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The Giant eBook for Urgent Care Startups
Startup & Specialties

The Giant eBook for Urgent Care Startups

eBook Overview

  • 10 Questions to Ask Before Starting an Urgent Care
  • 6 Mistakes to Avoid When Starting an Urgent Care
  • To-do Checklist for Starting an Urgent Care
  • 9 Features Your Next EMR Needs to Have
  • 4 Tips for Switching from Paper to Electronic Medical Records

 

Intro

This one-of-a-kind start-up resource will answer all your questions and guide you from day one. You’ll get more than 40 pages of tips, timelines, and proven real-world resources to answer your biggest questions and lay the groundwork for a successful launch and landing.

 

Chapter 1

10 Questions to Ask Before Starting an Urgent Care

If there’s one thing to be said about the urgent care industry, at this point, it’s growing faster than it ever has. Right now is the opportune time to break into the industry and start an urgent care clinic. Based on the Urgent Care Association of America’s data, there are about 300- 600 new centers being opened annually and there’s no indication that the growth rate will slow anytime soon. So if you’re in the market to open an urgent care clinic—look no further. We have just the resource for you.

 

Here are ten questions to ask before starting an urgent care clinic:

Question 1:

Where should I avoid starting my urgent care and why?

A lot of people will start by thinking about where they should start their urgent care. It is equally as important that you know where not to start one.

There are a handful of cities and states around the country considered to have “saturated” urgent care markets. Florida is fast becoming one of those states. The Sunshine State was an early adopter in the urgent care market, which explains why the competition has gotten so stiff in recent years. Metropolitan areas such as Ft. Lauderdale, Jacksonville, and Orlando have been eaten up by large, branded chains. Florida also gets low marks for reimbursement rates. This has been an ongoing issue with the state for years. Even if one is successful in landing a payer contract, the resulting rate is most likely lower than average.

Having closed networks from prominent payers—AETNA, HUMANA, BCBS, and UHS—hurts the industry. All four companies will make  doing  business in Florida hard. The payers will not answer calls or offer up contracts to new businesses that provide urgent care services.

When breaking into the urgent care industry, search elsewhere as  you will get more bang for your buck in a different state.

There are also other states that are less attractive for starting urgent cares. Anything from lease costs, difficulty negotiating in-network status, state regulation, and well-branded centers saturating the market.

Don’t forget that it is harder for non- physician owners because of Corporate Practice of Medicine (CPOM) laws.

According to Health Lawyers, the CPM doctrine generally prohibits a business corporation from  practicing  medicine or employing a physician to provide professional medical services.

This is an issue non-physician owners will have to consider during the initial stages as they look for a  location to call home—as it will have a significant impact on their operational structure and long-term expenses.

 

Question 2:

What are some key identifiers to watch for when looking for a location?

Finding the perfect spot for your urgent care clinic will not happen overnight. It takes time and energy to find the most strategic location. There are no telltale signs or lists. However, there are a few key identifiers to watch for when looking for a site.

The visibility of your location is a big deal. Sure, the building may  be visible to customers at this moment in time,  but will those same conditions ring true a year or even five years from now? Are developers planning on expanding in front or adjacent to your site? Will large trees bloom in front of your center? Are traffic patterns subject to change based on growth? These are all good, relevant questions that need to be asked when searching or selecting a location.

Another key identifier is signage. Right away, it will be crucial to figure out if there are limitations to size, color, and display type regarding a sign. Obtaining a permit is something else to think about when it comes to putting up a sign. The requirements vary by municipality, but the last thing you want is to get slapped with is a hefty fine before you open the doors to your brand new clinic. So, in short, always check local laws prior to placing signage.

You also need to know who your competition is and where their locations are. Finding out what sets you apart from them will help you market to the strengths of your center and inform the public of why they should choose you over the competition.

Parking and zoning sounds like a straightforward topic, yet that is not always the case. Things to consider when thinking about parking and zoning: Is the land zoned appropriately for medical use? Are there designated parking spots available for patients and clinical staff?

Parking, especially in bigger cities, can dictate the patient flow. If your parking lot is not big enough to facilitate the number of patients your facility can handle, patients may go to the clinic down the street when your parking lot is full.

 

Question 3:

What do I need to know and prepare for when applying for funding?

Finding the perfect spot for your urgent care clinic will not happen overnight. It takes time and energy to find the most strategic location. There are no telltale signs or lists. However, there are a few key identifiers to watch for when looking for  a site.

Funding is a big undertaking.  There  are a lot of moving parts with a lot of minute details that you have to know before you apply for funding. The first thing to be aware of is Small Business Administration (SBA) loans do not fund 100 percent of your need. SBAs only cover a certain percentage. Meaning, you’re responsible for coming up with whatever amount the SBA loan doesn’t cover. On average, you will have to contribute up to 20 percent of the total funding for the project.

For the SBA to even review your application, there haveto be three-to-four years of tax history, a personal financial statement, a business plan, and financial projections for the clinic. Keep in mind, SBA loans look at the creditworthiness of the entire household—even if the spouse is not a part of the business.

Many traditional line of credit loans, such as physician practice loans, do not fully cover project funding or allow for operational cash once the center is open. A separate business line of credit may have to be opened.

 

Question 4: 

Do I want the biggest clinic space I can get?

Bigger isn’t always better. No matter how many times we hear it in America, we should know this phrase does not always apply—especially when opening an urgent care center.

Why? Because increased space does not equal increased patient visits. Larger areas add up to bigger build-outs and higher long-term expenses. Bigger build- outs quickly drive up costs with longer labor hours and an increase in materials, while higher long-term expenses include the furnishing of the entire property and the future up keep that comes with having more square footage. The number one thing that initially drives patients to your clinic is visibility and convenience. What keeps them coming back is efficiency and excellent customer service.

