VelociDoc Urgent Care Blog

End of 2011, but Not End of Meaningful Use

2012-01-27T10:47:00.002-06:00

Nowthat 2011 is over, have you put meaningful use behind you? If so, you’re makinga costly mistake. According to the January Urgent Care News story “EMR Experts: Start EMR Todayand Still Get $44K,” 2011 was just the beginning for meaningful use. Physicianswho qualify for the program still have a chance to get full stimulus dollars –that’s up to $44K per physician for the Medicare program. Be sure to check outthe article for more information.

Hereare some important dates for the Medicareprogram to remember as you head into 2012:

October 1, 2012: This is the last date for you to begin meaningful use of an EMR and still be eligible for the full $44,000 from Medicare. Since it takes several months to up to speed for full meaningful use, however, we would recommend that you start using your EMR no later than mid-summer, 2012.

December 31, 2011: This was the date the reporting year ended for the Medicare program in 2011. That means if you were planning on attesting for 2011, you must have completed your 90-day reporting period by December 31, 2011.

February 29, 2012: Even though the deadline to complete your 90-day reporting period was December 31, 2011, you actually have until February 29, 2012, to register and attest to receive payment for 2011.

ALSO....

CMS allows 60 days after December31, 2011, for all pending claims to be processed, so February 29, 2012, is also your deadline for submitting pendingMedicare Part B claims from calendar year 2011.
Remember: the Medicare programincentive payments are based on 75 percent of Part B allowed charges fromvisits that occurred in 2011. If you did not meet the $24,000 threshold in PartB allowed charges by the end of the 2011 calendar year, CMS expects to issueincentive payments in April 2012 for 75 percent of your Part B charges from2011.

TheMedicaid program is handled byindividual states, so you must contact your state Medicaid agency for more informationon your specific Medicaid program.

Formore information on both programs, visit www.cms.gov/ehrincentiveprograms.

Get Free Advertising by Being a Healthcare Expert

2011-12-07T16:20:00.001-06:00

One of the tips I offer in my urgent care marketingvideo “How to Get FreeAdvertising” is to build good relationships with your local media by offeringto be a local expert for any stories they might be doing on healthcare-relatedissues. Doing media interviews in which you offer your expert insights on ahealthcare story, such as the importance of flu vaccinations, is great,unbiased exposure for your urgent care center. Not only will the localcommunity start to view you as a healthcare expert, they will associate yoururgent care center with expert healthcare providers. That kind of trust cannotbe built through a TV or radio ad.

Shawna Ziegler, a nurse at Park Plaza Urgent Care in Omaha, Nebraska,took time out of her busy schedule to do a timely, relevant media interviewabout the dangers of falling on ice. In this TV news segment, Zieglertalks about the kinds of injuries she’s seen at Park Plaza Urgent Care andprovides her expert advice on what people should do if they slip and fall onice. Her appearance on the news segment created public awareness of Park PlazaUrgent Care and showed the public that the staff at Park Plazais knowledgeable and capable of handling this type of injury.

Dr. Douglas Blevins of Optimus Urgent Care in Greensboro, N.C.,spoke to his local media about when it’s appropriate to visit an urgent carecenter versus a primary care doctor. The TVsegment also included an interview with a patient at his urgent care centerwho spoke positively about her experiences at Optimus Urgent Care. This is agreat testimonial for Dr. Blevins’ urgent care center because the patientoffers her candid opinion to the reporter, not the urgent care’s marketingdirector. We’ve all seen marketing testimonials before, and we all know to takethem with a grain of salt. The public will put far more trust in a testimonialprovided through an unbiased media interview than a marketing video on yoururgent care’s website.

You might think you don’t have time to do mediainterviews, and you’re partially right. You should certainly be selective ofwhich interviews you agree to take. While you can’t control the angle the reportertakes with the story, you can at least ask the reporter what the story is aboutto attempt to ensure that the story won’t misrepresent you or your urgent careclinic. You don’t need to worry too much about this, as local news stationsgenerally avoid conflict with local companies because they are part of yourcommunity and may want you to advertise with the station in the future. Andremember: even if you turn an interview down, be polite and maintain thatpositive relationship with the reporter. If they are doing a story like theones Ziegler and Blevins assisted with, you’ll want them to turn to you as ahealthcare expert.

Do You Need an MBA for Startup Billing?

2011-11-20T15:23:00.001-06:00

I saw an ad for a biller today. It read, "______ Urgent Care (a recent startup) is seeking a Billing Director to support our central billing office and multi clinic operation. Complete revenue cycle knowledge a must. MBA preferred...."

Interesting! This urgent care decided to save money by doing their own billing. But now they realize that they need serious expertise--so much so that they are willing to hire an MBA (at $60-80,000) to manage their revenue cycle.

Early on with Practice Velocity, we actually encouraged startups to do their own billing, but we rapidly realized that this was a mistake. Doctors had their spouses do it part time. Others hired someone who had "done billing" for a doctor's office, but then learned the hard way that the person had simply entered charges from a superbill in a physician office. This so-called "biller" had no significant knowledge of the entire billing cycle, from contracting/credentialing, coding, electronic billing, electronic remittance, clearinghouse exception reports, denials, non-contractual discounts, audits, compliance, payor downcoding, and much more. A simple mistake in just one aspect of the billing cycle can cost a center 10% or more, and costly mistakes are inevitable when a novice is doing the billing.

Startups often decide to do their own billing to "keep control" and "save money." But what they quickly discover is that they don't have control of systematization, rather they own their own chaos. And the supposed money "savings" were overwhelmed by the losses incurred by the ineptatude of the novice biller.

This center has realized the truth: you do need a very high level person to manage the extreme complexities of revenue cycle management. However, few MBAs have any medical billing expertise, and crackerjack billers are hard to find and are just as expensive as an MBA. Our own urgent care centers struggled for more than 10 years until we were finally able to solve the problem with the appropriate expertise and finances. Finding and funding the necessary expertise for successful revenue cycle management with an internal billing department is a classic conundrum--you need true expert billers for financial success, but until you have financial success, you can't afford true expert billers.

That is why we took our seasoned billers from our urgent care centers and turned them into a billing company (PV Billing) to help centers focus on providing excellent medical care and growing their business while we took care of the revenue cycle management.

It has been extremely gratifying to see more than 100 successful startups use PV Billing as a tool for success. We have been delighted to see so many startups rapidly open a second -- some even a third -- urgent care centers within two to three years.

Our motto at PV Billing is simply this: "You take care of patients; we'll take care of the rest." It is great to see it work so well for so many.

Week in Review: Urgent Care Awareness Week

2011-11-18T13:52:00.001-06:00

It was very heartening to see urgent cares acrossthe country join the public awareness efforts of Urgent CareAwareness Week over the last few days, including sharing links to UCAOA’s website www.urgentcarecenter.org, offeringdiscounted flu shots, posting urgent care factoids on Facebook, and submittingpress releases to their local media. Educating the public, including primarycare physicians and EDs, is crucial to ensure the important role urgent careplays in our nation’s healthcare is fully understood.

Urgent Care Awareness Week concludes on Sunday, soas Practice Velocity’s contribution to such an important awareness campaign,I’d like to offer a recap of the five 2-minute videos we shared throughout theweek. Each video offers a tip on how to maximize your urgent care’s marketingefforts. We hope they help you get your message out there.

UrgentCare Marketing Tip #1: How to Make Facebook Work for You

Are you getting the engagement you expected onyour urgent care’s Facebook page? If not, you might be making these commonmistakes. Watch tip #1 to learn how to make sure your Facebook page is notboring.

UrgentCare Marketing Tip #2: How to Get Involved in Your Community

It might seem like you have no time to getinvolved in your community, but the truth is that it’s not only possible to getinvolved, it’s also crucial if you want your patients to feel you areapproachable and trustworthy. Watch tip #2 to learn how to get started.

UrgentCare Marketing Tip #3: How to Get Free Advertising

Did you know you might be passing up freeadvertising for your urgent care? It’s hard to believe, but many urgent caresare doing just that. Watch tip #3 to learn how to make sure you’re not missingout on quality exposure for your practice.

Urgent Care Marketing Tip #4: How to Get YourBillboard Noticed

So you’re spending thousands of dollars on abillboard for your urgent care. Are people even noticing it? Watch tip #4 tolearn how to design a billboard that’s going to grab the public’s attention.

Urgent Care Marketing Tip #5: How to Be a “Guerrilla” Marketer

The public is inundated with marketing messageseverywhere they go. Are your marketing messages reaching them? Watch tip #5 tolearn how to be a “guerrilla” marketer without resorting to tactics that areshocking or in poor taste.

Great Marketing Tips from Dr. Stern for Urgent Care Awareness Week

2011-11-11T09:00:00.000-06:00

Are you participating inthe fourth annual Urgent Care Awareness Week next week? If so, Practice Velocity wants tocollaborate with you. We want to showcase your efforts to reach out to yourlocal communities. Send us your photos, news clippings, videos, etc., and we’llpost them to our Facebook page at http://www.facebook.com/practicevelocity.com.

You can submit via emailto Mika Doyle, Communications Coordinator, at mdoyle@practicevelocity.com.

In addition to helping youget your Urgent Care Awareness Week message out, Practice Velocity will beoffering daily videos starting on Monday that feature urgent care marketingtips and ideas to help you amp up your marketing campaigns. There are severalways you can access them:

Daily email blasts (Clickhere to subscribe)
Daily on Facebook at http://www.facebook.com/practicevelocity
Daily on YouTube at http://www.youtube.com/practicevelocity
A Friday digest on Practice Velocity’s blog at http://www.urgentcareblog.practicevelocity.com

If you don’t know aboutUrgent Care Awareness Week, it’s not too late to participate. This nationwidecampaign facilitated by UCAOA is November 14-18and is aimed at increasing public awareness of the urgent care industry and therole it can play in the nation’s healthcare. UCAOA is encouraging urgent caresto get involved by using their turnkey kit toreach out to their local communities and legislators. Be sure to check outtheir kit and try to pick at least one method of getting involved.

And don’t forget to “Like” our Facebook page so youdon’t miss all of the great Urgent Care Awareness Week posts we’ll be sharing.

Register to Win an iPad 2 at UCAOA

2011-10-17T12:56:00.002-05:00

In just a few daysseveral Practice Velocity team members will be in Dallas for the Urgent Care Association of America’s fallconference. It’s an exciting time of year for us because we get a chance tocatch up with colleagues and connect with people we haven’t had the pleasure ofmeeting yet.

We’ll have a lot of exciting stuff going on at our booth, sowe hope you stop by sometime during the conference. Here are a few reasons youshould come see us:

I will be giving live demonstrations of theVelociDoc^® EMR.
Registerto win an iPad 2.
Schedule free one-on-one consultations with me.
Schedule free one-on-one consultations with othermembers of the PV team.
Learn about our products and services, includingthe new features that came out in our latest release.
Ask our urgent care experts any questions youmight have about the industry, about starting an urgent care, and/or about runningan urgent care.

Whether you’ll be in Dallas or not, you can also stayconnected with us throughout the conference through Twitter and Facebook. We’vebeen posting Q&A interviews with our staff on Facebook so you can get toknow some of the faces behind PV, and during the conference we’ll be postingupdates, photos, and key takeaways from some the classes. If you haven’talready joined us, check us out at:

See you in Dallas!

Every1Matters at Practice Velocity

2011-10-12T10:34:00.000-05:00

This morning the Practice Velocity staff was greeted with apeculiar site: balloons were peeking over the walls of every single cubicle inthe building. It was quite a spectacle, and the staff had no idea that the celebrationwasn’t just for the company as a whole – it was for each and every one of themas well.

You see, we reached a milestone this month at PracticeVelocity, and today we took a moment to celebrate our success with the peoplewho helped make it happen: our team members.

As of this month, Practice Velocity is now serving urgentcare centers in 49 states. Fairlight Medical Center in Williston, North Dakota,came on board with us last week, becoming the first North Dakota clinic we haveserved. We now serve clinics in every state except South Dakota.

We are so thankful to all of our great customers forchoosing Practice Velocity, who we couldn’t support or serve without the greatteam we have on staff. To reflect our appreciation of all who have touched our lives,today we unveiled our #1 core value: Every1Matters.

Every1Matters means every single team member, every singlecontact, and every single customer matters to Practice Velocity. At PV: Imatter, we matter, you matter, every1matters.

As a gift to our team, we gave each of them a tumblerreflecting the Every1Matters message so they have a daily reminder that theymatter.

We all gathered together in one of the conference rooms and enjoyedsome apple cider and apple cider donuts from a local orchard. To see photos from today's celebration, visit our Facebook page to view the the photo album.

Celebrate National Health IT Week by Switching to an EMR

2011-09-14T12:00:00.000-05:00

President Obama has declared September 11-16, 2011, as National Health IT Week. Has your practice made the transition from paper to electronic charting yet? Making the change may seem like a daunting task, but the benefits of using an EMR over paper charts are immeasurable.

Here are my top 10 reasons you should consider switching to an EMR:

10. Faster documentation: There are no loose papers to sift through with an EMR. Chart quickly and efficiently, with all of your patients’ records readily available.

9. Reduction in errors: It’s far more difficult to make serious charting errors with an EMR, especially with those that feature built-in alerts.

8. Prevent lost records: EMR’s securely back-up your patient files.

7. Streamlined patient flow: Documenting visits faster and keeping better track of your patients with an EMR will streamline your patient flow and allow you to see more patients in less time.

6. Readily available data: Every healthcare provider needs timely access to their patient records, but this is crucial for practices with multiple locations. An EMR securely stores your patient records so you can access them from any of your clinic locations.

5. Grow your practice: With faster documentation and streamlined patient flow, you will easily be able to see more and more patients, growing your practice and increasing your revenues.

4. Protect your patients’ personal health information: An EMR will allow you to securely store patient information.

3. Increased revenues for your practice: If you choose an EMR designed with your specific practice in mind, your coding should be optimized to the specialized needs of your practice.

2. Improved patient experience: All of the above benefits contribute to a better experience for your patients, which is every healthcare provider’s #1 reason for entering the field.

1. Get government stimulus dollars: There is no better time than now to implement an EMR that has been ONC-ATCB Certified to help your physicians qualify for government stimulus dollars. If you implement in the next few months, you can still get all $44,000 per physician.

There’s never been a better time to make the switch from paper charting to an EMR. I encourage you to do your homework and choose a system that fits the specific needs of your practice.

If you’re interested in learning more about Practice Velocity’s EMR solution, request a free demo today.

"If you don’t have a meaningful web presence, you don’t exist."

2011-09-11T12:02:00.000-05:00

The quote above is attributed to Mark Britton, CEO of AVVO . Is it really true for urgent care centers? Note: he is not speaking about simply having a website, he is talking about a presence in social media?

Of course it is hyperbole, but there is real truth in this statement. For millions of Americans the phone book and the yellow pages are anachronisms, similar to the horse and buggy. In many communities, people search for their healthcare services on the Internet.

If your urgent care is not on social media, you are practically invisible on the Internet to people under thirty. If you want to argue with the "invisible" word, that's fine. Let's say instead, that you are missing out on a great opportunity to interact and attract this population.

