1. Thomas Grogan, MD

2. The Issue Patients desire an urgent response to injury Orthopedic injuries tend to occur after hours or on weekends Payers do not pay additional compensation for emergency or after hours office visits Orthopedic payer contracts are trending toward a decrease in reimbursement, limited access to imaging reimbursement, and limited networks Patient deductibles, co-payments, and cost share are increasing

3. The Issue Emergency Visits – 2011 Data 136.3 million visits 11.9% are admitted, 2.1% are transferred 86% are discharged home Injury related – 40.2 million Ankle sprains – 6.4 million 2% of Americans visit an ER for an ankle sprain each year 2013 ER “cost” study – ankle sprains 8,300 centers Median: $1,051 Mean:$1,498

4. Table 2. Ten most frequent treat and release ED Diagnoses, 2006–2008. Caldwell N, Srebotnjak T, Wang T, Hsia R (2013) “How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department. PLoS ONE 8(2): e55491. doi:10.1371/journal.pone.0055491 http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0055491

7. The Issue Premium increases are modulating, but out of pocket expenses are accelerating Since 2010 Deductibles up 67% Premiums up 25% Wages up 10% Average deductible - 2014 now $1,017 (was $370 in 2003) 46% covered workers > $1,000 20% covered workers > $2,000

8. The Issue Cadillac tax will only make it worse 2018 roll out 40% non-deductible tax Individuals - $10,200 Family - $27,500 Flexible saving account deductions count toward the cap for the employer Solution: Higher deductibles / co-pays to stay under the cap

9. One Answer Traditional Orthopedic “Urgent Care” In competition with the emergency room Extended office hours Evenings, weekends Usually staffed by Physician Assistants, surgeons as back up Require administrative staff to be present, x-ray tech Staff present even if no one comes by Insurance billing is an issue – no one to call Limited networks, HMOs, retro-authorizations, co-pays Get paid (if at all) at regular contract rates

10. Our Solution – “Ortho On Demand” Devise a platform that is physician friendly - but patient centric - to handle urgent walk-in issues afterhours Web based Patient can see which doc is available One fee set by the physician Covers visit, x-ray, primary intervention Payment is made via credit card at the time appointment made Patient can deal with their insurer if out of network benefits allow

11. Physician Friendly Docs can choose when they are available Docs can choose what they want to charge Paid outside of any contracts Paid as a contractor to our center – Pacific Coast Sports Medicine Additional treatment can be scheduled electively – handled under the regular insurance contract if applicable Captures the patient into the practice before the ER visit ER tends to make directed referrals to Hospital employed docs Service perfect for private practice – competitive advantage compared to Hospital based docs

12. Patient Centric Patients can get taken care of by an Orthopedic Surgeon on an urgent basis In ER – usually splinted and told to go see the Orthopedist the next day Entire transaction transparent – fees charged, services rendered - no co-pays May be able to choose from several docs – different prices Avoid the time / uncertainty of the ER visit

13. Patient Centric Do the right thing at the right time for the right reasons

14. Thank You!