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 has become. Consumers fed up with lengthy emergency room waits—for non-emergencies, no less—and an ongoing lack of timely primary care access have fueled demand for the convenient, efficient, and affordable style of health care that’s become urgent care’s brand. In additional, the promise of career autonomy coupled with financial independence make venturing into urgent care an often irresistible lure for many of the former family and emergency medicine physicians who dominate the field.

That said, it’s the “inner entrepreneur” stirring within many physicians that may actually be the strongest motivator to strike out and head up (or partner in) an urgent care venture. A physician can run the show without, say, a hospital administrator dictating how he/she practices medicine. As an added bonus, bankers, private equity firms, and the Small Business Administration have stepped up with the capital to get centers up and running. In short, it’s your business, potential earnings are substantial, and expansion is a possibility, should things go well. With the Affordable Care Act ushering in approximately 30 million new health coverage enrollees over the next few years—most without regular providers—urgent care is brimming with potential.

If You Build It, Will They Simply Come?
A bit of charming but old-school advice to medical graduates has been “hang your shingle and patients will find you”—meaning that when a practice opens its doors, its patients will naturally follow. While perhaps apropos in specialties facing critical shortages, as it relates to urgent care, nothing could be further from the truth. In fact, the entire “build it and they will come” concept is a certain plan for failure in businesses possessing a strong retail element. Hence, urgent care owner/operators have to accept—embrace, actually—that they’re squarely in the business of consumer-driven medicine.

For example, it used to be that clinical aptitude was by far the most important factor in earning revenue. Physicians who focused solely on delivering strong clinical outcomes rarely wanted for referrals. Urgent care, by contrast, is decidedly retail in that it views patients as essentially customers who choose to use the center versus other options. These “customers” have to be courted not only through targeted marketing and advertising, but sufficiently pleased with the overall service delivery—including the expected great clinical outcome—that they’ll recommend the center to others and return whenever future needs arise.

Granted, most of these “retail,” “marketing,” and “patient-ascustomer” concepts run contrary to time-honored precepts ingrained by a medical school education, but they’re nonetheless critical for an urgent care center to thrive. Fail to embrace and assimilate this entirely new paradigm of volume-driven, “entrepreneurial” medicine, and the financial independence you so doggedly sought could end in bankruptcy. You simply can’t sit back and wait for patients to spontaneously appear in your lobby. Opening and ramping up a center can require between $500,000 and $1 million in capital so the financial stakes are high.

You, as an urgent care physician/owner, likely accustomed to a background focused on the clinical side of medicine, must now become comfortable wearing two hats: That of a skilled and dedicated health care provider, and an enterprising entrepreneur with the vision, strategy, and desire to lead and energize a business and care team. Quite simply, it’s time to get your head in the urgent care game.

Think and Act Like an Entrepreneur
Raise the Visibility of Your Center in the Community
Due to its focus on high-visibility locations, extended operating hours, and customer service orientation, urgent care is often described as “retail medicine.” Thus, the goal is to drive consumers to your center in the same manner that retailers drive customers to their stores. Every center is a brand, and as an urgent care entrepreneur, one of your tasks is to find creative and cost-effective ways to market your brand to the surrounding community. Here are examples of common, low-cost marketing tactics proven very effective at getting the word out about your center:

  • Erect a tent and do drive-thru flu shots in the parking lot. This is a great way to get out in front of the eyes and ears of your community during flu season, particularly if your center is located in a retail strip with lots of vehicle traffic. Vaccinations only take 1 to 2 minutes to complete, and customers don’t ever have to leave their vehicle. You simply have the patient sign a consent form, and then administer the shot (typically in the arm or shoulder) right through the open car window. The entire process typically saves the customer 15 to 20 minutes that they’d otherwise have to actually spend inside the clinic for the same service.
  • Contact the local media for an interview when a hot medical topic is in the news. Print and TV reporters want “experts” to interview whenever a hot health topic is in the news. Let the local press know you’re available for interviews when a flu outbreak, obesity study, diabetes awareness campaign, etc. is making headlines. When giving an interview, be sure to request that the name of your urgent care center is either mentioned in the interview or displayed on screen. Later, you’ll be astounded by how many people remember you or your center from the interview, and you’ll be positioned as a community “health expert”—and primed for an increase in patient visits.
  • Participate in community events. By making your brand a ubiquitous presence around town, your center will instantly spring to mind when folks are sick but can’t see their personal doctor right away. Especially at events that allow tables, tents, or booth setups, bring signage, literature, refrigerator magnets, and treats to give away. To engage event patrons even further, employ a prize wheel or some other fun game with sights and sounds that attract interest and attention.