Of course, some argue that social media is just a fad that will come and go like the hula hoop. That's fine but the fad is here. Others argue that they would rather go with traditional advertising in newspapers and radio. Go ahead. But traditional advertising is very expensive and every year it offers less effective results.

What if someone had come up to you when you first opened your urgent care and offered to give you a product that would allow you to not just advertise, but to fully engage and interact with thousands of people in your community? Would you not have paid over $10,000 for the product? It is called social media; it is available now; and it is FREE.

So how should you respond? You don't need to do everything at once. It probably makes sense to just start with a single option and go from there.

Facebook: Get a Facebook page and interact with people and businesses in your community. Let you community know that you care. Get active and stay active. Check out these examples of urgent care centers that are using Facebook effectively: Acute Kids (over 4,000 "likes" as of today), NextCare, Health Now, and Urgent Care Niagara. Remember, Facebook is not just another webpage for your business. Facebook is a place where you can interact with your community and your patients.
Twitter: I admit only a few urgent cares get it on Twitter, but the ones that are using it are daily reminding in front of hundreds of patients that their urgent care centers are there to serve them. See Doctors Express PDX, Irvine Urgent Care, Urgent Care Manhattan, and Mission Urgent Care.
Blog: Adding a blog to your website is a great way to keep your site fresh and interesting to visitors. Your blog is not likely to be the most interesting and provocative healthcare website on the Internet, so that should not be your goal. Instead, find issues in your community related to disasters, safety, parenting, immunizations, infectious disease outbreaks, etc. that have a local angle and are truly interesting to your specific community. This will allow you to put a personal and personable face on your urgent care center. FastMed's blog does this well. Sonny Sagar of Downtown Urgent Care in St. Louis dares to be interesting without always being local. However, very few urgent care blogs are worth reading, and beware of the dead blog--a blog that hasn't been updated for months or years.

Your posts will be dated, and a website that keeps a stale Facebook, Twitter, or blog page online will simply look like the business does not pay attention to details. Worse people may assume that the folks at the urgent care simply don't care.

For another perspective on social media in medicine, listen to Dr. Mike Sevilla discuss how to use social media for physicians at AAFP Convention in Orlando.

But if you get involved and engage your patients and your community, social media can be a very effective way to serve your community and grow your urgent care.

Thank You to the Great Staff at Practice Velocity

2011-07-29T14:48:00.005-05:00

I have always felt that being a business owner is a rewarding experience, but when I arrived at the office this morning, there was something there waiting for me that blew all past awards and distinctions out of the water. Sitting right there on my desk was a gift and an anonymous thank you card from the PV staff:

The “Bombshizzle” reference might seem odd, but Practice Velocity has what we’ve named a “Bombshizzle Award” that is bestowed upon staff members who are nominated by their supervisors for oustanding performance.

This is one of the highest honors I have ever received. I want to thank my staff for all that they do. I am incredibly grateful to have the opportunity to work with each and every one of them.

The Recession Can’t Stop Practice Velocity

2011-07-27T16:20:00.001-05:00

It’s amazing to look back and recall Practice Velocity as an idea – an intangible concept that had yet to be realized – but less than 10 years ago, it was just that. I was working in urgent care with my two partners, Dr. John Koehler and Dr. Terry Buzzard, and we shared a frustration with the effectiveness of the nitty-gritty aspects of running our practice, such as billing, coding visits, maintaining a good patient flow, etc. When we began researching software that could help us get organized, it didn’t take long for us to realize that there really wasn’t anything out there that met the specific needs of an urgent care practice. We weren’t satisfied with using software that was designed for a different specialty because it created much unnecessary work and frequent work-arounds. So we went with the best option we had available: we created our own.

We founded Practice Velocity in 2002, and our first customer went online with PiVoT^®, our modified electronic medical record, in February 2003. Today we have a full line of services to offer urgent care practitioners, including a full EMR, practice management software, billing services, and contracting and credentialing services.

And we certainly serve more than just the original urgent care client (I sure am grateful they took a risk and came on board with us in those early days). Our first customer is still with PV today, and we now serve more than 750 urgent care centers in 48 states.

That’s a lot of growth in less than 10 years! Our staff has had to grow tremendously in order to help us keep up, and this month we reached a milestone: we hired our 200th employee. We are humbled to have been able to grow jobs during such a severe recession, and we feel incredibly lucky to be able to work with such an amazing team of people.

Thanks to all of our customers for helping us grow to where we are today, and a special thanks to Marge Simat and Long Island Medical in New York – the very first urgent care clinic to use Practice Velocity.

Practice Velocity has come a long way in such a short period of time, but we’re not done yet! We expect to see more growth in the coming years as more and more urgent care centers look to improve patient care and streamline processes through urgent-care-specific software.

Avoid Medicare Penalties by Implementing an EMR

2011-07-06T09:17:00.000-05:00

The regulations for meeting meaningful use in order to get government stimulus dollars have been causing significant challenges for many physicians. Most recently, the June 30 deadline for implementing e-Prescribing (eRx) has come and gone, and those who missed the deadline should receive a 1% penalty on all Medicare payments in 2012. I say “should” because, although it’s now too late to code the 10 visits with G8553, CMS is actually giving physicians a second chance to avoid penalties.

That’s right – if you missed the June 30 deadline, you can breathe easy because CMS has proposed a revision to the eRx portion of the Medicare EHR Incentive Program that, if adopted (which we fully expect), will allow physicians to meet the eRx requirements by fully implementing a certified EMR before October 1, 2011, and attesting to meaningful use. This is in addition to several somewhat obscure exemptions that allow for a little more wiggle room in the program. Read the CMS Fact Sheet on the proposed rule.

What does this mean? Well, if you thought it was too late to implement an EMR in your practice, think again. You now have until October 1 to adopt and implement a certified EMR. Not only will this allow you to access up to $44,000 in stimulus dollars, you will, also, be able to avoid Medicare eRx penalties.

Practice Velocity’s VelociDoc® Tablet EMR version 11.01 is 2011/2012 ONC-ATCB Certified by CCHIT®. If you’d like more information on how the experts at Practice Velocity can help your urgent care center get government stimulus dollars and increase your practice’s profitability, schedule a free demo today.

Choosing the Wrong Stimulus Program Could Cost You 10K or More

2011-06-30T10:07:00.000-05:00

I recently received a question from the executive director of an urgent care center regarding the difference between the Medicare EHR Incentive Program and the eRx Incentive Program, which are both being offered by the Centers for Medicare and Medicaid Services (CMS). Her group has four full-time physicians, but they only do about $40,000 total per year with Medicare. Because physicians can only participate in one of the two programs, she wondered if it would be more beneficial for her practice to go for the eRx bonus instead of the EHR bonus.

While it might seem like $40,000 in Medicare charges is not enough to garner much in stimulus money, crunching the numbers reveals it really would be advantageous to go for the EHR stimulus program. With the EHR program, eligible physicians can receive up to 75% of their Medicare allowable charges over the course of 5 years for a total of up to $44,000. However, with the eRx program eligible physicians can receive only 1% of their allowed charges in 2011 and 2012. Take a look at the figures:

EHR stimulus: 75% x $40,000 = $30,000
eRx stimulus: 1% x $40,000 = $400

That’s a difference of $29,600! Simply put, do not disregard the EHR Incentive program because you could be missing out on up to $44,000 in stimulus dollars. Registration opened in January, and you have until 2012 to receive maximum payments. It’s important to note that there are Medicare penalties after 2015 for physicians who do not demonstrate meaningful use of EHR technology, the main component of the incentive program.

For more information on the EHR Incentive Program, download a whitepaper produced by Practice Velocity.

Practice Velocity’s EMR is certified to meet meaningful use criteria for the EHR Incentive Program. View our certification details and schedule a free demo today.

Urgent Care Clinics Have 2 Days to Post Prices in Lobby

2011-06-29T15:50:00.001-05:00

Florida urgent care centers have until Friday to install signs in their reception areas that list the prices of their 50 most frequently provided services. The mandate is part of HB 935, which was approved by Florida Governor Rick Scott on June 2. Urgent care centers that don’t comply by Friday will face some stiff fines – up to $1,000 per day until they get those signs up.

State Representative Richard Corcoran (R), who sponsored the bill, says the goal is to provide patients with transparency in the cost of their healthcare. In media interviews, he has even gone so far as to say he expects this bill to be a stepping stone to making the cost of healthcare services more accessible to patients – a lofty goal given that healthcare services are not as easily priced as, say, the menu items at a fast food restaurant. As any physician will tell you, there are many different factors that contribute to what each patient is charged for their visit. In the case of urgent care, proper codes for visits cannot even be determined until:

after the doctor has evaluated the patient,
ordered tests, and
selected treatment.

It would seem to be more helpful to the public simply to note that the “typical visit” (i.e. median) costs $94 and note that costs may vary depending on tests, treatments, and severity of illness.

To my urgent care colleagues in Florida, I wish you all the best in meeting the requirements of this bill by the end of the week.

Open Forum for Urgent Care Professionals Launches

2011-06-22T09:20:00.002-05:00

If you go to any urgent care conference, meeting, gathering, etc., you’ll quickly learn that urgent care professionals are, for the most part, exceptionally open to sharing their knowledge of and experiences in starting and/or running their own urgent care centers. There truly is this spirit of “coop-etition” in which we are always cognizant of the competitiveness of running a business but vividly remember the struggles of being a novice urgent care center in a growing industry.

While willingness to share is certainly not a problem among urgent care professionals, opportunities to engage each other in those conversations are few and far between. Schedules are hectic, and time is always at a premium. However, the value of these conversations cannot be overstated.

That’s why we at Practice Velocity decided it was vital to create a public forum for urgent care professionals to connect with each other outside of the convention circuit that is accessible to anyone with an interest in urgent care – from those who are simply considering a transition to urgent care to urgent care veterans. To achieve this end, we have launched an online forum designed to allow urgent care professionals to connect with each other that is convenient, easily accessible, and free.

Urgent care professionals can access the forum at www.practicevelocity.com/forum. Anyone can view the forum threads, but in order to post a question or an answer, you must register as a user. For those who are on facebook, you can log in with your facebook credentials, which speeds up the registration process and eliminates the need to create a brand new username and password to remember. Users who log in with their facebook credentials also have the option of sharing their favorite threads with their facebook friends.

To kick off the forum, I have added 170-plus answers to questions I have received from others in the urgent care industry. I invite you to explore the plethora of topics that are currently open for discussion and encourage you to join the conversation by asking your own questions and posting your own answers.

For those who prefer a more private discussion arena, the Urgent Care Association of America (UCAOA) offers a highly professional members only forum. Current UCAOA members can access the forum by signing into the UCAOA UConnect Portal. If you’d like to get more information on joining UCAOA, visit the membership page on their website.

We’re excited to be able to offer this new, free tool to urgent care professionals. The forum is currently live, so check it out today at wwww.practicevelocity.com/forum and start connecting with your industry peers!

Learn How Meaningful Use Applies to Urgent Care

2011-05-25T09:05:00.001-05:00

I mentioned in my last blog post that I would announce the date and time of a webinar I’m offering on the basics of the Medicare EHR incentive program. The details of the webinar have been finalized; it will be held from 1 to 3 p.m. CDT today (Wednesday, May 25).

During the webinar, I will provide an overview of the Medicare government stimulus program for EHR implementation. I will also review the stimulus program and how it applies to urgent care using Practice Velocity’s VelociDoc^® Tablet EMR as a practical example of how you can use an EHR to capture those dollars for your practice.

Here’s a snapshot of the details:
What: FREE Webinar – “EMR Meaningful Use for Urgent Care”
When: 1 to 3 p.m. CDT Wednesday, May 25
You will learn:
• The basics of the incentive program
• Who qualifies
• What the regulations are
• How Practice Velocity’s VelociDoc^® Tablet EMR meets those regulations
• How to sign up for the stimulus programs
How to register: Click here to register

Get Paid by Uncle Sam to Use Our EMR

2011-05-17T16:28:00.000-05:00

Practice Velocity has just announced that the VelociDoc® EMR has been ONC-ATCB certified by CCHIT®, the most reputable organization for medical software certification. Review VelociDoc's full certification details on our website.

In the past year, Practice Velocity has been inundated with questions about the government incentive programs offering stimulus dollars for demonstrating meaningful use of electronic health record (EHR) technology. The programs are especially vexing for those in urgent care because they were designed with primary care practices in mind, creating a slew of challenges for the industry.

We at Practice Velocity understand what’s at stake: up to $44,000 in stimulus dollars for the Medicare program. In the future, providers who have not implemented meaningful use of an EMR will incur penalties in Medicare reimbursement. Thus, our development team has been working hard to update the VelociDoc® urgent care EMR and PVM^SMPractice Management software to comply with the meaningful use criteria.

I’ll be offering a webinar on the basics of the Medicare incentive program in the coming weeks, so watch out for announcements on how to sign up. Until then, please feel free to click the button below to download a whitepaper presented by Practice Velocity that provides an overview of the programs.

ACEP Attacks Dr. Stern's Editorial

2011-04-27T11:40:00.000-05:00

The American College of Emergency Physicians (ACEP) responded to my recent blog post “American College of Emergency Physicians Attacks Urgent Care” with a vigorous rebuttal. ACEP has attacked my editorial anonymously, stating “this blog post is a deliberate misreading of both the TIME article and ACEP’s position. ACEP never attacked urgent care centers or said anything about them.”

I would absolutely agree that urgent care was not mentioned, and this is exactly the problem. As I stated in my reply to ACEP (click the link above and scroll down to the comments), ignoring urgent care in the conversation is an “attack” by omission, much the same as having a polite discussion in your living room but ignoring the elephant sitting in the corner sipping tea.

Additionally, I find it interesting that the TIME editorial notes the “marginal cost” of seeing patients for minor problems in the ER, but the anonymous ACEP representative admits in his/her comments that ER “individual [patient] bills are high.” The ACEP representative goes on to defend these hefty bills by saying they help cover the cost of treating patients who don’t pay their ER bills.

So is ACEP saying it’s acceptable to make other patients responsible for these unpaid bills? Why not reduce the cost of staffing ERs by directing unnecessary visits to a place designed specifically to handle non-emergency injuries and illnesses: an urgent care clinic?

It’s preposterous that ACEP is not educating the public on ALL of their options, whether it is primary care, the ER, or an urgent care clinic. It’s an absolute disservice to the public to insinuate that after-hours illnesses or injuries that are not life-threatening require a long and costly visit to the ER or a wait until the patient’s primary care physician’s office is open.

But don’t just take my word for it – I encourage you to read the TIME Magazine editorial, as well as my editorial (linked above), and judge for yourself.

32-Clinic Urgent Care Chain Sold

2011-04-15T16:18:00.000-05:00

Urgent Care News sent out a Newsflash yesterday about Florida Governor Rick Scott’s sale of his shares of Solantic, the Jacksonville-based chain of urgent care clinics he founded in 2001. Although news reports credit the deal to increasing questions regarding conflicts-of-interest with healthcare changes the governor is trying to pass, the Urgent Care News article illustrates this sale is yet another in a growing trend of large investment companies pushing their way into urgent care.

