The University of Florida Department of Orthopaedics established an Orthopaedic After Hours/Weekend/Walk In Access Program called ORTHOcare After Hours to improve access to orthopaedic services, prevent lost business, and reduce unnecessary emergency department visits. The program operates 75 hours per week with physicians, residents, PAs, nurses and staff. It has been successful, seeing over 9,000 patients annually who generate millions in charges and collections. Over 1,500 orthopaedic surgeries have resulted from the program. Key factors in its success include convenient hours of operation, walk-in access, matching staffing to demand, incentives for providers, and monitoring utilization.

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Andrew Duncan, MBA
Chief Administrative Officer
Establishing an Orthopaedic After Hours/
Weekend/Walk In Access Program:
The UF Health Experience
The University of Florida Department of Orthopaedics
and Rehabilitation consists of 22 surgeons, 4 physiatrists,
2 sports medicine fellowship trained family physicians, 16
mid-levels, and 5 research faculty. The department cares
for patients from across the state and the southeast with
the predominance of patients coming from the fourteen
surrounding counties. In 2010 the department sought
to establish an orthopaedic access program. The goals
of the program were to improve access to orthopaedic
services, prevent lost business to competitors, and reduce
unnecessary emergency department visits. The program
was named ORTHOcare After Hours (OCAH) with
operations conducted in the existing orthopaedic clinic.
A physician director of OCAH was identified from
the existing faculty. The director was hired with the
expectation of working 4 ½ days per week during the day
in the clinic and to perform 20 sessions per year covering
OCAH. A stipend for the OCAH responsibilities was
added to the annual compensation with accountability
for OCAH staffing, metrics and quality. The program
operating hours were established as Sunday – Friday
from 5pm – 9pm and Saturday 9am – 5pm. In 2014 a
physician’s assistant was hired to cover ORTHOcare
Daytime (OCD) daily walk-ins Monday - Friday from 8am
– 5pm. Currently, access is available 75 hours per week,
363 days per year, closing only for the Thanksgiving and
Christmas holidays.
A model for compensation was established for the
covering OCAH attending physician per 4 hour shift
with a differential for weekends and holidays. OCAH
compensation is additional and work RVU’s generated
in OCAH are not included in the attending physician’s
annual incentive productivity target. Additional provider
staffing is scheduled as needed based on historical
volume and forecasting. Residents or Fellows providing
supplementary coverage must be in their 3rd year
or beyond, cannot work if OCAH coverage impacts
other assignments, have achieved >50% on OITE, be in
compliance with GME work hours and in good standing
academically. Residents, Fellows and Physician’s
Mark T. Scarborough, MD
Professor & Chair
Bryan Prine, MD
Director, ORTHOcare
Department of Orthopaedics &
Rehabilitation
University of Florida

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Assistant’s receive a rate per shift of 55% of that of the
attending. A productivity bonus was also established
based on a tiered number of patients seen for each OCAH
shift. Clinic support staffing for OCAH consists of 2 Check
In/Out personnel, 1 LPN, 1 CCA on high volume days of
the week (typically M-W), 1 Cast Tech, 1 DME Fitter, and 1
hospital based X-Ray Tech.
Scheduling of providers and staff is managed by the OCAH
director through the “When I Work” web based employee
scheduling platform. The platform is accessible by Smart
Phone. This allows providers and staff to find “Substitutes”
when needed. Department management reconciles
worked shifts and productivity in order to process extra
compensation payments.
To promote the OCAH program, the department
developed a marketing strategy that emphasized a direct to
consumer campaign such as billboards, bus wraps, print,
radio and TV advertisements. Targeted marketing was also
directed to the area athletic training programs which are
major utilizers of the service. Additionally, education of
local primary care offices, local EMS, and the Emergency
Department was implemented.
The results for ORTHOcare in FY 2015 were 9,713 wRVU’s,
charges of $3,388,777 and net collections of $1,126,658.
ORTHOcare also receives collections from the department
DME program. Overall ORTHOcare provides a positive
contribution to the department. Since inception there
have been 16,361 patient visits of which 1,545 orthopaedic
surgeries can be directly attributed to those OCAH visits.
A halo effect also resulted with 373 non-orthopaedic
surgeries within the UF Health system linked to OCAH
patient visits.
The established goals for the program were achieved. We
learned that OCAH can expect about 20 patients per 4
hours of clinic and that Monday, Tuesday and Wednesday
are the busiest days of the week; the demographics consist
mainly of younger, well insured patients, of which 90% are
new patients; most patients require X-rays and that MRI’s
are ordered for a few patients per session; and that there
have been very few patient complaints and few issues with
provider or clinic staffing. Unnecessary emergency room
visits were reduced and the COM dean and the Chair of
Emergency Medicine have been pleased with the success of
the program for the health system.
In summary, establishing an after-hours orthopaedic access
program has been extremely beneficial to our department.
The following key points contributed to the program’s
success: 1) Create open scheduling during attractive hours
of operation (Sun-Fri 5-9, Sat 8-5); 2) Encourage calling
ahead but welcome walk-in patients, including during
normal daytime operations; 3) Match staffing to demand;
4) Monitor and adjust staffing levels based on seasonal
and historical data; and 5) Incentivize providers through
additional compensation and volume targets.