 

Question 5:

If I am watching my build-out costs, does the contractor I use matter?

Without question, the contractor matters. An experienced urgent care contractor has the ability to save you thousands in expenses just by helping you avoid poor design and material choices. Additionally, they should understand radiology needs, installation of diagnostics, and be able to help properly coordinate the delivery of capital equipment. That way it’s there and ready for the go-live date. It’s important that the contractor understands storage and service offerings, too. That way they can assist in setting up adequate and proper storage solutions like shelves, hangers, cabinets, and counter heights.

If this doesn’t happen, it will be up to you to coordinate this post opening—the last thing you want to worry about after the doors are open.

 

Question 6:

When and why should I consider the selection of my EMR/RCM provider?

Selecting your EMR/RCM provider should happen as soon as you sign your lease. Choosing a provider at signing ensures your clinic will be  in-network by the time your center opens its doors. Most EMRs coordinate and offer RCM and credentialing services that tie into the contract as well.

EMR implementation and RCM setup (with fee schedules) needs to be organized early on in the start-up process. Assistance can be provided— so you can appropriately plan for contingencies—should there be any issues with go-live or contracting and credentialing services.

As far as the training of staff  and  users goes, it can  be arranged  during a slower period. The same applies to the customization of the EMR. Both tasks should be done weeks before  the launch—that way you do not find yourself doing them last minute.

As you can probably tell by now, you will have bigger fish to fry leading up to the go-live date.

 

Question 7:

How does contracting and credentialing affect my go-live date?

Contracting and credentialing undoubtedly have an effect on the go-live date. At times, it can take eight months or longer in certain areas to thoroughly complete the setup of contracting and credentialing services. It’s critical to get it set up sooner rather than later considering you want to be in-network with all major payers. On top of that, you want to have contracts and fee schedules ready to go.

A delay in contracting and credentialing services would hurt your clinic’s bottom line. If not in-network, there  wouldn’t be any incoming reimbursements from payers. Opening without being in- network also means a plan has to be implemented to manage patients who have insurance plans that likely won’t  be covered.

A question to ponder if that day comes for your center, “How will I handle the patients who have complaints after they are seen and receive their explanation of benefits (EOB)?” Unfortunately, non- credentialed providers are as bad as not having a contract. Non-credentialed providers cause delays and a reduction in reimbursement.

It’s easy to see why it’s important to get your EMR, RCM, and contracting and credentialing services squared away as soon as the lease is signed. All three can affect the go-live date and so much more.

 

Question 8:

How should I go about determining my go-live date?

The best way to determine the go-live date is to look at  when  the  majority  or largest commercial payer (typically BCBS) is fully contracted, the fee schedule’s loaded, and providers are credentialed. What commonly happens is operators feel the pressure to open the clinic once rent is due and the build- out is complete. They believe rent is more of a threat to expenses than all the operational costs combined.

 

Question 9:

When should I recruit providers? What do I need to know before I start recruiting?

It is in your best interest to start the recruitment process at least two-to- three months before the go-live date. Credentialing can be a lengthy process, and a non-credentialed practitioner will not have claims reimbursed promptly. When recruiting, some providers may have to apply for a license and DEA reciprocation if they plan on moving to your area. Applying for a license and DEA reciprocation can increase the time for bringing providers on board and delay the contracting and credentialing process.

Furthermore, most providers will have to give a significant amount of notice to their current employer if they intend on leaving. In some markets, especially rural ones, it may be harder to find the type or level of practitioner desired. It is not outside the realm of possibility that you may have to resort to hiring a recruiter or think of other strategies—which could increase the amount of time it takes to find and hire the right provider.

 

Question 10:

What resources are available and should I be seeking them out before opening?

It’s absolutely necessary to find the proper resources before opening. The best resource out there is an urgent care consultant. Urgent care consultants can guide you every step of the way. They can also coordinate resources, vendors, answer questions, and provide best practice information. An experienced contracting and credentialing team is a close second.

It is this team’s job to coordinate contracting with major payers, collect all needed information to credential providers, and provide information to help you set your fee schedule.

A trustworthy financial advisor— accountant or reliable funding resource—is needed to help gather necessary financial documents, determine the best corporate structure for the clinic, counsel on the lease, advise the purchase, and help analyze and plan cash flow once your urgent care is open.

Even though it was covered earlier in  the article, an urgent care EMR/PM/ RCM vendor is worth mentioning again. The best type  of  vendor focuses  on  its client’s success. They put all their resources toward the go-live date. In addition, it’s important to them  that they are well prepared, deliver on time, and continuously deliver after opening day. Improving your operations through technological advances, training, and enhancing your revenue is their focus.

Lastly, seek out successful urgent care owners—network, share ideas, and tap into what worked well for them.

 

Chapter 2

6 Mistakes to Avoid When Starting an Urgent Care

According to the Urgent Care Association of America, there are approximately 9,000 urgent care clinics in the United States — growing at a rate of over 300 centers per year nationally.1 The growth trend isn’t slowing any time soon. Urgent care clinics, from  single  sites  to franchises and large organizations, will continue to expand as the aging Baby Boomer population floods the healthcare market in need of episodic or acute care services.

In addition, the Affordable Health Care Act, often referred to as Obamacare, went into effect in 2014, creating the need for more healthcare providers as

30 million uninsured people become insured. The Association of American Medical Colleges estimates by 2020 the United States will face a serious shortage of both primary care and specialty care physicians — at 91,500 fewer doctors than needed for the population.

These factors have contributed to venture capitalists, hospitals, individual physicians, and even insurance companies rushing to open their own urgent cares.

While the  opportunity is  a  golden  one for business, opening an urgent care requires due diligence in upfront planning for long-term success.