Market Occupational Medicine Services to Employers
Occupational medicine entails the treatment of work-related injuries; pre-employment, fitness-for-duty and compliance physicals; and substance abuse screening. Each occupational medicine contract an urgent care center can nail down is worth its weight in gold, yet many centers focus strictly on walk-in patients. This is definitely a mistake to avoid, considering how potent a revenue source the local workforce can be for your clinic:

  • Increased patient volume. The most obvious benefit to handling a company’s occupational medicine is the resulting patient influx it’ll provide. Companies who require ongoing medical services such as pre- and post-offer exams, drug screens, and Workers’ Compensation injury care can provide a steady stream of patients. Workers’ Compensation often reimburses at a premium to group health contracts while physicals and drug screens are a “cash” business. With enough contracts, occupational medicine can account for a significant portion of your total patient revenue.
  • Free marketing. Employers are seeking ways to reduce employee health care expenditures and absenteeism so human resource departments can be invaluable when it comes to instilling your brand in the mind of a company’s employees, even when the need to see a physician isn’t work-related. For instance, when a sick employee informs the Human Resources (HR) staff that she’s feeling ill, but can’t get an appointment with her normal doctor that day, where is HR most likely to recommend she go for immediate care? The urgent care clinic that handles their occupational medicine. Also, it makes perfect sense that employees who first visit your urgent care for a company drug test will later think of your clinic when the kids or they come down with the flu, cut a finger, etc.

Co-Locate High-Margin Ancillary Services
Co-locating high-margin ancillary services is a great way for any practice to prop up flagging revenues and boost profits, not to mention improving overall patient care, utilizing excess capacity, flattening the ebb and flow of walk-in traffic, and diversifying the center’s revenue base. You’ll have to do your due diligence beforehand in regards to the feasibility of offering certain services, such as those listed in Table 1, which collectively can boost profit margins by 50% to 70%.

Table 1. Common Ancillary Services in Urgent Care
Ancillary ServiceDescriptionBenefit
Point-of-care Medication DispensingBecause urgent care physicians typically write many prescriptions for the same medications, dispensing directly from the clinic can enhance patient visit revenue.Patients appreciate the convenience of not having to make a separate trip to the pharmacy. Clinical outcomes improve as patients are more likely to adhere to their treatment plan when they start dosing immediately and leave the clinic with medication in hand.
ImagingUrgent care can aggregate demand for imaging in a community by taking referrals from other providers. Ultrasound, MRI, x-ray, and CT scan equipment can be leased rather than purchased outright if the cost lies outside the clinic budget.Timely and accurate diagnoses prevent delayed medical intervention and allow physicians to prescribe the proper course of treatment sooner.
Physical Therapy and RehabilitationWork with patients in developing a treatment regimen designed to maintain, restore, or improve physical abilities.Same-day referral to therapy can improve clinical outcomes in musculoskeletal cases. Especially for clinics that already do occupational medicine, this service works well in conjunction with rehabilitating Workers’ Compensation employees/patients.
Weight Loss and Diabetes ManagementCounseling, diet and nutrition/menu planning, and personalized treatment plans for diabetic and overweight/obese patients.Low start-up cost source of additional revenue that leads diabetic patients to consider/adopt the clinic as their “one stop shop” for additional health services.
Cosmetic and Anti-Aging ServicesSkin rejuvenation, aesthetic laser treatments, laser hair removal, and/or cosmetic skin injections.High-margin services that also work to position the clinic as a “one-stop shop” and utilize center capacity during off peak times.

This list is not intended to be exhaustive, but rather, to highlight the many proven ways that enterprising urgent care physicians are adding additional revenue streams to their practices. Simply put, the line between business and medicine is blurring, and urgent care owner/operators must be both health care providers and savvy entrepreneurs forever on the lookout for opportunities to maximize revenue.

Lead and Energize Your Staff
You may have undergone rigorous medical training and aced your boards, but all that clinical know-how won’t exactly come in handy when you are faced with the task of managing a full urgent care center staff of administrative and health care professionals, all with diverse personalities and skill sets. In fact, the more hierarchical and structured a physician’s former work environment (especially true of Emergency Room physicians), the more difficulty they seem to have in managing a team in the type of social atmosphere a successful urgent care center demands.

The good news is that, regardless of your clinical background, you can indeed implement several simple strategies that go a long way towards creating a true “community” in your practice—one where the clinic’s entire staff is aligned with the ultimate goal of stellar patient care and clinic success. Several well-known, proven methods for workplace team-building are described in Table 2.

