Keeping injuries out of the ER

By Gale Pryor | June 1, 2016

The High-Performing Physician Network

Data Snapshot

20% of convenient and urgent care clinics are located in medical offices.

Key Takeaways

  1. Consider offering urgent care to improve patient access.
  2. Same-day care leads to long-term patient loyalty and referrals.
  3. Keeping urgent care in-house can improve treatment and save costs.

When Chris Kean's young daughter hurt her ankle in an after-school soccer game, Kean had no choice but to steer her straight to the emergency room. It was parental instinct: “I didn't know if it was broken or not, but I wanted her seen right away."

Sitting in the waiting room, Kean witnessed a 5 p.m. rush. One after another, parents brought in kids with common injuries from playgrounds and sports.

“I thought, ‘this is a terrible place for this kind of problem,’” Kean says.


As chief operating officer of The San Antonio Orthopaedic Group, one of the largest orthopedic organizations in Texas, Kean could put her personal experience to work for patients.

One of the group’s partners, Marvin Brown M.D., had long wanted to create a fracture clinic that could introduce more patients to the practice and improve the continuity of care. The two ideas came together in OrthoNow, an in-house urgent care center, which operates in two of the group’s seven offices.

It was a characteristic move of a high performer. In an ongoing project, athenahealth researchers are examining key financial and operational metrics from across a national network of 99,000 providers and have identified the top 10 percent of performers. As one of them, it is no surprise that the San Antonio Orthopaedic Group is intensely focused on the total patient experience. 

For Kean, the demand for urgent care became clear when she realized her offices were getting a rush of afternoon calls about breaks, sprains, and pain — just like the ER.

The problem was, all seven locations closed at 5:30 p.m.

“The only answer we had for them was, ‘If you think it’s that bad, then our advice is to go to the emergency room,’” Kean says.

That meant patients faced the prospect of paying huge bills and waiting for hours near very sick people. And they were left on their own to decide how serious their injuries might be.

While some injuries can, in fact, wait a day or more for care, when patients are in pain, they want to be seen right away. “If you cannot get patients in as fast as they perceive they need to be seen,” Kean says, “you’re going to have a problem.”


And for injuries that need treatment, she says, the in-house clinic leads to better-coordinated care — and saves money for both patients and payers.

“We will definitively diagnose and treat the problem, set up any diagnostic work up the patient needs, and facilitate the care plan,” says Kean, “all in-house for the cost of a specialty physician office visit rather than an ER visit.”

OrthoNow, which is available for both new and established patients, is staffed with physician assistants, an after-hours receptionist, and an x-ray and casting staff. The in-house location minimizes the cost. Still, Kean says, the urgent care clinics aren’t revenue engines.

Because orthopedics is specialty care, the staff needs to collect referrals from primary care physicians after some patient visits. Sometimes, those referrals don’t come through — which means the practice can’t charge those patients for care.

But the long-term payoffs in patient loyalty and outcomes are worth the investment, Kean says.

“Often, our patient is not actually the patient,” she says. “It’s the mom who is taking care of her child, and whose elderly parents will need some kind of orthopedic service in the future.”

When choosing healthcare providers, patients value access more than any other criterion. Even when urgent injury care does not generate revenue for a practice, “this is actually a really good idea for an orthopedic group,” says Ateev Mehrotra, M.D., associate professor of health care policy and medicine at Harvard Medical School. “They don’t have to depend on the emergency department to funnel new patients who break a bone. They’re really expanding their patient base.”

Once a patient has made a connection with a medical office, she’s likely to return, Kean says — making the emergency room a distant second choice.

“When your kid’s ankle is purple,” Kean says, “we want you to come straight here.”

Learn more about the drivers and habits of high-performing physician networks.

Gale Pryor is associate editor for athenaInsight.

Keeping injuries out of the ER