Before opening your urgent care clinic, we recommend avoiding these classic missteps.

 

Mistake 1:

Not Planning Ahead or Having the Correct Expertise

While it may seem obvious, many clinics say that starting an urgent care takes advance planning (at least a year or more) and requires personnel knowledge in both business and healthcare.

Often, clinic  owners  have   expertise in one of these two areas. To give a balanced approach, adding a partner  or hiring experienced consultants can help counter areas of inexperience.

A proforma is required for loan financing, but outlined business and marketing plans are essential, especially in the first years of operation. Experienced clinics advise that you should be prepared to run at a loss (insurance reimbursements can take months)—and to have working capital to get you through the early stages of business.

Hiring the correct employees that fit your clinic’s mission will help prevent time-consuming rehiring.

In addition, careful selection of staffing models is recommended as hiring choices determine when a clinic will turn a profit.

Human resource requirements, payroll, employee training programs, and policy and procedures are all vital areas a new clinic should be prepared to research and understand. To help guide new clinics, the Urgent Care Association of America offers a Policy and Procedure Manual with sample templates,  so clinic administrators don’t have to write documentation from scratch.

Bottom line: Start with experience in both business and healthcare, have a business plan, and take time to hire the correct personnel and consultants.

 

Mistake 2:

Underestimating Build-out Time & Choosing the Wrong Open Date

While it may seem obvious, many clinics say that starting an urgent care takes advance planning (at least a year or more) and requires personnel knowledge in both business and healthcare. Often, clinic owners have expertise in one of these two areas.

To give a balanced approach, adding a partner or hiring experienced consultants can help counter areas of inexperience. A common oversight is underestimating the time it takes to open clinic doors. Using an existing building or leasing a space can cut down on construction time, but going with an existing building often limits space and lacks customized room layouts.

Consider carefully which building solution type is right for your clinic. Don’t overlook having your building set- up to comply with zoning, building, and health regulations. Ensure your building contractor has considered building codes during the layout configuration stage so your clinic passes inspection.

Having a detailed timeline will help you meet milestones and open on time. Include some flexibility in your build out schedule for unexpected setbacks, like delays in building construction, hiring employees, and obtaining contracts with payers.

When advertising, be vague about the opening date, such as saying “coming soon”, until closer to ribbon cutting time. You may want to consider a soft grand opening in the beginning, until your clinic is up and running smoothly.

It’s important to research patient volume for your clinic’s location for the chosen month of your opening — both for correct staffing amounts and revenue streams. Opening during a slow time of year can potentially bankrupt your clinic, but opening before the busy season can give your clinic a chance to streamline operations. In the beginning, hiring fewer or part-time staff and cross-training them can be a prudent move until patient volumes increase.

Bottom line: Choose your building carefully, have an opening schedule, and research the best month to open.

 

Mistake 3:

Not Choosing the Correct Location

Land and building price are often the determining factor when choosing your clinic’s location. However, the mistake of not reviewing nearby competition can be detrimental to your patient volume. Consider current clinics already in your area before choosing a spot. Existing clinics recommend being at least five miles from the  nearest competitor. Also consider ease of access via major roadways — in addition to the proximity to residential and commercial areas.

Because of the reliance on consistent walk-ins, most urgent cares are located in high traffic areas, such as on busy roads, local malls, or nearby (sometimes even inside of)  retail locations or pharmacies. Corner locations can be desirable as it allows your clinic to be seen by traffic from multiple directions. Remember to think outside your local community, too. Would you get more patients in a nearby city or town that has less healthcare options? Do your research first before picking your place.

Bottom line: Research local competition, think about traffic volume, and consider nearby communities or suburbs.

 

Mistake 4:

Not Starting Insurance Contracts & Credentialing Soon Enough

While an urgent care clinic may mainly operate with physician assistants, medical assistants, or nurse practitioners, at least one licensed physician is needed on staff.

Not only do physicians need their medical license to practice, it is  also  necessary to have insurance credentialing for physicians. Credentialing is the process of having a physician affiliated with major insurance companies in your area so your clinic can accept third-party reimbursement.

Physician credentialing allows clinics to receive steady payments; it also means physicians can see more patients, as physicians will be in-network or preferred providers for insurance companies.

Credentialing procedures vary from payer to payer, so decide which insurance companies you’ll participate with and start the process as soon as possible.

Once you’re credentialed, begin setting up contracts with the major insurance companies in your area.

Starting the contracting process ahead of time (generally six months before opening) helps ensure you have rates and discounts agreed upon before you receive patients. Front desk collections will be an important piece to your clinic’s overall reimbursement. Having a fee for service (FFS) or cash payment schedule in advance will allow the front desk staff to collect the appropriate amount before the patient is seen.

If your clinic is unsure on how to do credentialing and contracting correctly, hiring consultants with experience in this area is advisable. To ensure legal compliance, it’s also recommended that you examine state laws for both physicians and your clinic office so you meet all regulations.

Bottom line: Make sure physicians have insurance credentialing, negotiate contracts with payers well in advance, and verify you have the correct licenses to operate in your state and clinic location.

 

Mistake 5

Not Having a Billing Process Defined

For all the effort put into building a clinic, finding staff, and advertising, one important step often forgot is the clinic’s billing process. Whether you do billing and claims processing yourself or a third-party company handles it, who does your billing is a crucial decision to the success of your urgent care.

Billing controls  your  revenue  stream, so it’s important to have timely reimbursements from payers (preferably in 90 days or less). Delays from payers or frequent mistakes in claim submissions can significantly impact your bottom line.

