Urgent Care Happenings

Urgent Care Conference - 3 weeks away

2008-09-08T11:33:00.002-04:00

The UCAOA Fall Urgent Care Conference is right around the corner - there are 5 different courses being offered - something for every member of your clinic staff:

Starting a New Urgent Care Center
Marketing Your Urgent Care Center
Urgent Care Coding Basics
Advanced Urgent Care Coding
Essential Clinical Topics in Urgent Care

This post is primarily to encourage you to register now - Don't plan to "walk in" as we cannot guarantee we'll still have space for you! Click here to learn more and to register online today.

Urgent care in the news on the rise

2008-08-21T16:22:00.002-04:00

Aside from our own recent appearances in the media, and our member centers getting kudos and features in all sorts of places, what I am noticing most now is that in many, many "general health" articles urgent care is getting mentioned as if it's the most natural thing in the world and has been around for years.

This post from a public policy blog even calls for more centers...

The UCAOA vision is to be the catalyst for the recognition of urgent care as an essential part of the health care system. But whether we have been the catalyst or not, the recognition is certainly coming, which is great for all of us.

Hope you are seeing it and feeling it too...

Triage counts - a cautionary tale

2008-08-11T16:13:00.002-04:00

Here's a story in the San Diego newspaper that highlights the need for a triage process immediately upon presentation to the urgent care center - it's not a flattering story and works against what we are trying to accomplish - excellent service to patients and at the very least appropriate care. Make sure you have a process in place to do some sort of basic evaluation and triage of patients, "in order of arrival" is not always appropriate care.

http://www.signonsandiego.com/news/northcounty/jenkins/20080811-9999-1m11jenkins.html

New CDC study on ER wait times

2008-08-08T10:12:00.002-04:00

We've seen the "4 hours in the ER" statistic that turned out to be the total time, not the wait time. The CDC as now released new information that truly show wait time, and ties it to supply and demand, with visits going up and number of ERs going down. Wait times are up to an hour, while the unofficial urgent care standard for the entire visit is an hour (door to door average) - another reason to know where your community urgent cares are as well as you know where the nearest ER is - and for most things you can go to the urgent care first!

Average ER waiting time nears one hour, CDC says
AP/Yahoo News, August 6, 2008
The average time that hospital emergency rooms patients wait to see a doctor has grown from about 38 minutes to almost an hour over the past decade, according to statistics released by the Centers for Disease Control and Prevention. The increase is due to supply and demand, said Stephen Pitts, MD, the lead author of the report. Overall, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996. Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600,

"Pain Clinics" masquerading as Urgent Care finally shut down

2008-08-07T17:33:00.002-04:00

After many months of frustration for legitimate urgent care centers in Louisiana, three "pain clinics" using "urgent care" in their name were at last shut down and their leadership arrested.

Click here for the full story.

Neat collaboration between cardiologist group and urgent care

2008-07-17T15:03:00.002-04:00

The headline reads "Doctors, urgent care join to keep patients out of emergency rooms" - this collaboration between a group of cardiologists and urgent care centers includes training and screening tools and some occasional sharing of space. It's a great example of the ways that community physician groups and urgent care centers can work together to strengthen the health care "safety net".
http://www.daytondailynews.com/b/content/oh/story/business/2008/07/17/ddn071708heartweb.html

Physician Entrepreneur of the Year Award

2008-07-14T13:04:00.002-04:00

This seems tailor-made for many of our members! Modern Healthcare has created this new award and you certainly should consider applying. Here's the link for more information:

http://www.modernphysician.com/apps/pbcs.dll/section?category=mppeoty

Good luck!

New NEJM study on EHR adoption by ambulatory providers

2008-06-18T18:13:00.003-04:00

From today's Modern Healthcare - clearly, this market (us) is still wide open:

Few ambulatory docs have full-function EHR systems
Story posted: June 18, 2008 - 5:00 pm EDT

A summary report on a comprehensive survey of physician adoption of electronic health-record systems finds that after four years of federal ballyhoo of health information technology, more than eight out of 10 physicians practicing in the ambulatory-care environment still have no access to an EHR of any kind.

Just 4% of physicians in ambulatory care have access to a top-end EHR system with patient-safety features such as drug-drug and drug-allergy alerts and fully electronic prescribing.

Grading on a curve by giving partial credit to physicians who have something less than the best EHR system in their offices, researchers concluded the adoption rate for “basic” EHRs with a minimum set of functions is 13%. Given the low current availability of EHRs, “the U.S. healthcare system faces major challenges in taking full advantage of EHRs to realize its health goals,” according to a report on the survey conducted between September 2007 and March, and published in the June 19 issue of the New England Journal of Medicine.