Table 2. Methods for Team-Building in an Urgent Care Center
Cross Training – Cross training staff to perform each other’s job functions has many benefits:

  • Allows the clinic to run smoothly, and balances out uneven workflows when employees are absent because cross-trained team members can help pick up the slack. For example, a nurse can answer phone calls, or a billing employee can greet patients and take basic vitals when the clinic is super busy.
  • Provides variety in the clinic staff’s daily routine and alleviates boredom, which boosts overall morale.
  • Fosters teamwork, empathy, communication, and camaraderie between departments, since staff members gain a better understanding and appreciation of each other’s role in clinic operations. It also places an emphasis on staff interrelationships; neglected front-desk collections result in extra work for billing, overbooking by the scheduler strains the nursing staff and the front desk with patient overflow, etc.

Rewards/Incentives – Let your clinic staff know the importance of attaining specific performance goals/metrics, and offer rewards/incentives for individuals, departments, and even the clinic as whole. Some examples of achieved benchmarks you can reward include:

  • Increased number of patients seen per week
  • Lowered patient wait times in exam rooms, waiting areas, check in times, etc.
  • Increased number of outstanding collections accounts brought current in a given time period
  • Perfect attendance

Implementing such a reward system serves to energize the entire care team, and keeps everyone focused on the clinic’s big-picture goals. Furthermore, rewards don’t necessarily have to be paid in cash. Paid time off, event tickets, gift cards, electronics, and spa/salon outings are also excellent options for both front-line staff and mid-level providers who show a consistent dedication to patient care and to the clinic reaching its benchmarks.
 
Regular Staff Meetings – Regular staff meetings are often neglected in busy centers focused on serving heavy patient loads. However, they’re important for building a sense of community, discovering below-the-radar issues, and reinforcing clinic goals. Key here is not simply turning these meetings into boring lecture sessions, but instead allowing a relaxed and open setting where problems, concerns, and issues can be addressed in an attentive and nonjudgmental forum. Order pizzas or bring in donuts, let front-line staff report their tales from the front line, and require each meeting attendee to present one or two ideas that would help their department (or the clinic as a whole) run better. Also ensure that the meeting coordinator adheres to the oft-quoted 80/20 rule: 20% of the meeting time devoted to past issues, while the remaining 80% is dedicated to present and future concerns.
 
Management Open-Door Policy – The importance of having and maintaining an open-door policy really can’t be overstated. When your staff believes that if they come to you with a problem or concern you’ll work diligently toward a resolution, employee loyalty increases markedly. Care team members will feel that management respects and cares about them, which in turn invests them more fully in the clinic’s success. Letting staff know you’re always available also helps foster communication that keeps you in the loop on happenings on the front line. You’ll have your fingers on the “pulse” of the clinic, so to speak, which is crucial in a fast-paced environment like an urgent care center.

Be Vigilant Towards Broken Business Processes
A large part of running a successful urgent care center is ensuring that your patients/customers are so happy with your service delivery that they tell their friends and family good things about their experiences. The economic effect of this positive word-of-mouth is real and quantifiable, and one of the main fiscal drivers of the urgent care business model. On the other hand, patients experiencing service failure—caused by excessively long waits, inaccurate diagnoses, payor/billing issues, wrong prescriptions, and poor overall service—become angry and disgruntled “avengers” who can seriously damage a practice’s reputation (and revenue) in the absence of a swift and decisive “service recovery.” At the root of this service failure are broken, outdated, and dysfunctional business processes, the foundation upon which the entirety of many centers’ operational and clinical activities are built. What’s more, the economic damage of service failure invariably trickles down to your staff, as demoralized front-line employees bearing the brunt of relentless customer complaints buckle under the weight of excess emotional labor. Low morale, chronic absenteeism, and terminations are the inevitable and unfortunate end result, which does its own, separate damage to a clinic’s bottom line.
As the urgent care physician/owner, you must remain ever-vigilant in rooting out, identifying, and repairing every broken or inefficient process you or your staff uncover, no matter the financial costs. You’re in this business to make money, and while you may believe you’re saving money by ignoring dysfunctional work processes, there’s an abundance of data available that prove conclusively just how staggering the economic damage associated with ongoing service failures (directly caused by these process failures) can be.1 In fact, the eventual direct and indirect losses will far outweigh the savings realized by forgoing the necessary upgrades/fixes. In sum, if you “bite the bullet” now and allocate capital towards fixing/upgrading broken processes, the resulting influx of clinic revenue that will indirectly result will far exceed the capital outlay, and leave you, your staff, and your “customers” grateful that you did.

Roll Out the Red Carpet
On the strength of your marketing and advertising efforts, positive word-of-mouth, occupational medicine contracts, or just plain happenstance, patients/customers have shown up at your urgent care center. Now is the time to roll out the proverbial red carpet and deliver an outstanding service experience they won’t soon forget. The opposite of an aforementioned “avenger” are happy “evangelists”—highly coveted and powerful marketing allies who’ll help spread the “gospel” of your wonderful center, provided that your service delivery is top-notch.
You most definitely want your patients to become your evangelists, and giving them the royal treatment is the way to make it happen. Table 3 provides several effective tips and strategies for making a lasting, positive impression on the visitors to your center.

