Analyze the 3 case scenarios of Urgent Care medical practice operational plan, then answers these questions below. Then, create 12 Power Point slides for summary.
1) Urgent Care introduction! (What's Urgent Care clinic)
2) How do you plan to market the Urgent Care practice?
3) What are some of development plans for the Urgent Care medical practice?
4) Can you make any other necessary refinements as you incorporate additional learning of the Urgent Care business?
5) As you begin to synthesize your practice management knowledge, what are some of the knowledge gaps need to be filled in order for you to be a successful Urgent Care medical practice manager?
6) Create a personal development plan that ensures you will acquire such knowledge and skill in the future?
Once the paper is complete, please generate a Power point presentation summary of at least 12 slides and include a personal development plan at end.
Include 4 references please.
Case scenario 1:
In reference to staffing at urgent care centers, this paper will provide a general overview of the typical urgent care center wherein all urgent care centers have at least one physician with half of these physicians specializing in family medicine, while two-third are emergency medicine physicians and one-third are internal medicine practitioners (Boyle, 2012). Depending on the size of the urgent care center, the location, and the volume of patients, the urgent care center may also employ an orthopedic surgeon, but this only represents a small fraction of urgent care centers. Therefore, the overwhelming majority of urgent care medical centers are staffed with at least one full-time physician and several others medical staff like nurses and technicians(Boyle, 2012). Nevertheless, staffing models at any urgent care clinic will be contingent upon the specific needs faced by the individual urgent care clinic. If the urgent care clinic is small and located in a rural suburb setting, it would be nonsensical to staff multiple full-time physicians as one full-time physician would be sufficed (Solnik, 2014).
Larger clinics located in more populated areas will need to employ multiple full-time physicians because these clinics will be busier. Part-time physicians should also be employed as these physicians can pick up the extra slack when the full-time physicians are unavailable for any reason. These physicians have other positions in hospitals or private practices in the area but “moonlight” at urgent care clinics(Solnik, 2014). To fill foreseeable gaps that occur at any organization as well as to remain open 24 hours and on weekends, the urgent care clinic may also employ locum physician’s to staff their facilities. This is also needed during the busiest business quarters such as a flu season.
The majority of urgent care centers rely heavily upon a staffing model that utilizes the regular staffing of advanced practitioners such as nurse practitioners and physician assistants (Weinick, Bristol & DesRoches, 2009). These healthcare providers are similar to doctors and can work on a locum tenens basis because of their credentials. Some states allow nurse practitioners and physician assistants to possess the autonomy to work without a physician present, and as a result of the increase in urgent care centers over the last three decades, locum tenens such as PAs and NPs have become more common. It has been found that proximately sixty percentages of urgent care clinics use either nurse practitioners or physician assistants, and for urgent care centers that focus on retail medicine, physician assistants and nurse practitioners represent the majority healthcare provider and deliver the majority of care(Weinick, Bristol & DesRoches, 2009).
Staffing is predicated upon ensuring that the urgent care center can meet several necessary requirements. These include the ability to provide quick care in regard to ensuring that patients are seen faster than they would be seen an emergency room as this is the reason that people choose urgent care centers, for their convenience (Ayana, 2012). In addition, the staffing plan must achieve the goals that can ensure that patient needs are met. Therefore, the staffing plan can only keep the quality of care and patient satisfaction high with appropriate staffing levels met, qualified practitioners staffed, and flexibility in regard to scheduling that allows staff the ability to work in unison with staffing resources.
The plan must be in accordance to with individual clinics specific needs wherein numbers of physician’s specialists are needed to cover all patients’ visits with or without predominant treatment disorders that are included in the plan with variables such as ramped up need during cold and flu seasons(Ayana, 2012). Ensuring adequate staffing is a key for urgent care centers as this allows the patient to remain competitive. The only way that the center can provide quality care is to ensure that high quality healthcare professionals are recruited. The urgent care clinic must provide the most optimal benefits and work with anenvironment that will enable them to recruit nationally to find the most qualified candidates. It is understood that patients choose to go to urgent care clinics instead of an emergency room for short wait times, cost savings and convenience, and extended hours near their homes, but without the appropriate staffing, the clinic will fail to meet patient expectations (Solnik, 2014).
