VelociDoc

Urgent Care Excellence in Downtown St. Louis

2010-03-28T12:29:00.008-05:00

On a recent weekend, as with many weekends, I found myself in a different city with my son's soccer team. The team was playing a tough game, and Jack (not his real name) was flying down the far sideline and went up for a head ball. A player from the other team did the same thing and their heads made an attempt to violate the law of physics that two objects can not occupy the same space at the same time. Both young men crumpled to the ground in pain. Jack was moving but when the coach got to the far sideline, he immediately waved for me to come across the field. When I got there there was blood streaming from a laceration in his eyebrow. We wrapped his head with a tightly-tied tee shirt and held pressure to the wound.

The fields were at the Washington University Academy in downtown St, Louis. Two years ago, we would have had no choice but to go to an urgent care in the suburbs or to a downtown hospital emergency department.

But I was well aware that my friend Sonny Saggar, MD had opened a new urgent care in downtown St. Louis. Prior to opening, Sonny had shared his vision of a downtown urgent care center for the people of St. Louis. As with many startup urgent care centers, Sonny faced some significant hurdles:

Inept Consultants: He tried one of the Practice Velocity^® startup imitators--that offer all-in-one startup help--that is "just as good as" Practice Velocity. What he found out, however, was that the consultant had minimal experience in opening a single (and somewhat unsuccessful) urgent care center in a far-away state.
Inexperienced Billers: The all-in-one startup company vaunted it's urgent care focus, but the head of the company had been a hospital executive and had no significant urgent care experience. The billers he had hired had no urgent care experience.
Wrong EMR: The all-in-one startup company advertised its one-of-a-kind, "first true urgent care EMR" software. Yes, the software was one-of-a-kind, but Dr. Saggar discovered that it was cumbersome and impossible to use efficiently in real-life urgent care situations. NOTE: Although other companies might advertise that they offer an "urgent care EMR," the Practice Velocity VelociDoc^® EMR is the only EMR made in urgent care centers by urgent care professionals from the beginning. In fact, VelociDoc is so specific for urgent care and occupational medicine that we do not even recommend it for any other type of practice.
Tough Demographics: Prior to his opening, we discussed the difficulties of urgent care centers located in downtown in major cities, especially cities such as St. Louis that have modest populations, living in the downtown area. I told him that it would be tough, and I would recommend that he try a different location for his first center. Sonny loves a challenge, and he has a passionate commitment to the city. He later shared with me that my words of caution made him even more determined to succeed. An succeed he did. Upon our visit, we find that he has even expanded his services to include the only primary care practice in downtown St. Louis.

Now, back to the soccer injury.... We jumped into our cars, I Google-mapped "downtown urgent care st louis" on my Palm Pre, and ten minutes later Jack was receiving care from the excellent staff at Downtown Urgent Care. Check out the cool graphics in his logo. As you can see, they are located right on the street a lighted sign right over the window. The waiting room is ample, but feels even larger because of the high ceilings.

An hour later, Jack was eating lunch in the car on the five-hour drive back to our homes in Chicagoland.

Thanks Sonny, for your persistence in making sure that the people of downtown St. Louis (and the visitors to the city) have access to quality urgent care service. Jack's stitches are out, he is fully recovered, he scored a goal yesterday, and his parents are very thankful to Sonny and his excellent staff at Downtown Urgent Care in St. Louis.

Sisters of Mercy Urgent Care: Check Out This Beautiful Clinic

2010-03-14T11:26:00.002-05:00

Asheville, NC, nestled in the Blue Ridge Mountains, is known for being the boyhood home of novelist Thomas Wolfe and the site of America's largest home George Vanderbilt’s 250-room Biltmore House. It may not be well known, but Asheville is, also, home to one of the most stately urgent care centers in the USA--Sisters of Mercy Urgent Care West.

I had the pleasure of meeting with their dedicated staff last week, as they worked with me to implement Practice Velocity solutions to systematize the charting and coding for their urgent care centers. Upstairs, the urgent care center has a beautiful conference room, administrative offices, and a view across the valley. Downstairs the center has a spacious and tastefully decorated waiting room, a door to the clinical area that requires manual electronic access by the receptionist, ample exam rooms, and a semi-private charting area for providers. There is ample parking in the back and a covered driveway to allow for protection from the elements when dropping off a sick patient.

The center has a large, lighted sign on the street. Still, one other aspect of the center ties in with a previous post. When you drive up the road to the center, you will see it framed with the large billboard, telling the community, "We're here for you." Practice Velocity congratulates the staff of Sisters of Mercy Urgent Care Centers for being there for the urgent care needs of the people of Asheville.

Listing Wait Times Online: Is it a good idea?

2010-03-01T21:59:00.004-06:00

We frequently are told that a startup urgent care center has a great idea, they are going to post their wait times right online. It sounds like a great idea, with a direct view toward good customer service. People have the information and can decide whether to come in now or later. This afternoon we sampled the websites for two urgent care centers that post wait times. Snippets from their websites are attached. This afternoon's research seemed to indicate that both clinics were quite backed up. Does anyone seriously believe that very many website visitors actually visited the clinic today? On the other hand, if your goal is to attenuate visit volumes on busy days, could you come with a better way to discourage clinic visits?

It's not a new idea, and we have generally discouraged placing wait times online for several reasons:

Wait times may be high now. But you may be caught up in 30 minutes, which may be the time that it would take a visitor to your website to drive to your center. Patients are interested in the wait time for when they arrive at the clinic, and that has little to do with the current wait time in the clinic.
Staff will likely exaggerate wait times. It is human nature for staff to want to reduce their workload.
The term "wait time" is ambiguous. What is a "wait time?" Time that you will wait to see the doctor? That's probably what most patients think. Or is it the throughput time for patients? That's what many centers mean, but this time is often over 60 minutes, even when time to see the doctor is really under 30 minutes
Patients won't necessarily come in later. They may choose to go to another center. Is that what you want?