A copy of the full report should be released next month. The report, funded jointly by HHS and the Robert Wood Johnson Foundation, was not all gloom and doom. The surveyors, physician David Blumenthal and researchers from 902-bed Massachusetts General, Boston, also looked into whether physicians who use EHRs are satisfied with them and, generally speaking, they are.

And, of the barriers to faster EHR adoption that loomed largest to both users and non-users—cost was cited by both as the most significant hurdle—the researchers noted that other Western nations have adopted strategies of cost sharing that have boosted EHR adoption into the 90% range. The researchers recommended policy leaders look to those other countries for guidance in developing a U.S. adoption incentive program. -- by Joseph Conn

Interesting column with very cogent ED perspective on integrating UC in the ED

2008-06-18T17:12:00.003-04:00

This is an excellent, short list of why there are such difficulties in integrating urgent care services into an existing emergency department.

http://www.fiercehealthcare.com/story/a-physician-s-perspective-on-why-the-ed-model-is-stuck/2008-06-06

What Hospital Leadership is Thinking

2008-06-16T17:14:00.002-04:00

A recent HFMA report for hospitals called Your Strategy for Nonhospital Competitors had some interesting insights into how hospitals are looking to stay competitive in the primary care/health system entry point environment.

What does this mean for your urgent care? Hard to say, and depends on the makeup of your own community's health care system - but dialogues are taking place and you may want to consider becoming part of them.

It's a short report - only about 8 pages - here's the link:
http://www.hfma.org/NR/rdonlyres/2E6E9CB6-52F9-40D3-BC48-C0AEC881C0F9/0/400611.pdf

Retail Health Care Facility Permit Act

2008-05-19T18:25:00.002-04:00

In Illinois, State Representative Mike McAuliffe has introduced HB 1885, an act which will charge the Illinois Department of Public Health with regulating health care services provided in a retail store or pharmacy. Backed by the Illinois State Medical Society, the act reflects concerns that "... without state standards and supervision of store-based health clinics, patients’ continuity of medical care could be jeopardized...” (ISMS president, Peter E. Eupierre, M.D.).

For more details on the specifications, visit http://www.isms.org/newsroom/newsrelease/nr2007_0301.html

Specialty Urgent Care Centers

2008-05-13T14:17:00.002-04:00

I learned today about the first example I'm aware of (outside of pediatrics) that is a specialized urgent care center - one that only sees orthopaedic injuries. Somewhat like a specialty hospital, but this center is open the traditional extended hours, does not require an appointment, is staffed by physicians, and has x-ray on site - all of the traditional "requirements" to call oneself an urgent care. But they do not do any other kind of illness outside of orthopaedics. Very interesting. A trend?

WSJ Article notes some retail clinics slowing growth

2008-05-07T17:12:00.001-04:00

Health Clinics Inside Stores Likely to Slow Their Growth
By DAVID ARMSTRONG
May 7, 2008

The boom in walk-in health clinics located inside pharmacies, supermarkets and big-box retailers is showing signs of slowing.

Hailed as an inexpensive option for treating minor health ailments like sore throats and rashes, the retail clinics have grown in number to 963 as of May 1 from just 125 three years ago. The clinics typically feature nurse practitioners who can prescribe basic drugs, and the price for a visit ranges from $50 to $75.

But in recent months, retail health-clinic operators based in New York, Nevada, Indiana and Alabama have closed their doors, shuttering 69 clinics in 15 states, including ones operating inside outlets of Shopko Stores, Meijer Inc., Bi-Lo LLC, Wal-Mart Stores Inc. and the Medicine Shoppe unit of Cardinal Health Inc.

Now, the biggest retail-clinic operator, CVS Caremark Corp., says it is scaling back expansion plans for its MinuteClinic brand.

"We have seen fallout in this industry, on a smaller scale, that is not unlike the dot-com bubble," says Tom Charland, the owner of industry consultant Merchant Medicine LLC and a former vice president for strategy at MinuteClinic. "The big mistake was for people to think they could reach break-even in six months," he says. "People are learning this is an 18-to-24-month process to get to break-even."

Mr. Charland says the venture capitalists and private-equity firms that backed many of the retail clinic operators failed to appreciate how complicated and expensive the clinics are to operate. Research shows that patients are enthusiastic about the clinics' convenience and quality of care, but acceptance has been slow.

