Occupational health centers are increasingly adding urgent care services to diversify their business and improve their bottom lines. And while the rewards can be great, experts say that there are many pitfalls to avoid and factors to carefully consider before taking the leap.
The topic is expected to be a hot one at RYAN Associates’ 26th Annual National Conference in Chicago, October 8 – 10. A star panel will discuss integrating occupational health and urgent care on Tuesday, Oct. 9, from 1 p.m. to 3 p.m.
“It’s a big trend,” said Dr. David Stern, chief executive officer of Practice Velocity, an urgent care electronic medical record and billing services provider in Belvidere, Ill. Dr. Stern is the former owner of a chain of urgent care centers in Rockville, Ill., and will speak at RYAN Associates’ annual conference on blending these service lines.
“Urgent care is a rapidly expanding aspect of health care,” Dr. Stern continued. “Healthcare reform and expanded insurance coverage will produce even more demand.”
Concentra was one of the first pure-play occupational health providers to enter the urgent care sector. The Addison, Tex.-based company formed Concentra Urgent Care in 2004. Concentra was purchased by Louisville, Ky.-based insurer Humana in 2010 for $790 million.
Experts have seen the trend of blending urgent care with occupational health grow over the past five years, with more occupational health providers expanding into urgent care.
Ms. Lou Ellen Horwitz, immediate past president of the Urgent Care Association of America, said that the economic downturn first drove the trend. “Occupational medicine really struggled during the recession,” Ms. Horwitz said.
Potential synergy
Massive layoffs, a decline in manufacturing and the housing crisis meant lower demand for occupational health services. And in a poor economy, workers can be hesitant to report on-the-job injuries for fear of losing their employment, said Mr. Roy Gerber, senior principal at RYAN Associates.
Even as the economy has improved, workplaces in recent decades have become safer, and a shift away from manufacturing and construction means fewer clients for occupational health providers, Mr. Gerber said. “The market potential for occupational health in many locations, it is fair to say, has shrunk,” he said.
There’s potential synergy between occupational health and urgent care, Mr. Gerber said. Employees can be treated for on-the-job injuries and illnesses and can return for their urgent care needs.
In addition, urgent care can create a steady stream of business because occupational health centers are typically busier during warmer months – when the construction industry is in full swing – while urgent care centers tend to see more traffic during cold and flu seasons, Mr. Gerber said.
There are approximately 9,000 urgent care centers nationwide, with between 71 and 160 million patient visits annually. About 300 new urgent care centers have opened every year in the past few years, according to the Urgent Care Association of America. About half of urgent care centers are physician-owned, according to the association.
Ms. Horwitz said pairing urgent care with occupational health can be very positive. “In general, I think it’s a good thing for occupational medicine to diversify and not depend on a certain industry in their region for all business,” she said. “There’s a natural fit for those clinics.”
Factors to consider
But there are a number of factors to consider before plunging in, experts agreed.
While occupational health centers are accustomed to walk-in activities, they will need to offer expanded hours to accommodate urgent care visits. Expectations about clinic work hours will have to be re-set, and new staff members may need to be hired for early morning and evening hours.
“Your staff may be used to working bankers’ hours and now suddenly they are working on Christmas,” Dr. Stern said. Or at the very least medical, administrative, and support staff may have to work a few extra hours in the evening, he added.
Work flow will probably have to be overhauled as well. For instance, patient wait times will have to be kept to a minimum, or providers will risk losing important clients or repeat visitors. “Employers want their workers to have a minimum time away from work,” Mr. Gerber said. “It’s a challenge to run a blended practice. You don’t want patients to have to wait. The success really depends on the planning and execution.”
Providers should find out what the needs are in the community and among local employers before expanding into urgent care or other service lines, Mr. Gerber advised. “There are employers who don’t want their workers waiting in line behind a kid who’s getting a school physical,” he said. “The art of the blended practice is being able to focus on the needs of many different clients.”
Another big issue is the skill set of the staff. Are occupational health providers equipped to diagnose and treat urgent care patients? In many cases, the answer is no.
“Many physicians practicing in occupational medicine haven’t seen the kinds of conditions seen in urgent care in a very long time,” Ms. Horwitz said, citing examples such as women’s health conditions and pediatric illnesses.
Excluding pediatric services and women’s health from urgent care services provided by a clinic would severely curtail potential clientele, said Dr. Stern. “Urgent care without kids just doesn’t work,” he said. “And it’s the moms who make the decisions in the family about where to go for care. You have to have their buy-in.”
Doing a blended practice the right way
One solution could be to have a dedicated provider of occupational health, and others for urgent care working under the same roof, said Mr. Gerber. Separate waiting rooms for urgent care and occupational health can also help to make the practice run more smoothly, he said.
Providers should carefully weigh the types of software needed to run a blended practice, including electronic medical records and billing software, both Mr. Gerber and Dr. Stern said.
The most successful blended practices are blessed with good locations and lots of foot traffic, Dr. Stern said.
However, many occupational health centers are located in industrial, out-of-the-way places that are inconvenient for the general population, Dr. Stern said. “You can put the biggest sign in the world up and you still won’t get any traffic,” he said.
“Urgent care is driven by consumers,” he continued. “You need to be in a location that would be a good place for a Starbucks or a McDonald’s.”
An out-of-the-way location versus a central location can mean a big difference in revenue once that urgent care center shingle goes up, he said. A great location can double or triple revenues by adding urgent care, said Dr. Stern.
But even getting just a few extra walk-ins per day can add up over time, experts said. Adding urgent care to occupational health can tack on between a three percent and a 25 percent bump in overall revenues, Dr. Stern said.
It’s also an opportunity to better serve employer clients who are hungry to make health care more convenient for their workers, reduce their medical costs and thus increase productivity.
“It’s a chance to meet the total health needs of the community,” said Mr. Gerber.
