By Phyllis Hanlon
The American Academy of Urgent Care Medicine (http://aaucm.org/) reports that since 2008 the number of urgent care centers in the United States has increased from approximately 8,000 to 9,300 and between 50 and 100 new clinics are likely to open annually for the foreseeable future. Furthermore, the Urgent Care Association of America’s (www.ucaoa.org/) 2012 benchmarking survey found that in 2011, the average number of patients per day per location was 51— up from 45 or 13% in 2008. As occupational health programs continue to add prevention and wellness services to their model, it makes sense for the two entities to merge.
DUE DILIGENCE, LOCATION AND STAFFING
A blended model can encompass a total health management approach and provide services for work-related issues as well as for the employee’s family and the larger community. A blended clinic is the answer to a structured population medicine model,” one industry insider said, emphasizing the importance of due diligence. “You should know the risk factors in the community as determined by the Department of Public Health [before opening a blended practice].” By understanding the area’s demographics, including prevalent diagnoses and primary health concerns, a practice can tailor its services more effectively. Where you build your blended practice will also impact its success, said Steve Sellars, M.B.A., CEO, of Premier Health Convenient Care, L.L.C. He prefers highly accessible sites with plenty of parking. “Certain occupational medicine clients might need space for an 18-wheeler or a fire truck,” he pointed out, adding that highly visible signage helps attract patients.
Interior space and aesthetics deserve consideration as well. “Our experience is that if you have both sick urgent care patients and occupational medicine patients with dirty work boots, you should keep them separate,” Mr. Sellars noted. A neat, clean clinic with friendly, efficient staff and separate waiting rooms translates to satisfied patients and efficient workflow. Finding an appropriate staffing mix and level can be one of the biggest challenges of a blended clinic, according to Manoj Kumar, CEO, of Hometown Urgent Care in Columbus, Ohio. Typically, the model comprises clinical personnel, such as a physician, nurse practitioner (NP), physician’s assistant (PA) or medical assistant (MA), nurse, and receptionist. “Knowing how many occupational medicine patients and what kind of visits they will make helps determine staffing level,” said Mr. Kumar, noting that multi-site practices have an advantage. “With a large operation, you can move staff from one location to another to optimize operations.” Hometown Medical Director Narinder Saini, M.D., emphasized the importance of having a robust employee cross-training program to maintain efficiency, control wait times, and improve patient flow. In addition to clinical and support staff, blended practices should invest in a full-fledged sales and marketing team that collaborates with operations. “One key for occupational health is to understand that you are not selling a canned program. Every company has individual needs. You need a well-rounded training team that understands each industry,” said Chris Hale, vice president of employee relations at Hometown Urgent Care. Attention to the staffing mix can also affect your bottom line, said Tammy Mallow, director of contracting and credentialing at DocuTap. “If a state allows a medical assistant and paramedic instead of an RN, then take that option. You would pay an RN $30 an hour and two paramedics would cost $15 an hour. They are a better deal. But never compromise quality for cost.” Regardless of position, all staff must be properly credentialed under state law to perform their duties. “You should understand the legal scope of practice,” Ms. Mallow said.
ELECTRONIC EFFICIENCY
The right type of technology enhances operations for blended practices. From electronic medical records (EMR) to automatic billing, these practices require software that meets the needs of employer companies and the community in one convenient package, according to David Stern, M.D., CEO of Practice Velocity, a leading medical software company. “Using two different software platforms is never a good idea in a blended practice,” he said. “Doing this means front desk personnel, providers, billers, coders, and ancillary staff must learn two different systems and remember to switch back and forth multiple times per day. In addition, they can never get a complete view of the clinic’s patient flow in either system. Unfortunately, very few software packages can handle both. Retrofitting an existing software program won’t work. You need a program that was built to handle both occupational medicine and urgent care from the ground up.” The ideal program has features that will help both entities run smoothly. On the occupational health side, the program should include company-specific services with at least one protocol for every visit, a fee schedule for each company, an auto-split function for billing workers’ compensation claims, and employer-paid service claims from the same visit. Plus workers’ comp-related work-status reports and the ability to auto-populate any required state-specific workers’ compensation form. “These functions increase efficiency and positively affect workflow,” Dr. Stern said. For the urgent care population, the system should be set up to bill both private and non-occupational medicine payers. Also, the software should be hosted and specifically designed to work in the cloud––a.k.a. “software as a service” (SAAS). “Some clinics think if they have the vendor simply host a server-based system for the clinic [then] they are using the cloud. Software designed to sit in the clinic but hosted by the vendor, must use technological workarounds to tunnel through the internet, which is very slow,” Dr. Stern Noted. While one software system is ideal, using two billers, each one with expertise in either urgent care or occupational health, makes more sense. “Thirty percent of the revenue can be lost if the biller doesn’t understand the nuances of either urgent care or occupational medical billing. There is a tremendous amount of knowledge required on both sides. Bring [them] together for a few years so the knowledge can be shared,” Dr. Stern suggested, emphasizing that hiring a biller with up-to-date knowledge is critical, since insurance rules and practices are constantly evolving and differ from carrier to carrier, state to state, and month to month.
CHALLENGES AND BENEFITS
While blended practices can realize meaningful benefits, there are challenges involved too. For example, there is a need for urgent care staff to adjust to unfamiliar regulatory and compliance needs of companies. “Reporting back to employers is important in occupational medicine. Results of drug screens and other tests have to go back in an organized and timely manner. Occupational health staff has to collect co-pays and know about deductibles. So they are dealing with third-party payors, not just the employer,” Mr. Sellars said. “But occupational health patients learn they can bring their families back for urgent care needs. Business owners might know other employers with occupational health needs and could refer to the blended practice as an option.” Ms. Mallow pointed out that the combination of urgent care and occupational medicine presents a cost-effective option for employers and the community. “The urgent care clinic’s goal is to get the patient in and out within an hour. In a world where an employer is trying to cut costs, it makes sense to go through urgent care,” she said. In the past six years, Blended practices have become the model of choice. They are one-stop shopping versus fragmented services with the goal being to provide seamless delivery of care throughout the life span.
Integrating Occupational Health and Urgent Care Services will be the subject of course #10 at RYAN Associates’ 28th Annual National Conference with Dr. David Stern, Logan McCall, and Alan Ayers among the presenting faculty.