Patients aren't so much worried about the wait times for everyone else in a clinic, they are really concerned about what their own wait time will be. Is there a way to control that? Yes. Practice Velocity's client clinics use our ZipPass^® product for FREE. With the click of a mouse, visitors to the urgent care website (and visitors to the center's GoUrgentCare.com directory page) can "get in line, online." The software automatically uses the algorithm selected by the center to determine the next available appointment. This accomplishes three important goals for the urgent care center:

Operations Efficiency: ZipPass smooths out patient flow, by pushing appointments out when the clinic already has many patients in the clinic.
Patient Convenience: Barring an emergency patient visit, ZipPass holders are first in line when they get to the clinic. What a great deal! Who cares how long the line is; they are first in line. If any other patients seem unhappy with the ZipPass patient "cutting in line," your staff can simply offer them a brochure about the ZipPass service, "So next time, you can be first in line too."
Marketing Effectiveness: ZipPass converts website visitors into clinic visitors. If you doubt whether this will work, consider this fact: 85% of people who fill out a ZipPass^® show up for their appointment.

If the idea of appointments (even same-day appointments) is foreign to your conception of an urgent care, maybe you can look at it this way. Patients are not really making "appointments," they are simply getting in line from their home or office. Rather than wait in your waiting room, they can wait in the comfort of their home or office. You see more patients. You see them more efficiently. They get the convenience of shorter waits. It seems like a win for everyone involved.

No Sign Available? Try a Billboard.

2010-02-27T08:42:00.006-06:00

A year ago, Mickey Jones was starting an urgent care in a great location in Lehigh Acres, Florida. But he had one problem--no signage, and no available signage. There was a large billboard in front of his center, but he wasn't sure if buying space on the billboard would be cost-effective. To get some outside input, he discussed his situation with us at Practice Velocity. If he could afford it, it seemed like a great idea. We suggested that he make it clear that the billboard was acting as a giant sign on the street for his center. We suggested that he put a large arrow pointing to the center with the words, "Right Here." We encouraged him to see what kind of price he could get on the billboard. In the current recession, prices were quite reasonable.

We talked to him this week, and he told us that he had done exactly what we had suggested, and the results speak for themselves. The billboard is by far the number one marketing source for new patients at the urgent care center.

Advantages of billboard signage include:

Little up-front cost. Permanent signs can add $50,000-$100,000 to your startup cost.

Pay as you go. You are simply leasing the signage. Someone else is paying the capital cost of the sign infrastructure.

Can swap out graphics for a low price

Disadvantages include:

Price may go up. It might be a good idea to sign a contract for the length of your lease.

Increases financial risk of failure. You can avoid this risk by not signing a personal guarantee, i.e., sign the lease for your LLC, not as an individual

Unsightly. Everyone knows that billboards can be an eyesore, but the billboard is going to be there anyways. This allows you to control how the sign looks.

Our advice isn't guaranteed to always work out this well, but if you are starting a new urgent care we encourage you to consider coming to our headquarters near Chicago, IL and visit us for a free, full-day consultation tour of the 13 urgent care centers we own. Over 500 urgent care professionals have visited in the last two years. We would be honored to host your team.

Practice Velocity® Urgent Care EMR Now Serving Urgent Care Centers in Forty-Eight States

2010-02-01T09:37:00.006-06:00

Dr. Mark Ibsen and the rest of the Urgent Care Plus team

With the opening of Urgent Care Plus, Practice Velocity^® now is the EMR of choice for urgent care centers in forty-eight states.

Urgent Care Plus opened its doors to serve patients in Helena, MT in January, 2010. With the addition of Urgent Care Plus, Practice Velocity^® Urgent Care EMR serves the charting, coding and billing needs of over 600 urgent care centers in 48 states. The center has installed the online Practice Velocity Urgent Care EMR and practice management software.

Downtown Helena had no access to urgent care services, so this new center was welcomed by the people living in the area, and the clinic has already seen over 20 patients in a single day. Helena has a population of 30,000 and the surrounding area has a population of 80,000. It is the capital city of the State of Montana. An area of this size can easily support three urgent care centers.

Medical Director and owner Dr. Mark Ibsen has twenty-seven years of emergency medicine experience. Dr. Ibsen captures the vision for Urgent Care Plus with the motto, “The healing begins when you walk through the door.” He added, “We provide acute care with speed, compassion and thoroughness.”

We always say to our customers that, "It’s not about our software; it’s all about your urgent care success." We are honored to help this new urgent care clinic serve the people of their community.

PV Billing, a subsidiary of Practice Velocity, provides the back-office billing functions for the urgent care. In 2009, PV Billing processed over $100-million in claims. Their specialized urgent care expertise allows urgent care physicians to take care of patients and leave the complexities of the billing functions to specialists in urgent care billing.

The Practice Velocity team is unparalleled in experience and expertise, with a combined 200-years-plus experience in urgent care. These professionals have designed every aspect of the urgent care EMR, making the software uniquely focused on urgent care. That may be why more urgent care centers use Practice Velocity systems for charting and coding than every other system combined.

For more information, call Dana Flores at 815-544-7480 or click here to contact us online or to schedule an urgent care EMR web demo.

US Patent Office Issues Patent to Practice Velocity

2009-12-07T12:30:00.002-06:00

Practice Velocity^®, LLC has received a patent for the PiVoT^TM system. The PiVoT system is a completely unique system, and this means that the US Government has recognized this unique intellectual property. Many of the unique aspects of the PiVoT system have, also, been incorporated into the VelociDoc^® Urgent Care EMR, so this means that many aspects of VelociDoc are within the realm of this patent.