Start-up clinics often use revenue cycle management (RCM) providers so clinic staff can focus directly on patient care. When choosing an RCM company, look for one that has experience in the urgent care industry and offers a clear package or listing of what billing services it will provide. Services like taking patient phone calls and offering transparent billing data can save your clinic time and streamline management processes.

For clinics that choose to do billing “in- house”, a best practice is to hire dedicated billers and certified coders who can review claim submissions for accuracy and ensure proof of timely filing. This will save time and reduce back-and-forth claim rejections from clearinghouses. As clinic management, having access to accounts receivable is crucial as it allows you to see outstanding accounts—and where issues are occurring.

Bottom line: Determine a billing process before opening, consider using a third- party billing company, and have access to accounting figures.

 

Mistake 6

Not Having a Website or Clear Outdoor Signage

Have a clinic name picked out and your marketing budget set? Now, how are you going to reach your patient base? The best way to advertise 24/7 is to have your own website. Think of it as a permanent advertisement and information source for your clinic, available to anyone with an Internet connection.

With patient-centric healthcare becoming the norm, your clinic needs to meet web- savvy patients where they are—online.Not only does a well-designed, user-friendly website help give your clinic credibility, it also creates a good first impression and builds an online presence.

In 2012, Manhattan Research conducted a survey of 5,210 adults who use the Internet as a health resource. Fifty-four percent of respondents said they did online research to decide what services they might need and who should provide them. On your website, your clinic can post services offered, physician info, hours, contact info, directions to your clinic, and patient resources. Adding social media channels that link back to your website can help grow visits.

Website promotions and helpful content such as a blog with health tips can also improve SEO traffic to your website. However, it’s important to maintain up- to-date copy on your blog and social media to ensure you’re providing beneficial, timely info to patients.

Registering with local online business directories and with urgent care directories is also recommended. Free tools like Google Analytics can help you track website performance.

Ensure your website is listed on all your print marketing items—like brochures, t-shirts, and fliers. If possible, add a tracking question, like “How did you hear about us?”, to your patient form.

Physical signage is a given for a new clinic to attract patients. So you’d be surprised how many clinics don’t focus on creating legible, easy-to-view signs. Signs should not only be on the front of your building but also on marquees or in highly visible places within your parking lot. Ensure text is large and in a readable font. If the name of your clinic might not include the phrase “urgent care”, this should be added so your clinic clearly communicates your offerings.

Bottom line: Create a website, offer valuable patient information online, and design clear, visible signage for your clinic.

 

Conclusion

Opening an urgent care can be a profitable venture, if you avoid common mistakes. While you can prepare to the best of your ability on your own, nothing is more valuable than speaking with those who have actually been involved in opening an urgent care. Current urgent care clinic  owners,  physicians,  or healthcare vendors who are willing to share with you are excellent resources for learning. Hiring long-term consultants, either business-related or health care- oriented, can also be beneficial for this purpose while planning. Reviewing the industry itself and becoming familiar with existing clinics, typical service offerings, vendors, and support resources is helpful —not only in your local area, but also on a national scale.

The urgent care industry offers many opportunities for growth. But with all advice considered, it’s important to remember that a clinic is a service- oriented business. Thus, the quality and speed of service offered is what helps determine a clinic’s longevity. With the right plan and team in place, you can open a successful urgent care clinic that provides patients with efficient, recommendable healthcare services.

 

References

  • Urgent Care Association of America. (2012) Source. Urgent Care Benchmarking Study
  • Manley, Marisa. (2013) Source. How to Successfully Build Out an Urgent Care Center
  •  Segall, Eli. (2013) Source. Need healthcare? You can head to a WalMart or a strip mall
  • Dolan, Pamela Lewis. (2012) Source. Patients online drill deep for information on doctors, procedures

 

Special Thanks

To the following interview participants who graciously gave expert advice to be included in this ebook:

Disclaimer: The below urgent care clinics are clients of DocuTAP and were not compensated for their contributions.

  • Lori Japp. Co-owner, CEO, and PA at Integrity Urgent Care of Colorado Springs, CO
  • Catherine Matthews. Co-owner at Lansing Urgent Care of Lansing, MI

 

 

Chapter 3

To-do Checklist for Opening an Urgent Care

Opening an urgent care is an endeavor that requires diligent upfront planning. To help you prepare, it’s recommended you have business professionals, along with medical personnel, on your team. Business professionals can help with operational and legal needs, while medical personnel will bring valuable clinical knowledge to your practice.  Both staff types are recommended for a complete approach to make sure you’re ready when your doors open.

The timeline for planning a new urgent care should be at least one year in advance of open date. Planning in advance will ensure you have all your paperwork and legal needs covered—so you’re not scrambling later with revenue problems, lack of correct documentation, or inadequately trained  staff.  The  to- do items in this checklist are what you should focus on four months prior to open date.

To ensure you are ready when you open your urgent care, review these important to-do items and check them off your list as you complete them.

 

Suggested Timeline for Opening an Urgent Care

 

120 Days

  1. Obtain an NPI (national provider identifier), taxonomy, and POS (place of service code set).
  2. Decide if you will bill as an urgent care or as a primary care facility.
  3. Identify your medical director or primary physician.
  4. Begin physician/clinic credentialing and network contracting. Understand the timeframe according to your credentialer.
  5. Set a timeline for facility construction completion.

 

90 Days

  • Identify your suppliers for your everyday incidentals:
    • Medical supplies
    • Rx DME
    • Bank
    • Credit Card
    • Check processing
    • Electric funds transfer account
    • Cleaning services
    • Lock box
    • Phone services
    • Internet provider
    • Reference lab
    • X-ray overread
  • IT support
  • Apply for your CLIA (Clinical Laboratory Improvement Amendment) number, if you plan to do lab testing. Note: CLIA certificates should be received within 30 days after the application has been processed.
  • Select your EMR/PM vendor.
  • Decide on a billing team, either in house or outsourced.

