VelociDoc

UCAOA-2008 in New Orleans

velocidoc — Sat, 29 Mar 2008 19:47:00 +0000

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

velocidoc — Tue, 09 Oct 2007 04:54:00 +0000

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

velocidoc — Fri, 17 Aug 2007 11:56:00 +0000

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

velocidoc — Sun, 04 Mar 2007 14:55:00 +0000

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

velocidoc — Tue, 26 Dec 2006 03:36:00 +0000

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

velocidoc — Sat, 16 Dec 2006 19:06:00 +0000

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

velocidoc — Mon, 16 Oct 2006 14:58:00 +0000

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

velocidoc — Mon, 09 Oct 2006 00:05:00 +0000

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?

velocidoc — Wed, 13 Sep 2006 03:49:00 +0000

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)

velocidoc — Sat, 02 Sep 2006 06:12:00 +0000

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

velocidoc — Thu, 10 Aug 2006 03:41:00 +0000

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

velocidoc — Sun, 06 Aug 2006 03:56:00 +0000

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

velocidoc — Thu, 06 Jul 2006 04:52:00 +0000

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

velocidoc — Sun, 02 Jul 2006 04:09:00 +0000

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

velocidoc — Thu, 15 Jun 2006 00:20:00 +0000

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

velocidoc — Sat, 08 Apr 2006 11:02:00 +0000

"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!

Urgent Care Medicine Fellowship Announced

velocidoc — Mon, 30 Jan 2006 04:14:00 +0000

Last week marked what may be the biggest milestone in the urgent care industry since the founding of Urgent Care Association of America. The Urgent Care Association of America announced the approval of the first ever fellowship in Urgent Care Medicine. The urgent care fellowship will be supervised by Lee Resnick, MD at the Urgent Care Centers of the University Hospitals of Cleveland, Ohio.

This is the first specific postgraduate training in urgent care medicine available in the USA. The urgent care fellowship represents an innovative approach to provide the additional training necessary to meet the demands of one of the fastest growing specialties—Urgent Care Medicine.

Positions in the one-year fellowship are currently open to graduates of accredited Family Medicine and Med/Peds residencies. Qualified applicants can learn receive more information on the urgent care fellowship on the website of the Urgent Care Association of America.

Urgent Care Medical Director: Too Good for Her Own Good?

velocidoc — Sun, 01 Jan 2006 07:12:00 +0000

Today I received an email from a physician, who took over an urgent care center for a hospital several years ago. The urgent care center had been losing money for years, then she took over and rapidly catapulted it to profitability. Profitability was great because she had a contract that allowed her to take home any profits. Of course, the hospital administrators never really thought profits would happen; and at the outset of the agreement they would have been thrilled with the prospect of a breakeven urgent care center. But now there is a problem: the medical director of the urgent care center has become one of the highest paid employees in the hospital system. The hospital administrators no longer consider a breakeven urgent care center to be an impossible dream; they have it. Now they have to do something to eliminate this compensation aberration. They will move to drop the physician's salary to bring it within the norms for an urgent care physician. What should she do? Below is my [edited] answer to her.

Dear Successful Urgent Care Medical Director:

What a problem! You were so successful in producing financial benefits to the hospital that the hospital must fix the problem of overcompensating you.

Dealing with the Hospital Administrator Mentality
This is actually a common problem. When centers are financial losers, hospitals are happy to sign papers to compensate physicians “as if” they were owners. In reality, however, they are not owners. Once an urgent care center develops great profitability, being treated like an owner will not fit with the hospital administration mentality. Hospital administrators cannot tolerate wages that are out of line with "prevailing wages"--even if they are resulting in significant profitability for the hospital. Hospitals generally see themselves as compensating physicians for job descriptions, rather than compensating a physician for the value added to the organization. Believe it or not, true business leadership often seems to be a liability in the hospital urgent care setting. The leader physicians either end up feeling undercompensated, or the hospital feels they are overcompensated.

You may negotiate with the hospital, but I suspect the end result will be that they will end up dropping your overall salary dramatically. The administrators will pat themselves on the back with their success--physician wages will be "within the norm." If you decide to leave, by the time an accountant points out the red ink, the person responsible pushing you out will have been promoted to VP for her outstanding success in reducing wage costs (only slightly serious about that).