Practice Velocity expects to continue to innovate new ways to make our software solutions more efficient for use in urgent care centers, and we will continue to seek recognition and protection for the unique aspects of our intellectual property.

You can read the full press release at:
US Patent Office Issues Patent for PiVoT to Practice Velocity Urgent Care Solutions

UCAOA Fall Conference

2009-10-30T11:03:00.004-05:00

It was great to see so many of you at the Fall Conference in Dallas. Due the large numbers of people visiting the PV booth, many of you were unable to get a full demo of the system or get personalized attention to your questions. We apologize, but we are always available to take your calls and demo the systems online.
Second in attendance only to the UCAOA Spring Convention, the Fall Conference was clearly a hit, with over 250 attendees. Hitting their goals were all four tracks:
- Basic Coding
- Advanced Coding
- Clinical Urgent Care
- Startup Urgent Care

If you did not get a chance to talk to us or see the system in action, feel free to contact us directly to get a personalized demo of the system. We can go over every aspect of the system: online, same-day appointments, charting, coding billing and collections, EMR and much more. In addition, you may call us and set up a full-day tour of our sister urgent care centers (Physicians Immediate Care), where we outline every aspect of our operations and answer all of your questions.

See you in Orlando in the spring of 2010.

Thanks to Alan Ayers of Concentra for taking these photos.

Surprise the Insurance Company Owns our Competitor Urgent Care

2009-08-18T23:13:00.007-05:00

Recently, a group of physicians were in the process of opening a new urgent care center and had requested a contract with the dominant provider of healthcare insurance in the area. The payor was offering a contract with reimbursement well below Medicare rates. The physicians could not understand why the rates were so far below market and why the payor was refusing to budge. Then one of the payor representatives let it slip that the payor was thinking about expanding their own urgent care chain into that town. The doctors were dumbfounded. They had known the brand name of the urgent care chain, as this chain operated many urgent care centers in neighboring towns. The physicians were well aware that this urgent care chain was a potential competitor. But they had been previously unaware that the insurance company actually owned the urgent care chain.

In South Carolina, Blue Cross owns a very large urgent care chain. In California, Kaiser operates its own urgent care chain, and Kaiser generally does not even offer contracts to urgent care centers that it does not operate.

So what is the take-home lesson? If there are any larger chains of urgent care centers in your area, investigate them and be sure that you know what entity owns the centers, before you decide to open an urgent care center. Make sure that no local dominant payor is involved in the ownership. Opening an urgent care center is hard enough if all local payors are working with you. But opening an urgent care center with the dominant local payor refusing to contract (or refusing reasonable rates) will mean tremendous financial struggles. Yes, there may be potential antitrust issues, but getting the federal government to intervene is truly a long shot.

We all know the saying "Caveat Emptor," translated, "Let the buyer beware." Maybe there should be another saying, "Caveat Entrepreneur".

Physicians Immediate Care Makes Thousands of Children Happy

2009-05-06T13:08:00.005-05:00

Just how did our sister company (same owners as Practice Velocity, LLC) make make such a positive impact on kids? Last week, a little girl came into one of our clinics with a fever, cough and runny nose. Her flu test was positive for influenza A; it turned out to be the Swine (H1N1) flu strain, and the entire school district was closed down for two days… WooHaa… The weather was beautiful, and the kids had a great time. Bad news, however, the students will spend an extra two days in school at the end of the year.

While the kids where home, the local news showed public school staff “disinfecting” desks, floors, walls and school buses. Local administrators praised the effectiveness of this 'disinfection.'” After a day on a solid object (called a “fomite” in medical terminology) at room temperature, essentially 100% of flu viruses will no longer be viable. Thus, the staff may have been cleaning these objects, but they probably did not kill even a single flu virus in their hundreds of hours of work. This misdirection of resources emphasizes the need for better education of school administrators on the prevention and spread of influenza viruses.

One of our employees had a daughter who attended the same school as the index case came down with influenza A. Her daughter took the Tamiflu. From the picture, you can see that her daughter is already much better.

One point that the US Government seems to be missing in their efforts to prepare for an epidemic or biological terrorist threat is that hospitals and hospital emergency departments will not really be the front line, and their resources will be rapidly overwhelmed. Urgent care centers in the USA number almost 10,000. Urgent care is the clinic of choice for patients when they come down with acute, apparently non-life-threatening illnesses. That means that for any epidemic except a rapidly-fatal epidemic, urgent care centers will be the front line of health care. The Urgent Care Association of America is in the process of developing policies and information to disseminate this information to the public, government representatives and public health officials.

Even local urgent care centers seemed confused about how they should react. One local urgent care center made the local news (Urgent Care Center Turns Away Any Possible Flu Cases) when it posted a large "Swine Flu Notice" sign on the front door. The sign stated that no one suffering from a "sore throat, cough, runny nose or fever" should enter the clinic. Oops! Looks like even someone in the industry needed a little update on the mission of urgent care.

I bet that a lot of you have interesting stories about how your urgent care was involved in the Swine Flu panic of 2009. Just click on the link below to comment and share your stories.

UCAOA-2008 in New Orleans

2008-03-29T14:47:00.004-05:00

The annual UCAOA Urgent Care Convention in New Orleans promises to be the biggest and best-ever gathering of urgent care professionals.

In the speaking sessions, I will share my thoughts on managed care contracting in the Comprehensive Clinic Startup track, and I will give an update on urgent care coding (same talk will be available at two different times) during the main convention.