 

45 Days

Consider if you will sell retail medication:

  • Create your fee schedule (such as clinic fees, cash pay fees, insurance contract fees, and retail fees).
  • Design marketing materials (such as branding, logo, website, signage, and printed collateral).
  • Choose and purchase your hardware (such as tablets, desktops, laptops, printers, scanners, signature pads, thermal printer, and any medical devices/equipment for clinic use).
  • Consider if you will provide occupational medicine and workers’ compensation services. If so, begin these relationships with employers and consider needed protocols and required forms.
  • Note: Not all billing companies will complete occupational medicine claims.

 

30 Days

Outline your clinical procedures (such as what is completed in house verses what is sent out):

  • Create a training program. Decide how you will train your staff and providers.
  • Recommendation: All staff and providers should be on payroll one week prior to opening. The owner and site manager should be on payroll one month prior to opening.

 

15 Days

  • Begin release and customization of EMR/PM

 

7 Days

  • Obtain a certificate of occupancy (and all other pertinent facility documents) for operation.

 

0 Days

  • Go Live!

 

Vocabulary Glossary

Certificate of Occupancy

Permission to use a building: an official document showing that a building conforms to government regulations and can be occupied. This may be required to obtain a CLIA or finalize credentialing.

Credentialing

An assessment of whether the provider meets certain criteria relating to professional competence and conduct. The credentialing  process evaluates the qualifications of providers prior to inclusion in the insurance network and is completed before a practitioner is accepted for participation in the payer network. Re-credentialing is conducted after original credentialing to ensure professional qualifications remain valid and current.

CLIA (Clinical Laboratory Improvement Amendments)

Federal regulatory standards that apply to all clinical laboratory testing. For a clinic to be allowed to do any lab resulting a CLIA number is required. Upon CLIA approval, a clinic will receive a certification which indicates your classification, along with your assigned CLIA number.

Clinic Contracting

Providers operate under the payer agreement instead of having their own unique  agreement,  and  they   utilize the clinic’s Tax ID Number for billing purposes.

Network Contracting

The process of obtaining contracted rates with payers to be considered as in- network status for reimbursement.

Provider Contracting

Each provider usually has his or her own Tax ID Number and a contract that is unique to him or her.

DME (Durable Medical Equipment)

Equipment consists of crutches, splints, boots, air casts, etc. Clinics typically stock these items for retail sales, or to complement a patient visit, which results in a submission of payment to insurance.

Cash Pay Fees

A discounted rate for services provided to cash paying patients, on a seasonal basis (i.e. flu shots or sports physicals), or not-in-network insurance items.

Clinic Fees

Gross charges attached to any possible service provided at the clinic. This amount is typically higher than typical due to this amount being attached  to an insurance claim for reimbursement. Suggested  fees  can   be   determined by using a percentage of Medicare or utilizing the Wasserman file.

Fees

Amount charged the patient, in the form of a gross charge sent to insurance  or a discounted rate charged at time of visit. Fees are associated to a CPT code, HCPCS code, or Dummy (arbitrarily created) code.

Other Fees

Any other fee that will not appear within a standard CPT listing. HCPCS codes are associated to Durable Medical Equipment

(DME), Medications, and Screenings. For urgent care clinics, DME and Medications are the most popular HCPCS. Dummy codes are  those  codes  created  by   the clinic that identifies a specific procedure that is not defined by coding organizations. Fees for these items are typically a calculation determined by each clinic or an amount higher than the amount charged from your distributor.

Retail Fees

Clinics occasionally sell medical supplies not related to a specific patient visit, or medications sold instead of having the patient go to a pharmacy. This amount is typically a calculation higher than the amount charged from your distributor.

NPI (National Provider Identifier)

A unique 10-digit number used to identify providers or a health care institution. NPI designations are created and maintained by the National Plan & Provider Enumeration System (NPPES)

Occupational Medicine

Preventative or screening services used by employers.

POS (Place of Service)

A  numeric  code set  maintained  by  the Centers for Medicare & Medicaid Services (CMS) indicating where health services are being provided face-to-face. This designation is required for insurance payment.

Taxonomy Code

National specialty codes used by providers to indicate their specialty at the claim level.

Workers’ Compensation

Injury, accident, or therapy services used by employers.

 

Chapter 4

9 Things Your Next EMR Needs to Have

An efficient workflow is paramount to  an urgent care’s success. The difference between making a profit and experiencing a loss for an urgent care can be the speed of healthcare services delivered. It’s not surprising then  that  patient   workflow is one of the major  factors  considered by urgent care owners when selecting electronic medical record (EMR) software.

Unfortunately, many urgent cares are often unhappy with their EMR’s capabilities. Limitations can include poorly designed features, lack of technical support and training, and cumbersome on-screen navigation.

Thus, it’s common that EMRs  intended to improve patient care end up costing clinics time and money—and frustrating staff.

Most practices admit to not fully considering their clinic’s needs when analyzing which EMR to choose and yet the most overwhelming reason practices state for wanting to switch EMRs is due to this very fact—lack of meeting practice needs.1 As many as 17% of practices will have switched their EMRs by the end of 2013.

You undoubtedly have a running list of features you’d like to see in your next EMR. As a software vendor who’s helped hundreds of clinics switch EMRs, we consistently hear that an EMR needs to have the following features.

 

Feature 1

An Integrated Workflow

While many EMRs are advertised  to have an integrated system, the truth is that they have the ability to “interface” between systems.

A truly integrated approach means you don’t have to interface different products to get the main functionality you need  in your Practice Management (PM) and EMR.

With interfaced systems, the software has the same information in multiple locations, and requires actions to send information from one system to another. However, with an integrated system, no actions are required to push data from one system to the other; integrated software uses one source of data.