It is very rare for urgent care physicians to earn higher salaries than emergency physicians. Most urgent care physicians would be thrilled to have their salaries set at the prevailing salary for emergency physicians. Some sort of productivity bonus is common, but bonuses rarely will bring the physician salary to the levels you have enjoyed. Bonuses that result in salaries that are "out of line" seem to always come to an abrupt halt when the contract ends.

Urgent Care Medical Director Salary Negotiation
All that being said, you are starting with the average urgent care physician salary as a base for negotiation. Maybe the following points would provide a basis for negotiation:

Start with the base comparative salary they have offered (increase by ~10%)
Ask for a contingent revenue growth bonus
Ask for a personal productivity bonus, based on RVU production. If they balk, suggest that this can be given only for RVUs that are above the current average RVU at your center. Note: RVU-based bonuses are much
Ask for a medical director stipend (I have seen anywhere from $5,000 to $50,000). You may be able to use the average bonus for ED medical directors in your region
Assuming you have not signed an enforceable non-compete agreement, you may consider mentioning that you may "need to go out" and start your "own urgent care center."

Joint Venture Urgent Care Centers
Another option would be to open further centers under a joint agreement. There are UCAOA members that operate under joint agreements, where they share risk and share profits. If you want we can put you in contact with them.

Start Your Own New Startup Urgent Care Center
If this still does not result in a contract that works for you, maybe the best long-term answer is to open your own urgent care center(s). Employees get guaranteed wages; but owners take the risk of losses and bet on profits. It is unlikely that any hospital will ever see you as an owner. If you lack capital there are experienced operators out there that will team with you for a percentage of risk and a percentage of profits.

Good luck! Feel free to call me with questions.

David

Standardization: Freeing Average People to Deliver Outstanding Urgent Care Service

velocidoc — Fri, 23 Dec 2005 23:24:00 +0000

What seperates an excellent urgent care business from any other urgent care center.

Why it is not ________ that Produces Consistent Excellence:

If it is outstanding leadership, then the urgent care center will drift from excellence whenever the leadership is not on site.
If it is outstanding methods, how can you make sure that those methods are consistently followed?
If it is outstanding staff, can you really find enough MIT graduates to staff your urgent care center?
If it is something else, what is it?

Standardization to Excellence:
THE E-MYTH REVISITED by Michael Gerber suggests that standardization is key for any business or urgent care center that wishes to become free of the tyrany of massive everyday involvement by owners. Standardizing excellence appears to be the clear distinctive of what seperates McDonalds from a simple, inefficient, random-quality burger joint. Without standardization the urgent care center owns the owner. With standardization urgent care owners may become free to enjoy the fruits (rather than the burdens) of ownership. It is also clear that the leaders of any business must become passionately devoted to standardization, if standardization is to succeed.

The Replicatible Model Produces Replicatible Results
It seems that complete standardization is the hallmark of any replicatible model. Training & retraining of staff in a replicatible model (e.g., McDonalds, Starbucks, and many other multi-site businesses) does focus on memorizing sentences verbatim and exact procedures by average people. Standardization frees average staff to achieve world-class results. Otherwise, an urgent care operator must hire superstars, and that is cost-prohibitive.

Years ago, I lived and worked in Maryland, but I also commuted to once per month to an urgent care Illinois. I was amazed at how the drug reps were repeating (verbatim) the exact same high-impact sentences in both Maryland and Illinois. The drug companies knew that standardization could allow average salespeople to acheive world-class results.

Start Somewhere to Standardize Your Urgent Care Center
Maybe you want to consider starting standardization in you urgent care with a simple phrase used by all receptionists when patients enter the clinic. Maybe you can start with a simple sentence about strep testing when a patient presents with a sore throat. Maybe you will start with the way that the tray is set up for a laceration repair. This simple change can be the start of a new philosophy at your urgent care center. This change--along with scores of other standardized sentences and procedures--can be memorized and repeated thousands of times at your urgent care center. Standardization means:

You are not relying on the whim of each staffer to deliver care according to their personal preferences.
You can rapidly determine if a staffer is adequately trained in any area. You do not need to look only for gross deviation from standard of care. Rather, you can rapidly detect deviation from your specific standards--long before the deviation reaches the level.
Any properly trained high-school graduate can deliver excellence without any himming and hawing on day 1.