Click here to read the Urgent Care News article.

American College of Emergency Physicians Attacks Urgent Care

2011-04-13T09:10:00.001-05:00

Urgent care physicians have long urged payors to encourage patients to use the much less costly alternative to the hospital emergency department. Payors around the country are finally figuring this out and developing active programs to divert patients with non-emergency problems to urgent care centers. You won’t even believe the response of the American College of Emergency Physicians’ (ACEP). Instead of applauding this effort to reduce health care costs and unclog overcrowded emergency departments, ACEP has begun an active campaign to establish the importance of ED visits for patients with minor problems.

A TIME Magazine editorial, published in partnership with CNN on Monday defended the American College of Emergency Physicians’ (ACEP) for "launch[ing] a campaign to derail proposed policies to reduce the use of emergency departments (EDs)." The editorial, written by two emergency physicians Drs. Jesse M. Pines and Zachary F. Meisel, argues that efforts to steer patients away from visits to the ER in order to drive down health care costs in the U.S. are misguided and devalue emergency medicine because these efforts miss what the headline calls “the real value of emergency care.”

Is this just simply self-interested nonsense, or is it an authentic effort to maintain what is good about our healthcare system?

Drs. Pines and Meisel say that “some emergency care could probably be avoided if there were adequate alternatives, like clinic doctors who are responsive to their patients’ urgent needs. But the fact remains that for many there are no convenient alternatives to EDs.” Nonesense! The USA has over 8,500 “convenient alternatives.” They are called urgent care centers, and they are overwhelmingly staffed by “clinic doctors who are responsive to their patients’ urgent needs.”

So do the doctors discuss the urgent care alternative? No; it might seem incredible, but the words “urgent care” do not appear even once in the TIME editorial. One must wonder if the doctors thought that by ignoring the viable “alternative,” urgent care would somehow disappear from the debate.

Even the examples selected show their extraordinary bias. They mention “a young woman with an uncomfortable urinary-tract infection on a Saturday.” What a perfect case for a visit to an urgent care center! Instead, the editorial describes the woman’s sole alternative to an ED visit on Saturday as “wait[ing] until Monday when the doctor's office is open.”

Drs. Pines and Meisel state that retail clinics are “typically built in rich suburbs,” so they are not available across the country in small towns and big cities. Are they unaware of urgent care centers that in recent years have rapidly been opening in small towns and urban areas? As far as the lack of viable alternatives in poor urban areas, does that mean that the ED is the right place for treating these non-emergency issues? Maybe, instead, it means that CMS needs to focus on efforts to fund urgent care centers in poorer neighborhoods, where overuse of hospital EDs is an even bigger problem and the need for less costly alternatives to the ED is critical.

They, also, argue that hospital EDs are important because they are open 24 hours a day. Indeed, few urgent care centers are open 24 hours. But most urgent care centers do offer significant evening and weekend hours, and very few non-emergency problems need treatment outside of the typical urgent care center hours of operation: 8AM – 8PM. True emergencies should absolutely be treated at a hospital ED, and urgent care providers are quick to send emergency cases directly to the ED. But for those after-hours issues that require immediate treatment but are not life-threatening, urgent care centers are a great alternative.

Drs. Pines and Meisel obfuscate by waxing eloquence for the importance of the hospital ED as a place for treatment of the “entire cross-section of human illnesses.” Are they really serious? The hospital emergency department is designed, staffed and ideally suited for the treatment of emergency conditions—not the “entire cross section” of medical conditions.

The editorial goes on to state a ridiculous reason for patients to utilize the hospital ED for minor problems: “The fact is that nobody knows if they are having an emergency when they go in [to an ED] ... We all need to recognize the value of figuring it out, explaining what the problem is and providing reassurance...” Just because of the outside chance that my sore throat is an emergency, should I go to an “emergency” department? What nonsense! In my over 20 years of practicing urgent care medicine, I have only transferred a few patients to a hospital with true emergencies, and I have never had a single patient code in the urgent care. With very few exceptions, people have proven themselves quite capable of triaging true emergencies to hospital EDs.

More concerning is Drs. Pines and Meisel’s statement that the “marginal cost of an ED visit is actually lower than that of an off-hours clinic visit.” What? Are they saying it costs less to be treated in a facility that costs more than twice as much per square foot to construct and uses doctors and nurses who are paid twice the salaries of urgent care physicians and nurses? Forget about the intentionally confusing (and questionably accurate) statistic of “marginal cost;” what is the cost to the insurers and the patient? The truth is that emergency departments generally charge patients three times the fees for the same services in an urgent care center. If the marginal cost of an ED visit is so low, why not reduce ED charges by 60%? Then the ED would really be a cost neutral alternative to urgent care.

An informed reader will note that the editorial does not marshal a single valid argument for payors to cut their public awareness programs for urgent care. If an urgent care center was readily available in every single community in the USA and if patients were aware of the proper use of such centers:
• then hospital EDs could focus on what they do best—care for emergencies
• and then patients could get what they need most—appropriate, timely and economical care for their medical conditions.

If all patients don’t currently have ready access to urgent care centers, then the editorial simply underlines the fact that the USA still does not have enough urgent care centers.

Payors have every reason to educate patients as to the value of urgent care. Patients have a right to know that they do have an alternative to the ED for non-emergency medical problems that need timely treatment. In fact, this knowledge will inevitably drive down health care costs, when patients begin choosing the cheaper, more convenient and more cost-effective alternative—urgent care.

How One Urgent Care Clinic is Giving Back

2011-04-06T16:31:00.001-05:00

For most U.S. citizens, it’s difficult to imagine not having access to the bare minimum in health care. Yes, health care and its costs have been a topic of hot debate in the U.S. for quite some time now, but at least we have the option of debating what our options are. There are some places in the world that consider another day free of disease or death good health care.

Regardless of your stance on the current state of health care in the United States, it’s impossible to argue against the fact that the U.S. is exceptionally fortunate to have the resources we do in comparison to third world countries. One Practice Velocity customer recognized the urgent need for quality health care services in India and set out to help its residents receive the medical attention they are currently lacking.

Dr. John J. Koehler of Physicians Immediate Care (PIC) based in Rockford, Ill., realized that, while India’s urban middle class has ready access to health care, there are at least 135 million rural and tribal people who lack the bare minimum in health care. In fact, many people die before they are able to reach a hospital. Dr. Koehler made it his mission to utilize his urgent care experience and expertise to construct a Physicians Immediate Care clinic in Beulah City, India, which is surrounded by 70 villages in need of access to quality medical services. Through several years of hard work and dedication, Dr. Koehler is closer than ever to realizing his dream, as the clinic is projected to be dedicated in July of 2011.

It’s easy to get caught up in the nitty-gritty of everyday life and forget how fortunate we really are. Congratulations to Physicians Immediate Care for seeing such a worthy project come to fruition.

For more information on this exciting project, including how to get involved, visit http://www.physiciansimmediatecare.com/about_us/givingback2.php.

Practice Velocity’s ZipPASS Goes Mobile

2011-03-24T10:07:00.002-05:00

We’re excited to announce that Practice Velocity’s ZipPASS® service has gone mobile with a new partnership with Healthagen, the developer of the leading mobile consumer health care application iTriage. Surpassing more than one million downloads in a 12-month period in January of this year, iTriage is in the top one percent of all health care apps in all mobile markets.

This unique health care app allows users to input their symptoms to make a self-assessment, then provides recommendations on where to go for treatment, such as the ER, an urgent care center or retail clinic, or a primary care physician. The app also provides contact information and directions to health care providers in the user’s area. Smart phone users can download it for free at the Apple iTunes App Store or at the Android Marketplace.

Practice Velocity’s ZipPASS service is a web-based portal that offers patients the ability to schedule urgent care appointments from the comfort of their own homes, allowing them to “get in line, online” through the urgent care center’s website. Instead of waiting to see a physician in the urgent care’s waiting room, patients are given a specific appointment time and can wait wherever they choose, as long as they arrive at their scheduled appointment time.

With this new partnership with iTriage, patients won’t even need to be at a computer to schedule their ZipPASS appointment. In addition to the plethora of services the iTriage app already offers, patients can now use their smart phone to locate the nearest urgent care center and schedule an appointment.
The addition of the ZipPASS function to iTriage offers a tremendous value to patients, who use the app for their medical needs, as well as urgent care providers, who can experience greater efficiencies within their practices by utilizing the ZipPASS service.

If you haven’t seen Healthagen’s official press release on this partnership, click here to read it.

Practice Velocity Hires in Down Economy

2011-03-18T09:51:00.000-05:00

We’ve all had our fill of news stories featuring the “down-economy dead horse” that just won’t seem to die, and the economic climate of the Rockford region in northern Illinois, where Practice Velocity is located, is no different. With an unemployment rate that peaked at nearly 20% in January of 2010 and dropped to a less-than-comfortable 13.7% this January, Practice Velocity’s hometown has been hit hard by the Great Recession.

But for Practice Velocity, it couldn’t be a more exciting time. We have continued to grow at such a steady rate that we found ourselves with the need to hire for more than 30 fulltime positions added at the beginning of 2011 – despite the poor economic climate in our area. To solve the “problem” of recruiting for so many additional positions, we hosted a job fair at the beginning of March that was met with great success.

Nearly 400 job seekers attended, and PV staff from various departments spent more than four hours trying to interview as many of them as possible. Not only has the company continued to grow, but we have been able to provide jobs to an area stricken by high unemployment.

Job seekers stand in line waiting for interviews

PV staff conducted interviews with job fair attendees

The local news media seemed to agree. Several news stories featuring Practice Velocity’s job fair appeared in print and on TV, most using Practice Velocity’s hiring as a positive sign that the local economy is finally turning around. Check out the video below to view one of the many news stories broadcasted on one of the local TV stations:

Practice Velocity has been the leader in software solutions for the urgent care industry, and we’re happy to also lead the charge into an economic upswing, both locally and nationally. Thanks to the great leaders who ran the job fair so professionally. A special recognition is due to Practice Velocity staffers Monica Klosa, Linda Gumm, Kathy Holcomb, and Mika Doyle.

10 Steps for Choosing an EMR for Your Urgent Care

2011-02-14T10:48:00.000-06:00

Medscape, a part of the WebMD Professional Network, recently posted the article “The No-Confusion Way to Choose an EHR,” which provides 10 steps for choosing an EHR (electronic health record). If you’re still on the fence about how to transition from paper records to electronic records, this article provides some great guidance on why you should consider the switch and what to look for when researching technology.

To read the article on Medscape, you need to be registered as a user. Registration is free, so you can click here, register, and then view the article. Otherwise, here’s a link to a PDF of the article.

Cyndi Bryant Walker, CMB, CHBC, the article’s author, does a great job with 10 recommendations to help ensure that you end up satisfied with your EMR choice. In fact, these are similar to the steps we at Practice Velocity would recommend to our own potential customers when they approach us regarding our software solutions for their urgent care. Here’s the brief version of Walker’s recommended steps and how it might apply to your search for an urgent care EMR:

1. Take a closer look at ASP (application service provider) technology. With an ASP model, the EHR program and data are housed securely through the vendor, so there’s no need for expensive servers or tech support, and your software is always up-to-date. Many vendors do say they offer an ASP solution, but it is important to investigate the actual architecture. Systems that were initially designed for use on a local server will almost always be slow and cumbersome when accessed over the Internet. You need a system like Practice Velocity that was initially made and optimized for use over the Internet.

2. Take your time and evaluate companies thoroughly. Many vendors say their EMR will work in urgent care. Was the EMR designed by experienced urgent care professionals? How many real-world urgent care installations exist? Do you have to make fake appointments, or can you simply register patients as they come into the clinic? Does the system have significant functionality for occupational medicine and workers compensation cases? Can the doctor document most visits in less than three minutes?

3. Check out your software vendor. Ask for a list of references and talk to practices that have worked with the vendors you are considering. With more than 750 clinics in 48 states using Practice Velocity systems, Practice Velocity staff are happy to provide plenty of references.

4. Evaluate the EHR company’s daily support structure. Does the vendor offer live support, or are you required to submit ticket requests through email only? Be sure you’re comfortable with the support structure the vendor offers. If you are in urgent care, you will probably be open seven days per week. Does your software company have a human being answering the support line on evenings, Saturdays and Sundays? Practice Velocity offers a live human being (based in the USA) answering calls 365 days of the year, including evenings, weekends and holidays.

5. Make sure the company interfaces with your laboratory. Evaluate the needs of your urgent care in this area.

6. Scrutinize the medical notes preloaded into the EHR. Does the preloaded data fit your practice, or is it inapplicable and, therefore, unusable? If the EMR was not specifically made for urgent care, then your EMR will probably have lots of irrelevant information preloaded into the templates. Practice Velocity gets calls regularly from physicians in orthopedics, emergency medicine, psychiatry and many other specialties, but the answer is always the same: “Practice Velocity systems are specifically made for urgent care centers and occupational medicine clinics.”

7. Research the billing package. Be sure the billing package includes the must-haves of billing software: annually updated CPT and ICD-9 codes, automated statements, automated verification of benefits, rejected claim reports, electronic posting of payments and EDI transmission reports. All of these functionalities come standard in the PV billing package.

8. Add the scheduling and billing module first before bringing on the EHR. Walker recommends this strategy for those who are adding both a new billing system and an EHR at the same time so as not to overwhelm the staff with too many changes. This probably does not make sense for urgent care centers because very few visits are actually scheduled.

9. Set aside enough time to train. An EHR, no matter how good, is worthless if you don’t know how to use it. You need to “play” with the system to get skilled at using its functionality.

10. Prepare yourself and your staff for change. Change is difficult, especially of this magnitude. Walker recommends using a dual system of paper charts and the EHR before making the full transition. Practice Velocity is one of the very few EMR vendors that offers a dual method for entering data into the EMR: 1) PiVoT: scanned Practice Velocity templates and 2) VelociDoc: traditional EMR. Many practices have used this dual functionality to make the transition to EMR smooth, efficient and relatively painless.

For anyone researching EHRs specifically for urgent care, Walker’s steps will reveal why Practice Velocity’s VelociDoc® Tablet EMR is the leader in EMR software in the urgent care industry. In fact, Walker’s article describes the extensive functionality, benefits, support services, and training offered by Practice Velocity. It was almost as if Walker used the VelociDoc EMR as a template for most of her recommendations.

Urgent Care Marketing ROI Fail?

2011-01-26T10:00:00.001-06:00

Recently I saw a billboard for a pediatric clinic that also offers urgent care services, and the billboard had me doing a double-take. As you can see in the photo below, the messaging is clear: the clinic’s urgent care services are offered from 9 a.m. to 9 p.m. on Saturdays.

So what had me doing the double-take? Billboards are exceptionally expensive, and even urgent care centers that are open seven days a week have trouble justifying the cost of outdoor marketing of this scale. I find it difficult to believe an urgent care center that is only open one day a week is seeing a large enough return on their investment to justify the cost of such an expensive marketing tool.