For example, with an integrated system, if you enter a  patient’s  demographics in the registration portion of the PM,  this info should auto-populate (in real- time) into the EMR patient  chart  and the patient bill. This real-time updating across all segments of the software means higher productivity with less data entry, less chance for human error, and fewer opportunities to miss charges.

With a holistic, integrated system, there’s no reason to be double entering info or waiting for that data to be pushed into another system.

Tip: Look for an EMR vendor that offers an integrated PM and/or billing services as a part of their offerings. Also ensure you can easily customize workflow within the EMR to fit your clinic’s overall workflow management system.

 

Feature 2

Affordable Interfacing

No EMR is an island, even an integrated EMR. As a center storage area for patient data, an EMR needs to be able to transfer information both in and out of it. EMRs should offer you the ability to interface with outside labs, radiology centers, and pharmacies for ePrescribing. Most interfaces are accomplished  through the Health Level Seven (HL7) standard language.

Interfacing should have two-way data sharing, effectively swapping information back and forth, so when updates are done in one system—a patient address change for example—the change is also sent and recorded in the interfaced system. This joining of digital hands to accomplish workflow tasks  like  x-rays or lab work is essential to streamline an urgent care clinic’s abilities.

When evaluating EMR vendors,  check to see if they have completed the types of interfaces your urgent care will require. The most common example of an interface is with a lab, such as Quest or LabCorp. If the EMR vendor has done interfaces like these before, they should affordably and quickly be able to create a similar interface for you too.

Tip: Ask EMR vendors what their interface capabilities are — and if established third-party vendors are already in place.

 

Feature 3

An Internal Messaging System

Communication is essential for a smooth workflow. Front desk staff must be able to talk to nurses, nurses to providers, and providers to lab techs. That’s a lot  of information to be transmitted for one patient visit, let alone an entire day at an urgent care. Instead of using flags and sticky notes, look for an EMR that includes a messaging  system  within the software.

An EMR should allow you to send instant messages and attach scanned notes— such as those attached to a specific patient record. Conversations in an email system aren’t HIPAA compliant if they contain patient information. Face-to- face conversations aren’t traceable—and often forgotten. In an urgent care setting, saying something twice adds time to each patient visit, and lost procedures result in missed revenue.

Tip: See if the EMRs on your short list have an internal messaging system— and if you can tie communications  to specific action. Ensure there is a tracking method (log record) or time- stamp option for communication audits. Management should have easy access to past staff conversations.

 

Feature 4

A Secure, Cloud-based Model

If you’ve installed software, you know how much of a headache it can be. EMR vendors—and many software vendors in general—are moving to a purely cloud- based hosted environment. Rather than installing software directly on individual desktops or on a client’s server, an EMR vendor with a cloud-based model allows direct access via an internet connection.

This means no matter the device used, or where a provider may be, universal EMR access is available 24/7 online. With built- in auditing, you can also track user access and documentation changes to ensure compliance.

Implementation is significantly streamlined using a cloud-based EMR application— with access available virtually in minutes— perfect for an urgent care which can’t afford costly interruptions when switching EMRs.

Without high upfront technology costs, an urgent care can install a cloud-based EMR more affordably by paying a Software as a Service (SaaS) fee to access the software. IT requirements for testing security and automatic software updates are done by the EMR vendor. With a cloud-based EMR, data is frequently backed up, the system is always up-to-date, interfaces are more reliable, and the environment is more scalable.

Tip: Reduce cost and time of EMR implementation by considering a cloud- based EMR. Make sure EMRs perform well on multiple devices and web browsers (ask for a recommended  list of hardware and internet requirements). Also, ensure data storage is secure and HIPAA compliant.

 

Feature 5

Training and Technical Support

Software is a tool, not a final solution in itself. To make an EMR successful, those who use it—both administrative and clinical staff—must be properly trained.

When considering EMRs, ask vendors about their training programs. Do they have trainers on staff that will help get your clinic personnel up to speed during implementation? And is training included or an additional cost? What about on- going training?

Training programs, whether online or on location, will ensure your clinic stays up to date on software functionality. Access to online training helps save your clinic employees valuable time with training new personnel. This is especially helpful for urgent care clinics which can have frequent employee turnover, along with a high percentage of part-time staff and temporary personnel.

Of course, personalized training will be the most effective for EMR mastery, so check to see if the EMR vendor has separate, role-based training for registration, triage, and billing staff. Support doesn’t stop with implementation.

You’ll need on-going help to answer questions as they come up after training. Make sure your EMR vendor has its own technical support team (not contracted personnel) to help you out—and see if extended hours are available. Issues tend to happen during non-business hours, so see if they have the staff to handle after- hours troubleshooting.

Tip: See if training and support is offered as part of the EMR pricing or if it costs you more. Online training programs will save you valuable time with new hires. Reliable, committed EMR vendors will offer comprehensive, role-based training and on-going tech support.

 

Feature 6

Customization And Easy-To-Use Navigation

Most software is made to be  generic so it can be useful for a wide range of specialties.

However, the best software providers offer personalization options; EMRs should be no exception. Customization can improve chart completion rates and overall revenue. You’ll also notice higher employee satisfaction and engagement when customization is possible.

A flexible EMR—even a practice-specific model—should allow you to change documentation processes to meet your needs. You should be able to create complaint-specific templates  (and adjoining symptom attributes) based on each provider or clinic location’s desire. Staff reminders, free text fields, occupational medicine protocols, and reports should also be modifiable. Customization should be simple— without complex programming required.