It’s essential for urgent care medical practice centers to keep their trained employees. Because, the main objective of employee retention is to keep it open and keep the running urgent care. According to health system executives, the effect of staffing on the future of urgent cares practice and quality will be very important(Boyle, 2012). Hospitals will continue to incorporate urgent care centers into their business portfolio, which will increase the accessibility to the most qualified practitioners. The ability to create new revenue will continue to drive urgent care centers and allow for hospitals to create new revenue, increase annual savings, and bring in new patients(Weinick, Bristol & DesRoches, 2009). Therefore, staffing levels will be met as a result because the hospitals have more resources, higher staff levels, and other variables that will allow for staffing in future urgent care clinics to be predicated upon better staffing levels to meet the increasing demand of these clinics.
References:
Boyle, Michael F. (2012). The Healthcare Executives Guide to Urgent Care Centers and Free Standing ED’s. Retrieved November 7, 2015 from: https://healthleadersmedia.com/supplemental/10444_browse.pdf
Solnik, C. (2014). New York explores 'urgent care' definitions. Long Island Business News, Retrieved November 7, 2015 from: https://search.proquest.com.proxy.davenport.edu/docview/1507041410?accountid=40195
Ayana, Antoinette (2012).Urgent Care Clinics' Advantages. Retrieved November 7, 2015 from: https://www.articlesfactory.com/articles/health/urgent-care-clinics-advantages.html
Weinick, Robin M., Bristol, Steffanie J. &DesRoches, Catherine M. (2009). Urgent care centers in the U.S.: Findings from a national survey. Retrieved November 8, 2015 from: https://www.biomedcentral.com/1472-6963/9/79
Case scenario 2:
Many small medical practice offices like urgent care clinics are loan dependent but do have a process for developing a budgeting plan, expressing it in financial terms and detailing resources are required to achieve objectives (Kavilanz, P. (2012). Standard budget types include the following: Statistical budgets are used to give workload assumptions while expense budget gives the cost associated with providing the service like the amount of money each department expects to pay-out. For average urgent care practice, operating budget combines revenue, and expense and it lists, for the upcoming fiscal year, and anticipates income by a source (Iglehart, 2009). Cash budget gives cash on hand for day-to-day running of the practice, and future plans for acquisitions of practice facilities and equipment.
The Balanced Budget Act (BBA) of 1997 were authorized to establish a flex program in which certain Medicare participating facilities like urgent care centers to cover patient expenses. To increase urgent care’s bottom line and be a profitable, patients should carry or required to have insurance, more of cost responsibility would ultimately fall on the patient and the insurance companies (Schneider, 1997). This would happen because if health insurance becomes mandated for all, individuals would have less of an excuse why they are unable to finance their health care. This is of course, assuming that insurance plans are good enough that they cover procedures. If insurance plans leave some underinsured, the financial burden would still ultimately then fall on the patient (Schneider, 1997). And right now, how the current system is, the financial burden is on the patient because if they are not paid even after turning patients into collection agencies they must absorb that cost. Reform should possibly address this by providing some sort of assistance to medical firms to help offset that cost.
Many Medicare and Medicaid patientscould affect the overall revenue of the practice firm and the services it provides due to the fact that an increase in the number of Medicare and Medicaid patients will subsequently result in an increase in the guaranteed revenue of the medical center (Schneider, 1997). This is due to the fact that Medicare and Medicaid patients provide a clientele of guaranteed payment patients, whereas some patients without adequate health insurance coverage or no health insurance coverage may not pay at all for the services rendered (Iglehart, 2009). Due to the increase in the level of revenue for the urgent care facility and due to an increase in the number of Medicare and Medicaid patients, the urgent care facility will have the finances to expand the number of services that it can provide to patients and achieve goals of more than five years.
The service and consultation fees pricing will be determined based on market value, and compared to what the other similar medical practice center charge per patient. The medical practice to remain profitable in the long term, expenses such as equipment purchases and salaries can be reviewed often (Ayers, 2008).The purchases are dependent upon whether they provide long-term value and investment in the practice firm.Also to achieve goals and maintain profitable, benchmarking can be used. Changing the budget process to achieved financial flexibility and a reasonable pricing solution. Therefore, to achieve consistent financial goals, good expense calculation such as salaries, supplies and overheads has to be reached and controlled.