Marketing your urgent care center’s services is crucial to its success. After all, how are patients supposed to utilize your services if they don’t know your facility exists? However, you also want to ensure you’re maximizing your marketing dollars to ensure you’re getting the most out of your investment. Billboards may seem like an attractive marketing tool – they’re big and often flashy. However, it doesn’t mean it’s the right marketing tool for your urgent care center. When you’re only open for limited hours, there is a limit to the number of patients you can see and, therefore, a limit to the revenue it’s possible for you to achieve. It’s important to consider more than just the big and flashy when planning your marketing strategies. Utilize tools that are cost-effective, hit your target audience, and emphasize quality over quantity.

What are some marketing tools your urgent care center has utilized? What worked for you? What didn’t? I’d be interested to hear about your experiences.

ER or Urgent Care?

2011-01-24T10:00:00.001-06:00

United Healthcare, one of the largest insurance providers in the U.S., recently published an online news release educating consumers on seeking medical attention at an urgent care center or retail clinic instead of the emergency room. This is a positive sign for urgent care, which is still currently a source of medical attention that is often misunderstood and, therefore, overlooked by the average consumer.

Urgent care began in the mid-1970s as an alternative to emergency departments and primary care offices. However, most urgent care centers closed by the late 1980s, and it wasn’t until the late ‘90s that urgent care began to re-emerge as a means to unclog emergency departments and provide a lower-cost alternative. However, despite the resurgence of urgent care over the past decade, most consumers are still not aware of the services urgent care facilities provide or the cost savings they can experience – approximately a third of what they (or their insurance providers) would pay at the emergency room.

It’s encouraging to see a large health insurance company not only recognize the benefits of utilizing urgent care but also see the value in educating their customers on alternative sources of health care. More educational efforts such as this have the potential to have an exceptionally positive effect on the U.S. health care system, as consumers will then have the knowledge that they have other options besides the ER when their primary care physician in unavailable.

How Should Urgent Care Providers Navigate the Murky Waters of Social Media?

2011-01-20T15:56:00.004-06:00

Having a set of guidelines to follow is important for any corporate or professional presence on social media, but it is absolutely vital in the medical industry, where privacy and professionalism are not just cornerstones of the industry but are legal necessities. Given the open-book nature of social media, how do medical professionals stay on top of the Web 2.0 curve while still maintaining confidentiality and professional doctor-patient boundaries?

To help physicians navigate the murky waters of social media, the American Medical Association (AMA) recently released a social media policy for physicians that outlines how they can utilize social media to create a professional presence online. The policy begins by pointing out the benefits of participating in social media – points to remember when weighing the pros and cons of developing an online presence and fostering those online relationships. According to AMA, becoming active in the social media world can:

1) Support physicians’ personal expression;

2) Enable individual physicians to have a professional presence online;
3) Foster collegiality and camaraderie within the profession; and
4) Provide opportunity to widely disseminate public health messages and other health communication.

In other words, social media provides the opportunity for physicians to network with other industry professionals while developing a reputation as an expert in their field. AMA goes on to note that physicians do not necessarily need to limit their online interactions to just colleagues if they wish to connect with patients via social media as well, but physicians should proceed with caution if they decide to go this route by remaining cognizant of confidentiality issues and appropriate physician-patient boundaries. AMA suggests the easiest and potentially most effective way to do so is to separate professional content from personal content, which can be accomplished by creating private personal accounts that are separate from public professional accounts.

One physician who has successfully utilized social media to position himself as a healthy living expert is Timothy Reynolds, MD, managing partner of HealthCare Express. He has developed his Wordpress blog Living Every Minute as a social hub for articles, photos, videos, and even an online storefront for his products. Choosing a blog format over a regular website has allowed Dr. Reynolds to make his site a two-way conversation rather than a one-way broadcast of data. The people who check out his blog can subscribe so they get notifications whenever he publishes new content, and they have the opportunity to interact with Dr. Reynolds by leaving comments for him.

Dr. Reynolds has also utilized facebook as an added facet of his social media presence by creating both a page and a personal profile dedicated to building his professional presence online. Social media users now have three different ways to connect with Dr. Reynolds, and Dr. Reynolds is able to enjoy the four benefits of having a social media presence as outlined by AMA (discussed above). Most importantly, his content remains within the bounds of professionalism while allowing his followers to get a glimpse of the real, authentic Tim Reynolds, the most important element of a social media presence.

The main point to take away from AMA’s social media policy is to utilize common sense when building your social media presence. Always be professional, remember patient confidentiality, uphold proper physician-patient boundaries, and be online stewards by reporting any inappropriate online behavior that could be detrimental to the medical industry.

Teenager's Death Stresses Importance of Flu Vaccine

2011-01-17T10:03:00.002-06:00

Photo courtesy of UCA

Given the sophistication of modern medicine and medical technology, it can be quite easy for the public to believe that illnesses such as the flu cannot cause us more than a few days of discomfort. However, as medical professionals we know the truth is that, while modern medicine has prevented flu pandemics in recent years, the flu virus can still be just as deadly as it was centuries ago without the proper preventive treatment.

Urgent Cares of America (UCA), a Practice Velocity customer based in North Carolina, decided to take a proactive approach to this year’s flu season by offering free seasonal flu vaccines to one of the virus’ high risk groups. Starting at the beginning of January, UCA began offering free vaccines to all children and youths ages 4 through college students. Then, literally days after they began their preventive care campaign, media outlets in the area reported that a 15-year-old, whose gender was withheld in initial reports, died from complications associated with the flu, which has now become widespread throughout state. The Charlotte Observer reported in their January 7 article that the teen had not been vaccinated.

After the teen's death, the response UCA received to its offer of free vaccinations was tremendous. The teen’s tragic death served as a wake-up call to the public, who otherwise may not have considered flu vaccination a high priority. With their preventive care campaign already in full swing, UCA was ready for the influx of patients.

One can only wonder if one of these free flu shots ended up preventing flu and saving the life of another young person. If it didn’t save a life, one can be sure that the shots in aggregate prevented lots of lost school days and lots of aches and misery.

Practice Velocity congratulates Urgent Cares of America for its outstanding contribution to their community.

Nationally Certify Your Urgent Care Center

2011-01-06T14:22:00.000-06:00

The Urgent Care Association of America (UCAOA) announced this month that 17 urgent care facilities have just received the organization’s Certified Urgent Care Center designation. This month’s new additions bring the total urgent care facilities nationwide that have achieved certification to 219.

The certification program was designed to define what a true urgent care center is in order to distinguish urgent care facilities from other types of medical providers. Urgent care centers that wish to become certified must meet nationally-standardized criteria that outline the level of services they provide.

So what does it take to become certified? Here is a brief overview of the required criteria for certification:

• Accept walk-in patients during all hours of operation.
• Have X-ray and laboratory services on site during all hours of operation.
• Have a licensed provider on site during all hours of operation who can obtain and read an EKG and X-ray; administer PO, IM, and IV medication/fluids; and perform minor procedures.
• Meet a required checklist of equipment, with staff trained to use all specified equipment.
• Have at least two exam rooms, separate waiting area, and restricted-access patient restrooms.
• Meet all three criteria for the minimum hours of operation: 7 days/week (not including national holidays); 4+ hours each day; 3,000 hours per year.
• Have a licensed physician who is responsible for overall clinical quality designated as the medical director for the facility.
• Provide medical care and perform business activities in an ethical manner.

These criteria may seem simple, but as a UCAOA Board member at the time, I can assure you that they were a result of hundreds of hours of deliberation (often quite energetic) by the directors of UCAOA. Many other criteria were considered, but in the end there was a general consensus that these criteria would set urgent care centers apart from primary care practices that offered extended hours, walk-in clinics that offered minimal services, and retail clinics.

What are the benefits of certification? Certified urgent care facilities have the opportunity to educate their communities on the industry, eliminate confusion with other types of providers, a national benchmark for negotiating higher fee schedules, and an edge in marketing with clearly outlined levels of services provided at their facility. The program itself increases public knowledge and understanding of the urgent care industry.

Facilities can receive certification in one of two categories depending on their staffing model. Some facilities and practice types, such as chiropractic offices, pain clinics, or retail clinics, are unlikely to meet all of the above minimum criteria for certification and should use extreme caution when applying because the application fees are non-refundable.

Certification is not equivalent to accreditation. Certification defines the level of services, while accreditation demonstrates that a facility meets national safety and quality standards. Urgent care centers that become certified may also choose to become accredited by the Joint Commission. These centers can then receive a joint letter from UCAOA and the Joint Commission. The letter clearly specifies that the center is both certified as an urgent care by UCAOA and accredited by the Joint Commission. For more information on how to apply for certification, visit http://ucaoa.org/recognition_certification.php.

Ambulances in Canada Now Serving Urgent Care Facilities

2010-12-13T13:46:00.001-06:00

Canada’s CBC News recently published an article on a pilot program launching Wednesday, December 15, that will allow ambulances responding to patients with non-life-threatening injuries to transport them to Winnipeg’s Misericordia Urgent Care Centre instead of the emergency room. According to Lori Lamont, vice president and chief nursing officer for the Winnepeg Regional Health Authority (WRHA), “only patients in stable condition, those with non-life-threatening conditions who don’t need to be admitted to the hospital, will be taken to the care facility.”

The goal of the new program is to reduce wait times for patients and off-loading times for paramedics, who are required to wait at the hospital until the patient has seen a doctor – well after the triage process. Through this new program, patients in stable condition will be taken to the triage desk of the urgent care center, and the paramedics will be able to get back onto the street once the patient has been triaged.

This pilot program illustrates the great strides Canada has made in urgent care, as emergency respondents are now able to triage non-emergency cases in the ambulance and transport patients to the facility that best suits their medical needs. According to Lamont, this is a win-win situation for both the healthcare providers and patients because it “…will lessen demands on … emergency departments for stable patients who previously waited in emergency at the end of the triage scale and also for the paramedics who bring them in.”

With emergency department visits in the United States costing three times more than urgent care center visits, it seems the U.S. healthcare system could takes some notes from Canada, for a similar program implemented in the U.S. could potentially save the already overburdened healthcare system hundreds of millions (if not billions) of dollars.

Practice Velocity Customer Doctors Express Featured on NBC Nightly News

2010-10-26T06:41:00.001-05:00

NBC Nightly News just ran a story on the urgent care option for patients and featured Practice Velocity customer Doctors Express. The story emphasizes the cost savings of urgent care over the hospital emergency department ($125-140 vs $550).

NBC News Features Practice Velocity Customer Doctors Express

The story initially questions whether "this kind of treatment [is] the best medicine." But the story does not mention any quality issue, except that medical records in urgent care centers and ERs are not readily shared with primary care doctors. However, with interoperability standardization coming rapidly and the use of EMRs (such as VelociDoc) growing rapidly, one can expect this hurdle to be rapidly overcome. In addition, VelociDoc will soon have the functionality for urgent care centers to set up the system to automatically fax the patient record to the primary care physician after each patient visit.

The story featured the beautiful, new Doctors Express in Paramus, NJ. In addition, NBC noted, "Doctors Express is now a national franchise like McDonalds or Burger King.

In the background of several shots, Practice Velocity users will recognize Practice Velocity products in use in the Doctors Express.

USA Lags in Access to After-Hours Healthcare

2010-10-04T21:22:00.001-05:00

Jonathon Cohn writes today in The New Republic that the USA lags behind many countries in access to quality medical care after hours. He suggests that "market forces" could be applied to help solve this problem. He suggests that after-hours urgent care may be "a great business opportunity." He suggests that "government can also encourage this development with financial incentives, like boosting what Medicare and Medicaid pay for primary care (which the Affordable Care Act does very modestly)."

According to a 2007 survey 76% of Americans reported that they found access to after-hours healthcare to be very or somewhat difficult. That was the worst report of the seven nations surveyed.

Cohn, also, notes that the reason that the Netherlands appears to have the best access among countries surveyed is likely because the country has intentionally created "coverage networks for after-hours care."

This poor access to after-hours care seems to indicate that this dissatisfaction with access to healthcare in the USA is likely to continue to fuel the growth of the urgent care industry.

On a side note, one reader responded by claiming that for-profit healthcare was the problem, not the solution. On a recent urgent care visit, he observed the clinic receptionist ask for the patient's insurance card. "When the mother said, I don't have insurance. Can I pay to see the doctor? The employee said, 'I'm sorry, without insurance, we can't see your child--you'll have to go to Emergency at a hospital.'" Of course, this reader's tale seemed extremely far fetched, as cash is the proverbial king; and almost no urgent care will turn down a patient who will pay cash." In fact, most urgent care centers would prefer to avoid the costs, denials, red tape and delays of healthcare insurers. Almost all urgent care centers would much rather do business on a cash basis.

Branding and Signage in Urgent Care

2010-09-12T15:31:00.001-05:00

The other day, a simple glance on a drive by an urgent care center made it clear that the center had not consulted with anyone with urgent care banding or sign expertise. The center probably avoided paying a consultant for fear it would cost too much, but one can be almost certain that the center will lose hundreds-of-thousands of dollars due to their multiple mistakes in signage and branding. An expert consultant would have completely paid for himself or herself by allowing a center to avoid many mistakes.

Just a drive by the urgent care center made it clear that they had made the following mistakes:

Logo: illegal (Banned in all 50 states.)
Branding: ambiguous
Signage: obscured
Name: illegal (Banned in Illinois, Maryland, etc.)

A few pictures will allow you to see their mistakes up close an personal.

Can you see this urgent care sign? Hint, it's behind the "for sale" sign.

Their sign is tucked in behind the landlord's over-sized "for sale" sign. The sign is almost invisible to all cars driving by from this direction.. How much does this cost them? They will see hundreds of less patients in the upcoming months, due to the fact that their sign is essentially invisible. In addition, whatever the sign cost was a complete waste, because a sign that is not seen, is a sign that is worthless. What is the lesson? You need to have an expert in urgent care real estate review your lease before you sign it. No lease should allow a landlord to block the view of a tenant's sign.

Urgent Care Sign: Why is this sign illegal?

Besides the fact that it is invisible, what else is wrong with their sign? First, the state where they operate has a law, forbidding the use of the term “urgent” in any marketing. What is the penalty for violating this law? The fine is $1,000 per day of violation of this law.

Take a look at their logo—a slanted red cross. That's another mistake. The red cross, red crescent and red crystal emblems are designated as visible symbols of the protection afforded to war victims under the Geneva Conventions. These symbols stand for the neutrality of those who bear such victims of war. No entity that is not caring for or transporting war victims is permitted to use these symbols. Cost to change all signs and marketing materials will easily exceed $10,000.

Urgent Care Brand Confusion

Now let's look at the storefront of the clinic. Again, we see the the illegal red cross in the logo. Now we can finally read the name of the clinic, “Dr’s Immediate Care.” Why not put this on the street sign? A brand requires repetition and must focus on consistency. The more people see your name and logo, the more likely that they will remember your logo and corporate name. Even worse, we are still confused. Is this company name “Doctors Immediate Care, Inc (see logo),” “Dr’s Immediate Care,” or “Urgent Family Medical Care.”