An EMR needs easy navigation. While many EMRs utilize cumbersome drop- down lists and window-in-window navigation, an easy-to-use EMR should allow you to document in the least amount of steps possible. As with a paper chart, an EMR should let various staff document an encounter in any order they prefer—and have an intuitive flow of documentation steps. To accommodate the needs of real-life urgent care workflow, your EMR should also allow multiple people to document in a chart at the same time. Navigation support like single-click selections, search queries, and favorites lists help providers from having to re-enter info.

Tip: Pick an EMR that fits you, not  one that tries to make you fit within it. Ask up front about customization options so you know what can be changed within the software. Review what modifications will be  needed for optimal EMR use with your staff. Create an ideal flow beforehand—and see if the EMR can do it.

 

Feature 7

Patient-focused Functionality

A helpful EMR has features for patient interaction. A tablet-based EMR that allows for patient education at the same time as charting can be a vast improvement in delivery of care. Showing examples on a tablet can help the patient be more involved. In addition, an EMR can offer other interactive tools to help patients take charge of their health choices and payment options.

For example, an EMR should have a patient portal where a patient can login via the internet to view secure, private messages and documents from their doctor, such as lab results. A clinic can use the patient portal to  transfer  info to a patient’s primary physician, in a HIPAA-compliant environment. Another convenient EMR feature is online check- in, so patients can complete registration before they arrive at the clinic. Software that offers patients the ability to pay online or setup payment plans can vastly improve the patient experience—and your clinic’s collection time.

A helpful EMR also should offer discharge instructions and modifiable educational handouts relevant to the patient visit.

Tip: Engage patients with an EMR that allows for interaction. Collaborate and communicate back and forth with patients with an EMR that has a secure patient portal. Also consider using a tablet-based EMR that helps improve patient-doctor interaction.

 

Feature 8

Designed with a Dedicated Focus

Each practice has its own intricacies. A chiropractor office’s workflow is different than a pediatric clinic’s. Physical therapy is different than cardiology—and so forth. To  ensure your  clinic  is  using the best EMR,  choose  one  that  has the same focus as you do. This cuts down on modifying an EMR to fit your clinic workflow, since presumably the software is already aligned to typical patient scenarios you’ll be facing.

Trying to fit within a one-size-fits-all EMR will only cause frustration with generic documentation steps and templates that don’t fit your practice’s flow. Larger EMR vendors often focus on servicing hospitals and general practice clients— and don’t make EMRs to fit specialized medicine—nor are they focused on speed of documentation.

Tip: Pick an EMR that’s made specifically for your practice, even if it’s not as mainstream as  other larger EMR vendors. Also, beware of free generic EMRs who promise affordability but give you limited options—and charge for individual actions within the software.

 

Feature 9

Built-In Auditing And Reporting

Accountability is crucial. It’s wise to pick an EMR that can track users’ actions within the system, for legal reasons and employee performance reviews.

See if the EMRs you are considering keep an  easily  viewable  audit   log with time stamps, actions completed, communication records, and items documented on the patient’s record. Audit logs will also help prove you’re meeting measures for Meaningful Use attestation—and show critical data if you’re reviewed for compliance.

An EMR with reporting functionality should give you a bird’s eye view of what’s going on in each of your clinic locations. Data should include patient wait times, door-to-door times, patients seen per hour (and per provider), payment information, and so forth. While productivity reports can point out staffing needs, financial reports can help administration know where revenue gaps are occurring.

Make sure reports have a “push button” option, and don’t require you to know programming or ask the EMR vendor to run the report.

Tip: Get an EMR with built-in audit logs and reports. You’ll be  working  blind if your EMR doesn’t give you these critical numbers—which help you know how your urgent care is doing. Some EMRs have better reporting functionality than others, so see if the EMR’s abilities match what reports you’ll want.

 

Conclusion

It can be a daunting  task  to  choose  the right EMR for your ur-gent care— especially with so many EMRs to choose from. The success of  your  urgent  care is hindered or helped vastly by  your EMR vendor. If you’re switching from your current EMR, you already know the limitations some EMRs can have. Take your time and test each EMR option against the features you need it to have.

The perfect software, including a perfect EMR, doesn’t exist. But there  is  an EMR that will work best for your clinic’s situation.

An EMR review committee, composed  of various roles and perspectives, can help your clinic choose a new EMR. Most importantly, don’t settle for an EMR that will put you in the position of having to switch again. A good EMR will make your urgent care run smoothly and grow with your changing needs. Only you can determine which EMR that is.

 

References

  • Hall, Susan D. (2013) Source. Will 2013 be the ‘year of the great EHR vendor switch’?
  • McCann, Erin. (2013) Source. EHR users unhappy, many switching
  • Webster, Charles (2003) Source. Electronic Medical Record Workflow Management: The Workflow of Workflow.
  • Bennett, Kevin J. and Steen, Christian. (2010Source. Electronic Medical Record Customization and the Impact upon Chart Completion Rates.

 

Chapter 5

4 Tips for Switching from Paper to Electronic Medical Records

Change requires a willingness to challenge the status quo for the sake of improvement. The past several decades, the urgent care industry itself was born from this exact notion—the need for patients to have better, immediate access to care. Now, urgent cares are feeling the transition of change as the industry switches from the long-held medical standard of paper charting to electronic medical recording. Most urgent cares have adopted an electronic medical record (EMR) software in the past few years—or a hybrid version of an EMR combined with paper charting.

According to the Urgent Care Association of America, 79.9% of centers in 2012 were using technology in the areas of medical records, e-prescribing, protocol and lab management, and clinical guidelines.

A driving factor for urgent cares’ adoption of EMRs is Meaningful Use incentive programs, promoted by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

This switch in patient data recording has challenged providers into a new way of thinking—how to document without  paper.  This  digital  revolution is transforming traditional healthcare processes and re-inventing them in a new medium. EMRs present new advantages unavailable before, such as real-time data and safety alerts. However, EMRs also pose the need to bridge the world of the past with that of the future.

