Urgent Care Emergency Planning: A Pound of Cure

It’s important to consider urgent care emergency planning, especially when severe weather is emerging.

As the first real threat of the 2012 Hurricane season bears down on the Gulf Coast, thousands of residents in the region are scrambling to prepare before Isaac makes landfall. While many are evacuating, others are stocking up and battening down the hatches to ride out the storm. Although Isaac is expected to remain a Category 1 hurricane, even the most stalwart lifers of the area are still wise enough to realize that the resulting storm surges and tornado-like winds are nothing to take lightly.

As an Urgent Care owner or operator in the region, you might be faced with the decision of stay or go. Do you risk the well-being of your family and staff or do you heed the advice of emergency officials and head inland?

And what about your facility; the tangible assets as well as the security what steps have you taken to prepare? Whether or not you decide to stay or head for higher ground, what will you return to when the skies are once more sunny and blue?

The time to be thinking about preparing is not in the hours before the storm but rather long before the need ever arises. Having effective policies and procedures outlined and then training your staff to enact them is a critical part in being prepared for events such as fires, tornados, hurricanes and even other critical events such as violence committed by patients or staff.

Begin by defining which conditions under which you will close the urgent care. Typically these are things like hurricanes, flash floods which could be a threat to the well-being of staff or patients, and snow or ice conditions where the safety of staff commuting to work supersedes the need to be open. The list isn’t limited to these weather related items and policies need to address emergencies related to forced evacuations due to environmental disasters, terrorism, and any other threat to the safety of staff and patients.

Next, construct a notification procedure. How will you communicate with staff any closing of the urgent care and subsequently, the re-opening once an All-Clear has been given by the authorities? In the case of a natural disaster, it is often imperative that re-establishing medical care (both public and private) be given top priority. Do you have all of your staff home and /or cell phone numbers? Will they be evacuating as well? Will you establish a list of emergency employees that are first line call who are critical to the function of the facility.

And don’t forget to make preparations for the actual facility. You should have a checklist or procedure for each potential emergency situation (fire, flood, hurricane, etc) in place to prepare the contents as much as possible. How will you protect the capital equipment? How secure are your medical records? How fast will you be able to recover upon return? Can you connect with critical suppliers once the All-Clear has been established?

Finally, believe it or not, you should have a contingency plan for financials. Are you adequately covered both for damage and for operations afterward? Operators that have actually dealt with the aftermath of a natural disaster were surprised to find that one of the hardships was not the damage to their clinic but the financial toll of having displaced staff while the facility was being repaired. Worse still, many of their staff had damage to their own homes in the wake of the storm.

So while we watch the weather and certainly send our prayers and best wishes for safety to all our urgent care family along the coast, we remind everyone of the old adage that seems appropriate to our industry: an ounce of prevention is worth a pound of cure. Take a few moments to adequately plan for the safety of your clinic before the storm clouds arrive.

Breaking News: ICD-10 Delayed to October 2014

The federal government has finalized a one-year delay in the compliance deadline for the nationwide conversion to ICD-10 code sets. The delay, first proposed in April, will move the compliance deadline to Oct. 1, 2014.

HHS said the extra time would allow healthcare organizations small organizations in particular adequate time to get ready for the changeover.

“By delaying the compliance date of ICD-10 from October 1, 2013 to October 1, 2014, we are allowing more time for covered entities to prepare for the transition to ICD-10 and to conduct thorough testing,” HHS said in the rule. “By allowing more time to prepare, covered entities may be able to avoid costly obstacles that would otherwise emerge while in production.”

HHS included the change in a 208-page final rule (PDF) establishing a unique health plan identifier for all insurers. In a news release on the CMS’ website announcing the rule, HHS said the identifier along with other administrative simplification regulations included in the healthcare reform law will save the healthcare system an estimated $6 billion over the next decade.

Dangling a Rotten Carrot: How to incentivize urgent care practitioners

As your urgent care center grows or volumes increase one of the challenges that often faces the owner is: How to incentivize urgent care practitioners to perform better. In other words, how can you as the owner encourage your physicians to improve their documentation, dispense from your in-house formulary or perhaps even just pick up the pace in order to increase patient flow?