What is wrong with any of these names. Any specialist consultant in urgent care can warn you that the US Patent and Trademark Office is very unlikely to issue a trademark for any of these names for two reasons:

They might be considered as simply descriptive.
The same names are already in use by many other urgent care centers

This center’s many signage and branding mistakes are likely to cost them hundreds of thousands of dollars in lost income due to poor visibility, poor name recognition and additional legal expenses.

So what is the take-home lesson here? We would recommend that before you spend everything that you have on an urgent care startup, you need to spend network with plenty of other urgent care professionals. You might consider attending a conference put on by the Urgent Care Association of America. It seems like a good idea to invest in hiring a specialist consultant in urgent care startups. If this consultant is truly expert in urgent care startups, that consultant should pay for himself of herself. Beware, when it comes to hiring a consultant, there are plenty of so-called experts that have little or no experience in successful urgent care startups. Be sure that your so-called expert has personally been involved in multiple successful startups, has lost of urgent care (not generic healthcare) experience, is not just hiding behind a graphically-pleasing website, and most importantly check their references (preferably urgent care operators that now have at least 2-3 years of experience). The most experienced consultant in in startup urgent care consulting is NMN Consulting.

What's wrong with this picture?

2010-07-28T10:52:00.006-05:00

Recently, I almost got whiplash when driving past a billboard. The words were clear enough, but the message seemed misdirected. A hospital emergency department was advertising instant access to its wait times. The advertisement used simple words--bold and big enough to see at a glance. But the message targeted the wrong audience.

What's wrong with this picture?

According to the advertisement, patients get instant access to hospital ED wait times via text, website, or phone call.

I’m suffering crushing chest pain, and I can text to receive the current wait time at the local ED. Great concept? As my kids would say, “Not!” If I am suffering a true emergency, I need to go to the nearest hospital ED stat—not after checking wait times. Guess what the wait time is now—zero minutes; and I shoot through triage like a rabbit in a dog pound.

Does the ED actually want a patient suffering crushing chest pain to sit at home until wait times get less than two hours? Checking wait times makes no sense for people who are using the ED for true emergencies. It might even cause them to delay treatment for a true emergency.

Let’s analyze the real target audience of this advertisement. Is the target patients who should be properly using the hospital ED? Is a patient who has time to check wait times seeking care of real emergency (emergency medicine) or is the patient simply looking for timely access to walk-in medical care (urgent care)?

What is the hospital doing? This would be a great advertisement if it were targeting urgent care patients. Instead, this hospital is directly inducing patients to increase inappropriate utilization of the ED.

Let's imagine that a patient who fell down the stairs has a bone shard sticking out of her shin. Would she go through the trouble of going online, checking wait times, and making her decision of whether to visit the ED now or later--based on short wait times?

If the billboard was really directed at patients with medical emergencies, it might as well read, "Sorry! This isn’t Disney. No fast passes here…. But don’t worry, if the lines are short enough, you might get rapid care for your emergency. Better yet, sit at home with your emergency until we free up some space in the ED. Then, we will have time to see you.

To patients who would be better treated in an urgent care, it could have read, “Got a minor illness? Don’t bother with the local urgent care. We might be able to see you just as fast. Just text…..”

Hospital emergency departments are for patients suffering emergency medical problems. For non-emergencies, urgent care centers are the logical alternative to the hospital ED. Patients who need convenient, timely care for minor medical problems should not be encouraged to check ED wait times. They simply don’t belong in a hospital ED. Why not use an urgent care instead? Urgent care centers offer:

Convenience: Hospital emergency departments are set up for emergencies, not to care for minor medical problems. In one minute, a real emergency can balloon wait times to several hours.
Proper Use of Community Resources: Hospital emergency departments are outfitted with millions of dollars of equipment for treatment of bullet wounds, heart attacks and multiple trauma victims. It makes no sense to waste these very-expensive, highly-specialized resources to treat a patient with strep throat. It is like using an aircraft carrier to pull a water skier.
Proper Use of Staff: Emergency department staff are highly trained professionals, who spend years honing skills to treat serious emergencies. It is a waste of their precious skills to treat patients with minor complaints.
Cost: A visit to a hospital ED generally costs over $500 for even the simplest problem. A visit to an urgent care usually costs less than $130. For anyone concerned about the cost of medical care, properly utilizing urgent care centers seems like a no-brainer.

America needs hospitals, payors and physicians to work together to make a more efficient healthcare system. One way to do this is simply to encourage the public not to use hospital emergency departments for minor medical problems. Instead, it is a community service to encourage patients to utilize urgent care centers, which are a much more convenient and cost-effective than hospital emergency departments.

If you have seen advertising that seems to encourage the public to use a hospital ED instead of an urgent care for minor injuries or illnesses, please comment.

Urgent Care Excellence in Downtown St. Louis

2010-03-28T12:29:00.008-05:00

On a recent weekend, as with many weekends, I found myself in a different city with my son's soccer team. The team was playing a tough game, and Jack (not his real name) was flying down the far sideline and went up for a head ball. A player from the other team did the same thing and their heads made an attempt to violate the law of physics that two objects can not occupy the same space at the same time. Both young men crumpled to the ground in pain. Jack was moving but when the coach got to the far sideline, he immediately waved for me to come across the field. When I got there there was blood streaming from a laceration in his eyebrow. We wrapped his head with a tightly-tied tee shirt and held pressure to the wound.

The fields were at the Washington University Academy in downtown St, Louis. Two years ago, we would have had no choice but to go to an urgent care in the suburbs or to a downtown hospital emergency department.

But I was well aware that my friend Sonny Saggar, MD had opened a new urgent care in downtown St. Louis. Prior to opening, Sonny had shared his vision of a downtown urgent care center for the people of St. Louis. As with many startup urgent care centers, Sonny faced some significant hurdles:

Inept Consultants: He tried one of the Practice Velocity^® startup imitators--that offer all-in-one startup help--that is "just as good as" Practice Velocity. What he found out, however, was that the consultant had minimal experience in opening a single (and somewhat unsuccessful) urgent care center in a far-away state.
Inexperienced Billers: The all-in-one startup company vaunted it's urgent care focus, but the head of the company had been a hospital executive and had no significant urgent care experience. The billers he had hired had no urgent care experience.
Wrong EMR: The all-in-one startup company advertised its one-of-a-kind, "first true urgent care EMR" software. Yes, the software was one-of-a-kind, but Dr. Saggar discovered that it was cumbersome and impossible to use efficiently in real-life urgent care situations. NOTE: Although other companies might advertise that they offer an "urgent care EMR," the Practice Velocity VelociDoc^® EMR is the only EMR made in urgent care centers by urgent care professionals from the beginning. In fact, VelociDoc is so specific for urgent care and occupational medicine that we do not even recommend it for any other type of practice.
Tough Demographics: Prior to his opening, we discussed the difficulties of urgent care centers located in downtown in major cities, especially cities such as St. Louis that have modest populations, living in the downtown area. I told him that it would be tough, and I would recommend that he try a different location for his first center. Sonny loves a challenge, and he has a passionate commitment to the city. He later shared with me that my words of caution made him even more determined to succeed. An succeed he did. Upon our visit, we find that he has even expanded his services to include the only primary care practice in downtown St. Louis.

Now, back to the soccer injury.... We jumped into our cars, I Google-mapped "downtown urgent care st louis" on my Palm Pre, and ten minutes later Jack was receiving care from the excellent staff at Downtown Urgent Care. Check out the cool graphics in his logo. As you can see, they are located right on the street a lighted sign right over the window. The waiting room is ample, but feels even larger because of the high ceilings.

An hour later, Jack was eating lunch in the car on the five-hour drive back to our homes in Chicagoland.

Thanks Sonny, for your persistence in making sure that the people of downtown St. Louis (and the visitors to the city) have access to quality urgent care service. Jack's stitches are out, he is fully recovered, he scored a goal yesterday, and his parents are very thankful to Sonny and his excellent staff at Downtown Urgent Care in St. Louis.

Sisters of Mercy Urgent Care: Check Out This Beautiful Clinic

2010-03-14T11:26:00.002-05:00

Asheville, NC, nestled in the Blue Ridge Mountains, is known for being the boyhood home of novelist Thomas Wolfe and the site of America's largest home George Vanderbilt’s 250-room Biltmore House. It may not be well known, but Asheville is, also, home to one of the most stately urgent care centers in the USA--Sisters of Mercy Urgent Care West.

I had the pleasure of meeting with their dedicated staff last week, as they worked with me to implement Practice Velocity solutions to systematize the charting and coding for their urgent care centers. Upstairs, the urgent care center has a beautiful conference room, administrative offices, and a view across the valley. Downstairs the center has a spacious and tastefully decorated waiting room, a door to the clinical area that requires manual electronic access by the receptionist, ample exam rooms, and a semi-private charting area for providers. There is ample parking in the back and a covered driveway to allow for protection from the elements when dropping off a sick patient.

The center has a large, lighted sign on the street. Still, one other aspect of the center ties in with a previous post. When you drive up the road to the center, you will see it framed with the large billboard, telling the community, "We're here for you." Practice Velocity congratulates the staff of Sisters of Mercy Urgent Care Centers for being there for the urgent care needs of the people of Asheville.

Listing Wait Times Online: Is it a good idea?

2010-03-01T21:59:00.004-06:00

We frequently are told that a startup urgent care center has a great idea, they are going to post their wait times right online. It sounds like a great idea, with a direct view toward good customer service. People have the information and can decide whether to come in now or later. This afternoon we sampled the websites for two urgent care centers that post wait times. Snippets from their websites are attached. This afternoon's research seemed to indicate that both clinics were quite backed up. Does anyone seriously believe that very many website visitors actually visited the clinic today? On the other hand, if your goal is to attenuate visit volumes on busy days, could you come with a better way to discourage clinic visits?

It's not a new idea, and we have generally discouraged placing wait times online for several reasons:

Wait times may be high now. But you may be caught up in 30 minutes, which may be the time that it would take a visitor to your website to drive to your center. Patients are interested in the wait time for when they arrive at the clinic, and that has little to do with the current wait time in the clinic.
Staff will likely exaggerate wait times. It is human nature for staff to want to reduce their workload.
The term "wait time" is ambiguous. What is a "wait time?" Time that you will wait to see the doctor? That's probably what most patients think. Or is it the throughput time for patients? That's what many centers mean, but this time is often over 60 minutes, even when time to see the doctor is really under 30 minutes
Patients won't necessarily come in later. They may choose to go to another center. Is that what you want?

Patients aren't so much worried about the wait times for everyone else in a clinic, they are really concerned about what their own wait time will be. Is there a way to control that? Yes. Practice Velocity's client clinics use our ZipPass^® product for FREE. With the click of a mouse, visitors to the urgent care website (and visitors to the center's GoUrgentCare.com directory page) can "get in line, online." The software automatically uses the algorithm selected by the center to determine the next available appointment. This accomplishes three important goals for the urgent care center:

Operations Efficiency: ZipPass smooths out patient flow, by pushing appointments out when the clinic already has many patients in the clinic.
Patient Convenience: Barring an emergency patient visit, ZipPass holders are first in line when they get to the clinic. What a great deal! Who cares how long the line is; they are first in line. If any other patients seem unhappy with the ZipPass patient "cutting in line," your staff can simply offer them a brochure about the ZipPass service, "So next time, you can be first in line too."
Marketing Effectiveness: ZipPass converts website visitors into clinic visitors. If you doubt whether this will work, consider this fact: 85% of people who fill out a ZipPass^® show up for their appointment.

If the idea of appointments (even same-day appointments) is foreign to your conception of an urgent care, maybe you can look at it this way. Patients are not really making "appointments," they are simply getting in line from their home or office. Rather than wait in your waiting room, they can wait in the comfort of their home or office. You see more patients. You see them more efficiently. They get the convenience of shorter waits. It seems like a win for everyone involved.

No Sign Available? Try a Billboard.

2010-02-27T08:42:00.006-06:00

A year ago, Mickey Jones was starting an urgent care in a great location in Lehigh Acres, Florida. But he had one problem--no signage, and no available signage. There was a large billboard in front of his center, but he wasn't sure if buying space on the billboard would be cost-effective. To get some outside input, he discussed his situation with us at Practice Velocity. If he could afford it, it seemed like a great idea. We suggested that he make it clear that the billboard was acting as a giant sign on the street for his center. We suggested that he put a large arrow pointing to the center with the words, "Right Here." We encouraged him to see what kind of price he could get on the billboard. In the current recession, prices were quite reasonable.

We talked to him this week, and he told us that he had done exactly what we had suggested, and the results speak for themselves. The billboard is by far the number one marketing source for new patients at the urgent care center.

Advantages of billboard signage include:

Little up-front cost. Permanent signs can add $50,000-$100,000 to your startup cost.

Pay as you go. You are simply leasing the signage. Someone else is paying the capital cost of the sign infrastructure.

Can swap out graphics for a low price

Disadvantages include:

Price may go up. It might be a good idea to sign a contract for the length of your lease.

Increases financial risk of failure. You can avoid this risk by not signing a personal guarantee, i.e., sign the lease for your LLC, not as an individual

Unsightly. Everyone knows that billboards can be an eyesore, but the billboard is going to be there anyways. This allows you to control how the sign looks.

Our advice isn't guaranteed to always work out this well, but if you are starting a new urgent care we encourage you to consider coming to our headquarters near Chicago, IL and visit us for a free, full-day consultation tour of the 13 urgent care centers we own. Over 500 urgent care professionals have visited in the last two years. We would be honored to host your team.

Practice Velocity® Urgent Care EMR Now Serving Urgent Care Centers in Forty-Eight States

2010-02-01T09:37:00.006-06:00

Dr. Mark Ibsen and the rest of the Urgent Care Plus team

With the opening of Urgent Care Plus, Practice Velocity^® now is the EMR of choice for urgent care centers in forty-eight states.

Urgent Care Plus opened its doors to serve patients in Helena, MT in January, 2010. With the addition of Urgent Care Plus, Practice Velocity^® Urgent Care EMR serves the charting, coding and billing needs of over 600 urgent care centers in 48 states. The center has installed the online Practice Velocity Urgent Care EMR and practice management software.

Downtown Helena had no access to urgent care services, so this new center was welcomed by the people living in the area, and the clinic has already seen over 20 patients in a single day. Helena has a population of 30,000 and the surrounding area has a population of 80,000. It is the capital city of the State of Montana. An area of this size can easily support three urgent care centers.

Medical Director and owner Dr. Mark Ibsen has twenty-seven years of emergency medicine experience. Dr. Ibsen captures the vision for Urgent Care Plus with the motto, “The healing begins when you walk through the door.” He added, “We provide acute care with speed, compassion and thoroughness.”

We always say to our customers that, "It’s not about our software; it’s all about your urgent care success." We are honored to help this new urgent care clinic serve the people of their community.

PV Billing, a subsidiary of Practice Velocity, provides the back-office billing functions for the urgent care. In 2009, PV Billing processed over $100-million in claims. Their specialized urgent care expertise allows urgent care physicians to take care of patients and leave the complexities of the billing functions to specialists in urgent care billing.