CVS, which operates more than 500 MinuteClinic facilities, says its plan to scale back expansion is part of a change in strategy. David Rickard, chief financial officer, told analysts last week that the company expects to add 100 clinics this year, down from a prior estimate of 200 openings. He said the company may also close some MinuteClinic locations that aren't in CVS outlets. He said that CVS will focus on "enriching" services at MinuteClinic facilities rather than expansion, and that the company believes MinuteClinic will be a "terrific, successful little business."

Some operators are finding that the clinics are complex to manage. Earlier this year, CheckUps, a clinic operator based in New York, abruptly closed 23 clinics that it operated inside Wal-Marts in Florida, Mississippi, Alabama and Louisiana. It was stretched thin by operations in multiple states, says company spokesman William Armstrong.

"You have to have a critical mass of stores seeing a high number of patients to get somewhere," he says. He adds that new clinics need to spend a lot of money on marketing to build public awareness and that the clinics become expensive quickly. "We ran out of operating funds," he says.

Not everyone is trimming sails. Walgreen Co. says it still plans to more than double the number of its Take Care health clinics this year by adding about 240 locations between now and the end of the year, bringing it closer to the number operated by rival CVS. The expansion will cause a drag on earnings in fiscal 2008 of five cents a share, the company says.

Tina Galasso, an analyst who follows the retail clinic industry for Verispan LLC, says the cost of setting up an in-store clinic runs about $500,000. That is one reason why much of the future growth in walk-in health centers is expected to come from big companies with deep pockets and from hospital systems that are already well-known within a community and don't have to spend so much on marketing.

In a strategy that combines both elements, Wal-Mart plans to partner with hospital systems to open as many as 400 co-branded store clinics by the end of 2010, up from about 50 sites in operation now. That approach is a departure from an earlier strategy under which Wal-Mart leased space to operators like CheckUps that weren't associated with hospital systems.

from the Wall Street Journal May 7, 2008

Retail Clinics, Service, Volume and Paperwork

2008-04-21T16:46:00.002-04:00

I've just finished reading the Spring 2008 issue of Frontiers of Health Services Management, a quarterly publication of the American College of Healthcare Executives entitled "The Retail Clinic Strategy - Learn from the Innovators."

I could not help but notice several items that have given me pause:
1. Regularly in the articles they discuss the low volumes currently being seen in the clinics, and how those are projected to increase, etc. with breakeven figures and expected time frames for that (2 years) and so on and so forth.

2. They also cite great satisfaction rates from patients, which is terrific.

3. They also note how, although it wasn't the original model, most are now setting up to take insurance. An additional comment to this is that while the NPs who are staffing the clinics need very little clinical preparation, the training for dealing with all of the financial aspects (including all of the insurance issues) have been a bit of a learning curve.

All this has made me consider - with few patients coming in, it is no wonder the attention levels are high and the wait times are low - and satisfaction levels are great.

What happens when utilization starts to creep up - when they get as popular as they are predicted to be? When the NP is having to deal with lines of patients and paperwork ten times the current levels - will their challenges not be the same challenges we are seeing in urgent care (and all other health care outlets) now?

While I believe that retail clinics have their place in the healthcare system, and look forward to a good, integrated continuum of care that will put patients in the right place for the right conditions - I have concerns that over time the retail clinics will suffer the same burdens as the rest of us, regardless of the nationally-recognized volume-based delivery system concepts that are behind them. The majority of complaints we see about urgent care now are not about cost, but about wait times. They cannot meet demand. Retail clinics will help divert some of that traffic, but if no-wait non-urgent care gets pushed down yet another level (no disparaging of clinical care meant, but access point related) will that level not eventually suffer the same fate?

Hospital posting ER wait times

2008-04-18T11:04:00.002-04:00

Scottsdale Healthcare has started posting its ER wait times on its web site. It's an interesting move, and one to consider if your urgent care has PR issues in this area. It almost has to be driven by an EMR - so if you have one, check with your vendor to see if this is a possibility for you.

I have seen a few stories in the news about people choosing retail health over urgent care because of the wait times expected - so if you can give them a place to look at least they will be making a judgment based in reality.

New Study on Causes of ER clogging - it's not non-emergency patients

2008-04-14T09:49:00.001-04:00

According to a new article in the Annals of Emergency Medicine, many of the assumptions about ER overcrowding increases may be incorrect. There has not been an increase of uninsured or of inappropriate care seekers (who are better off in urgent care - this has held steady at 15% -still high) - it's the fact that there are no hospital beds to put people in when they are ready to leave the ER.

This article covers the study briefly - if you have access to the Annals the full study is available there: http://www.thenewstribune.com/news/nationworld/story/333924.html

Angie's List adding health care reviews

2008-03-24T15:03:00.003-04:00

If you aren't familiar with Angie's List, it's an online evaluation systems of service providers across the country. They have over 600,000 users.

