OrthoNOW paving a new path in urgent care

Area of expertise: OrthoNOW CEO and Chief Medical Officer Dr. Alejandro Badia, an orthopedic surgeon, reviews X-rays of a wrist fracture at the orthopedic care center in Doral. OrthoNOW is building a network of orthopedic urgent care centers and OrthoNOW Doral is the flagship location.
Area of expertise: OrthoNOW CEO and Chief Medical Officer Dr. Alejandro Badia, an orthopedic surgeon, reviews X-rays of a wrist fracture at the orthopedic care center in Doral. OrthoNOW is building a network of orthopedic urgent care centers and OrthoNOW Doral is the flagship location. Miami Herald

Dr. Alejandro Badia, an orthopedic surgeon, was frustrated seeing patients for the first time long after their injury, sometimes a month later. That’s because they often went to the emergency room or a general urgent care center first.

Too often, by the time the patients were referred to him, the injury worsened because it didn’t have the right attention early on. And patients wasted a lot of time and money seeing general doctors when what they needed was a specialist, he said.

That’s why five years ago he started OrthoNOW in Doral, a specialized walk-in orthopedic urgent care center for assessing and treating a range of orthopedic and sports injuries. Now OrthoNOW is franchising the concept, with a third South Florida location planned to open in September and a national expansion in the works.

“Why would you go to the hospital for an ankle sprain?” Badia asked. He hopes consumers will ask themselves that, too, the next time they trip while jogging, get hurt at work, or tend to their children’s injuries. “We are an extremely reasonable alternative to emergency rooms. These injuries just happen, and you can’t plan on it,” he said.

OrthoNOW has two locations in South Florida: its flagship center in Doral and the first franchised location in the Weston area, which opened in February. A franchised location in Aventura is expected to open in early September, and locations in Pinecrest and on Miami’s Biscayne Boulevard and Coral Way have begun build-out and are likely to open by the end of the year, the company said. Sites in Kendall, Boca Raton, Wellington, the Orlando area and two in Georgia are expected to open next year.

The appeal: While an ER visit could mean a four-hour wait in the waiting room, OrthoNOW says it can be treating a patient in 80 minutes or less.

“Patients can even use our free app that will herald the center, and we will be waiting for them with the X-ray machine ready,” said Badia, speaking about the “On My Way NOW” feature.

OrthoNOW accepts most major insurance plans, including Medicare and Medicaid. The average co-payment for OrthoNOW is $45, while an emergency room visit would be $200, according to the company. For the uninsured, an ankle sprain could easily end up costing more than $800 going to the ER, whereas it could be well under $300 at OrthoNow, said Justin Irizarry, OrthoNOW’s chief financial officer. And while there are some excellent urgent care centers, they likely won’t have the orthopedic specialists that OrthoNOW has, Badia said.

The model

OrthoNOW Doral is 3,000 square feet and part of a 14,000-square-foot facility that also includes Badia’s practice and surgery center. While most of the franchises are about 2,400 square feet, the Doral facility is equipped to be a model for the company with state-of-the-art equipment, Badia said while giving a tour of the facility.

In May, for instance, the Doral location added OrthoNOW Rehab, a room of treatment stations that was very active on a recent weekday. “It’s been proven that care is vastly improved when therapy is conducted in the same facility, and it is unusual to find an orthopedic urgent care center that offers all these services under the same roof,” Badia said when the new feature was announced.

By integrating the clinic with a rehab center, orthopedic surgeons and specialists are able to track patients from the moment they come to the center through to recovery. Services include anything related to the foot, ankle, knee, hip, wrist, elbow, shoulder and spine. The center also offers ARPwave Neuro Therapy, which alleviates acute and chronic pain.

“It’s traditionally used by elite athletes. In a nutshell, what it does is get to the origin of the pain. This technology works at the nerve level,” Badia said. OrthoNOW has been demonstrating the technology at events and will be at the upcoming Miami Iron Man.

It was at a CrossFit event, on a day when he had lower back pain, where Omar F. Cordero first tried out the ARPwave: He said he felt better nearly immediately. So when he experienced acute shoulder pain recently, he went to OrthoNOW Doral. A few treatments later, he was feeling almost 100 percent better.

“I train a lot; I put my body through a lot of physical demands,” said Cordero, who owns and runs StrongerRX. “I love the way OrthoNOW can take care of you. They know what they are doing, and they are results-oriented. They put a plan in place, and you follow the plan.”

Hardcore trainers like Cordero, as well weekend warriors, are one of OrthoNOW’s key target markets, but a growing area of focus is workers’ comp cases; Irizarry estimates it at 15 to 20 percent of OrthoNOW Doral’s business. Badia said Miami-Dade County has recently included OrthoNOW as one of the places employees can go at the time of injury. That could save the county $9.7 million yearly, according to his calculations.