The Practice Velocity team is unparalleled in experience and expertise, with a combined 200-years-plus experience in urgent care. These professionals have designed every aspect of the urgent care EMR, making the software uniquely focused on urgent care. That may be why more urgent care centers use Practice Velocity systems for charting and coding than every other system combined.

For more information, call Dana Flores at 815-544-7480 or click here to contact us online or to schedule an urgent care EMR web demo.

US Patent Office Issues Patent to Practice Velocity

2009-12-07T12:30:00.002-06:00

Practice Velocity^®, LLC has received a patent for the PiVoT^TM system. The PiVoT system is a completely unique system, and this means that the US Government has recognized this unique intellectual property. Many of the unique aspects of the PiVoT system have, also, been incorporated into the VelociDoc^® Urgent Care EMR, so this means that many aspects of VelociDoc are within the realm of this patent.

Practice Velocity expects to continue to innovate new ways to make our software solutions more efficient for use in urgent care centers, and we will continue to seek recognition and protection for the unique aspects of our intellectual property.

You can read the full press release at:
US Patent Office Issues Patent for PiVoT to Practice Velocity Urgent Care Solutions

UCAOA Fall Conference

2009-10-30T11:03:00.004-05:00

It was great to see so many of you at the Fall Conference in Dallas. Due the large numbers of people visiting the PV booth, many of you were unable to get a full demo of the system or get personalized attention to your questions. We apologize, but we are always available to take your calls and demo the systems online.
Second in attendance only to the UCAOA Spring Convention, the Fall Conference was clearly a hit, with over 250 attendees. Hitting their goals were all four tracks:
- Basic Coding
- Advanced Coding
- Clinical Urgent Care
- Startup Urgent Care

If you did not get a chance to talk to us or see the system in action, feel free to contact us directly to get a personalized demo of the system. We can go over every aspect of the system: online, same-day appointments, charting, coding billing and collections, EMR and much more. In addition, you may call us and set up a full-day tour of our sister urgent care centers (Physicians Immediate Care), where we outline every aspect of our operations and answer all of your questions.

See you in Orlando in the spring of 2010.

Thanks to Alan Ayers of Concentra for taking these photos.

Surprise the Insurance Company Owns our Competitor Urgent Care

2009-08-18T23:13:00.007-05:00

Recently, a group of physicians were in the process of opening a new urgent care center and had requested a contract with the dominant provider of healthcare insurance in the area. The payor was offering a contract with reimbursement well below Medicare rates. The physicians could not understand why the rates were so far below market and why the payor was refusing to budge. Then one of the payor representatives let it slip that the payor was thinking about expanding their own urgent care chain into that town. The doctors were dumbfounded. They had known the brand name of the urgent care chain, as this chain operated many urgent care centers in neighboring towns. The physicians were well aware that this urgent care chain was a potential competitor. But they had been previously unaware that the insurance company actually owned the urgent care chain.

In South Carolina, Blue Cross owns a very large urgent care chain. In California, Kaiser operates its own urgent care chain, and Kaiser generally does not even offer contracts to urgent care centers that it does not operate.

So what is the take-home lesson? If there are any larger chains of urgent care centers in your area, investigate them and be sure that you know what entity owns the centers, before you decide to open an urgent care center. Make sure that no local dominant payor is involved in the ownership. Opening an urgent care center is hard enough if all local payors are working with you. But opening an urgent care center with the dominant local payor refusing to contract (or refusing reasonable rates) will mean tremendous financial struggles. Yes, there may be potential antitrust issues, but getting the federal government to intervene is truly a long shot.

We all know the saying "Caveat Emptor," translated, "Let the buyer beware." Maybe there should be another saying, "Caveat Entrepreneur".

Physicians Immediate Care Makes Thousands of Children Happy

2009-05-06T13:08:00.005-05:00

Just how did our sister company (same owners as Practice Velocity, LLC) make make such a positive impact on kids? Last week, a little girl came into one of our clinics with a fever, cough and runny nose. Her flu test was positive for influenza A; it turned out to be the Swine (H1N1) flu strain, and the entire school district was closed down for two days… WooHaa… The weather was beautiful, and the kids had a great time. Bad news, however, the students will spend an extra two days in school at the end of the year.

While the kids where home, the local news showed public school staff “disinfecting” desks, floors, walls and school buses. Local administrators praised the effectiveness of this 'disinfection.'” After a day on a solid object (called a “fomite” in medical terminology) at room temperature, essentially 100% of flu viruses will no longer be viable. Thus, the staff may have been cleaning these objects, but they probably did not kill even a single flu virus in their hundreds of hours of work. This misdirection of resources emphasizes the need for better education of school administrators on the prevention and spread of influenza viruses.

One of our employees had a daughter who attended the same school as the index case came down with influenza A. Her daughter took the Tamiflu. From the picture, you can see that her daughter is already much better.

One point that the US Government seems to be missing in their efforts to prepare for an epidemic or biological terrorist threat is that hospitals and hospital emergency departments will not really be the front line, and their resources will be rapidly overwhelmed. Urgent care centers in the USA number almost 10,000. Urgent care is the clinic of choice for patients when they come down with acute, apparently non-life-threatening illnesses. That means that for any epidemic except a rapidly-fatal epidemic, urgent care centers will be the front line of health care. The Urgent Care Association of America is in the process of developing policies and information to disseminate this information to the public, government representatives and public health officials.

Even local urgent care centers seemed confused about how they should react. One local urgent care center made the local news (Urgent Care Center Turns Away Any Possible Flu Cases) when it posted a large "Swine Flu Notice" sign on the front door. The sign stated that no one suffering from a "sore throat, cough, runny nose or fever" should enter the clinic. Oops! Looks like even someone in the industry needed a little update on the mission of urgent care.

I bet that a lot of you have interesting stories about how your urgent care was involved in the Swine Flu panic of 2009. Just click on the link below to comment and share your stories.

UCAOA-2008 in New Orleans

2008-03-29T14:47:00.004-05:00

The annual UCAOA Urgent Care Convention in New Orleans promises to be the biggest and best-ever gathering of urgent care professionals.

In the speaking sessions, I will share my thoughts on managed care contracting in the Comprehensive Clinic Startup track, and I will give an update on urgent care coding (same talk will be available at two different times) during the main convention.

Please sign up at the PV Booth and join us at the Fourth Annual Practice Velocity Event on Thursday, May 1 at 7:30 PM. This year we are having a Blowout Mardi Gras Party. There will be music, food, drink and a drawing for over a thousand dollars in cash. You won't want to miss it.

This year will be your chance to view our new tablet PC EMR--VelociDoc™. Please drop by the Practice Velocity booth and see the EMR and give us your feedback.

See you in New Orleans.

Practice Velocity: The Un-Software Company

2007-10-08T23:54:00.001-05:00

MDNG Net Guide (September, 2007) recently ran a story entitled, “Shhhhh! (10 Secrets the EHR Companies Don't Want You to Know).” The article highlighted the seamy underbelly of the EMR business. The “secret” practices referred to in the article are useful for physician to note. Since so many of these practices might be hard to spot--and you might even wonder if Practice Velocity engages in any of these shady practices--we thought that it might be useful to compare these “secret” practices to the open practices of Practice Velocity.

Secret #1: EHR awards have been bought! Yes, many EMR companies have actually paid off companies to give them awards. Practice Velocity has never entered any of these rigged contests, because the only award that Practice Velocity has ever sought is the award the really counts, the accolades of its own customers.

Secret #2: That “non-biased” expert recommending an EHR to you may have been paid off too! Again, many EMR consultants are actually receiving sales commissions as for referrals to purchase their EMR. Practice Velocity has never participated in this deceptive practice. We believe that anyone acting as a salesperson for a product should be identified as a salesperson to the prospective buyer.

Secret #3: Even that EHR-using physician you’ve been referred to may have been paid off! People often ask us how our customers can be such raving fans of Practice Velocity products. No, we have never paid anyone to provide testimonials to the value of our products. Even the many customers that take the microphone and extol the value of Practice Velocity at the annual PV dinner (held during the UCAOA Annual Convention) have never been paid to take the microphone and tell about how PV has worked for them.

Secret #4: The respected physician leader of your local society may also be receiving compensation! Yes, leaders in national urgent care associations have and do use Practice Velocity, but Practice Velocity has never paid them to state this publicly. In fact, in order to protect their credibility as leaders in the urgent care industry, we have encouraged many of them to downplay the fact that they use PV products in their urgent care centers.

Secret #5: Determining how much a specific EHR costs is going to be difficult, and you are going to be nickel-and-dimed every step of the way! Since the very beginning, we have determined that we were tired of the way software companies had treated us as customers. One company even required us to pay up front just to get a quote on how much a modification to their system would actually cost. Instead, Practice Velocity has always made its prices simple and transparent. In addition, since putting our first customer online five years ago, our prices for our charting and coding solutions have never gone up one penny.

Secret #6: Your patient data will be a bargaining chip to prevent you from leaving an EHR company! What a scam! Practice Velocity would never want anyone to say that we had not treated them fairly on exit. That is why we clearly state, up front, in our contracts that the urgent care customer will always have a right to leave with a complete set of patient records.

Secret #7: The return on investment (ROI) argument is another way of saying “this solution is overpriced!” But what if you offered your product on a thirty-day trial basis with no money down, and the urgent care center doesn’t a pay a penny if it doesn’t see real the solution create more value than it costs? Yes, that is what PV promises, “Try us for thirty-days, if you are not absolutely convinced that Practice Velocity Templates (PiVoTs) is paying for itself, then you stop using PiVoTs and pay us nothing.” With the exception of two centers that used the system for under a week, every center that has tried the system for thirty days has decided to pay for and continue using the system.

Secret #8: EHRs don’t improve quality of care and often make you less efficient. And since you won’t figure this out until you are actually using the product, EHR vendors won’t let you try-before-you-buy, and there is no return policy! This is almost always true. But here Practice Velocity is completely different. Remember you can “try-before-you-buy” PiVoTs for 30-days. Even after the thirty days, since PiVoTs work on subscription you only pay for the visits actually charted on the system. You can stop any time with no penalty. Thirty-day trial, only pay for what you use, and stop whenever you want--now, that’s even better than a return policy.

Secret #9: A CCHIT-certified product, by definition, is often more expensive and less usable than non-certified products. That’s an absolute fact. If you make your product for a bunch of academics that don’t practice medicine but do research and evaluate bells and whistles in an EMR, you will make a product with bells and whistles that can pass a bells-and-whistles test. But if you want a product that will work in the cauldron of everyday urgent care, it probably makes more sense to try a product that was developed by urgent care professionals in urgent care centers and is already proven to work in over 180 urgent care centers. That description only fits one product—PiVoTs by Practice Velocity.

Secret #10: There are alternate ways to determine if an EHR, and the company selling you the product, will work for you. And there is no better way than the thirty-day trial that Practice Velocity offers. Try PiVoTs in your urgent care centers for up to thirty days. If you are not convinced that PiVoTs are the absolute best product that you have ever seen or could even imagine for your urgent care, simply stop using PiVoTs and you pay us nothing. As one early implementer (who still uses PiVoTs to chart over 100 patient visits each day in his urgent care center) put it, “Well, David. I guess that’s a no-brainer.”

Yes, and not only is it a "no-brainer," it is one more characteristic that separates PV from the rest of the field--NO SECRETS. Try it and see. For your free web demo of the Practice Velocity suite of urgent care solutions, call today -- (815) 544-7480.

Practice Velocity Upcoming Conferences

2007-08-17T06:56:00.000-05:00

The Practice Velocity team will have booths at the following shows. I will, also, be attending the shows, so drop by and let me know what you think of them.

October 22-24, 2007: National Association of Occupational Health Professionals National Convention: I will be speaking on Monday, Oct 22 about the challenges and benefits of mixed-use (occ health and urgent care) clinics.

October 26-27, 2007: Urgent Care Association of America Fall Conference, Chicago: I will be speaking in the coding track and the urgent care startup track.

November 28-29, 2007: Retail Health Summit: I will be speaking and moderating a discussion on the history and future of the urgent care industry

Please drop by and introduce yourselves if you attend any of these conferences.

Urgent Care Works for the Stern Family

2007-03-04T08:55:00.000-06:00

This weekend found me out of town with my two boys on our annual trip to an indoor soccer tournament in Milwaukee. After a 11:30 PM game on Friday night we retired to our hotel. The next morning at breakfast, our twelve-year-old soccer player developed a deep cough, could not eat breakfast; and he proceeded to cough, throw up, shiver, and turn pale and lethargic.
After cleaning him up, we drove back home; and on the way home dropped off at our local Physicians Immediate Care where they were experiencing an early afternoon rush. While Eric was getting a chest x-ray, I evaluated an ankle sprain and completed a DOT physical for a forty-two year old trucker, whose urinalysis demonstrated a new diagnosis of diabetes. The clinic was quickly caught up with patient flow.

Eric's chest x-ray is pictured above. The haziness on the lower half of the left lung (right side of image) demonstrated a clear left lower lobe infiltrate--pneumonia. One gram of Rocephin im (didn't hurt "too much"), and we were on our way home with a cracked-lipped, pale, lethargic boy, whose breath reeked of ketosis. For the rest of the day, I followed the advice that I have given to hundreds of parents--fluids, fluids, and more fluids. By the evening Eric was mostly rehydrated, and the next morning felt fine and went to church.
What this family episode drove home was the importance of local urgent care access. What if there was no readily accessible urgent care center in our community? If there was no easy access to urgent care for sick kids, would many parents shun the emergency room and wait till Monday to see their pediatricians; or would many parents spend hours in the emergency department and suffer along with their sick child? Either way, an urgent care is a much better option.
The good news is that our community has ready access to urgent care for sick children. Treating Eric's pneumonia within hours of onset, led to an extremely rapid recovery. His answer the next morning to, "How do you feel," was quite refreshing.
"You know Dad," he said, "when your really sick, it seems like it will never end. But when you get better, it doesn't seem like you were sick for very long."
To those of you who operate local urgent care centers, may I speak personally as a Dad? "Thanks. You really do make a difference in the lives of your friends and neighbors."

Humana Supports Urgent Care Centers

2006-12-25T21:36:00.000-06:00

Humana is one managed care organization (MCO) that seems to "get it" when it comes to urgent care. On their website, Humana has a page devoted to guiding their members toward urgent care centers when appropriate.
Humana lists the advantages of urgent care as:

Urgent care centers usually have extended and weekend hours.
No appointment is needed.
Generally wait times are short.
Urgent care physicians can deal with a wide range of conditions.
Members can be responsible for "most of the charges," if they use an ED "innapropriately."
"Best of all... you'll probably just pay a set copayment."

Humana, also, regards hospital-based urgent care centers as overusing resources. They state:

Don't let the urgent care sign fool you!
All centers are not created equal, and the difference can affect your wallet. To reduce your costs, choose a free-standing urgent care center, one that isn't located in a hospital. These facilities are well equipped to provide medical care for minor illnesses or injuries. The only difference is the location. Your copayment and other costs could be a lot higher if you choose an urgent care center in a hospital.