Please sign up at the PV Booth and join us at the Fourth Annual Practice Velocity Event on Thursday, May 1 at 7:30 PM. This year we are having a Blowout Mardi Gras Party. There will be music, food, drink and a drawing for over a thousand dollars in cash. You won't want to miss it.

This year will be your chance to view our new tablet PC EMR--VelociDoc™. Please drop by the Practice Velocity booth and see the EMR and give us your feedback.

See you in New Orleans.

Practice Velocity: The Un-Software Company

2007-10-08T23:54:00.001-05:00

MDNG Net Guide (September, 2007) recently ran a story entitled, “Shhhhh! (10 Secrets the EHR Companies Don't Want You to Know).” The article highlighted the seamy underbelly of the EMR business. The “secret” practices referred to in the article are useful for physician to note. Since so many of these practices might be hard to spot--and you might even wonder if Practice Velocity engages in any of these shady practices--we thought that it might be useful to compare these “secret” practices to the open practices of Practice Velocity.

Secret #1: EHR awards have been bought! Yes, many EMR companies have actually paid off companies to give them awards. Practice Velocity has never entered any of these rigged contests, because the only award that Practice Velocity has ever sought is the award the really counts, the accolades of its own customers.

Secret #2: That “non-biased” expert recommending an EHR to you may have been paid off too! Again, many EMR consultants are actually receiving sales commissions as for referrals to purchase their EMR. Practice Velocity has never participated in this deceptive practice. We believe that anyone acting as a salesperson for a product should be identified as a salesperson to the prospective buyer.

Secret #3: Even that EHR-using physician you’ve been referred to may have been paid off! People often ask us how our customers can be such raving fans of Practice Velocity products. No, we have never paid anyone to provide testimonials to the value of our products. Even the many customers that take the microphone and extol the value of Practice Velocity at the annual PV dinner (held during the UCAOA Annual Convention) have never been paid to take the microphone and tell about how PV has worked for them.

Secret #4: The respected physician leader of your local society may also be receiving compensation! Yes, leaders in national urgent care associations have and do use Practice Velocity, but Practice Velocity has never paid them to state this publicly. In fact, in order to protect their credibility as leaders in the urgent care industry, we have encouraged many of them to downplay the fact that they use PV products in their urgent care centers.

Secret #5: Determining how much a specific EHR costs is going to be difficult, and you are going to be nickel-and-dimed every step of the way! Since the very beginning, we have determined that we were tired of the way software companies had treated us as customers. One company even required us to pay up front just to get a quote on how much a modification to their system would actually cost. Instead, Practice Velocity has always made its prices simple and transparent. In addition, since putting our first customer online five years ago, our prices for our charting and coding solutions have never gone up one penny.

Secret #6: Your patient data will be a bargaining chip to prevent you from leaving an EHR company! What a scam! Practice Velocity would never want anyone to say that we had not treated them fairly on exit. That is why we clearly state, up front, in our contracts that the urgent care customer will always have a right to leave with a complete set of patient records.

Secret #7: The return on investment (ROI) argument is another way of saying “this solution is overpriced!” But what if you offered your product on a thirty-day trial basis with no money down, and the urgent care center doesn’t a pay a penny if it doesn’t see real the solution create more value than it costs? Yes, that is what PV promises, “Try us for thirty-days, if you are not absolutely convinced that Practice Velocity Templates (PiVoTs) is paying for itself, then you stop using PiVoTs and pay us nothing.” With the exception of two centers that used the system for under a week, every center that has tried the system for thirty days has decided to pay for and continue using the system.

Secret #8: EHRs don’t improve quality of care and often make you less efficient. And since you won’t figure this out until you are actually using the product, EHR vendors won’t let you try-before-you-buy, and there is no return policy! This is almost always true. But here Practice Velocity is completely different. Remember you can “try-before-you-buy” PiVoTs for 30-days. Even after the thirty days, since PiVoTs work on subscription you only pay for the visits actually charted on the system. You can stop any time with no penalty. Thirty-day trial, only pay for what you use, and stop whenever you want--now, that’s even better than a return policy.

Secret #9: A CCHIT-certified product, by definition, is often more expensive and less usable than non-certified products. That’s an absolute fact. If you make your product for a bunch of academics that don’t practice medicine but do research and evaluate bells and whistles in an EMR, you will make a product with bells and whistles that can pass a bells-and-whistles test. But if you want a product that will work in the cauldron of everyday urgent care, it probably makes more sense to try a product that was developed by urgent care professionals in urgent care centers and is already proven to work in over 180 urgent care centers. That description only fits one product—PiVoTs by Practice Velocity.

Secret #10: There are alternate ways to determine if an EHR, and the company selling you the product, will work for you. And there is no better way than the thirty-day trial that Practice Velocity offers. Try PiVoTs in your urgent care centers for up to thirty days. If you are not convinced that PiVoTs are the absolute best product that you have ever seen or could even imagine for your urgent care, simply stop using PiVoTs and you pay us nothing. As one early implementer (who still uses PiVoTs to chart over 100 patient visits each day in his urgent care center) put it, “Well, David. I guess that’s a no-brainer.”

Yes, and not only is it a "no-brainer," it is one more characteristic that separates PV from the rest of the field--NO SECRETS. Try it and see. For your free web demo of the Practice Velocity suite of urgent care solutions, call today -- (815) 544-7480.

Practice Velocity Upcoming Conferences

2007-08-17T06:56:00.000-05:00

The Practice Velocity team will have booths at the following shows. I will, also, be attending the shows, so drop by and let me know what you think of them.

October 22-24, 2007: National Association of Occupational Health Professionals National Convention: I will be speaking on Monday, Oct 22 about the challenges and benefits of mixed-use (occ health and urgent care) clinics.