Market size

To be sure, the market is large. Work-related musculoskeletal disorders accounted for a third percent of all injury and illness cases in 2013, according to the Bureau of Labor Statistics, and have been estimated to cost the U.S. economy $45 billion to $54 billion annually. Orthopedic urgent care centers are beginning to proliferate around the country — there are more than 170 of them, but most are independent players or units attached to practices. Badia believes OrthoNOW is the first franchised brand.

The general urgent care industry is exploding, too, growing into a $17 billion industry this year, with an average growth rate of 8.1 percent, according to IbisWorld research. It is also a fragmented marketplace with few big players.

Badia’s idea for OrthoNOW was actually born out of a failed franchise attempt. A year after he opened his surgical practice, Badia Hand to Shoulder Center, in Doral in 2008, he became a franchisee of DoctorsNow. The franchise didn’t work out.

While he wanted to focus on orthopedic injuries, “the franchise was focused on general urgent care centers and the concept of ortho urgent care hadn’t evolved at that time,” he said. “But that was pretty valuable for me to be a franchisee and see it from that perspective.”

Badia closed that business in 2010 and reopened later that year as OrthoNOW in Doral.

Irizarry joined OrthoNOW about that time to work with Badia “to perfect the OrthoNOW model to get it cash-flowing and profitable.” In 2013 and 2014, Irizarry, who has an MBA from the University of Pennsylvania’s Wharton School, has been sharply focused on getting the franchise model off the ground. He began commercializing it this year.

OrthoNow’s Doral location, at 3650 NW 82nd Ave. in Doral, has about 15 employees, including doctors, physician assistants and nurse practitioners trained in sports medicine and orthopedics. It also has partner surgeons in specialties such as foot, spine and elbow. One of the biggest challenges has been public awareness because people and workplaces don’t realize an ortho-specific urgent care facility is out there, said Irizarry. Irizarry wouldn’t disclose the company’s revenue but said revenue grew 150 percent from 2012 to 2013 and 75 percent from 2013 to 2015.

Looking forward

The next franchise set to open is the Aventura location, not far from Oleta River State Park. Monica Torres, who is from Venezuela and will manage the center, has been busy with a flurry of pre-opening details and getting the word out.

Torres’ husband, a physician, is part of a small investment group that was looking for healthcare opportunities in the U.S. “We were looking for a franchise related to orthopedic services because patients are tired of going to ERs in hospitals and waiting long hours and paying a lot and not being seen by a specialist, and we knew this would be a good investment. That’s when we stumbled upon OrthoNOW,” Monica Torres said.

She said OrthoNOW, the franchisor, has been helping her with operational issues such as permitting, licenses and inspections, as well as dealing with medical suppliers. “The most important thing for a franchisee to do is getting the word out, getting involved in the community and educating them about how this is better for them,” said Torres, who has joined chambers and other business associations, attended events and even set up a booth in the park. “OrthoNOW is a pioneer. It’s a new concept, and we know it is going to work.”

Being among the first franchises in a new concept is never easy, and Badia said there are operational “challenges” with the OrthoNOW Weston franchise location. The OrthoNOW Weston franchisee, RP Brothers Group International, did not respond to requests for an interview and calls to that facility last week were not answered.

Franchisees can expect to make $1 million to $2.5 million in annual revenues with profit margins of 15 to 30 percent, Irizarry said. These ranges are based on the experience at Doral, and the results are going to be strongly influenced by the owner-operator, he said.

“We give them everything they need to run a center,” including a 450-page manual, guidance on site selection, contracting and leases, marketing materials, website and app, Irizarry said. “It’s a turnkey solution.”

Follow Nancy Dahlberg on Twitter @ndahlberg.


Business: OrthoNOW, one of the country’s first orthopedic urgent care center franchises, offers specialized orthopedic urgent care centers focused on assessment and treatment of a range of orthopedic and sports injuries on a walk-in basis.

Founder and CEO: Dr. Alejandro Badia.

Flagship location: 3650 NW 82nd Ave., Suite 201, Doral

Number of employees (Doral location): 15.

Franchises: One in operation; four more set to open this year.

Costs to franchise: Initial fee of $65,000; average investment of $250,000 to $500,000. Support provided for franchisees includes: access to national design and construction firm, staffing recommendations, employee training, medical billing and collections, discounts on medical supplies, assistance with accreditation and licensing.

Awards and honors: Legacy Award by the Doral Business Council; ‘Top 100 Power Leaders in Healthcare’ by the South Florida Business Journal, ‘Top 100 Under 50 Diverse Executive Leader’ by Diversity MBA Magazine; ‘Top Ten Franchise Opportunity’ in healthcare by Entrepreneur magazine; Legacy Award by Today’s Work Comp Professionals.