Walk-in and urgent care services are a few of the many tactics healthcare providers are using to decrease costly emergency room visits and extend care to a new group of patients. Ambulatory surgery centers are also getting into the game with orthopedic urgent care services.
Here, representatives from three ambulatory surgery centers discuss their experiences building a program and where the urgent care trend is heading in the future.
Q: What are the advantages of having walk-in services at your ASC?
Sandy Fragale, administrator at Orthopedic & Sports Medicine Specialists of Green Bay (Wis.): The biggest advantage is the benefit it provides our patients. It’s a lower cost alternative to urgent or emergent care. It’s less expensive than the ER or urgent care. Additionally the patients get to see a physician, which is a big bonus. Most urgent care centers have midlevel providers, but we want our patients to see orthopedic physicians.
Josh Siegel, MD, Northeast Surgery Center in Newington, N.H.: Our organizational philosophy has always been to provide high quality orthopedic care and services in a convenient manner. Our walk-in clinic allows us to be available when our patients need us and with no appointment necessary. In many cases, our patients are able to come to the walk-in clinic and see an orthopedic specialist the same day. This expedites the recovery process and helps us deliver our promise to see people quickly.
It also benefits our occupational medicine practice, allowing us to see injured workers immediately and offer walk-in testing for employers.
Alejandro Badia, MD, Badia Hand to Shoulder Center in Doral, Fla., CMO of OrthoNOW: The urgent care centers are also downstream revenue for the practices. Hospitals don't have any business seeing ankle sprains, and some of the specialists in the emergency room don't have the expertise to treat these patients. We are the experts and the ones who should be capturing that income.
Q: How is the schedule organized for the walk-in clinic?
SF: Our clinic is first-come, first-serve, but even then patients generally have a shorter wait time than the ER. Our wait time is generally 25 minutes to 30 minutes, but it’s variable.
Q: How busy are your walk-in services?
SF: It started out really slow, there were just a few patients per week. But between marketing and word-of-mouth, every month we have seen growth. We actually hoped for the slow start to make sure our processes were in place and everything worked efficiently. In the first week, we had four patients but now we are seeing around 50 patients per week who are walk-ins. That growth literally occurred week-by-week, month-by-month, and it’s been eight months since we started.
AB: Because of our urgent care, in a typical month we are referring just shy of 60 operative cases out. There is a surgery center in the building and depending on what insurance company the patient has they can have their cases done in the surgery center. The downstream revenue for around 60 additional cases per month is conservatively $1 million in extra revenue for the ASC per year.
JS: Our urgent care services are quite busy. We are open Monday through Saturday with early morning and extended evening hours. We see a steady patient volume each day. The volume does vary seasonally around the holidays, etc., but people really seem to appreciate having this option, especially after hours or when a primary care physician is not available.
Q: How do you attract new patients?
AB: Part of the OrthoNOW model is sports medicine, so we have a strong outreach to patients themselves. We're proactive about our reputation and we meet with our preferred providers regularly. We have a presence at competitions and tell people there are board-certified orthopedic surgeons at our urgent care center. We did that at the Miami Ironman competition as well as Pee Wee Football leagues. We speak to the parents and let them know about our experiences as well as our services.
JS: There are several other walk-in or urgent care centers opening up throughout our area. Some are affiliated with hospitals and are extensions of the hospital ER. Others are independent urgent care centers or are pharmacy-based walk-in clinics. It has become the trend in the healthcare market for this consumer-based approach to doctor visits.
It will be interesting to see what the future will bring with the urgent care/walk-in industry. It seems that there may be a saturation point, however we feel that our affiliation with a highly recognized orthopedic surgery group will still give us an advantage and keep people coming back.
SF: For us it’s been the warmer weather; we’ve seen the largest increase during the summer months. I think it’s because people are out and more active than in the winter. Patient volume also spikes earlier in the week. Monday is our busiest day. I’m assuming people are out and about over the weekend and hurt themselves. Then they want to take care of it right away and come in on Monday.
Q: How are you staffing to keep up with the demand growth?
SF: We have two physicians working the clinic at any given time. We staff it with physicians who are already working in the office to see patients. There are six orthopedic surgeons in our practice, so at busy times we have all hands on deck. When there are six physicians, we can get through the walk-in patients easily.