Urgent care typically can be held responsible for acts of for employee and non-employee personnel injury because most doctors who work for urgent care cents are independent which means that a doctor that commits malpractice acts that caused the injury to a patient is liable unless certain circumstances are met (Ayers, 2008). In addition, if an urgent care employee commits malpractice while being supervised by a doctor who is an independent, the doctor will be liable if the employee is under the supervision of the doctor when the misdeed occurs. A doctor who has an independent practice has control to prevent the employee's negligence. Fortunately, patients are allowed to sue the urgent care practice, even if the doctor is not an employee of the practice (Newman, 2010). Therefore, if a doctor commits medical malpractice on a patient who was injured in a car crash, then he can be sued. His practice can also be sued when the practice allows a knowingly incompetent doctor to practice in their firm whereinit will be held responsible. Hence, the best way to eliminate medical malpractice and frauds are all the staff to take responsibility for their actions, be liable and face the consequences (Newman, 2010). In addition, training and supervision should be offered to all the staff.
To prevent medical malpractices and fraudulent schemes, it’s important for the medical to have basic understand about patient negligence. Malpractices and fraudulent are often healthcare personnel not taken initial responsibility solving the problem. Hence, under the standard of care, all patients have the right to expect that the health care professionals that they trust will deliver treatment that’s consistent with the standard of care (Newman, 2010). However, if it’s determined that the standard of care has not been met, or was bridged; negligence may be established under the malpractice. On the other hand, most of patient negligence and malpractices can be prevented or eliminated if all the health care personnel are training in regular basis and taught proper patient treatments. According to several researches, most common fraud in healthcare is internal rather external and the sources of these frauds include forged checks, misapplied payments, incorrect deposits, none-apply charges or payments, and even embezzlement of payments (Ayers, 2008). However, most of these can be prevented in simple tracking and auditing of payment activities.
Different collection capability (1st party vs. 3rdparty)to reduce the overall firm’s debt revenue system can be used with medical debt collection (Fay, 2015).However, health related debt expenses are not the same as using a credit card to charge several pairs of designer shoes. Most often, people do not go to the hospital or urgent care medical center because they desire to. It is usually for emergency situations. Charging interest on credit card purchases and essentially borrowed money is hardly comparable to charging interest on the cost of lifesaving procedure. The money spent was not meant to be spent to live outside of one’s means, but instead to keep them healthy and alive (Fay, 2015). Like I mentioned previously, health care instructions should work with patients to pay their bills, either in in-house collection or third party collection as last option. Just adding extra fees and interest would only discourage patients from paying their bills because the interest would make it higher than it even is.
To check the practice’s financial data and follow up expenditures, a computerized banking system can be set up. A financial data of an urgent care clinic does not provide huge information since most urgent cares are owned few partnered doctors; however, it does provide simple understanding of the urgent care’s performance and determines the revenue cycle and medical practice’s profitability (Crestwell, 2014). The financial data also evaluates the medical firm’s strength and growth potential when dealing with vendors or planning large expenditures like buying new equipment’s, buying new a building or hiring more staff.
An urgent care practice firm can establish relations with money vendors that provide medications like pharmaceutical companies and pharmacies (Belli, 2014). Also, the medical office can establish long term relations with companies that provide medical equipment and necessarily supplies practice needs.
References:
Kavilanz, P. (2012). Doctors living off of loans. Retrieved on November 14, 2015 from https://money.cnn.com/2012/01/20/smallbusiness/doctor_loans/index.htm
Iglehart, J. K. (2009). Budgeting for change -- Obama’s down payment on health care reform. The New England Journal of Medicine, 360(14), 1381-3. Retrieved November 14, 2015 from: doi:https://dx.doi.org/10.1056/NEJMp0901927
Ayers, Alan A. (2008). Urgent Care Budgeting Presentation. Urgent Care Association of America. Retrieved November 15, 2015 from: https://www.alanayersurgentcare.com/Linked_Files/UCAOA_Budgeting_Presentation_2008_04_29.pdf
Newman, Benjamin W. (2010). Reducing Liability in Urgent Care. Retrieved November 14, 2015 from: https://www.gray-robinson.com/articles/newman5410.pdf
Crestwell, Julie (2014). Race is on to Profit from Rise of Urgent Care. Retrieved November 15, 2015 from: https://www.nytimes.com/2014/07/10/business/race-is-on-to-profit-from-rise-of-urgent-care.html
Schneider, Andy (1997). Balance Budget Act and Overview of Medicaid Provisions. Retrieved November 15, 2015 from: https://www.cbpp.org/archives/908mcaid.htm
Fay, Bill (2015). Medical Debt and Collections. Retrieved November 15, 2015 from: https://www.debt.org/medical/collections/
Belli, Brittany (2014). Vendor Relationships; Beyond EBITDA: What a Buyer Looks for When Acquiring an Urgent Care Center.
