Alejandro Badia is an orthopedic hand and upper limb surgeon at BADIA Hand to Shoulder Center and the founder of OrthoNOW, a network of orthopedic walk-in centers. In an interview with Invest:, Badia discussed the shortcomings of the U.S. health system, the coming tide of telemedicine and the benefits of being in Miami.
Having written a book about it, Healthcare from the Trenches, what are some of the shortcomings of the U.S. healthcare system and how do you fix them?
By way of example, I was having a medical issue, excessive coughing, and it turned out to be gastric reflux. All I had to do was change certain habits at night, take medication for a couple of weeks, and it cleared up. But I went to an ear, nose and throat guy for the first stop. The point is you need the right clinician at the right time. The key is to try to eliminate the middleman. Sometimes those middlemen can be great, but, in general, there are way too many of them, which includes well-meaning primary care physicians and insurance adjusters and bureaucrats. Those middlemen suck a lot of money out of the system.
The other problems are delays and missed diagnoses. That can have a catastrophic impact on some people, whether a cancer is missed or somebody is living in pain. We need to get away from these concepts. People are under the misapprehension that you’re going to spend a lot of money by going to a specialist. This couldn’t be further from the truth. You need primary care, private practice, and family doctors to take care of you for life; they need to follow you along and manage any chronic diseases. But you’re likely not going to go to these people for an eye or throat problem. That’s what we are trying to establish in the orthopedic sector, and that will save money. Specialists paradoxically order fewer tests because their specific knowledge basis arrives at the diagnosis much faster, allowing the most appropriate treatment for that musculoskeletal condition or injury.
In fact, we’re twice as expensive as the next country in terms of GDP and it’s because we have way too much bureaucracy, way too many middlemen, way too many hurdles that you have to jump over. I’m hoping that here in Miami, if we can get better support and engagement, some good things will happen, and it looks like they might be. I believe that part of that is the silver lining of the pandemic.
Why did you lower the cost of your telehealth consultations from $79 to $25 at OrthoNOW?
Most physicians really care about what they do. We recognized that people were afraid to go to different places during the pandemic and we wanted to eliminate that barrier at OrthoNOW. I have been using telemedicine at my practice, Badia Hand to Shoulder, for the past six years since many of the patients are international. However, at OrthoNOW walk-in centers, we needed tele-orthopedics since we were in lockdown but injuries still occurred, mostly at home or doing fitness, and people still had severe pain issues that could not wait. We talked about making it free, but people don’t appreciate free and we thought there’d be less engagement. Twenty-five dollars though doesn’t put people out too much, and we wanted to make sure people would show up. We wanted to do something good for the community, something that was necessary. But at the same time, we wanted people to understand telemedicine and tele-orthopedics.
We want people to understand that, except where you obviously need an X-ray, we can diagnose a lot of things — shoulder or knee pain — just from a patient’s demographics and history, and a little bit of a remote exam. This approach can decompress hospitals. We didn’t want people coming to hospitals because my colleagues were really taking care of sick people. It didn’t make sense for somebody with severe knee pain to go to the hospital. And we accomplished that. I think we provided a service to the community, but, at the same time, we got more adoption in telemedicine. We still use it. At OrthoNOW, every day I see emails in which people are registering. Now, they’re not doing it because they’re afraid to go outside, they’re doing it because Miami traffic is starting to get tough again. Telemedicine will serve a lot of roles moving forward, and that is not going away with the pandemic.
What are the benefits of working in Miami?
Being in Miami is practical as it’s such an international city. It allows my patients from different parts of the globe to receive an expert opinion from a U.S.-trained surgeon, with American technology, while understanding their cultural nuances, including the language in most cases. Furthermore, there are always fellow orthopedic surgeons from abroad coming here and exchanging ideas. In this line of work, this exchange is very important. Our European colleagues, as well as our colleagues from Latin America, all find Miami a practical and an easy meeting point for communication. Finally, we are also talking about growing our OrthoNOW network internationally; São Paulo, Guayaquil, Lima, Bridgetown, Barbados — these are all places that have shown an interest in the business model, above and beyond patients from those countries coming to Miami for actual orthopedic care.
