DDx — ORTHOPEDIC & MSK
Orthopedic & MSK: the five ways this presents
Each presentation below lists what could be causing it, ranked, with the finding that tells the causes apart and what resolution actually looks like. 20 causes, 20 tests, each cited to a primary source for this specialty rather than borrowed from another one.
Nothing on these pages describes a client or an engagement.
PRESENTATIONS
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Patient acquisition cost is climbing
Cost per new patient is climbing and the marketing budget is being defended on a number that mixes two businesses. Orthopedic and MSK demand arrives two ways — direct, at the clinic front door, and referred, into the operating room — and averaging them produce…
4 CAUSES · 4 TESTS
WORK IT THROUGH → -
New patient volume is short of plan
Volume is under plan, the phones are busy, and the referrals look intact. In musculoskeletal care the most common cause of a volume shortfall is not demand and not creative — it is the next available appointment.
4 CAUSES · 4 TESTS
WORK IT THROUGH → -
Growth has plateaued
Clinic volume has held for a year, spend has held or risen, and the group is measured on visits while the economics live in surgical cases. The plateau in this category is usually a conversion or a capacity finding rather than a demand one.
4 CAUSES · 4 TESTS
WORK IT THROUGH → -
Performance varies by location
Same brand, same protocols, same spend per site, and the sites do not perform alike. In this category the single largest driver of the spread is one number that nobody reports next to volume: the wait for a new patient appointment.
4 CAUSES · 4 TESTS
WORK IT THROUGH → -
Preparing for sale
A process is in view and the group is measured on visits while a buyer will price cases and referral durability. The work here is to make the pipeline legible and the referral base look like a system rather than a set of friendships.
4 CAUSES · 4 TESTS
WORK IT THROUGH →
WHICH ONE
How to tell which one you have
These five overlap, and two or three usually apply at once. The order to read them in is set by which number actually moved. If cost per new patient moved, start there. If demand held and bookings did not, start with the volume page. If nothing moved at all, start with the plateau page — and if the group total looks acceptable while one site keeps coming up in conversation, read the variance page first, because a pooled number is structurally incapable of showing you what you are looking for.
Every cause on every page above carries a measurement you can run in your own systems, with the finding that confirms it and the finding that rules it out. Run two or three before you brief anybody. If the tests tell you this is not a marketing problem, that is the correct answer and it cost you nothing.
RESOLUTION
What resolves each, and what resolved looks like
Each presentation resolves to a different part of the work, and the pages say which: reporting and attribution where the finding is a measurement error, conversion and desk work where the loss is between the inquiry and the admission, acquisition where the demand genuinely is not there, and pre-sale work where the question is whether growth can be re-run by somebody else.
Each also carries what resolved looks like as a number — the measure, the published median, the top decile where an honest one exists, and a target range — with the source in the row. Where no credible distribution is published, the page says so instead of borrowing one from an adjacent specialty. That absence is itself a finding: it means your own trailing history is the only benchmark worth measuring against.
WHERE YOU STAND
Reference ranges for orthopedic and MSK groups
See also where you stand and what decides the outcome before any of this is treated.
A differential narrows the list. It does not close it — that is what the examination is for.
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