Angie's List has just decided to open categories for practitioners and facilities and insurance companies.

Here's the story http://www.insideindianabusiness.com/newsitem.asp?ID=28504

Triaging Joint Pain - free CME webcasts for all clinical staff

2008-03-17T12:56:00.003-04:00

An organization has developed several CME programs targeting patient presentations that may be seen in an urgent care center. This is part of a larger initiative to educate the primary care/urgent care community on specific diagnoses and treatments. See below for details and to register:

Primary Cares: Triaging Joint Pain Through a Quality Improvement Approach

A chief complaint of joint pain accounts for a large percentage of office visits each year. The reasons behind the pain are numerous and often hidden. Time and other resources spent recognizing and diagnosing the etiologies add to the burden already faced by the primary care community.
Successful recognition and diagnosis of the underlying cause of joint pain is initially associated with better patient outcomes, and ultimately in savings of both clinic time and resources.

Join us for a unique Quality Improvement initiative where you will be guided along a process designed to increase the efficiency of the practice flow when faced with these patients. Regsiter today at www.Qicme.org/jointpain or call Qicme, LLC, at 800-777-5790.

Webconference dates: Tuesday, March 18 at 1pm ET, Thursday, March 20 at 2pm ET, and Monday, March 24 at 12pm ET

Learning Objectives At the completion of this educational activity, physicians and nurses who care for patients with joint pain will be able to:
Conduct a self assessment to contrast their own clinical management of joint pain with best practice guidelines
Identify perceived or real barriers to improving the management of joint pain patients in their clinical setting
Enumerate strategies to improve coordination between interdisciplinary members of the care team within their clinic
Understand criteria and timeline for enrolling in the site-based QI initiative to improve the care of joint pain patients.

Accreditation
The Peer•Point Medical Education Institute, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME Credit Designation
The Peer•Point Medical Education Institute, LLC, designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nursing Accreditation
The Peer•Point Medical Education Institute, LLC, is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
This program is accredited for 1.0 contact hours and contains 0.1 hours of pharmacology (Rx) content.

Transparency

2008-03-03T11:07:00.002-05:00

The "transparancy movement" is spreading across the country and through all aspects of healthcare - and urgent care may be next.
With retail clinics posting prices, and now some physician's offices are being required to share fees billed...well, you can easily see that we are between these two and likely to be next on the list of those being asked to share fees.
So, if you aren't already talking about this with your center's leadership, it's probably a good topic of conversation to get started.
Here's a doctor that's already done it in Florida
http://www.news-press.com/apps/pbcs.dll/article?ID=/20080303/NEWS01/80302054/1002

Here Comes Wal-Mart

2008-02-12T11:55:00.000-05:00

In Modern Healthcare's IT Newsletter earlier this week: (learn more at our special session on Wal-Mart's plans at the Convention in April)

Wal-Mart set to open EMR-enabled clinics
A convenient-care facility known as "The Clinic at Wal-Mart, owned and operated by St. Vincent Health System" is expected to open in Little Rock, Ark., by the end of April and will be the first of some 400 co-branded retail clinics that Wal-Mart expects to open by 2010. Potentially, what this could also mean is that there will be at least 400 more medical facilities in the country using electronic medical records.

"All of our members use electronic medical records," said Tine Hansen-Turton, executive director of the Convenient Care Association trade group. "That is a cornerstone of our business model."
She added that using EMRs is one of the 10 standards her organization has developed for retail clinics, but one of the challenges these clinics face is sharing patients' medical information with primary-care doctors who may still rely on paper records. In most of these cases, Hansen-Turton said the clinics use faxes to share the information.

A letter of intent has also been signed between Wal-Mart and the Houston-based retail clinic operator, RediClinic, to open in-store clinics at 200 Wal-Mart Supercenters. The chief executive officer of RediClinic is Web Golinkin, who is also currently serving as the president of the Convenient Care Association, so it is expected that the Wal-Mart clinics will use EMRs.

Wal-Mart signed another letter of intent to operate four of these facilities in Little Rock with the two-hospital St. Vincent, which is affiliated with Catholic Health Initiatives. It was also announced that, by the end of April, a facility branded "The Clinic at Wal-Mart owned and operated by RediClinic" will open in association with a local Atlanta hospital system, and—by this summer—Wal-Mart expects to open co-branded clinics with RediClinic and a local hospital system in Dallas, according to a news release.