Examples of Standardization in the Retail Industry:

Starbucks: the staffer always places the coffee cup on the counter. I realized why when a new trainee handed the coffee to me, and was instantly admonished by the trainer to place it on the counter. Reason? I suspect that scalding a customer with coffee is much more likely and liability is higher if the coffee is transferred from staffer’s hand to customer’s hand.
McDonalds: “Have a nice day.”
Best Buy: “For your protection, you can purchase a prolonged warrantee with this appliance. . .” Note: last Christmas I entered the line at Best Buy at the back of the store and purchased the item in less than ten minutes. This “miracle” in customer service probably has a lot to do with standardization that seperates Best Buy from the rest in customer experience and Wall Street performance.
Walmart: Sam Walton obsessed about getting credit card processing under one minute. He would be happy to see how his obsession about standardization and speed helped push the credit card revolution into Starbucks and McDonalds.
Your Urgent Care Center: Send us your example of stardarization in your urgent care center with a comment below.

Why have a Practice Velocity Blog?

velocidoc — Sun, 11 Dec 2005 03:28:00 +0000

Blogging has become a popular way to communicate timely information of all sorts. We decided to have a company blog to allow us to communicate much of what we are learning from our daily interactions with urgent care physicians, administrators and patients. We have engaged in significant discussion as to how urgent care physicians and administrators can use this blog. Our goals for this blog include:

Giving back to the urgent care industry:
Throughout the existence of our company, we have been blessed to interact with hundreds of urgent care professionals in the USA. We have taken home hundreds of pieces of information that has helped us improve our products and services. We hope that our insights and observations will allow urgent care centers to benefit and improve their services.

Sharing new products and enhancements:
Practice Velocity has an entire research and development team constantly at work improving and upgrading our product line. A blog will give us an opportunity to inform the urgent care industry of our new products and services.

Relating best practices in urgent care centers:
Not only do I and my partners continue to practice urgent care medicine, we also meet with urgent care operators throughout the USA. Last week I was in Lexington, KY where Dr. Fadi Bacha has taken a group of urgent care centers that were in serious financial difficulty under the ownership of the University of Kentucky. In three short years, he has turned them around financially, while continually upgrading the standard of care. Many other urgent care physicians have success stories to share, and this blog will allow us to share these stories with you.

Discussing current issues in urgent care medicine:
Travel around the country has given me insight into the challenges facing urgent care centers. This week I visited with a group of urgent care centers in North Carolina. They are facing an all out assault by Minute Clinic on their metropolitan area. Ten new centers in local pharmacies are scheduled to open in the next few months. It seems that every time you turn on the television there is an advertisement for the stripped down services of these nurse practicioner-staffed pocket clinics. Will these clinics siphon off a large enough number of less-ill patients and force traditional urgent care centers to shut down? Will shutting down the traditional urgent care centers shunt patients with moderate acuity injuries and illnesses back to the hospital emergency department? If so, does the proliferation of the pharmacy pocket clinic mean that the current overcrowding crisis in America's hospital emergency departments will escalate out of control?

We hope that you feel free to enjoy and interact with the ideas that we share.

Urgent Care Medicine

velocidoc — Mon, 07 Nov 2005 01:56:00 +0000

Urgent care medicine is an exciting rapidly-developing specialty. Over the past sixteen years working in an urgent care medicine, I have had the opportunity to watch the field rapidly develop into a full-fledged speciality. Last year this culminated in the formation of the Urgent Care Association of America. This was an exciting development as it marked the first time that urgent care physicians and administrators were represented in a fully-democratic national organization.

Urgent Care Convention - 2005

This last April, over 250 urgent care professionals gathered at the first annual UCAOA Convention in Orlando. The Convention was a smash hit. Administrators spent a full-day pre-conference learning billing skills from Elizabeth Woodcock, while fledgling urgent care entrepreneurs spent a full day learning the secrets of success from urgent care veterans. Quality educational programs were offered in both a clinical track and an administrative track. Jim Gore, MD and Ken Palistrant, MD were elected to the Board of Directors. The accreditation program of the Urgent Care Association was unveiled.

Urgent Care Center Accreditation

The urgent care center accreditation program will allow urgent care centers to get credit for providing quality urgent care services. The accreditation process will allow centers to evaluate and make conscious improvements in almost every area of the delivery of health care services.

Challenges and Developments in Urgent Care

The specialty of urgent care medicine has many challenges ahead. Over the upcoming months, I hope to share many of these challenges with our Practice Velocity customers and other visitors to the website. It will take the efforts of all of us in the urgent care industry to allow us to improve public access.