The following is a list of frequently asked questions (FAQs). Click on the question to reveal the answer.
The AAUCM has noted a trend that hospital entities are changing their staffing models from employment of RNs & LPNs to the utilization of MAs, RTs and EMTs who are all crossed trained (for cost-reduction purposes).
The average income for Urgent Care PAs/NPs is $55/hour.
New patient visits used to be easy to distinguish from those with established patients. A new patient was someone you had not previously seen or perhaps someone for whom you did not have a current medical record. Today, like so many other aspects of health care delivery, differentiating between new and established patients and coding your services accordingly has become more complex. By CPT definition, a new patient is "one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years." By contrast, an established patient has received professional services from the physician or another physician in the same group and the same specialty within the prior three years.
The average is 2-5%; it all depends on the size of the billing company, the type of ARs reporting produced, and if the company will be scrubbing the charts for optimal billing.
Unfortunately, there are no formal training programs in Urgent Care for Nurse Practitioners at this time. Most get their experience from working in the ED. An alternative option is to spend some time at an Urgent Care center shadowing someone for a few weeks to get a sense of the skill sets required. As a member benefit, the AAUCM can assist in finding a center for NPs to shadow someone.
A quarterly medical chart review for each provider conducted by the Medical Director can be used to measure quality in an Urgent Care center.
Yes, as insurance companies continue to narrow the margins of profitability and patients expectations of convenience and cost, self -dispensing is becoming more of the norm, with the exceptions of states that do not permit dispensing.
Yes, the AAUCM has an Urgent Care Center Quality Assurance Checklist available for purchase. To purchase, please use the Urgent Care Center Quality Assurance Checklist Order Form
SUGGESTED MAJOR MEDICAL EQUIPMENT:
X-ray (digital preferred)
For: Diagnostics - Chest, head, body, extremities
Developer - 90 second
For: Wet process chemical development of x-rays
For: Digital system to control x-ray unit
Hematology unit (optional)
For: Blood samples, WBC, RBC, Platelets, Differentials
For: Cardiac diagnostics
MCG Ultrasound (optional) (from Cardiac Analytics)
For: Diagnosis CAD in office (for carotid/cardiac, abdominal, DVT) along with cart
For: Measures lung capacity
For: Electric device to remove skin lesions, also used for cauterization of veins
For: Used to freeze off dermatological occurrences
For: Used to look at serum, stools, urine, sputum
For: Used to produce lab samples for study
For: Sterilizes instruments
Surgical lights (2)
For: High intensity light for minor procedures
For: High intensity, small lights for examinations
For: Tests hearing (workman comp contracts require)
Crash cart (Banyan kit or similar)
Oxygen Regulator & Tanks
For: Administering D5W/NS etc. & meds
Kick bucket (stainless steel with 4 wheels)
Baum Meters (10) (wall mounted & portable blood pressure units)
Electronic thermometers (4)
For: Ear canal readings
Surgical Instruments, Assorted
Assorted Misc. Lab and Clinical minor equipment & supplies
Scales (one adult, one pediatric)
Otoscopes/Ophal. (wall mounted, cordless halogen)
For: minor surgery and specific exams (obese pt./handicap )
Exam tables (with electric and drawers)
For: Physicians to examine patients
Staff seating (mix of ergonomic seats)
Staff desks (all executive style)
Patient seating (ergonomic modern)
Patient furniture (mix of tables and lamps)
Telephone system (console with speakerphones)
Security system (full alarm with security camera and recording capabilities)
Televisions (13” cable ready – in exam rooms)
DVD player (to interface with TVs)
For: drugs and supplies
Fax machine (plain paper, dry toner or ink jet)
Photocopier (15 page per minute, reduction, auto-feeder)
Photocopier (8 page per minute for clinical use)
Postal meter & scale Calculators (with paper tape)
File cabinets (standard 2 drawer lateral)
Misc. Equipment (small office supplies & equipment)
Signs – Internal (various required signs and placards)
Signs – External (one or two signs, lighted or back lit - plastic or wood)
Safe (standard with .5 cubic meters of storage)
Safe (with 4 drawers and suitable for data)
For: Scanning of documents; capable of scanning health insurance cards and insert into EHR
EHR (Electronic Health Records)
Digital Camera (2)
For: To insert picture of patients into medical records; To document patient dermatology or other conditions
For the most part Urgent Care centers no longer utilize nurses in their clinics because of cost/reimbursement issues. Urgent care centers operate on very thin margins, given the high operational costs of running a center and the reimbursements from insurance companies. An MA or nurse would be expected to take vital signs, administer medications or injections under the supervision of a physician, start an IV, provide nebulizer treatments, assist or apply casting/ortho hardware, provide gait training, infection/ wound management, do urine drug screens, do pulmonary functions, BATs (Blood Alcohol Test), supply management, re-ordering, and lift capacity testing to name a few.
Typically if the Urgent Care Center has a volume of less than 35 patients a day the facility should have one front desk person, one back office MA/BMO (basic machine operator), one physician and a manager who is crossed-trained that can pitch in to do drug screens, BAT tests, etc. For a range of 35-60 patients a day the facility should have two front desk representatives to do check in and check out, two back office staff/clinical people with one of those clinical people that is a BMO (basic machine operator) for X-ray/clinical, one physician and one manager. The physician should be able to see 4-5 patients an hour on average. If the Urgent Care Center sees more than 60 patients a day the facility should have two front desk representatives, two back office staff (as described), one fast tracker who does vitals and rooms patients and can do drug screens, one physician and one Physician Assistant.
For more information on staffing guidelines, please see Urgent Care Staffing Guidelines.
Standard of care requires a ROS and Past Medical History, just as is done in the ER. You can help expedite the care by having a patient fill out a ROS check list and/or provide it "online" as part of the pre-registration process. The billing department will not be able to optimize reimbursements if ROS and PMX is not included.
An Urgent Care center needs to have X-ray on-site or under the same roof if the clinic is part of a multi-specialty group.
The ER can refer patients to the Urgent Care center and vice versa.
Locating an Urgent Care Center is all about what the competition is like in the area, the size of the organization, and the strengths of what will be offered. Density of population in the area is also important. For example, in a highly-populated city like NYC having a center two blocks away from another can be fine, but in a suburban area the clinic would not likely do well. A safe rule of thumb is to maintain a 3-5 mile radius from another center.
The regulations for minimum medical record retention periods vary by state. Please refer to this document for the regulations for your state: http://www.healthit.gov/sites/default/files/appa7-1.pdf.
The square footage of your clinic will depend on the volume that you project to have. On average, 3,000 square feet, depending what the design features will entail. For example:
It is not advisable to have the Urgent Care Center open without a medical provider present because of potential liability issues and standards of care.
Please note, the information provided here in no way should it be considered as legal or medical advice. Always consult an attorney or insurance carrier for specific information regarding this issue.
The average Urgent Care Center sees approximately 60-80 patients per day.
According to this article in the American Journal of Clinical Medicine, “Most urgent care centers are open at least twelve hours a day on weekdays. It is not unusual to find centers opening as early as 7 a.m. and closing as late as 12 p.m. for patient convenience. Weekend hours are also the norm. Weekend hours vary from six to more than twelve hours a day.”
The number of X-ray exams can be variable by location and population served, i.e. heavier load of Workman Comp cases, vs insurance carrier population, i.e. Medicaid/Medicare, however in general, approx. 6 per 30 days.