Retrieved November 15, 2015 from: https://www.ambulatoryadvisor.com/tag/vendor-relationships/
Case scenario 3:
The overall urgent care medical center operation’s plan is as follows; the objective of the urgent care will be to provide walk-in services for treatment of injuries or illnesses requiring immediate care but not serious enough to require an emergency care visit (Weinick, Burns& Mehrotra, 2010). The overall responsibility of the urgent care practice will be a licensed physician operating as the medical director. The business hours of the practice will be 8.00 am to 8.00pm. The practice will become a member of the Urgent Care Association of America. The practice will have approximately about five to six examination rooms, one office room, one diagnosis equipment room, and one room for medical procedures. For example, the urgent care medical practice will be set up in rented premises on a major street, close to a neighbor with a high population. The initial investment approximately will be between $500,000 of which $200,000 will be used for buying diagnostic equipment including x-ray machine and phlebotomy. When a patient walks into the clinic he will be screened within five minutes by a medical assistant to ascertain if he has a condition that requires emergency medical care(Weinick, Burns & Mehrotra, 2010). If that is the case, he will be re-directed to the emergency room of ahospital.If there is an urgent medical condition, he will be examined by the assistant and prescribed treatment. The endeavor of the clinic will be reducing the waiting time for patients. After the patient has been examined, he or she will be sent to the office to make payments.
The patient experience in the urgent care will be positive. The person can walk into the clinic twelve hours every day, seven days a week(Davis, 2015). Even when the doctor’s clinics are closed, urgent care practice will be open. Further, the patient will be examined within five minutes of walking in. This will reduce the time spent at the urgent care. At least, our five exam rooms will enable it. Diagnostic equipment is available. Finally, the cost is value for money. Urgent care medical practice will cost comparable to going to a doctor’s clinic (Davis, 2015). The cost will be lower than that in the emergency clinic.
The patient can make an appointment online using the urgent care practice website, can send in an e-mail for an appointment, or can phone and make an appointment. Alternately, a patient can walk in. The difference between the two is that in case of an appointment, the patient has to provide the details of insurance coverage (Amiel, 2014). In case of walk-in by patients, the patient has to provide insurance details to the desk outside the office. This takes three to five minutes time. The patient will be examined first by a medical assistant; however, if the patient needs diagnosis using equipment, the patient is sent to the diagnosis room. After the procedure has been completed, the patient returns to the exam room with the same medical assistant who provides the treatment and the prescription. The patient goes from the exam room to the office where the patient pays the bill. After payment, the patient leaves the premises of the office.
As a regulatory compliance, in case of urgent care practice, the practice will conduct laboratory tests such as blood glucose monitoring, using devices approved by the Food and Drug Administration; it will obtain a CLIA Certificate of waiver for clinical laboratory tests. It will also obtain an X-ray permit for X-ray services. Since the center is not owned by a hospital, the practice will not be covered under the Emergency Medical Treatment and Labor Act. Next, the center will get on insurance payers’ lists. The process of getting on the insurance companies that are active in the area will be completed (Amiel, 20143). The urgent care medical practice will also contract with government payers such as Medicare, Medicaid, and TRICARE. For the purposes of IRS the practice will be proprietorship. The practice will apply for the employer identification number with the IRS. Local pharmacies will be contacted for a referral agreement. The Joint Commission has created a Comprehensive Manual for Ambulatory Care, which will be used to “evaluate immediate threat to health and safety, situational decision rules, direct impact requirements, and indirect impact requirements” (Gardner, Gravestein, Baier & Shamji, Hannah, 2014). Evidence of Standards Compliance will be provided and accreditation will be obtained to reducing risk.