October 26-27, 2007: Urgent Care Association of America Fall Conference, Chicago: I will be speaking in the coding track and the urgent care startup track.

November 28-29, 2007: Retail Health Summit: I will be speaking and moderating a discussion on the history and future of the urgent care industry

Please drop by and introduce yourselves if you attend any of these conferences.

Urgent Care Works for the Stern Family

2007-03-04T08:55:00.000-06:00

This weekend found me out of town with my two boys on our annual trip to an indoor soccer tournament in Milwaukee. After a 11:30 PM game on Friday night we retired to our hotel. The next morning at breakfast, our twelve-year-old soccer player developed a deep cough, could not eat breakfast; and he proceeded to cough, throw up, shiver, and turn pale and lethargic.
After cleaning him up, we drove back home; and on the way home dropped off at our local Physicians Immediate Care where they were experiencing an early afternoon rush. While Eric was getting a chest x-ray, I evaluated an ankle sprain and completed a DOT physical for a forty-two year old trucker, whose urinalysis demonstrated a new diagnosis of diabetes. The clinic was quickly caught up with patient flow.

Eric's chest x-ray is pictured above. The haziness on the lower half of the left lung (right side of image) demonstrated a clear left lower lobe infiltrate--pneumonia. One gram of Rocephin im (didn't hurt "too much"), and we were on our way home with a cracked-lipped, pale, lethargic boy, whose breath reeked of ketosis. For the rest of the day, I followed the advice that I have given to hundreds of parents--fluids, fluids, and more fluids. By the evening Eric was mostly rehydrated, and the next morning felt fine and went to church.
What this family episode drove home was the importance of local urgent care access. What if there was no readily accessible urgent care center in our community? If there was no easy access to urgent care for sick kids, would many parents shun the emergency room and wait till Monday to see their pediatricians; or would many parents spend hours in the emergency department and suffer along with their sick child? Either way, an urgent care is a much better option.
The good news is that our community has ready access to urgent care for sick children. Treating Eric's pneumonia within hours of onset, led to an extremely rapid recovery. His answer the next morning to, "How do you feel," was quite refreshing.
"You know Dad," he said, "when your really sick, it seems like it will never end. But when you get better, it doesn't seem like you were sick for very long."
To those of you who operate local urgent care centers, may I speak personally as a Dad? "Thanks. You really do make a difference in the lives of your friends and neighbors."

Humana Supports Urgent Care Centers

2006-12-25T21:36:00.000-06:00

Humana is one managed care organization (MCO) that seems to "get it" when it comes to urgent care. On their website, Humana has a page devoted to guiding their members toward urgent care centers when appropriate.
Humana lists the advantages of urgent care as:

Urgent care centers usually have extended and weekend hours.
No appointment is needed.
Generally wait times are short.
Urgent care physicians can deal with a wide range of conditions.
Members can be responsible for "most of the charges," if they use an ED "innapropriately."
"Best of all... you'll probably just pay a set copayment."

Humana, also, regards hospital-based urgent care centers as overusing resources. They state:

Don't let the urgent care sign fool you!
All centers are not created equal, and the difference can affect your wallet. To reduce your costs, choose a free-standing urgent care center, one that isn't located in a hospital. These facilities are well equipped to provide medical care for minor illnesses or injuries. The only difference is the location. Your copayment and other costs could be a lot higher if you choose an urgent care center in a hospital.

We have not previously seen payors steering patients away from hospital-based urgent care centers. This directive seems to be an attempt by Humana to avoid paying the facility fees or ED codes that are sometimes charged in urgent care centers that are based on the hospital campus or centers that are fast track segments of the emergency department. If many payors put this type of pressure on patients to avoid hospital-based urgent care centers, financial pressures on hospitals to move urgent care centers off campus may not be far behind.

Few Practices Using Computer-Assisted Coding

2006-12-16T13:06:00.000-06:00

Over 39% of medical offices and institutions are finding a very difficult or extremely difficult time finding coders—so says a survey conducted in May by the American Health Information Management Association and the American Hospital Association with support from the American Medical Association.

Despite this shortage, only 12% of health organizations are taking advantage of computer-assisted coding. Why the do practices disregard computer-assisted coding? There are several obstacles to implemenation of computer-aided coding--all of which have more than adequate solutions in Practice Velocity Templates, PiVoTs:

Lack of awareness: Many physicians are unaware that Practice Velocity offers a solution that computerizes the coding of all E/M, ICD, and CLIA-waved test codes.
Expensive systems: Most systems require massive up front outlays to implement the system. Not so for PiVoTs. With no up-front costs, simply try the PiVoTs for 30 days in one of your urgent care centers. If Practice Velocity does not speed up your patient flow and increase your practice revenues, simply stop using the system and pay us nothing. Every urgent care center that has installed PiVoTs in their clinics has immediately realized more revenue than the monthly subscription payment to Practice Velocity. Thus, Practice Velocity systems actually pay for themselves..
Cumbersome systems: Practice Velocity has become the largest provider of urgent care software solutions for one main reason—the PiVoT is the easiest computerized charting and coding solution. Physician users need no computer skills and never have to deal with navigating computer screens. If you can write with a pen on paper, you can probably use the system with only an hour and a half of training.
Protective coders: Many coders fear computer-assisted coding, because they have the mistaken impression that the computer will replace the coder. While this is true for the mundane work of coding each and every chart, coders will always be needed to code complex cases and to provide quality assurance. There already is a shortage of coders and high-quality coders will always be needed.

Is one of the reasons above holding back your urgent care from taking advantage of computer-assisted coding? Practice Velocity is your answer for your urgent care center or occupational medicine clinic. Why not sign up for the 30-day trial and watch Practice Velocity speed your charting, improve your coding compliance and improve your bottom line? Call today, and watch implement computerized coding and realize peace-of-mind profitability in your urgent care center.