The clinic is in the same building as the practice and surgery center, which is nice. The difference between the walk-in clinic and our regular patients is the walk-in patients aren’t pre-registered. All the pre-registering is done when they walk in and takes from 10 minutes to 30 minutes to complete, depending on their medical and surgical history. The surgical staff then fits these patients into the physician’s schedules who are available so these patients don’t disrupt the regularly-scheduled patients.
Q: Are the patients in the walk-in clinic insured? How do you deal with payments?
SF: The patients are able to use insurance at our clinic. If the patient is out-of-network we let them know ahead of time. We get their insurance card scanned into our system, let them know the payment if they are out-of-network, but we are in-network with most of the payers in our market so this isn’t usually a big issue for us. But our clinic is even less expensive for the out-of-network patients than the ER. Many patients today have high deductibles, and if you can come into our office and pay $200 instead of $2,000 in the ER, that’s a big difference.
Q: How are walk-in services integrated into the overall practice and surgery center?
JS: The majority of the individuals we see in our walk-in clinic are orthopedic or sports medicine patients. The affiliation with our practice allows many patients to be seen by a specialist the same day if during regular business hours or the next day with a surgeon if necessary. This integration works very well to facilitate patient care and expedite the recovery process.
Individuals with non-orthopedic illness or conditions are instructed to follow up with their primary care provider. We understand the importance of primary care physicians and the overall health and wellness of each individual patient. Our clinic is not intended to replace this relationship but offer a convenient option when the patient needs care quickly and in a cost-effective manner.
SF: Our clinic works seamlessly with the ASC. When appropriate, patients can come into the clinic, see a physician, have an MRI and outpatient surgery all in the same day in one location. We have had someone come in and do all three on the same day. Generally, if there is a delay in services, it’s to achieve insurance company approval.
That’s different from the hospital, where patients might spend hours waiting to see a physician who admits them to the hospital and then has to schedule surgery, which is more difficult at a hospital. The timing here is pretty seamless.
Q: How often do the walk-in patients need surgery?
SF: About 40 percent of the patients we see need surgery, and those surgeries are usually fractures. There are a lot of cases that come through, from broken noses to chronic pain patients who have a flare-up.
Q: What are the biggest challenges you’ve had with the walk-in services? Any surprises?
JS: The licensing process is somewhat intensive. There are many rules and regulations that are beyond the scope of a general orthopedic practice but other than that there were few major challenges or surprises.
SF: For us, physician staffing is always a challenge, but all 10 of the orthopedic surgeons in the group committed to this. We are proud to staff with the physicians, so we want to make it work. Another challenge is having the right supplies on-hand, but with the ASC right there so if a physician needs a more specific suture pan, we can borrow it from the ASC. That was a surprise, but we work back and forth to make sure we have everything we need.
Q: Do you see urgent care at orthopedic practices and ASCs as an effective business strategy?
JS: Absolutely. People want access to everything more quickly than ever. They are becoming more savvy as healthcare consumers and they are willing to shop around. By providing low-cost services, quickly and efficiently and in a location that is convenient to the patient, we hope to continue to benefit from this urgent care/walk-in/orthopedic model moving forward.
AB: There are a lot of groups that want to add urgent care services. You don't make much money on the clinic, but you are driving cases to the surgery center. There is a huge trend toward urgent care clinics, but general clinics don't always drive costs down because they triage to the wrong physicians. At the orthopedic-focused clinics, we understand how to deliver quick, quality and cost-effective care.
Q: What advice do you have for orthopedic and sports medicine physicians considering opening a walk-in facility?
JS: Do not underestimate the amount of additional administrative and clinical oversight that is required to open and operate an urgent care facility. If possible, bring on providers with experience in this area to help facilitate and walk the organization through the process. Consider hiring a walk-in medical director with experience in occupational health or general practice to help provide oversight.
SF: The front desk has to be ready or prepared to register and schedule when the patients come in the door. There were some staffing accommodations we had to make. We spent a lot of time trying to anticipate what patients would come in and prepare with those resources. Also, surgeons must be okay with starting slow. Know the clinic will gradually build. It was hard for our physicians to put money into this program and only see few patients in the first few weeks.