The private, Latino-owned upper extremity facility offers specialized services in a state-of-the-art environment.

The Miami Hand Center has found a unique niche in the Florida orthopedic market. It is the only practice devoted to hands and upper extremities in the Sunshine State. “The specialty of hand surgery is very diverse because we’re basically every type of surgeon for the hand,” says Alejandro Badia, MD. “We’re the orthopedic surgeons, we’re the plastic surgeons, we’re the vascular surgeons, we’re the neurosurgeons of the hand.”

On the surface, such a specialized practice might not seem to make economic sense, particularly in light of the trend toward large group practices that can cover every orthopedic problem. But the Miami Hand Center’s success has disproved the conventional wisdom-Badia and his three colleagues perform between 80 and 100 surgeries and see 400 to 500 patients every week. By concentrating on a single specialty, the private Latino-owned clinic can be run much more efficiently from both an economic and patient point of view. There’s another payoff for the center’s four surgeons. “Personally, I was offered a position with a group up in the Fort Lauderdale area, but what I realized early on, particularly in my specialty, which is so diverse-there’s so many different types of cases-is that it woul4d be best to join somebody else who does that specialty, not only to be able to ask somebody else questions, [but to] be able to share work with somebody else on the most interesting and challenging cases,” says Badia. “The group I was going to join had a spine guy, a sports medicine guy, a pediatric orthopedist, but if I got a difficult hand case I didn’t want to be the only person to know something about that. Just the other day I saw a case I’ve never seen before.” He adds that being in a specialty practice also gives him and his other colleagues an opportunity to learn from one another.

Founded in 1995

The Miami Hand Center was founded in 1995 by Jorge L. Orbay, MD, and Badia was the first surgeon to join him. The center’s current facility was completed in 1997 and has a staff of 45. The clinic includes seven examination rooms, two operating rooms, and radiology and rehabilitation facilities. All of the surgeries performed by Badia and his colleagues, such as carpal tunnel release, orthoscopic procedures, rotator cuff, and pin removals, are outpatient procedures. And having its own on-site operating facilities has made the clinic more efficient for both the staff and patients. “We can really be a very separate entity,” says Badia. “As fast and as good as hospitals can be, and there are several hospitals where I like to work in Miami and still do, when it comes to high-volume hand surgery cases, there’s no way you can be more efficient than a unit that knows exactly what you need for that hand case. When you’re a small center, you know what you need-what’s necessary and not necessary-so you can be much faster, and it’s more cost efficient and better for the patients because it can be tailored to [them].”

In its short history, the center has become a de facto emergency clinic. Local emergency departments send hand trauma cases, such as amputations and manglings, to the clinic for reconstructive work. If complications occur or inpatient recovery is required, patients can be moved to the acute care hospital 1,500 feet down the street. “We’re basically on call,” says Badia. “We’ll be operating on somebody, and in the middle of surgery I’ll get a call about a crush injury to a finger or a fractured wrist, then the patients come over, I’ll walk out of the operating room and see them; if they need surgery right away, they get scheduled, and they have their surgery within a couple of hours sometimes.” The only upper extremity procedures not performed at the clinic are large joint replacements and shoulder orthoscopy.

All Age Groups and Walks of Life Welcome

Though specialized in its practice, the clinic does not have a specialized patient demographic. Cases come from all age groups-from newborns to the elderly-and all walks of life.

Though most of their patients go to outside groups for rehabilitation, the more complicated cases return to the clinic for specialized help. Badia is able to monitor the progress of these patients through a window looking onto the rehab section that he affectionately calls “the fishbowl.” “It allows us to monitor our patient’s progress while doing therapy,” says Badia. “That’s a big advantage because in hand surgery the therapy is really critical.” However, the rehabilitation services the clinic offers are limited-both by insurance approval issues and by the limited number of rehab therapists it employs-and is not a key part of the center’s income flow.

Its high volume and status as an emergency center made the Miami Hand Center an ideal choice to be a pilot site for a new digital radiography system. The system allows the doctors at the center to manipulate the images, making them lighter or darker, or zoom in on the damaged tissue-all in order to make a better diagnosis. The system also makes good business sense for the practice by freeing space for the storage of films and increasing the efficiency of cataloging the studies.

An Informal Hand Surgery Fellowship

Badia and his colleagues have not created a monopoly on their knowledge. At any time they have three to four hand surgeons working at the clinic as part of an informal hand surgery fellowship. These visiting physicians-most of whom are from Latin America-study at the Miami Hand Center from a few weeks to 3 to 6 months honing their skills. Badia says that these “fellows” serve an important purpose for the practice. “The fellowships are the key because it brings in new thoughts, and allows us to teach,” he says. In connection with the fellowship, Badia is in the process of setting up a cadaver laboratory to teach orthoscopy techniques-including wrist, base of the thumb, and carpal tunnel release.

No matter how techniques and technology may change the way the physicians at the Miami Hand Center manage their practice and provide service to their patients, one thing will not change: every day will bring unexpected and new challenges that they will have to solve.

Chris Wolski is associate editor of Orthopedic Technology Review.


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