ICD-9 Coding in the Urgent Care Center

2006-10-16T09:58:00.000-05:00

Question: Recently, we received the following question about ICD-9 (diagnosis) coding.

A nursing supervisor through our parent hospital is questioning the ability of an MA to legally write in ICD-9 codes matching physician diagnoses. It is my understanding that MAs get this training in school and as long as the physician is assigning the diagnosis and E&M code, the MA (certified MAs) can write in an ICD-9 code which directly matches. It has been this way in all offices I have worked in. If you have any like or something in writing supporting this, please let me know.

Answer: The physician is ultimately responsible for all codes billed out for all professional services billed under the physician's provider number. There are many ways, however, for the facility to do this.

Have staff assign the codes, and require the physician to initial the final codes.
Force physician to assign all codes.
Have staff assign the codes (after physician writes down the diagnosis), but have physician do audits of randomly selected charts on a regular basis to make sure that, for compliance reasons, the physician agrees with the codes being chosen.
Use checkboxes on a form so the physician can assign the majority of codes. If this is combined with a commercially available "cheat sheet" of most common codes, over 90% of the ICD-9 codes can be readily assigned by the physician, without slowing down the process.
There are probably other compliant methods for ICD coding in the urgent care center.

Urgent Care Mini-Conference a Big Success

2006-10-08T19:05:00.000-05:00

We just returned from the Fall Mini-Conference of the Urgent Care Association of America in Phoenix, AZ. The Association was expecting an attendance of fifty, but the urgent care community responded enthusiastically, and 125 urgent care professionals showed up at the conference. The enthusiasm of the attendees was exceptional, and the most common theme of goodbye was, "See you in Daytona," i.e., the 2007 National Convention of UCAOA (May 9-12, 2007).

I had the privelege of sharing three talks, 1) MCO Negotiation for Startup Urgent Care Centers, 2) Problem-Based Coding, and 3) Specialized Codes in Urgent Care (S9083, S9088, 99050, 99051 and 99058). All talks from the mini-conference will be available on CD through the UCAOA in a few weeks.

It has been a joy to watch UCAOA develop its vision to be a democratic, representative, professional organization of the highest caliber. Congratulations are due to Lou Ellen Horwitz (Executive Director, UCAOA) for the excellent quality she delivered at her first UCAOA conference.

See you in Daytona.

Will the Computer Replace the Urgent Care Physician?

2006-09-12T22:49:00.000-05:00

I wonder if every medical student wonders if someone could simply put all the symptoms of a patient into a computer, and the computer would generate the most likely diagnosis. Could the computer even use artificial intelligence and become a better and better diagnostician. Well that future may be a somewhat distant dream, but EasyDiagnosis.com is a website that may be offers some promise to help a patient discover some diagnostic alternatives for their sympton cluster and give the patient a rough statistical probability for each suggested differential diagnosis.

EasyDiagnosis.com allows patients to input age and sex and then guides them through a list of historical information to help determine the chances of specific diagnoses. The sample template on their website was for back pain. I answered the questions to indicate (among other items) I was a fifty-year-old male and that I was suffering sciatica and weight loss. The program determined my diagnostic probabilities as:

73% Tumor

17% Spinal Stenosis

9.4% Herniated Lumbosacral Disc

0.1% Chronic Low Back Syndrome

0.1% Osteoporosis

0.1% Osteomyelitis

0.1% Depression

0.1% Chronic Arthritis

0.1% Acute Lumbar Strain

0.1% Miscellaneous

Not really that bad. It's not quite ready to replace the physician, but it may help patients find the correct care for their medical problem. Allowing programs like this to interact with patients and physicians is definitely the future of medicine, allowing patient to input their symptoms and triage themselves in the waiting room of the urgent care center. Certain symptom constellations could even be used to expedite care of patients who need it. Allowing patients to do this from home may even allow patients to be directed to an urgent care center or to a hospital emergency department. Allowing computers to improve the care of patients in the urgent care center is the goal of Practice Velocity Software Solutions, and Practice Velocity will continue to bring innovative computer solutions to improve the efficiency and care of your urgent care center.

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Urgent Care Fall Mini-Conference: Coding & Startup Tracks (Phoenix, AZ--October 6-7)

2006-09-02T01:12:00.000-05:00

Join us at the first annual Urgent Care Association Fall Mini-Conference in Phoenix, AZ at the beautiful Pointe South Mountain Resort on October 6-7, 2006. This should be an intimate conference with excellent opportunities for networking with the faculty. Expected attendance is about fifty urgent care professionals.

Conference registration is still open, but vendor booths are completely sold out. There will be two tracks:

How to start an urgent care center: Join me for a talk and discussion of basics of managed care contracting. The track includes tours of two different urgent care centers in the Phoenix area. This appears to be the most extensive course ever offered on starting an urgent care center.
Advanced coding in urgent care: I will be speaking on specialized codes in urgent care and on negotiating problem-based evaluation and management (E/M) coding. Coders, administrators and physicians will all benefit from gaining this knowledge.

My partner John Koehler and I will, also, be speaking at the National Association of Occupational Healthcare Professionals (NAOHP) in Philadelphia on October 23-25. Ryan Associates have requested that we speak on the topic, Benefits and Challenges of the Mixed-Use (occupational medicine and walk-in care) Clinic. Be sure to introduce yourself at the Practice Velocity booth.