American Academy of Family Physicians President Jim King said EMRs are one of the "desired attributes" that the AAFP developed for retail clinics, and although widespread, King said he didn't think EMR use was universal at these facilities. According to King, about 37% of family physicians have EMRs and 13% said they plan to implement a system this year.
King, who practices in Selmer, Tenn., added that—having an EMR by itself—will only do so much to improve quality.

"If you have an EMR in your office, you have an EMR in your office," King said. "What we hope will happen with the influence of these retail clinics is that it will push forward connectivity and make it less expensive and easier to connect (physicians') EMRs to hospitals and pharmacies." -- by Andis Robeznieks / HITS staff writer

Billing staff tidbits

2008-01-24T17:06:00.000-05:00

Some nice ratios here from Physicians Practice Pearls:

QUESTION: We are trying to develop a budget for our central billing department that supports 20 physicians at nine different sites. We currently have 12 full-time staff posting all of the charges and payments, sending out claims, and doing A/R follow-up. Can you give me any insight regarding the FTE per provider for billing?

ANSWER: The Medical Group Management Association says multispecialty practices spend a median of 2.7 percent of net medical revenue on staff related to patient accounting, general accounting, and managed-care administration. Not exactly what you needed to know, but it's a start.

They also list that a median number of 0.61 staff per FTE provider in these categories.That said, here is what Physicians Practice recommends for billing staffing, by claims volume, where a biller is defined as anyone who touches the process from the time a charge becomes a claim until the claim is fully paid:

Full-time billing employees per 100,000 claims: 10.45 (Claims are the basic work unit of a billing staff member, just like work RVUs are for a provider.)

Payment posting/cash management FTEs per 100,000 claims: 1.9

Credit resolution FTEs per 100,000 claims: 0.4

Insurance denial and follow-up FTEs per 100,000 claims: 3.1

Patient follow-up and inquiry FTEs per 100,000 claims: 1.8

One biller per 10,000 claims may seem a bit low, but if the claims are clean, then no billing staff intervention is needed at all. Therefore, the ratio is not just a reflection of how good the biller is, but how good the process is.

Keep these principles in mind: Busier physicians generate more claims. Some specialties have more difficulty than others when collecting. Some patient populations are harder to collect from than others. Good staff can pay for themselves easily if they boost collections. Technology can make staff much more efficient. The best benchmarks may be your own internal performance over time. If collections are poor now and you truly believe adding staff might help, it's generally worth the money spent to reap even more.

-- Pamela Moore, PhDRead more questions and answers from our experts on the Physicians Practice Web site.

Quick Holiday Tip

2007-12-18T20:08:00.000-05:00

Just saw a great little press release by an urgent care center in Tennessee - announcing their "Holiday Hours" to let people know where to go if they are sick over Christmas.

It also gave them an opportunity to mention their regular hours, locations, etc.

Just an idea for you to try over the next couple of days.

FCC Awarding up to $400 million in rural IT grants

2007-11-13T13:28:00.001-05:00

If you are an urgent care servicing a rural area, this could be good news for you.

"Federal Communications Commission Chairman Kevin Martin announced that the commission will be awarding up to $400 million in grants over the next three years to help expand healthcare connectivity in rural and underserved areas. The FCC hopes to provide connectivity for 6,000 providers such as hospitals, clinics, rural health centers and mental health facilities in 42 states. The grants will pay up to 85% of a grant applicant's cost to deploy broadband connectivity, according to Martin. Applicants must utilize a statewide or regional health information exchange to participate."

Use recent MRSA publicity to your center's advantage

2007-11-12T13:21:00.000-05:00

While in the company of one of our board members recently, we got into a discussion over the media frenzy over MRSA that has been sweeping the country - and how odd it is for a diagnosis that is not a new problem to be presented as if it is a completely new phenomenon.

What you can do is use this opportunity to educate your community, like Kirk Bortel at MidMichigan Urgent Care Center did. Click here to see the story.

Flu Season - we have a winner for first confirmed case

2007-10-19T13:45:00.000-04:00

Moments ago in our October Newsletter we noted that we hadn't heard of any confirmed cases - and sure enough, we now have our first three reported.

Dr. Peter Lamelas of MDNow in Florida writes:

"UCAOA,We have a three confirmed cases of Influenza this year already! The first case was in our Royal Palm Beach UCC on Oct 1st 2007, then later over the last two weeks we had two more cases both at our Lake Worth UCC. These were all confirmed both clinically and using a RAT test (Rapid Antigenic Test for Influenza A& B) we have the QuickVue nasal swab test.It appears like it is going to be a bad...or good flu season, depending on how you look at it.Peter Lamelas, MD, MBA"

Additional reports welcome if you'd like to post them in reply.