We have not previously seen payors steering patients away from hospital-based urgent care centers. This directive seems to be an attempt by Humana to avoid paying the facility fees or ED codes that are sometimes charged in urgent care centers that are based on the hospital campus or centers that are fast track segments of the emergency department. If many payors put this type of pressure on patients to avoid hospital-based urgent care centers, financial pressures on hospitals to move urgent care centers off campus may not be far behind.

Few Practices Using Computer-Assisted Coding

2006-12-16T13:06:00.000-06:00

Over 39% of medical offices and institutions are finding a very difficult or extremely difficult time finding coders—so says a survey conducted in May by the American Health Information Management Association and the American Hospital Association with support from the American Medical Association.

Despite this shortage, only 12% of health organizations are taking advantage of computer-assisted coding. Why the do practices disregard computer-assisted coding? There are several obstacles to implemenation of computer-aided coding--all of which have more than adequate solutions in Practice Velocity Templates, PiVoTs:

Lack of awareness: Many physicians are unaware that Practice Velocity offers a solution that computerizes the coding of all E/M, ICD, and CLIA-waved test codes.
Expensive systems: Most systems require massive up front outlays to implement the system. Not so for PiVoTs. With no up-front costs, simply try the PiVoTs for 30 days in one of your urgent care centers. If Practice Velocity does not speed up your patient flow and increase your practice revenues, simply stop using the system and pay us nothing. Every urgent care center that has installed PiVoTs in their clinics has immediately realized more revenue than the monthly subscription payment to Practice Velocity. Thus, Practice Velocity systems actually pay for themselves..
Cumbersome systems: Practice Velocity has become the largest provider of urgent care software solutions for one main reason—the PiVoT is the easiest computerized charting and coding solution. Physician users need no computer skills and never have to deal with navigating computer screens. If you can write with a pen on paper, you can probably use the system with only an hour and a half of training.
Protective coders: Many coders fear computer-assisted coding, because they have the mistaken impression that the computer will replace the coder. While this is true for the mundane work of coding each and every chart, coders will always be needed to code complex cases and to provide quality assurance. There already is a shortage of coders and high-quality coders will always be needed.

Is one of the reasons above holding back your urgent care from taking advantage of computer-assisted coding? Practice Velocity is your answer for your urgent care center or occupational medicine clinic. Why not sign up for the 30-day trial and watch Practice Velocity speed your charting, improve your coding compliance and improve your bottom line? Call today, and watch implement computerized coding and realize peace-of-mind profitability in your urgent care center.

ICD-9 Coding in the Urgent Care Center

2006-10-16T09:58:00.000-05:00

Question: Recently, we received the following question about ICD-9 (diagnosis) coding.

A nursing supervisor through our parent hospital is questioning the ability of an MA to legally write in ICD-9 codes matching physician diagnoses. It is my understanding that MAs get this training in school and as long as the physician is assigning the diagnosis and E&M code, the MA (certified MAs) can write in an ICD-9 code which directly matches. It has been this way in all offices I have worked in. If you have any like or something in writing supporting this, please let me know.

Answer: The physician is ultimately responsible for all codes billed out for all professional services billed under the physician's provider number. There are many ways, however, for the facility to do this.

Have staff assign the codes, and require the physician to initial the final codes.
Force physician to assign all codes.
Have staff assign the codes (after physician writes down the diagnosis), but have physician do audits of randomly selected charts on a regular basis to make sure that, for compliance reasons, the physician agrees with the codes being chosen.
Use checkboxes on a form so the physician can assign the majority of codes. If this is combined with a commercially available "cheat sheet" of most common codes, over 90% of the ICD-9 codes can be readily assigned by the physician, without slowing down the process.
There are probably other compliant methods for ICD coding in the urgent care center.

Urgent Care Mini-Conference a Big Success

2006-10-08T19:05:00.000-05:00

We just returned from the Fall Mini-Conference of the Urgent Care Association of America in Phoenix, AZ. The Association was expecting an attendance of fifty, but the urgent care community responded enthusiastically, and 125 urgent care professionals showed up at the conference. The enthusiasm of the attendees was exceptional, and the most common theme of goodbye was, "See you in Daytona," i.e., the 2007 National Convention of UCAOA (May 9-12, 2007).

I had the privelege of sharing three talks, 1) MCO Negotiation for Startup Urgent Care Centers, 2) Problem-Based Coding, and 3) Specialized Codes in Urgent Care (S9083, S9088, 99050, 99051 and 99058). All talks from the mini-conference will be available on CD through the UCAOA in a few weeks.

It has been a joy to watch UCAOA develop its vision to be a democratic, representative, professional organization of the highest caliber. Congratulations are due to Lou Ellen Horwitz (Executive Director, UCAOA) for the excellent quality she delivered at her first UCAOA conference.

See you in Daytona.

Will the Computer Replace the Urgent Care Physician?

2006-09-12T22:49:00.000-05:00

I wonder if every medical student wonders if someone could simply put all the symptoms of a patient into a computer, and the computer would generate the most likely diagnosis. Could the computer even use artificial intelligence and become a better and better diagnostician. Well that future may be a somewhat distant dream, but EasyDiagnosis.com is a website that may be offers some promise to help a patient discover some diagnostic alternatives for their sympton cluster and give the patient a rough statistical probability for each suggested differential diagnosis.

EasyDiagnosis.com allows patients to input age and sex and then guides them through a list of historical information to help determine the chances of specific diagnoses. The sample template on their website was for back pain. I answered the questions to indicate (among other items) I was a fifty-year-old male and that I was suffering sciatica and weight loss. The program determined my diagnostic probabilities as:

73% Tumor

17% Spinal Stenosis

9.4% Herniated Lumbosacral Disc

0.1% Chronic Low Back Syndrome

0.1% Osteoporosis

0.1% Osteomyelitis

0.1% Depression

0.1% Chronic Arthritis

0.1% Acute Lumbar Strain

0.1% Miscellaneous

Not really that bad. It's not quite ready to replace the physician, but it may help patients find the correct care for their medical problem. Allowing programs like this to interact with patients and physicians is definitely the future of medicine, allowing patient to input their symptoms and triage themselves in the waiting room of the urgent care center. Certain symptom constellations could even be used to expedite care of patients who need it. Allowing patients to do this from home may even allow patients to be directed to an urgent care center or to a hospital emergency department. Allowing computers to improve the care of patients in the urgent care center is the goal of Practice Velocity Software Solutions, and Practice Velocity will continue to bring innovative computer solutions to improve the efficiency and care of your urgent care center.

Technorati Profile

Urgent Care Fall Mini-Conference: Coding & Startup Tracks (Phoenix, AZ--October 6-7)

2006-09-02T01:12:00.000-05:00

Join us at the first annual Urgent Care Association Fall Mini-Conference in Phoenix, AZ at the beautiful Pointe South Mountain Resort on October 6-7, 2006. This should be an intimate conference with excellent opportunities for networking with the faculty. Expected attendance is about fifty urgent care professionals.

Conference registration is still open, but vendor booths are completely sold out. There will be two tracks:

How to start an urgent care center: Join me for a talk and discussion of basics of managed care contracting. The track includes tours of two different urgent care centers in the Phoenix area. This appears to be the most extensive course ever offered on starting an urgent care center.
Advanced coding in urgent care: I will be speaking on specialized codes in urgent care and on negotiating problem-based evaluation and management (E/M) coding. Coders, administrators and physicians will all benefit from gaining this knowledge.

My partner John Koehler and I will, also, be speaking at the National Association of Occupational Healthcare Professionals (NAOHP) in Philadelphia on October 23-25. Ryan Associates have requested that we speak on the topic, Benefits and Challenges of the Mixed-Use (occupational medicine and walk-in care) Clinic. Be sure to introduce yourself at the Practice Velocity booth.

Urgent Care Association of America Launches Journal

2006-08-09T22:41:00.000-05:00

The Urgent Care Association of America, UCAOA, has announced the launch of The Journal of Urgent Care Medicine (JUCM). The Journal will serve the rapidly-growing urgent care industry. As the official journal of the UCAOA. JUCM will offer a mix of practical, peer-reviewed clinical and practice management articles, focused specifically on the delivery of urgent care services.

Lee Resnick, MD, will serve as the first Editor-in-Chief of the Journal of Urgent Care Medicine. Dr. Resnick is Medical Director of four urgent care centers in the University Hospitals Health System in Cleveland, OH, where he is the Director of the first Urgent Care Fellowship program in the country. The fellowship program is being offered at University Hospitals of Cleveland /Case School of Medicine, through the Department of Family Medicine and is funded by University Primary Care Practices (UPCP, Inc.). Dr. Resnick also is the Chairman of the Academic Committee of UCAOA.

Dr. Resnick said, "JUCM will reflect the urgent care physician's perspective, with articles written by urgent care physicians and specialists who understand our practice. We will supplement this unique clinical content with practical practice management tools, industry news, and coverage of legal issues in urgent care and UCAOA happenings. For the urgent care professional, this means no more sifting through other journals for information relevant to your practice. It's all in one journal now."

JUCM will be published in partnership with Braveheart Publishing, with over 30 years of medical publishing experience and expertise. Peter Murphy, former publisher of the Journal of the American Medical Association, (JAMA) and Stuart Williams, former publisher of Medical Economics magazine, spearhead Braveheart's operation. The large UCAOA database of urgent care physicians ensures highly targeted distribution of Journal of Urgent Care Medicine to the urgent care industry.

The first issue of JUCM will appear in October 2006. Circulation will include physicians, nurse practitioners and physician assistants practicing urgent care medicine nationwide.

Physicians, physician assistants and nurse practicioners can click here to sign up for a free subscription to The Journal of Urgent Care Medicine.

Controlling Burn Rate in the Startup Urgent Care

2006-08-05T22:56:00.000-05:00

Someone once said, "The number one reason that startup businesses fail is that they run out of money." It sounds profound, but running out of available capital is not actually a "reason" that startup urgent care centers fail. This is akin to saying that the number one reason teams lose baseball games is that they score less runs than the opponent. The real reason for losing baseball games are failure to execute a successful game plan. In the same way, running out of available capital is not a cause; it is the end result and positive proof of failure. There are multiple reasons that urgent care centers fail, and you can click here to read some startup urgent care reasons for failure .

One reason for failure in a startup urgent care is a failure to monitor just how rapidly you are approaching and how close the urgent care center is to running out of cash. You can do this by making sure that your monitor and control the burn rate of your startup urgent care center. Jeff and Rich Sloan of StartupNation.com recently wrote an article entitled, "Controlling Your Startup Business 'Burn Rate.'” The ideas are particularly apropos for the startup urgent care. If you are involved in a startup urgent care you might want to review these ideas to see if they might benefit your startup.

Carefully monitor your startup burn rate: Every month you want to calculate how much startup cash your urgent care center has burned. Analyze how much of your total investment capital has been burned. Make sure that you are not in danger of running out of capital. If you see that you are in danger of running out of capital, you will want to arrange for additional capital.
Calculate the burn rate for your startup urgent care: Make sure that you are not suddenly surprised that you have run out of available capital. For example if your center has $500,000 of available capital, has lost a total of $400,000, and after one year is losing an average of $10,000 per month--you are only ten months away from running out of capital. But with your current growth rate and controlling your expenses, you should reach profitability before running out of capital.
Keep your expenses in check: The burn rate for your urgent care center has two components: cash deposits and expenses. Obviously, you have much more direct control over the expenses than you have over the cash deposits. About expense monitoring, Jeff and Rich Sloan say, "You should be ruthless about it, particularly in the early going. Monitor expenses every day."
Watch out for the big startup cash outlays: They say, "Spend your precious cash on what’s critical to producing revenue for your startup business." You will want to avoid purchasing lab equipment for CBC and CMP, expensive artwork, and plush furniture for your urgent care center. Instead, your capital outlays should be for critical components of your startup urgent care, including x-ray equipment, billing and charting software, signage, and advertising.

The Sloans conclude: "Controlling your burn rate can give you the confidence and resources to ramp up your startup business the way you want. Squeezing expenses in that new business is the best way to do it. If you don’t, you’ll learn just how unforgiving the marketplace can be."

Independence Day in the Urgent Care Center

2006-07-05T23:52:00.001-05:00

A patient presented to one of our urgent care centers with a wrist fracture and wanted a red-white-and-blue cast. Those of you who know John Koehler, MD might understand why he saw this a great way to demonstrate our mission of "spectacular customer service".
How many people do you think saw this and asked, "Where did you get that cast?" What a great opportunity to produce a happy patient and more positive PR for the urgent care center. With an emphasis on patient service, you too can find a great way to provide patients with unique ways to tell everyone in your community about the convenience and professional excellence of your urgent care center.

Free Market Forces and Urgent Care Centers

2006-07-01T23:09:00.000-05:00

An interesting reference to urgent care is found in an essay titled, "In Defense of Consumerism," by Llewellyn H. Rockwell, Jr. (Founder of the Ludwig von Mises Institute in Alabama). Consumerism has been much-maligned as merely giving plebeian access to superfluous items such as cappuccinos and gas guzzling SUVs, but Rockwell points out:

But are people buying superfluous things that they can do without? Certainly. But who is to say for sure what is a need as versus a mere want? A dictator who knows all? How can we know that his desires will accord with my needs and yours? In any case, in a market economy, wants and needs are linked, so that one person's necessities are met precisely because other people's wants are met.

Here is an example.

If my grandchild is desperately sick, I want to get her to a doctor. The urgent care clinic is open late, as is the drug store next door, and thank goodness. I'm in and out, and I have the medicine and materials necessary to restore her to health. No one would say that this is a superficial demand.

But it can only stay open late because its offices are nestled in a strip mall where the rents are low and the access is high. The real estate is shared by candy stores, sports shops selling scuba gear, a billiard hall, and a store that specializes in party favors – all stores selling "superficial" things. All pay rent. The developer who made the mall wouldn't have built the place were it not for these less urgent needs.

The same is true for the furniture and equipment and labor used in the urgent-care clinic. They are less expensive and more accessible than they otherwise would be due to the persistence of non-essential consumer demands. The computers [and the software] they use are up-to-date and fast precisely because technicians and entrepreneurs have innovated to meet the demands of gamers, gamblers, and people who use the web to do things they shouldn't. . . .

Rockwell's point is true that the consumer's demand for convenient, after-hours access to medical care has produced the much-needed urgent care center in his own neighborhood. Whether or not you agree with Rockwell's premise that consumerism is a force for the good of society, it is refreshing to see intelligent recognition of economic forces that have produced the much-needed urgent care centers and the technology (such as Practice Velocity Urgent Care Solutions) that helps make urgent care centers more efficient.

Ideal Location to Start an Urgent Care

2006-06-14T19:20:00.000-05:00

I frequently mention to inquirers that most people make the mistake of starting their new urgent care in their own home town, rather than look for an ideal town to start an urgent care center. After mentioning this to hundreds of people who are getting into the urgent care business, someone finally asked me for a list of criteria for choosing a town that would virtually guarantee success when starting urgent care center.

So, I sat down and wrote out my own ideas for a perfect town, in which to locate an urgent care center.