Urgent Care Association of America Launches Journal

2006-08-09T22:41:00.000-05:00

The Urgent Care Association of America, UCAOA, has announced the launch of The Journal of Urgent Care Medicine (JUCM). The Journal will serve the rapidly-growing urgent care industry. As the official journal of the UCAOA. JUCM will offer a mix of practical, peer-reviewed clinical and practice management articles, focused specifically on the delivery of urgent care services.

Lee Resnick, MD, will serve as the first Editor-in-Chief of the Journal of Urgent Care Medicine. Dr. Resnick is Medical Director of four urgent care centers in the University Hospitals Health System in Cleveland, OH, where he is the Director of the first Urgent Care Fellowship program in the country. The fellowship program is being offered at University Hospitals of Cleveland /Case School of Medicine, through the Department of Family Medicine and is funded by University Primary Care Practices (UPCP, Inc.). Dr. Resnick also is the Chairman of the Academic Committee of UCAOA.

Dr. Resnick said, "JUCM will reflect the urgent care physician's perspective, with articles written by urgent care physicians and specialists who understand our practice. We will supplement this unique clinical content with practical practice management tools, industry news, and coverage of legal issues in urgent care and UCAOA happenings. For the urgent care professional, this means no more sifting through other journals for information relevant to your practice. It's all in one journal now."

JUCM will be published in partnership with Braveheart Publishing, with over 30 years of medical publishing experience and expertise. Peter Murphy, former publisher of the Journal of the American Medical Association, (JAMA) and Stuart Williams, former publisher of Medical Economics magazine, spearhead Braveheart's operation. The large UCAOA database of urgent care physicians ensures highly targeted distribution of Journal of Urgent Care Medicine to the urgent care industry.

The first issue of JUCM will appear in October 2006. Circulation will include physicians, nurse practitioners and physician assistants practicing urgent care medicine nationwide.

Physicians, physician assistants and nurse practicioners can click here to sign up for a free subscription to The Journal of Urgent Care Medicine.

Controlling Burn Rate in the Startup Urgent Care

2006-08-05T22:56:00.000-05:00

Someone once said, "The number one reason that startup businesses fail is that they run out of money." It sounds profound, but running out of available capital is not actually a "reason" that startup urgent care centers fail. This is akin to saying that the number one reason teams lose baseball games is that they score less runs than the opponent. The real reason for losing baseball games are failure to execute a successful game plan. In the same way, running out of available capital is not a cause; it is the end result and positive proof of failure. There are multiple reasons that urgent care centers fail, and you can click here to read some startup urgent care reasons for failure .

One reason for failure in a startup urgent care is a failure to monitor just how rapidly you are approaching and how close the urgent care center is to running out of cash. You can do this by making sure that your monitor and control the burn rate of your startup urgent care center. Jeff and Rich Sloan of StartupNation.com recently wrote an article entitled, "Controlling Your Startup Business 'Burn Rate.'” The ideas are particularly apropos for the startup urgent care. If you are involved in a startup urgent care you might want to review these ideas to see if they might benefit your startup.

Carefully monitor your startup burn rate: Every month you want to calculate how much startup cash your urgent care center has burned. Analyze how much of your total investment capital has been burned. Make sure that you are not in danger of running out of capital. If you see that you are in danger of running out of capital, you will want to arrange for additional capital.
Calculate the burn rate for your startup urgent care: Make sure that you are not suddenly surprised that you have run out of available capital. For example if your center has $500,000 of available capital, has lost a total of $400,000, and after one year is losing an average of $10,000 per month--you are only ten months away from running out of capital. But with your current growth rate and controlling your expenses, you should reach profitability before running out of capital.
Keep your expenses in check: The burn rate for your urgent care center has two components: cash deposits and expenses. Obviously, you have much more direct control over the expenses than you have over the cash deposits. About expense monitoring, Jeff and Rich Sloan say, "You should be ruthless about it, particularly in the early going. Monitor expenses every day."
Watch out for the big startup cash outlays: They say, "Spend your precious cash on what’s critical to producing revenue for your startup business." You will want to avoid purchasing lab equipment for CBC and CMP, expensive artwork, and plush furniture for your urgent care center. Instead, your capital outlays should be for critical components of your startup urgent care, including x-ray equipment, billing and charting software, signage, and advertising.

The Sloans conclude: "Controlling your burn rate can give you the confidence and resources to ramp up your startup business the way you want. Squeezing expenses in that new business is the best way to do it. If you don’t, you’ll learn just how unforgiving the marketplace can be."

Independence Day in the Urgent Care Center

2006-07-05T23:52:00.001-05:00

A patient presented to one of our urgent care centers with a wrist fracture and wanted a red-white-and-blue cast. Those of you who know John Koehler, MD might understand why he saw this a great way to demonstrate our mission of "spectacular customer service".
How many people do you think saw this and asked, "Where did you get that cast?" What a great opportunity to produce a happy patient and more positive PR for the urgent care center. With an emphasis on patient service, you too can find a great way to provide patients with unique ways to tell everyone in your community about the convenience and professional excellence of your urgent care center.

Free Market Forces and Urgent Care Centers

2006-07-01T23:09:00.000-05:00

An interesting reference to urgent care is found in an essay titled, "In Defense of Consumerism," by Llewellyn H. Rockwell, Jr. (Founder of the Ludwig von Mises Institute in Alabama). Consumerism has been much-maligned as merely giving plebeian access to superfluous items such as cappuccinos and gas guzzling SUVs, but Rockwell points out:

But are people buying superfluous things that they can do without? Certainly. But who is to say for sure what is a need as versus a mere want? A dictator who knows all? How can we know that his desires will accord with my needs and yours? In any case, in a market economy, wants and needs are linked, so that one person's necessities are met precisely because other people's wants are met.

Here is an example.

