Q. What is an acceptable income per patient visit for an urgent care clinic? A. The recent benchmarking survey completed by the Urgent Care Association (UCA) found that the average urgent care center collects $110 per patient. However, the “acceptable” net revenue per patient visit varies widely from center to center and state to state. It fluctuates based on many variables: Existing contracts from payors State (e.g., payors in California and Arizona typically have lower …
Read MoreHIPAA Hypos and Privacy Paradigms
John Shufeldt, MD, JD, MBA, FACEP One of the moderately entertaining aspects of law school was answering hypotheticals (“hypos”) in class. They would go something like this: “Mr. Shufeldt, suppose that an off-duty police officer witnesses what she believes is an aggravated assault. Without identifying herself as a police officer, she disarms the assailant and, while doing so, the gun discharges and the bullet strikes and kills a bystander, who happens to be an emancipated …
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A Return on Investment Approach to Urgent Care Marketing
Urgent message: In a volume-driven business like urgent care, marketing should be viewed as an investment with a financial return that can be measured in order to allocate the center’s advertising dollars among the tactics most effective in generating patient revenue. ALAN A. AYERS, MBA, MAcc Practice Velocity Success in the “business” of urgent care boils down to one factor: “feet through the door.” That’s because once a center’s fixed costs are covered, each additional …
Read MoreHIPAA for Health Care Heroes
John Shufeldt, MD, JD, MBA, FACEP You are working in an urgent care center when a mother shows up with her 18-year-old daughter, who is “mildly developmentally delayed,” per her mom. The daughter turned 18 yesterday and the mother is concerned that she may have gotten a little “too wild” while celebrating her birthday at a friend’s house and she would like her tested for drugs and STDs. The daughter appears to understand what is …
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The Role of Urgent Care in an Integrated Care Delivery System: Insights from Kaiser Permanente
Urgent message: As the Affordable Care Act encourages greater integration of health insurers, hospitals, and physicians, urgent care will play an important role in increasing patient access, improving clinical outcomes and reducing health care costs. ALAN A. AYERS, MBA, MAcc, Experity Hospitals across the country are partnering with doctors and health insurers—linked by an electronic health record (EHR)—to form accountable care organizations (ACOs) as a way to control health care expenditures by coordinating patient care. …
Read MoreDeveloping Data: November, 2014
These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care). In …
Read MoreWorkers’ Compensation Visits, Cerumen Removal
Q. I have a question on coding Workers’ Compensation claims. I work in a hospital system and hospital coders oversee our charts. I feel they under code for the work we do. They are afraid of audits and refusal to pay. Typically, they will return the chart so that I can document my time and then they will charge for the time spent instead of the documentation. I’m told there are no “bullet points” or …
Read MoreNew CMS Modifiers, Urgent Care Codes, Supply Codes
Q. What will be the impact of use of the new HCPCS modifiers related to modifier -59 beginning January 1, 2015? A. CMS recently announced the creation of four new HCPCS modifiers that will further refine modifier -59, “Distinct procedural service.” According to CMS, modifier -59 is the most widely used modifier, and it is being used inappropriately in most cases. Adding modifier -59 indicates that a code represents a service that is separate and …
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Head in the Game: Cultivating the Mindset of a Successful Urgent Care Operator
Urgent message: Just because you build it, patients won’t necessarily come. As entrepreneurs, successful urgent care center owners must market their services to the community, innovate with new services to fill excess capacity, and create positive patient experiences that spur repeat visits and positive word-of-mouth. ALAN A. AYERS, MBA, MAcc Practice Velocity One needn’t look further than the 20,000+ physicians already practicing in urgent care centers nationwide to grasp just how attractive this business model …
Read MoreDeveloping Data: October, 2014
These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care).
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