Table 3. Making a Lasting, Positive Impression on Urgent Care Patients
Be extremely time-conscious – Long waits are by far the top complaint of patients/customers across the entire health care spectrum. When patients visit your center, it’s your job to let them know you value every second of their time, and you’re working to get them in and out (with a correct diagnosis and great clinical outcome, of course) as soon as possible. Assign someone on the clinic staff to monitor how long each patient has been in the clinic, and have someone address them at regular time intervals (i.e., provide a status update every 10 minutes). You can also offer patients the following little perks if the clinic is busy and wait times begin to creep up:

  • If the center is in a strip mall and patients feel up to it, offer to let them window-shop next door and promise to send a text message as soon as a clinician become available.
  • Have patients go next door and grab complimentary coffee and donuts as a “thank you” for waiting.

 
Provide amenities galore – Your patients are already uncomfortable and anxious due to sickness or injury. Make their wait as comfortable as possible by providing amenities in the lobby area, and they’ll definitely appreciate it. A few common waiting area amenities include:

  • Complimentary Wi-Fi access
  • Complimentary liquid refreshment (coffee, hot cocoa, bottled water)
  • Complimentary snacks (e.g., granola bars)
  • Flat-screen TV in the waiting area
  • Play area for children (tables, toys, coloring books, etc.)

 
Personalized service – Let your patients/customers know that they’re welcomed guests at your center, and that you intend to make their visit as satisfying as possible. A couple inventive ways that you can pour on the personal touch are as follows:

  • Wear a name tag that clearly expresses your customer service orientation such as, “At your service.”
  • For patients who express concerns with billing, medications, doses, or are anxious about some other issue, give them your personal cell phone number and tell them to call you directly if there’s a problem, and you’ll work through it (an NP, PA, or other physician extender can rotate on who takes after-hours calls). Of course you can’t do this with every patient for obvious reasons, but for the few who require that extra reassurance, you’ll endear your clinic to them forever.

 
Timely follow-ups – Make timely patient follow-ups a clinic priority. Patients will appreciate that you’re closely monitoring the status of their condition (even after they’ve left the clinic), confirming that the prescribed medication was accurate and effective, and ensuring that they’ve received a successful clinical outcome.
 
Service Recovery – Proactively seek out patient complaints and concerns through direct inquiry, surveys, suggestion boxes, and follow-up phone calls. Studies show that many patients don’t complain about service failures because they don’t believe the issues will be remedied,1 so you can imagine how pleasantly surprised they’ll be when the clinic actually invites them to point out service delivery shortcomings. These and similar gestures have the powerful effect of letting patients know that their opinion is valued, and that their satisfaction is foremost in the minds of center staff.

 
Conclusion
Running a successful and profitable urgent care center requires fully embracing the very entrepreneurial spirit that leads many physicians to urgent care in the first place. Although you most likely didn’t learn business and marketing concepts while pursuing your medical degree, you must still cultivate the mindset of an enterprising entrepreneur willing to capture and retain patients through concerted marketing and a dedicated customer service philosophy. Urgent care is indeed retail medicine, patients are customers, and they come to your clinic with expectations unlike those of a traditional medical patient; they’re instead discerning consumers with choices as to who they’ll patronize for their urgent medical needs. Learn to compete for customer business and resolve to transform your clinic into the best in your community. Go to association conferences, attend local management seminars, read literature on entrepreneurship and marketing, and network with professionals who already run thriving clinics for valuable insights and knowledge on how it’s really done.
In addition to learning the ins and outs of customer retention, you must also learn how to successfully manage, lead, and motivate a staff of health care professionals to work as a collective toward patient care and clinic success. Create a community where your entire staff is a valued and essential member of the care team, and reward those who go above and beyond in the name of outstanding service delivery. Provide an open door policy for team members to address concerns, and have regular meetings so that staff can vent frustrations, share stories, and suggest improvements to the clinic in a supportive and caring environment. This will do wonders to get your staff fully on board and dedicated to the clinic operating at a high level.
In sum, your urgent care clinic is a substantial financial investment. Roll up your sleeves, and get to work on making it thrive. Commit yourself fully to the urgent care “game” and watch your clinic take off beyond what you may have believed was possible.

Reference

  1. “Fixing Healthcare Service Failures.” American College of Healthcare Executives. Web. Accessed 18 May 2014. http://www.ache.org/pubs/pdf_excerpts/Fottler%20Excerpt.pdf

 

Head in the Game: Cultivating the Mindset of a Successful Urgent Care Operator

Alan A. Ayers, MBA, MAcc

President of Experity Networks and is Practice Management Editor of The Journal of Urgent Care Medicine
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