How does an urgent care go from paper to electronic in a smooth manner? The switch itself is as much mental acceptance as it is learning a new physical routine.

As an EMR vendor, we know the most successful transitions take place with clinics that focus on the improvements— and fully  commit  to  change.  Here  are a few practical tips to help your urgent care make the switch from paper to an EMR.

 

Tip 1

Plan ahead and involve staff from all roles

Planning makes everything smoother. Once your urgent care has decided to switch, it’s important to lay out a plan to transfer your current workflow to a digital format. Look at your workflow and envision what that will look like without paper. Remove every piece of the paper in your process—from registration through billing—and see what  that  requires your staff to do and re-learn. Scanners, tablets, and computers will become your staff’s go-to tools.

During the beginning stages of switching, include staff from each department of your clinic in the process of converting— so each role has a voice and can lead excitement for the change. Designate super users in the EMR so department leaders can champion changes in the EMR that better the whole workflow. Train staff to be mentally ready to remove the paper crutch from daily tasks. Envision the computer or tablet as the new clipboard.

Discuss with staff the new needs for communicationthatan EMRwillpresent. Rather than paper changes triggering workflow tasks, staff need to look for updates within the software to know the next steps to take in the patient visit. Training on digital documentation, per staff role, also ensures procedures are followed for HIPAA compliance— and helps visits be coded and billed correctly.

Consider the implications using an EMR will have on your billing team, as they’re likely not using a fully paper system.

Ensure the EMR and/or practice management data will be transferred to your billers smoothly so reimbursements and revenue stays on track.

 

Tip 2

Set a transition period (and stick to it)

Transitions require preparation. But even the best planning might not catch  all the details you might have overlooked when switching to an EMR. Experiencing lessons through trial and  error  might be the way you have to learn—if you don’t have guidance from others who’ve already made the switch. Be patient with the learning process and stay the course by setting a time frame for the transition period.

While the transition period may differ per practice, it’s a good rule  of  thumb to make the transition time a firm date range. In our experience, we know the switch can be successful in 30 days.

While you may be more comfortable with a longer time period, the longer you extend the time—the more your staff  will rely on paper, rather than learning the new EMR. Stick to your time period, and work through the learning process together.

Your EMR vendor can help with a lot of the legwork by configuring data into the EMR, such as payer info, fee schedules, and pharmacy lists. Take advantage of your EMR vendor’s configuration services so you don’t have to manually enter data into your EMR. Reframe how your clinic views paper by seeing it as only a last resort if the EMR, or your internet, goes offline.

 

Tip 3

Decide what to do with paper files

Now that you’ve gone digital, what do you do with the old paper charts? And what do you include in your new EMR? Urgent cares by nature do not have consistent repeat visits like primary care providers do. Therefore, patient demographics and records fall out of date quickly and are less relevant for episodic care. DocuTAP recommends not entering old patient info if you have less than 60% repeat visits. However, your urgent care should scan in relevant files for reference—and have them easily accessible within a digital folder.

Generally, the last two years of charts should be kept on hand. According to the Centers for Medicare and Medicaid Services, HIPAA law  requires  archives of medical records for patients for a minimum of six years from the anniversary date of the last treatment. You’ll be required to keep workers’ compensation records for even longer.

Record archives maybe kept on-site or off-site, carefully consider which files you’ll want your staff to have quicker access to. Put a plan in place for destroying paper files when appropriate. This should be in a reasonable time frame after records are no longer needed and all vital data has been saved within the EMR. Adhere to state laws for proper record retention formats, and clearly communicate how and when records will be destroyed to your entire staff.

 

Tip 4

Adjust EMR workflow as needed

New processes often need refinement. Once you’ve switched from paper to your EMR, take a step back and look at your digital workflow. Are templates in the EMR working to their max potential for your providers? Is staff doing additional work that the EMR could do for them? Don’t be afraid to tweak workflow as you begin using your EMR.

Mentally prepare your staff for slight changes to workflow for the first few months. Don’t feel bound to your previous paper workflow—or the workflow you first create in your EMR. View workflow creation as something you can alter and improve as  providers’  needs  change or as services are added to your urgent care. Document your workflow so your staff can visualize the complete patient visit using the EMR. You may decide to add or remove interfaces in the EMR as well; keep staff up to date on expected changes and train them on new steps as they are added.

 

Conclusion

While using an EMR is still in its relative infancy in the medical world, urgent cares can move forward to this new standard of patient care by learning from others’ EMR transitions. Some staff members may be more willing to adapt to an EMR than others, so be prepared to help them mentally reframe their idea of charting. Be mindful that staff will adapt to the EMR at different rates—and in different ways. Keeping positive attitudes about the improvements that will come from the switch to an EMR will help during the transition time.

Training is the best preparation tool—and pairing those who are experienced with technology with those who are not can help your staff feel more comfortable. As your staff uses the EMR, remember to promote the patient-provider relationship using the new technology. While change can be daunting, remember the benefits of EMRs far outweigh the challenge of transitioning. Embracing change is the most important step your urgent care can take toward improving healthcare for patients.

 

References

  • Urgent Care Association of America. (2012) Source. Urgent Care Benchmarking Study
  • Centers for Medicare and Medicaid. (2013) Source. MLN Matters

 

Summary

Partner with DocuTAP to accelerate your urgent care startup process. Learn more.

 

TAKE THE NEXT STEP

Faster charting.
More revenue.
Shorter wait times.

Because we’re solely focused on urgent care, we eat and breathe efficiency. We think about software solutions the way you think about on-demand care. It should begin with a goal, remove obstacles, and make life better.