🔒In growing outpatient bone and joint care market, Orthopedic Associates debuts storefront clinic

If you’re seeking a location for a new orthopedic clinic, it makes sense to open it just down the street from the Shops at Evergreen Walk, an upscale retail center in South Windsor that invites people to leisurely stroll from store to store while they shop.

After all, you can’t enjoy shopping if your back, knee or foot hurts.

Yet, the newest patient care center for Orthopedic Associates of Hartford (OAH), at 25 Buckland Road, represents more than just “going where the people are,” said OAH President Dr. Pietro A. Memmo.

It’s actually an example of a national healthcare trend.

“What’s happening in health care is that orthopedics is migrating from being inpatient to outpatient,” Memmo said during a recent ceremony marking the opening of the clinic. “This is really the first time that Orthopedic Associates of Hartford has gone a little bit more retail.”

The new 5,969-square-foot facility is located in a small shopping center, next door to Removery, a tattoo removal shop, and a Hartford HealthCare/GoHealth urgent care center. Across the parking lot are a martial arts school, vape shop, barbershop and mattress store.

It’s a vastly different setting from where the clinic was previously located, about 3 miles away at 29 Haynes St., in Manchester, next to Manchester Memorial Hospital.

“Normally, we’re in the healthcare hubs in Farmington, Glastonbury, what have you,” Memmo said. “South Windsor is really the crossroad of this region, where patients can come from so many communities — whether it’s Manchester, Vernon, East Hartford or Ellington — they can come here instead of traveling so far like they have in the past.”

The new location serves as an office for as many as 12 orthopedic specialists and offers a range of services, including specialized care for joint replacement, sports injuries, spine conditions, foot, ankle, hand, wrist and elbow issues, and general orthopedic care. It also offers physical therapy, X-rays, and cast application and removal.

‘Substantially cheaper’

The South Windsor location is not a surgical center — OAH has outpatient surgical facilities in Hartford, Glastonbury and Rocky Hill and co-manages the Bone and Joint Institute in Hartford with Hartford HealthCare — but it’s another example of an independent orthopedic group investing in outpatient clinics.

According to a report from Grand View Research, a San Francisco-based market intelligence firm, the U.S. orthopedic ambulatory surgery center market was valued at $10.1 billion in 2022, and is expected to grow 4.6% per year from 2023 to 2030.

The report attributes that growth to the lower cost of surgeries performed in ambulatory surgery centers vs. hospitals. It cites research from the Rothman Orthopaedic Institute in Philadelphia and Hospital for Special Surgery in New York that found that treatment in ambulatory surgery centers costs about 40% less than in hospital-based outpatient departments.

“The trend in health care for a number of years has been for procedures that used to have to be performed in an inpatient hospital setting, with an extended length of inpatient stay, are now performed in an outpatient setting,” said Arnold Menchel, a partner with Hartford law firm Halloran Sage, who represents hospitals, medical practices and other healthcare-related facilities.

Menchel said there is a domino effect that results from the shift to outpatient procedures, in that “some things that used to require an outpatient setting can now be done in an office setting.”

For example, hip replacement surgery was once strictly an inpatient procedure that required a week’s stay in the hospital, he said. “Now, in the right circumstances, it is not uncommon to have it done on an outpatient basis in an ambulatory surgical center with the patient going home the same day.”

Menchel said there are several reasons for this trend that are “favorable for the patients, the providers and the payers.”

Patients don’t spend time in a hospital, reducing the risk of infection while also recovering more comfortably at home. Surgeons have easier access to an outpatient operating room compared to competing for time in a hospital OR, and they are now more likely to “own a part of the ambulatory surgical center,” he said.

OAH, in fact, is a privately held, independent partnership of 29 physicians.

Lastly, as noted by the Grand View report, it is generally “substantially cheaper” to do a procedure in an ambulatory surgical center than in a hospital,” Menchel said, because a center “doesn’t have to be staffed 24/7, nor do they have to offer all of the services that hospitals do. So, they are much less expensive.”

“The hospitals also recognize these facts and are investing in (ambulatory surgery centers) as well,” Menchel added. “This trend continues on down the line, so that some diagnostic tests and rehabilitation treatments that used to be done in an outpatient facility are now able to be performed in an office setting,” as is possible in OAH’s new South Windsor facility.

Well-equipped

Memmo said patients also demand outpatient care, as do insurance companies and even the Centers for Medicaid and Medicare Services.

“I predict that in the next year or so, in order to do an inpatient orthopedic procedure, you better have a good reason for it,” Memmo said.

Menchel noted that outpatient facilities are often equally well-equipped.

“Underlying all of these changes are advances in technology and technique, in terms of the diagnostic, surgical and rehabilitative equipment,” Menchel said.

OAH has invested in the high-tech equipment that helps make surgeries less invasive, Memmo said, citing MAKOplasty — robotics used for full or partial knee replacement or for hip replacement surgery — and Mazor, a robotics guidance system used for spinal surgery.

“The precision that is now offered by these robotics … cuts the amount of time it takes to do these cases,” and reduces the amount of pain control required after the procedure, Memmo said.

OAH also invested last year in an Epic electronic medical records system, which he calls a “game-changer.”

“I never realized how much information and data we were missing,” Memmo said. “Now I have a 360-degree view of my patients. I had nothing close to that last year.”

Epic also has made providing care — from coordinating prescriptions and scheduling procedures to billing and receiving payments — more efficient, saving administrative costs.

All of this, he added, has gained the attention of health systems looking to switch to value-based care, which favors the quality of care over the quantity of patients treated while seeking to reduce costs.

“We’ve been approached and we are doing some of that with health systems like ProHealth, … Optum, and UnitedHealth,” Memmo said.

One-stop shopping

He added that OAH has been focused on investing in its facilities because it anticipated the change to outpatient treatment, as well as the growth of out-of-state companies entering the market.

In addition to the South Windsor facility, OAH has orthopedic urgent care locations in Farmington and Glastonbury.

He cited private equity firm Spire Capital, HOPCo (Healthcare Outcomes Performance Co.), Summit Health, and Walgreens-backed VillageMD as organizations that have acquired or opened orthopedic care facilities in the state.

OAH invested in its facilities, Memmo said, “knowing that if we want to sustain and compete with all these entities, we have to be vertically integrated, where we have a place like this where we offer one-stop shopping.”

“We’ve been in practice for 50 years,” he added. “I’m committing to you that we’re going to make the investments to stay in business another 50 years.”