John Shufeldt, MD, JD, MBA, FACEP I have been practicing medicine for nearly 30 years. I have received countless letters from law firms for records requests and notifying our group or me of an impending issue. I’m kind of numb to it. Conversely, anytime I get a letter from the medical board, I go into SVT. I am sure it is the same way with the physician assistant and nursing boards. You just start thinking, …
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The Sword and the Shield: Best Hiring Practices for Urgent Care Facilities
Urgent message: It is imperative that urgent care centers utilize the various tools at their disposal to recruit the best candidates, while implementing best practices that mitigate the potential for lawsuits. DAMARIS L. MEDINA, ESQ. Urgent care is one of the fastest growing segments of American health care. Historically, many urgent care facilities were considered small businesses because they employed fewer than 15 people, making them exempt from certain hiring discrimination claims under The Federal …
Read MoreDeveloping Data: December, 2014
Data from the Centers for Medicare and Medicaid Services and Aetna show that as the cost of health care treatment continues to rise, urgent care offers a compelling low-cost alternative for delivering care outside the hospital. By transitioning unnecessary emergency department visits to urgent care, $18 billion in savings is projected to be possible. In this issue: Low-Cost Setting as a Driver of Urgent Care Industry Growth
Read MoreRevenue Per Patient, Prescription Drug Management for MDM, Medicare and HCPCS J3301 Denials
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 …
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