doi:10.1377/hlthaff.2024.00001.
Smith FM, et al. Missed fractures on radiographs in a pediatric emergency department. Pediatr Emerg Care. 2016;32(12):819–823. doi:10.1097/PEC.0000000000000953
Mounts J, Smith WS, Housholder DF, et al. Most frequently missed fractures in the emergency department. Clin Pediatr (Phila). 2011;50(3):183–186. doi:10.1177/0009922810384725
Canton SP, Via GG, Mead L, Johnson PC, Althausen PL. Current Ancillary Service Opportunities, Access Points, and Options for Revenue Distribution. Journal of Orthopaedic Business.
McGuireWoods. CMS and OIG Issue Final Rules Modernizing Stark Law and Anti-Kickback Statute. 2021. [Details/DOI pending]
Centers for Medicare & Medicaid Services (CMS). Physician Self-Referral (Stark) Law Overview. [Details/DOI pending; URL: https://www.cms.gov/physician-self-referral]
Via GG, Mead L, Johnson PC, Althausen PL. When to Hire a New Orthopedic Surgeon. Journal of Orthopaedic Business.
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Copyright (c) 2026 Garrhett Via, Lisa Mead, Brian Schneiderman, Peter Althausen
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