The most common answer for many operators is to offer some sort of bonus structure or Pay for Performance (P4P) in addition to the practitioner base salary. Based on a variety of measurable factors such as productivity, coding, or revenue, these P4P schemes have been commonplace in many health systems for years and are even resurfacing as a hallmark of Accountable Care Organizations (ACO’s) in an effort to help reduce readmissions and over-utilization.

In urgent care, bonus structures or similar P4P have likewise been implemented to promote adherence to proper documentation, utilization of in-house pharmacy, and patient satisfaction. But in general, most practitioner bonus structures are more of an effort to reward good work rather than tool to alter behavior.
Perhaps this is a smart approach? Consider for a moment a recent study conducted by Dr. David Himmelstein, professor at the City University at New York’s School of Public Health. Dr. Himmelstein found that overly prescriptive financial P4P contracts may lead to practitioners feeling as though they have lost the motivation to do what’s best for the patient, instead engaged in gaming “ or teaching to the test.
He found in systems that extensively promote P4P or other forms of bonus structures, practitioners were often more focused on the rules or statistics being measured rather than the outcomes of the patients under their care. Ultimately, one would think that optimal outcomes would be the goal, but in the age of cutting costs and enhancing revenues, all-too-often the paradigm shift seems to be less patient-centered and more about efficiencies with dollar signs attached.

Other similar studies concur with Dr. Himmelstein’s opinion finding when reward based incentives are used to guide performance often the results are counter-productive. While the output for some tasks might increase, often times motivation is weakened and performance on tasks that require highly cognitive function (such as medical care) generally declines. Dan Ariely, James B. Duke Professor of Psychology and Behavioral Economics at Duke University, stated in his book about reward “based performance, that the unintended consequence is likely a worsening of care, not its improvement.”

So where does this leave you “ the owner of the urgent care who’s simply trying to reward his staff while promoting certain behaviors that ultimately will benefit the function of your clinic while enhancing the experience of your patients? On one hand, many practitioners have come to expect bonus structures for performance, but on the other, shouldn’t employees just be expected to do a good job?

It’s a tough predicament, especially when you’re faced with trying to increase patient transit times in the clinic or encourage your providers to document visits more thoroughly. But if Dr. Himmelstein’s research is correct, then the motivation to perform is more intrinsic and less monetary. To do otherwise will only weaken overall care and create an environment where staff performs to a minimum requirement needed to achieve the reward.

And perhaps this makes sense; after all, do you really want an employee who performs better only when you PAY them to do so?

So then, if P4P schemes aren’t the way to go, what can you offer practitioners on your staff as an incentive to perform better or to increase certain markers such as patient satisfaction?

Maybe the answer is simple- Begin with clear expectations of performance. Creating a wage that compensates for that expected performance does not need a bonus dedicated to going above and beyond since the practitioner would already be meeting the expected level. Providing ongoing training and feedback also helps staff know when they are meeting expectations of the job. Far too often, many operators never meet with their staff until they have some axe to grind about the employee’s work. By then, the work habits are ingrained or the behaviors seemingly accepted by management and no amount of reinforcement (positive or negative) will have long term affect.

And lastly, know when to throw in the towel with a poorly performing employee. Most will agree that even with P4P schemes, the employee that simply has no desire to adhere to the organizations guidelines for quality will not be motivated by any amount of bonus money. Identify these employee’s early on and don’t be afraid to encourage them to find other career paths outside your urgent care.

Rewarding employees for good work is still a GREAT thing to do. Just make sure that you aren’t falsely creating rewards for work that should be an expected part of the employee’s job. Poor staff will never follow no matter how big of a carrot you dangle in front of them and great staff will eagerly go above and beyond because they are inspired or impassioned to do so. What are you incentivizing for in your practice?

5 Urgent Care Startup Pitfalls

To help you avoid making the same mistakes, we’re sharing some of the top urgent care startup pitfalls.