If my grandchild is desperately sick, I want to get her to a doctor. The urgent care clinic is open late, as is the drug store next door, and thank goodness. I'm in and out, and I have the medicine and materials necessary to restore her to health. No one would say that this is a superficial demand.

But it can only stay open late because its offices are nestled in a strip mall where the rents are low and the access is high. The real estate is shared by candy stores, sports shops selling scuba gear, a billiard hall, and a store that specializes in party favors – all stores selling "superficial" things. All pay rent. The developer who made the mall wouldn't have built the place were it not for these less urgent needs.

The same is true for the furniture and equipment and labor used in the urgent-care clinic. They are less expensive and more accessible than they otherwise would be due to the persistence of non-essential consumer demands. The computers [and the software] they use are up-to-date and fast precisely because technicians and entrepreneurs have innovated to meet the demands of gamers, gamblers, and people who use the web to do things they shouldn't. . . .

Rockwell's point is true that the consumer's demand for convenient, after-hours access to medical care has produced the much-needed urgent care center in his own neighborhood. Whether or not you agree with Rockwell's premise that consumerism is a force for the good of society, it is refreshing to see intelligent recognition of economic forces that have produced the much-needed urgent care centers and the technology (such as Practice Velocity Urgent Care Solutions) that helps make urgent care centers more efficient.

Ideal Location to Start an Urgent Care

2006-06-14T19:20:00.000-05:00

I frequently mention to inquirers that most people make the mistake of starting their new urgent care in their own home town, rather than look for an ideal town to start an urgent care center. After mentioning this to hundreds of people who are getting into the urgent care business, someone finally asked me for a list of criteria for choosing a town that would virtually guarantee success when starting urgent care center.

So, I sat down and wrote out my own ideas for a perfect town, in which to locate an urgent care center.

40-50,000 people
2-3 McDonalds (They do great demographic research.)
No existing urgent care center in town
Routine ER waits of 3+ hours
Good physician is available in the town to help you staff the new urgent care center.
Good industrial base for occupational medicine
Location for startup urgent care center is available on busy road (used frequently by most people in town) with good signage.
But, as she mentioned, the most important is whether her spouse was willing to live there.

These towns still exist. Today, I met with a group, looking to start the first urgent care center in their town of 35,000 with 150,000 people that live in the surrounding area and five McDonalds in town. As long as they don't make any big errors, they should be looking to open a second center within the first two years.

If you want to hit a home run with your first urgent care center find the perfect location, do all your research, listen to any experienced urgent care professional who will talk to you, get ready to work hard and love it, and move to the "perfect" town.

Over the years in our seven sister urgent care centers, we've hit a few bunt singles and a few home runs. Call Practice Velocity if you want to schedule a tour of one our sister urgent care centers to see how we do it.

Managed Care Organization (MCO) Insists that Urgent Care Physician has Hospital Admitting Privileges

2006-04-08T06:02:00.000-05:00

"What do I do, if the managed care organization (MCO) insists that I have admitting privileges to a hospital? I am an emergency physician, and I have never had admitting privileges." This question came up in my talk (available on CD; to order contact bburress@ucaoa.org) yesterday at the Lake Tahoe UCAOA Annual Convention, a great success with over 350 attendees and 52 vendors with helpful products or services for urgent care centers.

It is important to get face-to-face with the managed care organization (MCO) representative, who is actually empowered to make decisions. It is key NOT to ask your rep, “Who will really make this decision.” Instead, ask the rep, “Before you make this decision, who will you want to consult with.” Answer is—the person who actually makes the decision. Then, you arrange for a meeting with that person in the offices of the MCO. Explain to the rep that:

You operate an urgent care center,
Urgent care centers are exclusively outpatient specialists,
Few urgent care centers ever directly admit to the hospital,
You always admit to a specialist, the PMD or to a hospitalist.
Thus, admitting privileges are irrelevant.

If they still insist, then maybe you should see if courtesy privileges will suffice. If they still insist, (i.e., they don't give you enough respect to listen to your point of view), then you might try to get admitting privileges. If you can’t get admitting privileges, and the MCO won’t budge, then bad news; what is probably happening is that you are dealing with an MCO that doesn’t think it needs you (or maybe even any urgent care center) as a participating provider.

Still the managed care organization has no interest in contracting. Time to give up? No! Now you need to explain the value of urgent care centers in:

decreasing expensive ED visits,
improving client satisfaction,
covering the medical needs of the walking well (which are the only sources of profits for the MCO).

Still the managed care organization has no interest in contracting. Time to give up? No!

Now you need to find or land a large (larger the better) employer that:

is thrilled with your services
you have visited with face-to-face and you have a good relationship with
and uses the MCO in question for covering healthcare for it’s employees.

Ask the HR rep, if he or she is willing to send a letter to the MCO, stating:

That having your urgent care center on their panel is “very important” for a continuing relationship with the MCO. Translation: “Get the urgent care center on the panel, or you risk losing our account."
Next, type up the letter, email it to the HR rep, and thank the rep for being willing to send this letter under the company letterhead

Still the managed care organization has no interest in contracting. Time to give up? No! Just keep providing great service to walk-in patients and for corporate clients. Always, make sure that you give a typed letter (with stamped envelope) for any employer or patient to sign, expressing dissatisfaction that your urgent care center is not a participating provider with the managed care organization. If you can mail the letter yourself, do it. Over time, your urgent care center will win, because you are providing an important cost-effective alternative to the hospital ED. Whether the MCO knows it or not, the MCO needs your urgent care center.

More information on managed care contracting for the urgent care center is available on CDs of my two talks at UCAOA-2006, which are available through the Urgent Care Association of America (all proceeds are kept by UCAOA to benefit the organization). Contact bburress@ucaoa.org to get an order sheet for the CDs.

Good luck!