According to the Joint Commission, it has provided many best practices in the journal of Quality and Patient Safety (Gardner, Gravestein, Baier & Shamji, 2014). The urgent care medical practice will comply with each of these practices. Continuous quality improvement can be implemented at the urgent care practice by monitoring compliance with the best practices. For six months weekly, monitoring of compliance with the best practices will be done and after six months there will be a monthly review of compliance with the eight best practices.
I will develop and maintain an ethical, quality and compliant practice for a long time by complying with all regulatory and accreditation requirements at the inception(Gardner, Gravestein, Baier & Shamji, 2014).Also, I will provide training on legal, ethical and accreditation requirements to all employees of the urgent care at the commencement of the practice. I will also develop a computer based training program on legal, ethical, and accreditation requirements.This program will be administered to every employee after every six months. Further, I will monitor compliance with these requirements on a monthly basis (Weinick, Burns & Mehrotra, 2010).
The regulatory bodies, I have to be concerned with on an ongoing basis, are the Department of Health, the Joint Commission for Accreditation, government payers for Medicare, Medicaid and TRICARE(Weinick, Burns & Mehrotra, 2010). In addition, I have to be concerned with the IRS and the Urgent Care Association of America.
Therefore, the future is bright for the operations of urgent care business. There is frustration over long waits in emergency rooms for non-emergency care. Also, patients often have to wait for several weeks to see their primary care physician, and the need for immediate access to medical care will drive the growth of urgent care business in the future(Gardner, Gravestein, Baier. & Shamji, 2014). Therefore, In the future, there will be mandatory licensing for urgent care, mandatory accreditation for urgent care, and compulsory board certification for physicians who run urgent care. Hence, in the future, the urgent care center will be a widely recognized specialty for physicians.
An optimal care environment will be created by providing a premise that is well constructed and suitable for urgent care, providing equipment and information technology that is comparable with the best, and manning the practice with personnel who are competent, efficient, and ethical. To provide an optimal care environment, the facilities and performance of personnel will be reviewed on monthly, six monthly and annual bases (Gardner, Gravestein, and Baier. & Shamji, 2014). Corrective action will be taken to keep the environment healthy.
The future of urgent care medical practice is strong. For many patients urgent care is the most convenient place to visit because it is open on weekends and evenings when primary care physicians are closed(Jain, 2014). The visit to the urgent care center typically takes half an hour which is far less than an emergency room visit. Furthermore, employers, insurers and other payers will also encourage visits to urgent care clinics. High standards of quality will be maintained at the urgent care medical practice(Jain, 2014). For example, in comparison, an urgent care clinic that’s located at a major street with high a population area could be more successful than an urgent care clinic that’s less populated area.
References:
Gardner, Rebekah L., Gravestein, S., Baier, Rosa R. & Shamji, Hannah (2014). Coordination of Care. Improving the Quality of Care and Communication during Patient Transitions. Best Practices for Urgent Care Centers. Retrieved November 21, 2015 from: https://www.jointcommission.org/assets/1/18/Coord_of_Care_JQPS0714.pdf
Davis, Stephanie (2015). Essential Procedures for Practitioners in Emergency, Urgent and Primary Care Settings, a Clinical Companion, Theresa M. Campo, Keith A. Lafferty, Springer Publishing Company (2011), ISBN: 978-0-8261-1878-3. Retrieved November 20, 2015
Amiel, C., (2014). Reasons for attending an urban urgent care center with minor illness: a questionnaire study. Emergency Medicine Journal: Emermed. Retrieved November 20, 2015
Weinick, Robin M., Rachel M. Burns, and Ateev Mehrotra (2010). Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs, 29: 1630-1636. Retrieved November 21, 2015
Jain, Ruchi (2014). Improving Access to Health Care in Rheumatology Practices through Initiation of an Outpatient Urgent Care Clinic.
Paradigm Shift." ARTHRITIS & RHEUMATOLOGY. Vol. 66. 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY-BLACKWELL. Retrieved November 21, 2015