When beginning your urgent care startup project, the last thing you want to focus on is failure. And we get that, we do. But if you assess the common mistakes of other startup urgent care ventures, you’ll be much less likely to fall victim to them yourself. While no system is fool proof, there are key factors that- if not avoided- can most certainly contribute to the demise of your clinic.

1. Location, Location, Location
Location is critical in the success of your urgent care startup. Your initial entrepreneurial instinct might be to search for potential sites based on cost or cosmetics. But, believe it or not, those are not the main factors of concern. Instead, focus on the site visibility and competition factor.

Qualify your location with these simple questions: Is it on a high traffic road? Is it near a strong retail anchor? Are you permitted ample signage? Does this area need an urgent care? Is there already convenient access of care?

2. Lack of Planning
I have an idea! Ready, Set..Hold on! Any successful business owner will tell you not to dive right into a project. It is essential to have a strategic business plan. Many small businesses fail because of fundamental shortcomings in their planning. It is imperative that your business plan be based on accurate data from current statistics with educated projections for the future.

Consider these topics when writing your business plan:
– Target Demographic
– Competitive Advantage
– Corporate Structure
– Market Analysis
– Staffing Model
– Capital Costs
– Financial Forecast

3. Insufficient Capital
A financial plan, also known as a pro forma, is a vital tool in your startup success. A pro forma is a line item multi-year financial blueprint that encompasses every financial need the startup project may encounter. Insufficient funding is a critical mistake that can be easily avoided with proper planning.

For Example: Did you know on average your accounts receivable will take 3-4 months to mature? Are you considering how your clinic will stay solvent during this period? How will you maintain staffing and operational costs with limited income?

Your capital costs go far beyond purchasing equipment and paying rent. A thorough pro forma, will incorporate not only your startup costs but also cash-on-hand required to stay solvent while your AR matures. It is important to have a realistic expectation of money coming in vs money going out. This step is simply a reiteration of how important planning is to your startup success.

4. Inadequate Internet Presence
To many inexperienced urgent care owners, the dollars allocated to marketing can seem overly substantial. They focus on the initial investment amount instead of the return on investment; thus slashing their marketing budgets. A detrimental mistake. Marketing is the tool in which a startup clinic introduces itself to the community, shares its hours and location and promotes its available services.

Throughout the years we have been advocates prominent signage, and for the most part clinics now understand the importance of their target demographic being able to easily locate and recognize the facility. Kudos! But what about the potential patients, that aren’t driving around looking for a clinic? How are you reaching the sick patrons that prefer to internet search their options?

As a nation, we want the easiest most convenient way to find solutions and the internet is our answer. To succeed, your clinic must have a plan to advertise via the internet. There is an array of methods able to efficiently market your clinic while staying cost effective. At the very least, you should have a well-designed website featuring your location, services and hours.

A corresponding option would be to create a business Facebook page. Facebook is a FREE social media site in which you can advertise your clinic information AND connect with the community through photos and patient interaction.

Remember if you don’t have an internet presence, you’ll most likely be losing business to those that do.

5. Poor Management
Owner-operators frequently lack relevant business and managerial expertise in finance, purchasing, marketing and hiring and managing staff. Unless they recognize their shortcomings, and seek assistance, the clinic could soon be facing disaster. A good clinic leader is one that creates an environment in which the staff has an understanding of their expectations and is confident they have the tools to deliver efficient, compassionate care to the patients.

Non physician owners may have the exact opposite situation. They embody managerial knowledge but lack operational experience. The key here is to find a Medical Director that:
– Compliments your vision
– Can adjust to high volumes as needed
– Delivers excellent service
– Adheres to policy & procedure
– Clearly communicates expectations to the staff
– Embraces Change
– Is able to think strategically

The true goal is to find someone, whether it’s the owner-operator or a hired medical director, that can balance both the operational and financial decisions with the clinic’s overall well-being.

The bottom line? There is no fool proof plan. Take the time to fully assess your project and map out a plan to avoid these common mistakes. In the words of Gordon Moore Most of what I learned as an entrepreneur was by trial and error, but why not let them be someone else’s trial and error.