40-50,000 people
2-3 McDonalds (They do great demographic research.)
No existing urgent care center in town
Routine ER waits of 3+ hours
Good physician is available in the town to help you staff the new urgent care center.
Good industrial base for occupational medicine
Location for startup urgent care center is available on busy road (used frequently by most people in town) with good signage.
But, as she mentioned, the most important is whether her spouse was willing to live there.

These towns still exist. Today, I met with a group, looking to start the first urgent care center in their town of 35,000 with 150,000 people that live in the surrounding area and five McDonalds in town. As long as they don't make any big errors, they should be looking to open a second center within the first two years.

If you want to hit a home run with your first urgent care center find the perfect location, do all your research, listen to any experienced urgent care professional who will talk to you, get ready to work hard and love it, and move to the "perfect" town.

Over the years in our seven sister urgent care centers, we've hit a few bunt singles and a few home runs. Call Practice Velocity if you want to schedule a tour of one our sister urgent care centers to see how we do it.

Managed Care Organization (MCO) Insists that Urgent Care Physician has Hospital Admitting Privileges

2006-04-08T06:02:00.000-05:00

"What do I do, if the managed care organization (MCO) insists that I have admitting privileges to a hospital? I am an emergency physician, and I have never had admitting privileges." This question came up in my talk (available on CD; to order contact bburress@ucaoa.org) yesterday at the Lake Tahoe UCAOA Annual Convention, a great success with over 350 attendees and 52 vendors with helpful products or services for urgent care centers.

It is important to get face-to-face with the managed care organization (MCO) representative, who is actually empowered to make decisions. It is key NOT to ask your rep, “Who will really make this decision.” Instead, ask the rep, “Before you make this decision, who will you want to consult with.” Answer is—the person who actually makes the decision. Then, you arrange for a meeting with that person in the offices of the MCO. Explain to the rep that:

You operate an urgent care center,
Urgent care centers are exclusively outpatient specialists,
Few urgent care centers ever directly admit to the hospital,
You always admit to a specialist, the PMD or to a hospitalist.
Thus, admitting privileges are irrelevant.

If they still insist, then maybe you should see if courtesy privileges will suffice. If they still insist, (i.e., they don't give you enough respect to listen to your point of view), then you might try to get admitting privileges. If you can’t get admitting privileges, and the MCO won’t budge, then bad news; what is probably happening is that you are dealing with an MCO that doesn’t think it needs you (or maybe even any urgent care center) as a participating provider.

Still the managed care organization has no interest in contracting. Time to give up? No! Now you need to explain the value of urgent care centers in:

decreasing expensive ED visits,
improving client satisfaction,
covering the medical needs of the walking well (which are the only sources of profits for the MCO).

Still the managed care organization has no interest in contracting. Time to give up? No!

Now you need to find or land a large (larger the better) employer that:

is thrilled with your services
you have visited with face-to-face and you have a good relationship with
and uses the MCO in question for covering healthcare for it’s employees.

Ask the HR rep, if he or she is willing to send a letter to the MCO, stating:

That having your urgent care center on their panel is “very important” for a continuing relationship with the MCO. Translation: “Get the urgent care center on the panel, or you risk losing our account."
Next, type up the letter, email it to the HR rep, and thank the rep for being willing to send this letter under the company letterhead

Still the managed care organization has no interest in contracting. Time to give up? No! Just keep providing great service to walk-in patients and for corporate clients. Always, make sure that you give a typed letter (with stamped envelope) for any employer or patient to sign, expressing dissatisfaction that your urgent care center is not a participating provider with the managed care organization. If you can mail the letter yourself, do it. Over time, your urgent care center will win, because you are providing an important cost-effective alternative to the hospital ED. Whether the MCO knows it or not, the MCO needs your urgent care center.

More information on managed care contracting for the urgent care center is available on CDs of my two talks at UCAOA-2006, which are available through the Urgent Care Association of America (all proceeds are kept by UCAOA to benefit the organization). Contact bburress@ucaoa.org to get an order sheet for the CDs.

Good luck!

Urgent Care Medicine Fellowship Announced

2006-01-29T22:14:00.000-06:00

Last week marked what may be the biggest milestone in the urgent care industry since the founding of Urgent Care Association of America. The Urgent Care Association of America announced the approval of the first ever fellowship in Urgent Care Medicine. The urgent care fellowship will be supervised by Lee Resnick, MD at the Urgent Care Centers of the University Hospitals of Cleveland, Ohio.

This is the first specific postgraduate training in urgent care medicine available in the USA. The urgent care fellowship represents an innovative approach to provide the additional training necessary to meet the demands of one of the fastest growing specialties—Urgent Care Medicine.

Positions in the one-year fellowship are currently open to graduates of accredited Family Medicine and Med/Peds residencies. Qualified applicants can learn receive more information on the urgent care fellowship on the website of the Urgent Care Association of America.

Urgent Care Medical Director: Too Good for Her Own Good?

2006-01-01T01:12:00.001-06:00

Today I received an email from a physician, who took over an urgent care center for a hospital several years ago. The urgent care center had been losing money for years, then she took over and rapidly catapulted it to profitability. Profitability was great because she had a contract that allowed her to take home any profits. Of course, the hospital administrators never really thought profits would happen; and at the outset of the agreement they would have been thrilled with the prospect of a breakeven urgent care center. But now there is a problem: the medical director of the urgent care center has become one of the highest paid employees in the hospital system. The hospital administrators no longer consider a breakeven urgent care center to be an impossible dream; they have it. Now they have to do something to eliminate this compensation aberration. They will move to drop the physician's salary to bring it within the norms for an urgent care physician. What should she do? Below is my [edited] answer to her.

Dear Successful Urgent Care Medical Director:

What a problem! You were so successful in producing financial benefits to the hospital that the hospital must fix the problem of overcompensating you.

Dealing with the Hospital Administrator Mentality
This is actually a common problem. When centers are financial losers, hospitals are happy to sign papers to compensate physicians “as if” they were owners. In reality, however, they are not owners. Once an urgent care center develops great profitability, being treated like an owner will not fit with the hospital administration mentality. Hospital administrators cannot tolerate wages that are out of line with "prevailing wages"--even if they are resulting in significant profitability for the hospital. Hospitals generally see themselves as compensating physicians for job descriptions, rather than compensating a physician for the value added to the organization. Believe it or not, true business leadership often seems to be a liability in the hospital urgent care setting. The leader physicians either end up feeling undercompensated, or the hospital feels they are overcompensated.

You may negotiate with the hospital, but I suspect the end result will be that they will end up dropping your overall salary dramatically. The administrators will pat themselves on the back with their success--physician wages will be "within the norm." If you decide to leave, by the time an accountant points out the red ink, the person responsible pushing you out will have been promoted to VP for her outstanding success in reducing wage costs (only slightly serious about that).

It is very rare for urgent care physicians to earn higher salaries than emergency physicians. Most urgent care physicians would be thrilled to have their salaries set at the prevailing salary for emergency physicians. Some sort of productivity bonus is common, but bonuses rarely will bring the physician salary to the levels you have enjoyed. Bonuses that result in salaries that are "out of line" seem to always come to an abrupt halt when the contract ends.

Urgent Care Medical Director Salary Negotiation
All that being said, you are starting with the average urgent care physician salary as a base for negotiation. Maybe the following points would provide a basis for negotiation:

Start with the base comparative salary they have offered (increase by ~10%)
Ask for a contingent revenue growth bonus
Ask for a personal productivity bonus, based on RVU production. If they balk, suggest that this can be given only for RVUs that are above the current average RVU at your center. Note: RVU-based bonuses are much
Ask for a medical director stipend (I have seen anywhere from $5,000 to $50,000). You may be able to use the average bonus for ED medical directors in your region
Assuming you have not signed an enforceable non-compete agreement, you may consider mentioning that you may "need to go out" and start your "own urgent care center."

Joint Venture Urgent Care Centers
Another option would be to open further centers under a joint agreement. There are UCAOA members that operate under joint agreements, where they share risk and share profits. If you want we can put you in contact with them.

Start Your Own New Startup Urgent Care Center
If this still does not result in a contract that works for you, maybe the best long-term answer is to open your own urgent care center(s). Employees get guaranteed wages; but owners take the risk of losses and bet on profits. It is unlikely that any hospital will ever see you as an owner. If you lack capital there are experienced operators out there that will team with you for a percentage of risk and a percentage of profits.

Good luck! Feel free to call me with questions.

David

Standardization: Freeing Average People to Deliver Outstanding Urgent Care Service

2005-12-23T17:24:00.000-06:00

What seperates an excellent urgent care business from any other urgent care center.

Why it is not ________ that Produces Consistent Excellence:

If it is outstanding leadership, then the urgent care center will drift from excellence whenever the leadership is not on site.
If it is outstanding methods, how can you make sure that those methods are consistently followed?
If it is outstanding staff, can you really find enough MIT graduates to staff your urgent care center?
If it is something else, what is it?

Standardization to Excellence:
THE E-MYTH REVISITED by Michael Gerber suggests that standardization is key for any business or urgent care center that wishes to become free of the tyrany of massive everyday involvement by owners. Standardizing excellence appears to be the clear distinctive of what seperates McDonalds from a simple, inefficient, random-quality burger joint. Without standardization the urgent care center owns the owner. With standardization urgent care owners may become free to enjoy the fruits (rather than the burdens) of ownership. It is also clear that the leaders of any business must become passionately devoted to standardization, if standardization is to succeed.

The Replicatible Model Produces Replicatible Results
It seems that complete standardization is the hallmark of any replicatible model. Training & retraining of staff in a replicatible model (e.g., McDonalds, Starbucks, and many other multi-site businesses) does focus on memorizing sentences verbatim and exact procedures by average people. Standardization frees average staff to achieve world-class results. Otherwise, an urgent care operator must hire superstars, and that is cost-prohibitive.

Years ago, I lived and worked in Maryland, but I also commuted to once per month to an urgent care Illinois. I was amazed at how the drug reps were repeating (verbatim) the exact same high-impact sentences in both Maryland and Illinois. The drug companies knew that standardization could allow average salespeople to acheive world-class results.

Start Somewhere to Standardize Your Urgent Care Center
Maybe you want to consider starting standardization in you urgent care with a simple phrase used by all receptionists when patients enter the clinic. Maybe you can start with a simple sentence about strep testing when a patient presents with a sore throat. Maybe you will start with the way that the tray is set up for a laceration repair. This simple change can be the start of a new philosophy at your urgent care center. This change--along with scores of other standardized sentences and procedures--can be memorized and repeated thousands of times at your urgent care center. Standardization means:

You are not relying on the whim of each staffer to deliver care according to their personal preferences.
You can rapidly determine if a staffer is adequately trained in any area. You do not need to look only for gross deviation from standard of care. Rather, you can rapidly detect deviation from your specific standards--long before the deviation reaches the level.
Any properly trained high-school graduate can deliver excellence without any himming and hawing on day 1.

Examples of Standardization in the Retail Industry:

Starbucks: the staffer always places the coffee cup on the counter. I realized why when a new trainee handed the coffee to me, and was instantly admonished by the trainer to place it on the counter. Reason? I suspect that scalding a customer with coffee is much more likely and liability is higher if the coffee is transferred from staffer’s hand to customer’s hand.
McDonalds: “Have a nice day.”
Best Buy: “For your protection, you can purchase a prolonged warrantee with this appliance. . .” Note: last Christmas I entered the line at Best Buy at the back of the store and purchased the item in less than ten minutes. This “miracle” in customer service probably has a lot to do with standardization that seperates Best Buy from the rest in customer experience and Wall Street performance.
Walmart: Sam Walton obsessed about getting credit card processing under one minute. He would be happy to see how his obsession about standardization and speed helped push the credit card revolution into Starbucks and McDonalds.
Your Urgent Care Center: Send us your example of stardarization in your urgent care center with a comment below.

Why have a Practice Velocity Blog?

2005-12-10T21:28:00.000-06:00

Blogging has become a popular way to communicate timely information of all sorts. We decided to have a company blog to allow us to communicate much of what we are learning from our daily interactions with urgent care physicians, administrators and patients. We have engaged in significant discussion as to how urgent care physicians and administrators can use this blog. Our goals for this blog include:

Giving back to the urgent care industry:
Throughout the existence of our company, we have been blessed to interact with hundreds of urgent care professionals in the USA. We have taken home hundreds of pieces of information that has helped us improve our products and services. We hope that our insights and observations will allow urgent care centers to benefit and improve their services.

Sharing new products and enhancements:
Practice Velocity has an entire research and development team constantly at work improving and upgrading our product line. A blog will give us an opportunity to inform the urgent care industry of our new products and services.

Relating best practices in urgent care centers:
Not only do I and my partners continue to practice urgent care medicine, we also meet with urgent care operators throughout the USA. Last week I was in Lexington, KY where Dr. Fadi Bacha has taken a group of urgent care centers that were in serious financial difficulty under the ownership of the University of Kentucky. In three short years, he has turned them around financially, while continually upgrading the standard of care. Many other urgent care physicians have success stories to share, and this blog will allow us to share these stories with you.

Discussing current issues in urgent care medicine:
Travel around the country has given me insight into the challenges facing urgent care centers. This week I visited with a group of urgent care centers in North Carolina. They are facing an all out assault by Minute Clinic on their metropolitan area. Ten new centers in local pharmacies are scheduled to open in the next few months. It seems that every time you turn on the television there is an advertisement for the stripped down services of these nurse practicioner-staffed pocket clinics. Will these clinics siphon off a large enough number of less-ill patients and force traditional urgent care centers to shut down? Will shutting down the traditional urgent care centers shunt patients with moderate acuity injuries and illnesses back to the hospital emergency department? If so, does the proliferation of the pharmacy pocket clinic mean that the current overcrowding crisis in America's hospital emergency departments will escalate out of control?

We hope that you feel free to enjoy and interact with the ideas that we share.

Urgent Care Medicine

2005-11-06T19:56:00.000-06:00

Urgent care medicine is an exciting rapidly-developing specialty. Over the past sixteen years working in an urgent care medicine, I have had the opportunity to watch the field rapidly develop into a full-fledged speciality. Last year this culminated in the formation of the Urgent Care Association of America. This was an exciting development as it marked the first time that urgent care physicians and administrators were represented in a fully-democratic national organization.

Urgent Care Convention - 2005

This last April, over 250 urgent care professionals gathered at the first annual UCAOA Convention in Orlando. The Convention was a smash hit. Administrators spent a full-day pre-conference learning billing skills from Elizabeth Woodcock, while fledgling urgent care entrepreneurs spent a full day learning the secrets of success from urgent care veterans. Quality educational programs were offered in both a clinical track and an administrative track. Jim Gore, MD and Ken Palistrant, MD were elected to the Board of Directors. The accreditation program of the Urgent Care Association was unveiled.

Urgent Care Center Accreditation

The urgent care center accreditation program will allow urgent care centers to get credit for providing quality urgent care services. The accreditation process will allow centers to evaluate and make conscious improvements in almost every area of the delivery of health care services.

Challenges and Developments in Urgent Care

The specialty of urgent care medicine has many challenges ahead. Over the upcoming months, I hope to share many of these challenges with our Practice Velocity customers and other visitors to the website. It will take the efforts of all of us in the urgent care industry to allow us to improve public access.